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Flunitrazepam abuse and personality characteristics inmale forensic psychiatric patients
Karolinska Institutet, Stockholm University.ORCID iD: 0000-0002-8562-5610
Department of Psychiatry, Research and Development, Danderyd’s Hospital, Danderyd, Sweden.
2001 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 103, no 1, 27-42 p.Article in journal (Refereed) Published
Abstract [en]

Sixty male non-psychotic forensic psychiatric patients, aged 16-35 years, were studied after they completed their ordinary forensic psychiatric assessment (FPA). The prevalence of flunitrazepam (FZ) abuse was investigated by using both structured and in-depth interviews with the objective of studying the relationship between the abuse and personality traits. The patient’s characteristics, DSM-IV disorders, and actual sentences were obtained by studying their files. In order to obtain measures on their personality traits, self-report inventories were administered to the patients. Eighteen out of 60 patients were FZ abusers, but only 4 of them received a diagnosis related to the FZ abuse during the ordinary FPA. In almost all cases, however, indications of the FZ abuse were found in the files. No differences in personality traits were found between the groups. The frequency of previous admissions to an FPA and actual sentences of robbery, weapons offenses, narcotic-related offenses, and other crimes, such as theft, among the FZ abusers deviated significantly from forensic non-FZ abusers. Therefore, the FZ abuse per se might be more responsible for their tendency to commit crimes characterized by danger and thrill-seeking, such as robbery, weapons offences, and theft, than personality. The most important conclusion is that assessment of FZ abuse is needed in forensic psychiatry.

Place, publisher, year, edition, pages
Goettingen: Elsevier, 2001. Vol. 103, no 1, 27-42 p.
Keyword [en]
Flunitrazepam abuse; Forensic psychiatry; Robbery and weapons offences; Personality traits; Risk assessment
National Category
Forensic Science Psychiatry
Research subject
SOCIAL SCIENCE, Psychology
Identifiers
URN: urn:nbn:se:hv:diva-4978OAI: oai:DiVA.org:hv-4978DiVA: diva2:581293
Projects
Dyslexi bland rättspsykiatriskt undersökta män: Psykologiska, sociala och biologiska indikatorer
Available from: 2012-12-30 Created: 2012-12-30 Last updated: 2015-02-03Bibliographically approved
In thesis
1. “Dr Jekyll and Mr Hyde?”: Abuse of potent benzodiazepines, exemplified by flunitrazepam, in mentally disordered male offenders
Open this publication in new window or tab >>“Dr Jekyll and Mr Hyde?”: Abuse of potent benzodiazepines, exemplified by flunitrazepam, in mentally disordered male offenders
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Flunitrazepam (FZ) is an example of a sedative-hypnotic benzodiazepine whose pharmacokinetic properties include a rapid onset of action and an intermediate duration of action. It has a high affinity to central benzodiazepine receptors and affects them profoundly. These properties, and its profile of activity, increase the probability of abuse by those who have access to it. Known side effects of FZ are abuse and amnesia. FZ is widely abused and it has become a drug of choice among opioid abusers, as a club drug, and as a classic “date-rape” drug. FZ is often involved in fatal intoxication. It is therefore expected that FZ abuse is common in serious offenders. I have studied the reasons for FZ abuse and mapped the prevalence of the abuse, with the objective of studying the personalities and the background factors of the abusers, and of drawing some conclusions about assessment procedures of FZ abuse and the position of FZ in society.

The participants in the studies summarised here were fifty-six juvenile delinquents from Swedish youth correctional institutions, aged 14-20 years, and sixty non-psychotic male offenders referred for a forensic psychiatric evaluation (FPE), aged 16-35 years. The participants answered questions regarding their abuse, and this enabled us to understand why they abused just FZ (and not another substance). The participants also completed a number of self-reported inventories, which enabled us to obtain measures of personality traits. They were also rated for psychopathy. Five forensic psychiatric cases of FZ abusers were studied in more detail. Furthermore, the forensic psychiatric participants’ psychiatric diagnoses, and both groups’ crime-related measures, were obtained from their files.

About 40% of the juvenile delinquents and 30% of the offenders referred for a forensic psychiatric evaluation abused FZ. The main reason for the FZ abuse was to change a perception of reality and to obtain an increased feeling of power and self-esteem, a feeling that everything was possible. Both samples of offenders differed from the normal population in many personality traits, suggesting that the participants possessed a high level of vulnerability for developing mental disorders, but only a few differences in personality traits were found between FZ abusers and non-FZ abusers. The juvenile delinquent FZ abusers had higher scores than non-FZ abusers in the verbal aggression and sensation-seeking boredom susceptibility scales. In the juvenile sample, FZ abuse was associated with the abuse of amphetamines and/or cocaine, cannabis, and opiates, and with childhood psychological/psychiatrical contact, with living in a metropolitan housing area, and with recidivism into crimes leading to care in a juvenile correctional institution. In this sample, FZ abuse was also associated with weapons offences and narcotics-related crimes. In the forensic psychiatric sample, FZ abuse was significantly associated with previous admission to an FPE, and convictions for robbery, for weapons-related offences, for narcotics-related offences and for theft. The results show that FZ is more common in offenders who score high on Facet 4 (Antisocial) in the Hare psychopathy model, and that FZ abuse has high correlation with Item 20 (Criminal versatility). All of the FZ abusers reported side effects from FZ that resulted in the brutality of their violent acts and anterograde amnesia. FZ abusers, when intoxicated with FZ, had a reduced capacity for both empathy and anticipatory anxiety, in contrast to their “daily” behaviour and “ordinary” (i.e., without the influence of the FZ) personality characteristics. They were not characterised by classic characteristics of psychopathy, such as lack of empathy. This may indicate that FZ induces psychopathic-like state-dependant (FZ intoxication) traits, and temporary dissociate states (“Dr Jekyll and Mr Hyde”?).

In conclusion, FZ abuse is common in the population of young offenders with mental disorders, and FZ is often used for nonmedical purposes. The practical implications of these conclusions are that clinicians and those who develop or manage therapeutic programs should be aware of FZ abuse when choosing the most effective treatment for male offenders. General practitioners who prescribe potent sedative compounds should be aware of their possible adverse effects. The availability of FZ should be limited further, because FZ is frequently abused in vulnerable male offenders, and because FZ has serious adverse mental health-related effects and is related to robbery and weapons‑related crimes.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2005. 124 p.
Keyword
Flunitrazepam (FZ) abuse, side effects of FZ, offenders referred to forensic psychiatric evaluation, juvenile delinquents, personality traits, psychopathic traits and lifestyle (PCL-R)
National Category
Medical and Health Sciences
Research subject
SOCIAL SCIENCE, Psychology
Identifiers
urn:nbn:se:hv:diva-5047 (URN)91-7140-584-4 (ISBN)
Public defence
2005-12-02, Bi 3-221, Alfreds Nobels Allé 10, Huddinge, 10:00 (Swedish)
Opponent
Supervisors
Projects
“Dr. Jekyll och Mr. Hyde beteende” bland manliga kriminella ungdomar i samband med alkohol kombinerad med bensodiazepiner: Biologiska och psykologiska indikatorerDyslexi bland rättspsykiatriskt undersökta män: Psykologiska, sociala och biologiska indikatorer
Note

1. Följande forskningsfinansiärer (det går inte att skriva in dem i följande ruta): Preparation of this thesis was supported by a doctoral fellowship from the Swedish Foundation for Care Sciences and Allergy Research. I have also been twice awarded a scholarship for research with violent offenders from the Swedish Carnegie Institute, and a scholarship for an “in-depth study into alcohol and drugs” from the Swedish Medical Society of Addiction Medicine. The Swedish National Board of Forensic Medicine (Rättsmedicinalverket), The Swedish Alcohol Research Fund, Karolinska Institute, Lund University, Stockholm University, and The Söderström-Königska Foundation also supported this thesis by grants.

2. Forskningsämne är rättspsykiatri (detta går inte heller att välja i rutan ovan)

Available from: 2013-01-11 Created: 2013-01-10 Last updated: 2014-01-10Bibliographically approved

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