The association between schizophrenia and offending is related in part to psychotic phenomena, particularly where there are feelings of threat-control override. However, the roles of substance misuse and non-compliance with treatment are significant. But offending always has a contextual element; people with schizophrenia have disabilities and lives that are likely to provoke angry confrontations whether or not these are based on delusions. People with schizophrenia commonly depend on others for support in day-to-day life. Interactions with family, carers, health- and social-care staff, housing and welfare agencies are likely to impinge significantly on daily living. Difficulties in obtaining benefits, shelter, warmth, nourishment, cigarettes, and alcohol may be regular experiences that can give rise to conflict on a near-daily basis. Criminal behaviour, even when it appears to be attributable to psychotic symptoms, needs to be considered in this wider context.

Affective disorder

Major affective disorder in association with crime is less commonly encountered than is schizophrenia; alcohol or drug misuse is often an associated factor. In hypomania and mania, grandiosity of mood and disinhibition commonly leads to public disorder and driving offences, theft, or fraud (e.g. failure to pay for restaurant and hotel bills). Sometimes manic behaviour may result in a serious sexual or violent crime.

The role of depressive disorders in offending behaviour is controversial and probably rare. (8Z> An association between shoplifting and depression is largely derived from historical literature. However, a recent study of !649 shoplifters in Montreal found ! per cent who were suffering from depression or bipolar disorder. (88) In assessing depressed mood in arrested or convicted subjects, the importance (and difficulty) of establishing the presence of symptoms prior to the offending behaviour cannot be overemphasized.

Extended suicide or altruistic homicide is the rare but well-recognized phenomenon in which a depressed person (usually a parent) kills one or more family members (usually including a child) to 'spare them suffering' and then commits or attempts suicide. Given the frequency of depression and the rarity of extended suicide it seems an impossible task to identify these cases in advance.

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