Abstract：
The relationship between schizophrenia spectrum disorders (SSD) and violent offending has long been the subject of research. The present study attempts to identify the content of delusions, an understudied factor in this regard, that differentiates between violent and non-violent offenses. Limitations, clinical relevance, and future directions are discussed. Employing a retrospective study design, machine learning algorithms and a comprehensive set of variables were applied to a sample of 366 offenders with a schizophrenia spectrum disorder in a Swiss forensic psychiatry department. Taking into account the different contents and affects associated with delusions, eight variables were identified as having an impact on discriminating between violent and non-violent offenses with an AUC of 0.68, a sensitivity of 30.8%, and a specificity of 91.9%, suggesting that the variables found are useful for discriminating between violent and non-violent offenses. Delusions of grandiosity, delusional police and/or army pursuit, delusional perceived physical and/or mental injury, and delusions of control or passivity were more predictive of non-violent offenses, while delusions with aggressive content or delusions associated with the emotions of anger, distress, or agitation were more frequently associated with violent offenses. Our findings extend and confirm current research on the content of delusions in patients with SSD. In particular, we found that the symptoms of threat/control override (TCO) do not directly lead to violent behavior but are mediated by other variables such as anger. Notably, delusions traditionally seen as symptoms of TCO, appear to have a protective value against violent behavior. These findings will hopefully help to reduce the stigma commonly and erroneously associated with mental illness, while supporting the development of effective therapeutic approaches.
摘要：
精神分裂症谱系障碍（SSD）与暴力犯罪之间的关系一直是研究的主题。本研究试图确定妄想的内容，这方面的一个研究不足的因素，区分暴力犯罪和非暴力犯罪。局限性,临床相关性，并讨论了未来的方向。采用回顾性研究设计，在瑞士法医精神病学部门，机器学习算法和一组全面的变量被应用于366名精神分裂症谱系障碍罪犯的样本。考虑到与妄想相关的不同内容和影响，八个变量被确定为对区分暴力和非暴力犯罪有影响，AUC为0.68，灵敏度为30.8%，特异性为91.9%，这表明发现的变量对于区分暴力和非暴力犯罪是有用的。妄想的宏伟，妄想警察和/或军队追捕，妄想症感知的身体和/或精神伤害，控制或被动的妄想更能预测非暴力犯罪，而具有侵略性内容的妄想或与愤怒情绪相关的妄想，苦恼,或激动更经常与暴力犯罪有关。我们的发现扩展并证实了当前有关SSD患者妄想内容的研究。特别是,我们发现威胁/控制超控(TCO)症状并不直接导致暴力行为,而是由愤怒等其他变量介导.值得注意的是,传统上被视为TCO症状的妄想，似乎对暴力行为有保护价值。这些发现有望有助于减少与精神疾病普遍和错误相关的污名，同时支持有效治疗方法的发展。
