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Theory of Mind Functioning in Mentally Disordered Offenders Detained in High Security Psychiatric Care: Its Relationship to Clinical Outcome, Need and Risk

NCJ Number
Criminal Behaviour and Mental Health Volume: 17 Issue: 5 Dated: 2007 Pages: 300-311
David Murphy
Date Published
12 pages
This study tested whether theory of mind (ToM) performance--the performance of cognitive mechanisms that allow individuals to infer their own mental states and those of others--in relation to other cognitive and clinical variables, is related to measures of subsequent clinical outcome among male patients with schizophrenia in a high-security hospital.
The study findings suggest that social perceptual ToM impairments--i.e., difficulties with making rapid "online" judgments about another individual's mental state by observing facial and body expressions--at the time of admission to a hospital may be a significant predictor of worse functional outcome and a higher number of clinical needs. ToM results may also reflect the degree to which an individual may benefit from treatment and provide a focus for treatment. There is evidence that ToM impairments are subject to improvement (Sarfati, 2000; Roncone et al., 2004). Interventions aimed at improving ToM impairments may also reduce the risk for future interpersonal violence. The inclusion of ToM as part of formal risk assessment of individuals with schizophrenia requires further exploration. Thirty consenting male patients with a primary diagnosis of schizophrenia and detained in high-security psychiatric care were included in the study. The patients were administered neuropsychological tests, the revised eyes task, the modified advanced theory of mind test, the Health of the Nation Outcome Scale, the Camberwell Assessment of Need--Forensic Version, and the HCR-20. The latter instrument is a structured clinical assessment aid that assesses psychosocial adjustment and history of violence, risk factors based on current or recent functioning, and evaluator opinions about the adequacy of the individual's plans for institutional or community adjustment. 3 tables and 30 references