Delusional themes and forensic status in schizophrenia spectrum disorders: a machine learning based discriminative study.
Bizarre delusions are far more common in forensic than general psychiatric patients.
Delusional themes and forensic status in schizophrenia spectrum disorders: a machine learning based discriminative study.
Schizophrenia spectrum disorders (schizophrenia spectrum disorders) are associated with an elevated risk of violent and offending behavior; however, the specific contribution of delusional content remains insufficiently understood.
This study therefore aimed to examine whether specific psychopathological symptoms discriminate between FPP and general psychiatric patients with schizophrenia spectrum disorders.
In this retrospective study, data from 740 patients with schizophrenia spectrum disorders (370 FPP, 370 general psychiatric patients) treated at a Swiss university hospital were analyzed.
bizarre delusions were far more common in forensic than general psychiatric patients
Naïve Bayes achieved the best performance (AUC = 0.81, balanced accuracy = 78.2%), with stable results in the validation sample.
Global symptom severity measures, including PANSS scores, did not contribute to the model.
The qualitative content of delusions - particularly bizarre and aggressive themes - shows substantial discriminative value for forensic status in schizophrenia spectrum disorders, beyond overall symptom severity and established comorbid risk factors.
These findings highlight the relevance of symptom-specific, cognitive-affective mechanisms in forensic evaluations.
Incorporating structured assessment of delusional content may complement existing psychometric approaches in forensic psychiatric evaluations.