AT WPA 2017

BERLIN (FRONTLINE MEDICAL NEWS) – Among inmates in a Mexican federal prison, psychiatric disorders went hand-in-hand with low or extremely low IQ scores, a study showed.

About 86% of the inmates with a mental illness also had an IQ of 67-69. These men were likely to have multiple psychiatric diagnoses compounded by traumatic brain injury and substance dependence. They also were lowest in the hierarchy of organized crime, Isaac S. Carlos, MD, said at the meeting of the World Psychiatric Association.

Outside prison, this combination of mental illness and low intelligence set these men up for manipulation by more intelligent criminals, who used them most frequently as drug mules or henchmen, Dr. Carlos said. Inside, they were still extremely vulnerable to manipulation and abuse by more intelligent inmates who retain their intellectual dominance in the prison social structure.

“A striking thing that we also saw was that almost all of our inmates who had mental illness didn’t have just one. They had two, three, or even four or more diagnoses,” said Dr. Carlos, a criminal psychiatrist at the Jalisco Institute of Mental Health, Zapopan, Mexico.

Dr. Carlos is an attending psychiatrist in a large, maximum security federal prison that houses thousands of men convicted mostly in organized crime rings associated with drug trafficking. About 45% of the country’s federal inmate population overall has been diagnosed with some kind of mental disorder and requires treatment, but there are few options, he said. In Dr. Carlos’s institution, with one psychiatrist, one criminologist, and 20 psychologists to serve more than 5,000 prisoners, there are few opportunities to do rehabilitative therapy, counseling, or any behavioral interventions. Medication is about the best treatment offered, Dr. Carlos said.

He said he is actively trying to establish an integrative care system there. As part of the project, Dr. Carlos and his colleagues looked at the co-occurrence of psychiatric diagnoses and IQ level.

His group comprised 400 inmates who were sent for psychiatric assessment, which included the Wechsler Abbreviated Scale of Intelligence, Second Edition. Each inmate also received a ranking for his role in organized crime: intellectual (administrative leaders and organizers at the top of the hierarchy), technical (responsible for transportation and transactions), or material (executers of the criminal commands from above).

Of the 400 inmates referred, 300 had at least one ICD-10 mental illness diagnosis. These men were a mean of 30 years old with a mean of 10 years of education. About a third of the group had a triple diagnosis of psychosis, dependence on multiple substances, and dissocial personality disorder (which is comparable to antisocial personality disorder in the DSM-5). These inmates also had the lowest IQ measurements.

Other diagnostic combinations included schizoaffective plus dissocial disorder; substance abuse plus psychosis; dependent personality disorder plus dissocial disorder; traumatic brain injury or posttraumatic stress disorder with psychosis; dependent personality plus dissocial disorder; bipolar disorder plus either dissocial disorder or dependent personality; depression plus borderline personality disorder; depression plus narcissistic disorder; depression plus both personality disorder and dependent personality disorder; adjustment disorder plus dissocial disorder; anxiety plus both dependent and personality disorder, with or without narcissistic disorder; and dependent disorder plus either narcissism or borderline personality disorder.

Only one inmate had a high IQ score. This man had a dual diagnosis of depression and narcissism, and an IQ of 129. He was considered an intellectual offender.

The next highest IQ was 77 – the upper limit of a large group of scores in the 70s. Diagnoses included adjustment disorder plus dissocial disorder; posttraumatic stress disorder plus dissocial disorder; bipolar plus dissocial disorder; and depression plus borderline personality disorder. These men largely fell into the “technical” offender category – the middlemen of organized crime.

At the lower end of the IQ scale were the men categorized as “material” offenders. With IQs ranging from 67 to 69, these men frequently had multiple mental illnesses complicated by brain damage and substance abuse. When psychosis occurred, it was always in conjunction with these lower IQ scores. Low scores were common, Dr. Carlos said: In fact, 45% of the cohort had an IQ of 67; 22%, an IQ of 68; and 19%, an IQ of 69.

“It is necessary to understand the psychiatric comorbidities as well as the IQ in order to get better treatment responses,” Dr. Carlos said. “In some other prisons, this is already understood and a part of therapeutic treatment, but we just don’t have this (in the federal prison system). We have to make the people who run these prisons understand this.”

He had no relevant financial disclosure.

msullivan@frontlinemedcom.com

On Twitter @alz_gal

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