Clinical validity of a Personality Inventory for Children (PIC) profile typology.

We evaluated the validity of a profile typology for the Personality Inventory for Children (PIC), a parent-informant measure of child psychiatric status. For referred children, we studied (a) the convergence of PIC profile types with diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., American Psychiatric Association, 1980) and (b) the incremental validity of the PIC over diagnoses in the prediction of symptom ratings completed by teachers and clinicians. We found a high diagnosis-PIC correspondence only for developmentally disordered children; the overlap for children with emotional-conduct problems was poor. For the latter group, however, the correlation of diagnoses with symptom ratings was low, but the incremental validity of the PIC over diagnoses was high. We discuss the use of this profile typology in the clinical evaluation of children and present a case example.     

Clinical Validity of a Personality Inventory for Children (PIC) Profile Typology

We evaluated the validity of a profile typology for the Personality Inventory for Children (PIC), a parent-informant measure of child psychiatric status. For referred children, we studied (a) the convergence of PIC profile types with diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., American Psychiatric Association, 1980) and (b)the incremental validity of the PIC over diagnoses in the prediction of symptom ratings completed by teachers and clinicians. We found a high diagnosis-PIC correspondence only for developmentally disordered children: the overlap for children with emotional-conduct problems was poor. For the latter group, however, the correlation of diagnoses with symptom ratings was low, but the incremental validity of the PIC over diagnoses was high. We discuss the use of this profile typology in the clinical evaluation of children and present a case example.     

Gender differences in psychopathy in a Swedish offender sample

In this study we examined gender differences in the PCL:SV employing a variety of statistical methods with two subsets of psychopathic individuals drawn from larger samples of 129 female and 499 male Swedish offenders. The larger samples included forensic psychiatric patients, forensic psychiatric evaluees and criminal offenders. We found gender differences in antisocial behavior, as defined in factor 2 of the PCL:SV, with female psychopaths (PCL:SV>or=18) displaying significantly more lying, deceitfulness and lack of control, while male psychopaths were more antisocial as measured by the PCL:SV. We conclude that it might be meaningful to use gender specific definitions in the assessment of psychopathy or, alternatively, slightly revise the diagnostic tools. Our results support the use of the three-factor model of the PCL-R and PCL:SV introduced by Cooke and Michie (2001) in female populations.     

Double Jeopardy: Suicide Rates in Forensic Hospitals

While a number of studies have described high and increasing rates of completed suicide among psychiatric patients, the suicide risk of forensic hospital patients is virtually unknown. This paper reports on the suicides that have taken place in the country's oldest continually operating institution housing persons formerly labeled “criminally insane,” the Bridgewater State Hospital. The results show considerable variation in the suicide rate by historical period, with suicide prior to 1968 a considerably more infrequent event. By contrast, the post-′68 rate of 232 per 100,000 is comparable to data reported in a series of studies of psychiatric suicides, and significantly higher than that found in U.S. studies of correctional populations. These differences are discussed. The results strongly suggest that forensic hospital populations have suicide rates broadly comparable to other psychiatric populations.     

Beitrag der Neurowissenschaften zur forensischen Psychiatrie

Forensic psychiatry is a subspecialty dedicated to the interface between psychiatry and law. It uses paradigms and knowledge from general psychiatry for diagnostics, assessment, therapy and research under consideration of the special requirements of legal aspects and framework conditions; therefore, scientific development in forensic psychiatry is substantially dependent on scientific progress in psychiatry and thus nowadays also in neurosciences. Neurobiological hypotheses on the neuronal foundations of psychiatric diseases have been established, for example the dopamine hypothesis for schizophrenia, in a manner that led to important therapeutic advances in the treatment and long-term quality of life for affected persons. Analogous advances should not be withheld from forensic psychiatric patients, who are doubly affected by the disease and the accompanying limitations in their rights to freedom, which is why research in this field must be driven forwards. Clear advances in knowledge of the neurobiological foundations of forensic psychiatric illnesses have, for example, already been made in the field of pedophilia and psychopathy. Based on studies of investigation populations, such neuroscientific knowledge on the neurobiological principles of forensic psychiatric diseases, however, requires a carefully concerted communication with respect to dissemination in the media as well as in the interpretation of individual cases, for example in court. This is of great importance in order to prevent simplifying misconceptions and to avoid a subsequent loss of trust in the scientific process. Therefore, training of the new generation of forensic psychiatrists in the understanding and communication of scientific methods of modern forensic psychiatric neuroscience is of great importance for the societal impact and further advancement of the discipline.     

Personality disorders in a Dutch forensic psychiatric sample: convergence of interview and self-report measures

Convergence of PDQ-R- and SIDP-R-derived personality disorder diagnoses was studied in a sample of 85 forensic psychiatric patients. For categorical diagnoses, the mean kappa was .34, but on a dimensional level convergence was somewhat higher. Paranoid, antisocial and borderline personality disorders had prevalence rates around 40%; the other personality disorders occurred with much lower frequency. The PDQ-R yielded more diagnoses, except for antisocial, histrionic, narcissistic, and sadistic personality disorder. Because the latter disorders are among the most prevalent in forensic settings, and because they have important risk and treatment implications, the PDQ-R is not suitable as a screening device in forensic populations. Semistructured interviews that make use of collateral information are recommended for diagnosing personality disorders in forensic subjects.     

Forensic neuropsychiatric evaluation of a personal injury case

Civil litigation involving the forensic neuropsychiatric evaluation of a personal injury case requires an assessment of damages and causation. The expert witness is obliged to integrate data from three critical sources of information: the review of records; the results of neuropsychological testing; and the findings from the clinical examination. In civil litigation involving a personal injury claim, the expert witness can be expected to address causation and prognosis of any neuropsychiatric damages. We discuss the undertaking of a forensic neuropsychiatric evaluation, psychiatric disorders often encountered in personal injury litigation, provide case vignettes and describe a number of special types of forensic neuropsychiatric evaluations, for example, Workers' Compensation, VA Disability and Social Security Disability.     

Umgang mit gefährlichen Straftätern in England und Wales

Forensic psychiatric institutions exist in all western European countries. Their organisation depends on a number of factors including the legal framework and societal attitudes towards mentally disordered offenders. This article describes and critically comments on the forensic psychiatric system in England and Wales, its legal framework and approaches to dealing with dangerous offenders. England and Wales have a long forensic psychiatric tradition with the first high security hospital, Broadmoor hospital, having been established in 1863. Evidence-based treatment approaches in forensic hospitals as well as in prisons, training of forensic psychiatrists and research in the field of forensic psychiatry have gained international recognition. However, there are some worrying aspects in the system of forensic psychiatric care and the criminal justice system more generally, in particular the high and still increasing number of prisoners in comparison with other European countries, the low age of criminal responsibility, long sentences, increasing length of stay in forensic care and the increasingly risk averse culture. A number of differences to the German system can be found; one such difference relates to the role of criminal responsibility which is irrelevant for decisions regarding commitment in England and Wales. Only the mental state and need for treatment at the time of trial (or later assessment in prison) determine whether an offender is admitted to psychiatric care or receives a prison sentence. A number of new initiatives have been launched in recent years resulting in an increasing number of individuals being detained in forensic psychiatric and criminal justice institutions, in particular the initiative for the detention and treatment of individuals with so-called dangerous and severe personality disorders, the sexual offenders register and the new sentence of indeterminate imprisonment for public protection. These initiatives have been the subject of a number of complaints to the European Court of Human Rights. Nevertheless, the trend towards a more and more risk averse culture continues.     

Dual diagnosis in an Australian forensic psychiatric hospital: prevalence and implications for services

Despite a growing awareness of the unique needs of psychiatric patients with co-occurring substance abuse and dependence disorders (i.e. dual diagnosis), there is a dearth of research investigating the prevalence of dual diagnosis in forensic psychiatric populations. Similarly, little work has been done to determine the implications of dual diagnosis for forensic psychiatric patients. Patients at the Thomas Embling Hospital in Victoria, Australia, were assessed to determine the prevalence of substance abuse disorders and mental illnesses within this population. Results reveal that the majority of patients (approximately 74%) have a lifetime substance abuse or dependence disorder. Information was collected concerning patients' criminal histories and the Level of Service Inventory, Revised, was completed for each patient who participated. Results suggest that patients with both major mental illnesses and substance abuse disorders have more extensive criminal histories and demonstrate a higher level of risks and needs when compared with patients with major mental illness alone. The implications for the development and delivery of effective forensic mental health services that address both co-occurring disorders are also discussed.     

Self-reported personality traits and disorders (DSM-IV) and risk of criminal recidivism: a prospective study

Assessment and management of criminal offenders require valid methods to recognize personality psychopathology and other risk and protective factors for recidivism. We prospectively explored the association between dimensional and categorical measures of personality disorder (PD) measured with the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q, Ottosson et al., 1995) and registered reconvictions in adult offenders. One hundred and sixty-eight offenders consecutively referred for pre-sentencing forensic psychiatric evaluation in Sweden during 1995-1996 completed DIP-Q self-reports. The subjects received different types of sanctions and were followed for an average of 36 months after release from prison, discharge from a forensic psychiatric hospital, or onset of nondetaining sentences. Age-adjusted odds ratios revealed a 4.8 times higher risk for any recidivism and a 3.7 times higher risk for violent recidivism among subjects whose self-reports suggested a categorical diagnosis of antisocial PD as compared to offenders without antisocial PD. The remaining nine categorical DSM-IV PD diagnoses were not significantly related to recidivism. In dimensional analyses, each additional antisocial and schizoid PD symptom endorsed by participants at baseline increased the risk for violent reoffending. Our results suggest a relationship between self-reported behavioral instability and interpersonal dysfunction captured primarily by DSM-IV antisocial and schizoid PD constructs, and criminal re-offending also in a multi-problem sample of identified offenders.     

Schizophrene Patienten der forensischen Psychiatrie im Vergleich zu schizophrenen Patienten der Allgemeinpsychiatrie

Background

The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Some researchers assume that these forensic patients form a group of patients with very complex mental disorders, a number of risk factors and insufficient pretreatment in general psychiatry. This study aimed to identify differences regarding the history of treatment of forensic and general psychiatric patients diagnosed with schizophrenia.

Method

The matched samples included 72 male patients from forensic wards and 72 male patients from general psychiatric institutions diagnosed with schizophrenia. The history of psychiatric treatment was reconstructed by interviewing the patients as well as outpatient psychiatrists and patients’ legal custodians and by analyzing patient medical records.

Results

In contrast to the general psychiatric patients, prior to admission forensic patients were less integrated into psychiatric care and showed a lower rate of treatment compliance. They also showed a higher rate of previous compulsory treatment because of aggressive behavior towards other persons as well as higher rates of treatment difficulties and violent behavior during previous inpatient treatment. Furthermore, forensic patients had a higher number of previous criminal convictions and had been convicted more often for violent offences. With regard to other relevant risk factors (e.g. comorbid substance abuse disorder, age, education, conduct disorder, antisocial personality disorder, previous exposure to violent and abusive behavior) the two patient groups were, however, comparable.

Conclusions

Regarding schizophrenic patients with comorbid substance abuse disorders, previous violent delinquency and violent behavior during previous inpatient treatment, an intensive outpatient aftercare should be arranged before they are discharged from general psychiatric institutions.     

An Empirically Derived Typology of Families: I. Relationships with Adult Health

In this report we describe the development and partial validation of an empirically derived typology of families based on 11 family variable composites derived from the California Family Health Project. Our goal was to use the typology to condense and integrate the findings from previous analyses of a large group of family variables and to account for differences in the self-reported health of adult family members. Exploratory and confirmatory cluster analyses conducted separately by gender classified 97% of the sample into four parallel types for husbands and wives: Balanced, Traditional, Disconnected, and Emotionally Strained. A 1-way MANOVA indicated that all 11 family variable composites significantly differentiated the four family types for husbands and wives. Significant differences among the four family types were also found on 10 demographic and other family variables, using ANOVA. Using MANOVA, we compared the four family types on 12 self-reported health and well-being variables by gender. Both husbands and wives from Balanced and Traditional families reported higher health scores than spouses from Disconnected and Emotionally Strained families, but no single profile of health scores was unique to a particular family type. The four family types provide an integrated and comprehensive framework for describing the family in health research.     

The impact of psychological therapies on violent behaviour in clinical and forensic settings: A systematic review

Violent behaviour is a serious problem in terms of the impact on victims, quality of life for perpetrators, and the financial burden on the prison service, the health sector, and society generally. However, to date there is not a general consensus as to how this can be managed other than removing the perpetrators from communities. Incarceration can be on an indeterminate basis or for a short period of time before reintegration into society, depending on the gravity of the offence. This systematic review critically examines the existing research literature on psychotherapeutic interventions for violent behaviour in forensic and clinical populations. Five databases were searched, selected journals were hand searched, and authors of identified papers were contacted in efforts to obtain relevant unpublished work. The first author and a colleague independently evaluated the eligibility of all studies identified, abstracted data, and assessed study quality. The overall findings provide tentative support for the utility of psychotherapeutic interventions in reducing aggressive behaviour in forensic and psychiatric patients with a history of violent behaviour.     

Gewalttaten psychisch Kranker

Only a minority of mentally ill persons become conspicuous due to acts of violence. Nevertheless, from time immemorial there has been a certain fear of the alleged unpredictability of the mentally ill, particularly of people who suffer from a psychosis. The creation of psychiatry as an independent medical discipline was designed from the very beginning to separate people deemed to be dangerous from society and to detain them in institutions in order to heal them, to make relevant improvements or to keep them indefinitely. The movement of dehospitalization since the 1970s, which in turn was a consequence of revolutionization of treatment options through modern neuroleptic and antidepressive drugs, led to a distinctive separation between general psychiatry and forensic psychiatry, institutionally (general psychiatric institutions with periods of hospitalization of a few weeks and psychiatric forensic committment lasting many years) as well as increasingly more in scientific discourses; however, a close cooperation is necessary for healthcare treatment, which meets the requirements of patients and also public security. In this respect general psychiatry must still undertake substantial safety reponsibilities, which it can learn from forensic psychiatry, whereas forensic committment must rapidly acquire the therapy experience of general psychiatry.     

Wo steht der Jugendmaßregelvollzug in Deutschland aktuell?

With up to 67% of all young offenders suffering from mental illnesses, the question of how professional care should be arranged for them arises. The ability to detain a young offender for an indefinite period of time in a forensic psychiatric institution represents the final solution in juvenile law. This currently affects approximately 300 patients nationwide, of which there is precise data available only for patients who were detained before the age of 18. This is due to the differing nationwide organisational structures within specific forensic psychiatric institutions for adolescents. There is currently a lack of forensic psychiatric units in several federal states providing treatment for adolescents. When examining under what basis, and when the relocation of a person from a young forensic psychiatric institution into the corresponding adult one occurred, and how long specific pedagogic facilities were provided to these individuals, the differences between various adolescent forensic psychiatric institutions become apparent. This especially concerns young adolescent offenders suffering from delayed mental development.     

Can We Use Hare’s Psychopathy Model within Forensic and Non-Forensic Populations? An Empirical Investigation

Although psychopathy construct (Self-Report Psychopathy Scale–Short Form [SRP–SF]) was assessed among various samples, prior research did not investigate whether the model proposed by Hare and colleagues can be used to capture psychopathy scores derived from forensic and nonforensic populations. The main objective of the current study was to test dimensionality, construct validity, and factorial invariance of the SRP–SF within prison (n = 730) and student (n = 2,506) samples. Our results indicate that the SRP–SF measure cannot be used in the same way within forensic and nonforensic samples, which may be due to the inclusion of criminal/antisocial traits as an integral part of psychopathy.     

What's the point? Towards a methodology for assessing the function of psychiatric inpatient aggression

There are few examples in the literature of the application of functional analysis to psychiatric inpatient aggression. Structural assessment approaches have dominated. This paper introduces a system for classifying the functions of aggression in psychiatric inpatients that was applied to 502 aggressive behaviours exhibited by patients in a secure forensic psychiatric hospital. At least one function was identified for the majority of aggressive incidents; the most common functions pertaining to patients' responses to the restrictions and demands of the inpatient setting, to express anger or to punish others perceived as provocative, and to maintain status. There was little evidence suggesting that aggression was used to obtain tangible rewards, to reduce social isolation, or to simply observe the suffering of others. Differences in the function of aggressive behaviour were found across victim types. Results of this study have implications for the prediction and prevention of inpatient aggression and for the treatment of aggressive inpatients.     

The Novaco Anger Scale-Provocation Inventory (1994 version) in Dutch forensic psychiatric patients

We examined the psychometric properties of the Novaco Anger Scale-Provocation Inventory (NAS-PI, 1994 version) in Dutch violent forensic psychiatric patients and secondary vocational students. A confirmatory factor analysis of the subscale structure of the NAS was carried out, reliability was investigated, and relations were calculated between NAS-PI scores and other measures of personality traits and problem behaviors. The 3-subscale structure of the original NAS could not be confirmed. However, the internal consistency of the NAS and the PI was excellent, and the test-retest reliability of the NAS was good. The validity of the NAS and the PI was supported by a meaningful pattern of correlations with alternative measures of anger and personality traits. Forensic psychiatric outpatients displayed higher NAS scores than secondary vocational students, but inpatients scored even lower than this nonclinical control group. Our preliminary conclusion is that the NAS-PI is a valuable instrument for the assessment of anger in Dutch violent forensic psychiatric patients.     

Catechists' conceptions of their catechetical learning environments

In ‘A Typology of Catechetical Learning Environments’ (2014), De Kock presented a typology for describing different types of catechetical practices. The typology serves as a theoretical framework for empirically investigating the effects of catechetical practices in church communities. This current article investigates, on the basis of interviews with catechists, whether the types of catechetical learning environments drawn from the typology are reflected in catechists' conceptions of their catechetical practices. It concludes that the stipulated categories are only partially reflected in the conceptions of learning goals at which respondents aim, as well as in the role divisions between catechumens and the catechist. Moreover, the types of learning environments drawn from the typology are not clearly reflected in catechists' own reflections on their catechetical practices. Implications for both the professional practice of catechesis and for further research are suggested.