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.     

A comparative analysis of North American adolescent and adult mass murderers

Thirty adult mass murderers and 34 adolescent mass murderers in North America are compared on both offender and offense variables to delineate similarities and differences. Findings indicate a plethora of psychiatric disturbances and odd/reclusive and acting-out personality traits. Predisposing factors include a fascination with weapons and war among many of the adolescents and the development of a "warrior mentality" in most of the adults. Precipitating factors indicate a major rejection or loss in the hours or days preceding the mass murder. Results are interpreted through the lens of threat assessment for targeted violence (Borum, Fein, Vossekuil, & Bergland 1999), recognizing that a fact-based, dynamic behavioral approach is most useful for mitigating risk of such an extremely low-base-rate violent crime.     

Australian lawyers' views on competency issues in older adults

Lawyers are often called upon by their older clients to draft contracts, make up wills or powers of attorney, or provide other forms of legal advice or service. With the increasing numbers of older people in the population, the numbers of older clients for legal practitioners is likely to increase. Older people are also at increased risk for impaired cognitive processes that can affect their ability to make reasoned judgements in civil contracts and other legal arrangements. Here we report on the results of a survey of 302 Australian solicitors as to their experience and practices in determining the capacity of older clients to make legal decisions. The responses, reflecting a 20.7% return rate, showed a wide range of experience in conducting capacity assessments, with a mean of 15.7 years (SD = 10.59). There was a very wide range of practices in determining capacity with no consensus. The most frequent form of questions older clients were asked related to personal and family history. Less than one-quarter asked for the rationale of the decision: the most appropriate form of question in the literature. The results suggest a need for further training of solicitors in the assessment of the capacity of older clients to make legal decisions.     

Eye-fixation patterns of high- and low-span young and older adults: down the garden path and back again

Young and older adults' eye fixations were monitored as they read sentences with temporary ambiguities such as "The experienced soldiers warned about the dangers conducted the midnight raid." Their fixation patterns were similar except that older adults made many regressions. In a 2nd experiment, high- and low-span older adults were compared with high- and low-span young adults. Pint-pass fixations were similar, except low-span readers made many regressions and their total fixation times were longer. High-span readers also used the focus operator "only" (e.g., "Only experienced soldiers warned about the dangers.") to immediately resolve the temporary ambiguities. No age group differences were observed. These results are discussed with reference to theories of the role of working memory in sentence processing.     

A diffusion model analysis of the effects of aging in the lexical-decision task

The effects of aging on response time (RT) are examined in 2 lexical-decision experiments with young and older subjects (age 60-75). The results show that the older subjects were slower than the young subjects, but more accurate. R. Ratcliff s (1978) diffusion model provided a good account of RTs, their distributions, and response accuracy. The fits show an 80-100-ms slowing of the nondecision components of RT for older subjects relative to young subjects and more conservative decision criterion settings for older subjects than for young subjects. The rates of accumulation of evidence were not significantly different for older compared with young subjects (less than 2% and 5% higher for older subjects relative to young subjects in the 2 experiments).     

The associative memory deficit of older adults: further support using face-name associations

Previous studies have established an associative deficit hypothesis (Naveh-Benjamin, 2000), which attributes part of older adults' deficient episodic memory performance to their difficulty in creating cohesive episodes. In this article, the authors further evaluate this hypothesis, using ecologically relevant materials. Young and old participants studied name-face pairs and were then tested on their recognition memory for the names, faces, and the name-face pairs. The results extend the conditions under which older adults exhibit an associative deficit. They also show that reduced attentional resources are not the sole mediator of this deficit.     

Multiply controlled verbal operants: an analysis and extension to the picture exchange communication system

This paper presents Skinner's (1957) analysis of verbal behavior as a framework for understanding language acquisition in children with autism. We describe Skinner's analysis of pure and impure verbal operants and illustrate how this analysis may be applied to the design of communication training programs. The picture exchange communication system (PECS) is a training program influenced by Skinner's framework. We describe the training sequence associated with PECS and illustrate how this sequence may establish multiply controlled verbal behavior in children with autism. We conclude with an examination of how Skinner's framework may apply to other communication modalities and training strategies.     

Immortality

In December, the President's Council on Bioethics released Beyond Therapy: Biotechnology and the Pursuit of Happiness. Here, Lustig discusses the six-part report that provides a balanced but critical assessment of actual and prospective developments in biotechnology and seeks to anchor its discussion in shared moral and metaphysical concerns--the nature of human nature, and the social and political implications of unfettered choices in altering the human prospect through biotechnology.     

Borderline personality disorder features predict negative outcomes 2 years later

In a sample of 351 young adults, the authors assessed whether borderline personality disorder (BPD) features prospectively predicted negative outcomes (poorer academic achievement and social maladjustment) over the subsequent 2 years, over and above gender and both Axis I and Axis II psychopathology. Borderline traits were significantly related to these outcomes, with impulsivity and affective instability the most highly associated. The present findings suggest that the impulsivity and affective instability associated with BPD leads to impairment in relating well with others, in meeting social role obligations, and in academic or occupational achievement. Therefore, these may be especially important features to target in interventions for BPD.     

Do college students drink more than their non-college-attending peers? Evidence from a population-based longitudinal female twin study

The association of college attendance with alcohol use and alcohol use disorders was examined in a population-based young adult female twin sample identified from a systematic search of birth records. College-attending women consumed a larger overall volume of alcohol than did their non-college-attending peers, but they were not more likely to be diagnosed with an alcohol use disorder. Significant associations between college attendance and alcohol involvement were probed using 3 different complementary research designs: multivariate cross-sectional analyses, longitudinal analyses of the precollege and college years, and cotwin-control analyses of twin pairs discordant for attending college. Although demographic and lifestyle characteristics accounted for most or all of the association between college attendance and alcohol involvement, there was 1 aspect of drinking behavior, occasionally consuming large quantities of alcohol, that remained significantly associated with college attendance even after controlling for these characteristics or for genetic and family background factors. These results are consistent with the conclusion that some aspect of the college experience may be an important environmental risk factor for this pattern of drinking among young adults.