Applicability of two violence risk assessment tools in a psychiatric prison hospital population

The risk of violent behavior is known to be higher for patients who suffer from a severe mental disorder. However, specific prediction tools for clinical work in prison psychiatry are lacking. In this single-center study, two violence risk assessment tools (Forensic Psychiatry and Violence Tool, “FoVOx,” and Mental Illness and Violence Tool, “OxMIV”) were applied to a prison hospital population with a primary psychotic or bipolar disorder and subsequently compared. The required information on all items of both tools was obtained retrospectively for a total of 339 patients by evaluation of available patient files. We obtained the median and inter-quartile range for both FoVOx and OxMIV, and their rank correlation coefficient along with 95% confidence intervals (CIs)—for the full cohort, as well as for cohort subgroups. The two risk assessment tools were strongly positively correlated (Spearman correlation = 0.83; 95% CI = 0.80–0.86). Such a high correlation was independent of nationality, country of origin, type of detention, schizophrenia-spectrum disorder, previous violent crime and alcohol use disorder, where correlations were above 0.8. A lower correlation was seen with patients who were 30 years old or more, married, with affective disorder and with self-harm behavior, and also in patients without aggressive behavior and without drug use disorder. Both risk assessment tools are applicable as an adjunct to clinical decision making in prison psychiatry.     

Age-associated memory impairment—pathological memory decline or normal aging?

The aim of the study was to determine whether the memory capacity of individuals with age-associated memory impairment (AAMI) over a period of approximately 3½ years declines more, if at all, than the memory capacity of persons without AAMI. Four computerized and three non-computerized memory tests, a naming test, and a test of visuo-motor speed were administered twice. Two estimates of intellectual capacity were made, one at the first examination and the other 3½ years later. One person in the AAMI group (n=44) developed vascular dementia. The group of AAMI subjects did less well on two of the seven memory tests after 3½ years than they did initially; the control group (n=18) had lower scores on one memory test at follow-up than they had previously. The data suggest that the memory capacity of subjects with AAMI is not pathologically impaired. The general intellectual level significantly influences whether an individual with memory complaints will be classified AAMI or not. People with high intelligence are less likely than people with lower intellectual capacity to fulfill the AAMI criteria. This suggests that AAMI lacks in construct validity.     

Toilet training of normal and retarded children

Early elements in an operant chain of toilet behaviors were trained in three normal infants and five retarded children. Following that, eliminative behaviors were conditioned by operant procedures. Each child was equipped with an auditory signalling device that gave cues to the learner. Baseline behavior was recorded for a period of five days. The procedure for training consisted of two steps. First, a response was obtained through physical, verbal, and auditory prompts. Second, prompts were faded until the child responded in the presence of the auditory signal. When the device was removed the child performed without the auditory prompt. Parents were instructed in a similar procedure to enhance generalization in the home. Seven of the eight subjects reached a criterion and maintained that behavior during three criterion sessions.     

How Couple- and Parenting-Focused Programs Affect Child Behavioral Problems: A Randomized Controlled Trial

The significance of enhancing parenting skills to reduce child maladjustment is well-established and supports the important role of evidence-based parenting programs. However, the notion that parenting should be the exclusive focus for enhancing child behavior is necessarily limiting. Evidence is growing that relationship-oriented treatments may be another powerful approach to improve child adjustment, albeit the underlying effects in couple- versus parenting-focused programs have been subject to limited study. The aim of this RCT was to compare the treatment effects of (1) a couple-focused program (the Couples Coping Enhancement Training) to (2) a parenting training (Triple P) and (3) a control group on children’s behavioral problems in 150 couples. The parents’ perceptions of relationship quality, parenting behavior, and child’s behavioral problems were assessed by means of questionnaires completed prior to and 2 weeks after the end of the treatment. Multi-group path analyses revealed that in mothers’ perception the couple-focused program reduced child behavioral problems by enhancing the relationship quality whereas improved parenting mediated the benefits in the parenting training. In fathers’ evaluations the couple-focused program reduced dysfunctional parenting which largely accounted for the benefits in child adjustment. The dearth of research on child outcomes in couple-focused intervention studies is a striking gap that should be overcome. It is a promising field because of its evident potential to foster the health of many children.     

Relationship Between Time in Residential Treatment and Youth Outcomes: Results from a Cross-Site 5-Year Analysis

There is a need to evaluate the effectiveness of residential treatment centers (RTCs) due to scrutiny around use of this service that is viewed as costly, restrictive, and has resulted in mixed outcome results for youth. Discrepancies exist in residential literature regarding the amount of time in treatment that is optimal for having a positive effect on youth outcomes. This study used archival data to examine the relationship between time in treatment and youth’s improvement in functioning and restrictiveness of living environment in a cross-site evaluation of a large sample of youth (N = 716) who discharged from RTCs over a 5 year time period. Researchers aimed to identify an ideal time in treatment that is beneficial for youth and to add to the practice-based evidence for the effectiveness of RTCs. Results of segmented regression analyses indicate a non-linear relationship that showed a longer time in treatment predicts improvement in overall functioning and restrictiveness of living environment during the first 6 months of treatment. However there is no relationship between time in treatment and outcome variables between 6 and 10 months, and a negative relationship exists between longer time in treatment and outcome variables after 10 months in treatment. Practical implications of results can be used to inform advocacy efforts, discharge planning, and return on investment calculations.     

Parenting Behaviors of Mothers and Fathers of Preschool Age Children with Internalizing Disorders

This study investigated parenting behaviors of mothers and fathers of clinically anxious preschool children (with or without depressive comorbidity) and healthy comparison children. Studies assessing children from early school age onwards have found that parental control, rejection, and inconsistent discipline are associated with the presence of children’s internalizing symptoms/disorders. Despite the scarcity of studies investigating these associations at preschool age, we assumed that findings with older children would also apply to children in this age group. In a cross-sectional study we assessed N = 176 children of preschool age (M = 5; 2 years) and both of their parents. A diagnostic interview (Preschool Age Psychiatric Assessment) was conducted to determine children’s psychiatric diagnoses, yielding the following results: a group of n = 67 children with pure anxiety disorders (AD group), a group of n = 38 children with anxiety disorders with depressive comorbidity (AD/DC group), and a comparison group of n = 71 children without psychiatric disorders. Both parents completed the German extended version of the Alabama Parenting Questionnaire. We evaluated maternal depressive symptoms and children’s temperament as further correlates. All variables that differed significantly between groups were entered into multinomial logistic regression analyses to test which variables predict group membership. When comparing each of the two anxiety groups with the comparison group we obtained the following results: (1) Inconsistent paternal discipline and maternal depressive symptoms increased and children’s positive affectivity decreased the probability of children of being in the AD group rather than in the comparison group. (2) Maternal overinvolvement, maternal depressive symptoms and children’s negative affectivity increased and children’s positive affectivity decreased the probability of children of belonging to the AD/DC group rather than to the comparison group. When comparing the two anxiety groups with each other, we found that inconsistent paternal discipline increased and children’s negative affectivity decreased the probability of children of being in the AD group rather than in the AD/DC group. The results suggest that paternal parenting behaviors show different associations with internalizing disorders at preschool age than maternal parenting behaviors. This underlines the importance of including fathers in the prevention and treatment of internalizing disorders at preschool age.     

Borderland-Jugendliche

The process of identity formation as a central task of adolescence is difficult and fragile but even more so in adolescents with a migration background. Confronted with adverse experiences, cultural peculiarities of the country of origin can aggravate the second individuation phase of the adolescent, superimposed by a third phase caused by migration (Blos, Ahktar). With three case reports of mentally disturbed adolescents from different migration backgrounds, some specific dangers of such borderland adolescents are presented. All three cases have something in common: the importance of the glorified militant ideologies of the country of origin influencing the mental disorder of the adolescent in a special way such as a suitable target of narcissistic self-aggrandizement. The dangers of diagnostic colonization of alien symptoms and reactivation of elements of the Nazi past into the present with offender-victim constellations triggered by alienation are pointed out and discussed. The inability to draw borderlines between reality and fantasy and transmissive and deposed conflicts are described.     

An Integrative Approach to Conceptualizing and Treating Complex Trauma

Complex trauma (CT) often presents with polymorphous symptoms (i.e., emotional dysregulation, dissociation, somatic distress) resulting from repeated and chronic exposure to traumatic stressors. While the public is increasingly aware of posttraumatic stress disorder (PTSD) and its accompanying symptoms, the phenomena of complex trauma is less recognized and understood. Since the trauma reactions with CT typically occur during childhood, and the symptoms go well beyond PTSD, the authors of this article assert that an integrative approach is needed that synthesizes the most effective elements of cognitive-behavioral therapy (CBT) while blending a self-psychological approach. A review of the literature addresses the definition of complex trauma, cognitive-behavioral conceptualizations and treatment approaches, self-psychological models, current theories of attachment, and advances in neuropsychoanalysis. An integrative model is then proposed, supported by clinicians in the trauma field, identifying three intertwined phases of treatment.     

A Leader-Led Supervision Group as a Model for Practicing Genetic Counselors

With the stage set by the overview of supervision models in the previous paper, thispaper now presents the development and evolution of a currently ongoing leader-ledsupervision group for experienced genetic counselors. I discuss the procedures forgetting started; the creation and maintenance of the contract; typical issues and themesconsidered; the format for case presentation; and the overall growth of the group and itsmembers.