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.     

Negative priming effects in children engaged in nonspatial tasks: evidence for early development of an intact inhibitory mechanism

Three experiments are reported that examined conceptual negative priming effects in children 5 to 12 years of age. Experiment 1 used a negative priming variant of a flanker task requiring the naming of a central color blob flanked by irrelevant distractors. Experiment 2 used a negative priming variant of the Stroop color-word task. Experiment 3 used a same-different matching task with novel 3-D shapes. Results revealed significant and equivalent magnitudes of negative priming across the tested age groups for all 3 tasks. It is concluded that the inhibitory mechanism underlying conceptual (i.e., identity or semantic) negative priming in visual selective attention tasks is intact in young children. Because the findings and conclusions diverge from the developmental literature on negative priming, the authors attempt to reconcile the contradictions by pinning down the reasons for the discrepancies.     

Families created through surrogacy arrangements: parent-child relationships in the 1st year of life

Findings are presented of a study of families created through surrogacy arrangements. Forty-two surrogacy families were compared with 51 egg-donation families and 80 natural-conception families on standardized interview and questionnaire measures of the psychological well-being of the parents, the quality of parent-child relationships, and infant temperament. The differences that were identified between the surrogacy families and the other family types indicated greater psychological well-being and adaptation to parenthood by mothers and fathers of children born through surrogacy arrangements than by the natural-conception parents.