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  • Selected Abstracts

    Temporal reliability of psychological assessments for patients in a special hospital with severe personality disorder: a preliminary note

    Professor P. Tyrer
    Background The new programme for assessing those with dangerous and severe personality disorder relies heavily on psychological assessments of personality disorder and risk. Methods The temporal reliability of assessments of psychopathy (PCL-R), risk (HCR-20) and personality was assessed using the International Personality Disorder Examination (IPDE) in 15 randomly selected male prisoners in a high secure hospital carried out at intervals varying between a mean of nine and 19 months after initial assessments by a variety of assessors. Results Using the intra-class correlation coefficient the agreement varied between0.57 (HCR-20), 0.58 (PCL-R) and 0.38-0.70 for IPDE personality disorders, with the best agreement for antisocial personality disorder (0.70). Comment These levels of agreement are consistent with other recent work on temporal reliability of personality instruments but are a little too low for confidence in these measures alone in the assessment process. Copyright © 2005 Whurr Publishers Ltd. [source]

    Mortality among mentally disordered offenders: a community based follow-up study

    Tabita Björk
    Background Follow-up information about outcome for hospitalized mentally disordered offenders (MDO) is necessary for evaluation and improvement in quality of forensic psychiatric care. Aim A study was undertaken to estimate the standard mortality rate (SMR) of a population based sample of people sentenced to forensic psychiatric care. Method All MDOs in Örebro County, Sweden, discharged from a forensic psychiatric treatment unit between 1992 and 1999 were identified (n = 46). The variables were gender, age, offence, diagnosis and duration of admission. Case linkage was made with the National Cause-of-Death register. Median follow-up time was 53 months (0,93). Results The sample yielded a significantly elevated SMR 13.4 (95% CI 4.35,31.3) times higher than that in the general population, mostly due to suicide. Conclusions The cohort size is small but representative, and it provides data from an additional country for the growing international pool confirming the high risk of premature, generally self-inflicted death among MDOs. Resettlement and rehabilitation services for them may need to take as much account of mortality risk as that of reoffending. Copyright © 2005 Whurr Publishers Ltd. [source]

    The manualization of a treatment programme for personality disorder

    Mary McMurran
    Background The advantages of manualized psychological treatments include: the promotion of evidence-based practice, the enhancement of treatment integrity, the facilitation of staff training, and the potential replicability of treatment. Argument The manualization of a multi-component, multidisciplinary treatment programme for male personality-disordered offenders is described. The background to this development is explained and the treatment setting is described briefly, followed by a description of the eight treatment manuals: (1) the treatment overview, (2) Psychoeducation focusing on personality disorder diagnosis and core beliefs, (3) Trust and Self-awareness group exercises, (4) Stop & Think! - a social problem-solving intervention, (5) Controlling Angry Aggression, (6) Controlling Substance Use, (7) Criminal Thinking/Belief Therapy, and (8) Skills for Living - a social skills manual. Conclusions In addition to the original aims of manualization, this exercise has clarified the treatment programme, included less highly trained staff in the delivery of therapy and permitted the evaluation of treatment modules, thus contributing to the incremental evaluation of the overall programme. These manuals may usefully be shared with other practitioners in the field. Copyright © 2005 Whurr Publishers Ltd. [source]

    Using the SWAP-200 in a personality-disordered forensic population: is it valid, reliable and useful?

    Luisa E. Marin-Avellan
    Background Treatment and risk management of forensic patients relies heavily on diagnosing psychopathology, yet the reliability of clinical diagnoses of personality disorder has been found to be only fair to low. Structured instruments for the global assessment of personality disorder are infrequently used in clinical assessments possibly due to their limited validity and clinical utility. Aims/methods The Shedler-Westen Assessment Procedure-200 (SWAP-200) was developed in an effort to address these limitations. Although good reliability and validity in relation to clinicians' diagnosis of personality disorder has been reported, to date the validity of this instrument has not been assessed in relation to other standardized instruments or in a personality-disordered, forensic population. This study aims to establish the reliability and validity of the SWAP-200 against other diagnostic instruments and measures of interpersonal functioning in a personality disordered forensic population. Results This paper reports the results of 30 subjects from a high secure hospital in the UK who were assessed with the SWAP-200, the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), the Adult Attachment Interview (AAI) and the Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE). Preliminary results suggest that the SWAP-200 is a reliable instrument for the diagnosis of personality disorder in forensic patients. Conclusions Although the small sample size allows only preliminary conclusions about the validity of this instrument, early results show a reduction of the diagnosis of comorbidity compared with the SCID-II, together with an increased number of expected associations between independent measures of interpersonal functioning and categories of personality disorder. Copyright © 2005 Whurr Publishers Ltd. [source]

    Protective factors for youth considered at risk of criminal behaviour: does participation in extracurricular activities help?

    Jodi M. Burton
    Background There is a lack of research investigating the potential protective effect of participation in extracurricular activities on youth who are at risk of engaging in delinquent activity. Aim This study examined the potential for participation in extracurricular activities to act as a protective factor for youth deemed at risk of engaging in delinquent activity. Method One hundred and sixty-nine secondary students from Glasgow, Scotland completed two questionnaires (the Youth Self-Report and an additional information sheet) requesting information about their participation in extracurricular and delinquent activities as well as their possible risk factors. Activities included sports, non-sports (hobbies and games), current activities (youth clubs and other organisations) and previous involvement in activities. Risk factors included residing in a broken home, having four or more siblings, academic failure and lacking a nonparental very important person. Delinquent activities included rule-breaking and aggressive behaviours. Results Independent samplest-tests found that females participated in significantly more non-sports and previous activities than males and that males participated in significantly more rule-breaking behaviour than females. Hierarchical multiple regression analyses found that gender and participation in sports were strong predictors of rule-breaking behaviour. A significant positive correlation was found between participation in sports and involvement in aggressive behaviour. Conclusion The results suggest that participation in extracurricular activities does not act as a protective factor for youth, regardless of whether or not they are considered to be at risk of engaging in delinquent activity. The significant correlation found between participation in sports and involvement in aggressive behaviour suggests that youth participation in sports may act as a risk factor. Copyright © 2005 Whurr Publishers Ltd. [source]

    Juvenile sexual delinquents: contrasting child abusers with peer abusers

    J. Hendriks MA
    Background There is growing concern regarding juvenile sex offenders, and concomitant interest in a more scientific database which could help direct management and treatment resources. Aims To investigate whether juveniles who sexually offend against children (or those at least five years younger than themselves) differ from those who sexually assault their peers or older victims. Method The study is based on data from psychological screenings conducted for the juvenile courts in the Netherlands. Results As hypothesized, juvenile child molesters scored higher on neuroticism, had experienced more social problems, and had been bullied more often at school than their peers who sexually assaulted same-age or older victims. Child molesters also reported a more negative self-image. When referred for screening, they were younger but had committed more sex offences, more often against males than females. Conclusions The results were suggestive of greater need for psychological interventions in the child molester group, although in both groups substantial minorities had had experience of early childhood deprivation or abuse. Copyright © 2004 Whurr Publishers Ltd. [source]

    Mental health outcomes of adjudicated males and females: the aftermath of juvenile delinquency and problem behaviour

    Mélanie Corneau
    Background Empirical evidence indicates that the rates of mental health problems and disorders are relatively high among adjudicated youths, especially females, yet few longitudinal studies have focused on gender differences regarding their mental health outcomes as adults. Aims The present study was designed to assess the prevalence rates of self-reported suicide attempts and psychological help-seeking in young adults adjudicated for antisocial behaviours in adolescence. This study also assessed gender differences in the prevalence rates of mental health problems and disorders reported by participants. Methods Structured interviews assessing personal and social adaptation were conducted on three occasions with 292 adjudicated male and 113 female youths (mean age 15 years on the first occasion). Data from the third testing wave (mean age 23.51 at T3) provide information on their mental health outcomes in adulthood. Results Results indicate that in individuals with a history of juvenile delinquency and/or problem behaviour over 10% of the males and 20% of the females reported suicide attempts, and one-fifth and one-third respectively reported psychological consultation. Similar and lower proportions reported psychiatric hospitalization and/or drug addiction programme/therapy at the beginning of adulthood. Implications for practice The present study suggests that these youths may need more mental health directed interventions in their assessment rehabilitation programmes. Copyright © 2004 Whurr Publishers Ltd. [source]

    Precursors and correlates of criminal behaviour in women

    Dr Julie Messer
    Background The precursors and correlates of criminal behaviour in women were examined in this longitudinal study of women in their late thirties. Methods The sample consisted of a high-risk group of women (n = 86) and a comparison group ( n = 97): the former had been raised in institutional care. Questionnaire measures of childhood behaviour problems and detailed interview data from two time points in adulthood were obtained, along with official records of offending. Results In terms of childhood precursors, antisocial behaviour, institutional rearing, hyperactivity and adolescent conduct disorder were found to be significantly related to offending. Later adolescent factors were also found to be important: mixing with deviant peers and leaving school without any qualifications or plans for work. Correlates of offending in adulthood included difficulties in mental health, drug use, marriage and parenting. Further analysis was undertaken to clarify the associations by using ex-care status and conduct disorder as covariates. Discussion Well-established predictors of offending in male samples seem quite as important for women and girls. The findings also suggested strong links between offending and problems in parenting. Copyright © 2004 Whurr Publishers Ltd. [source]

    Understanding sexual offending in schizophrenia

    Christopher R. Drake M Clin Psych MAPS
    Background Studies have found an elevated incidence of violent sexual offences in males with schizophrenia. The relationship between sexual offending and psychiatric illness is, however, complex and poorly defined. Aims The aim of the present article is to delineate possible mechanisms that underlie offensive sexual behaviour in schizophrenia that can be used as a framework for assessing and treating these behaviours. A review of research pertaining to the aetiology of sexual deviance in schizophrenia was conducted, focusing in particular on the role of early childhood experiences, deviant sexual preferences, antisocial personality traits, psychiatric symptomatology and associated treatment effects, the impact of mental illness on sexual and social functioning, and other potential contributory factors. Towards a typology It is proposed that schizophrenic patients who engage in sexually offensive activities fall into four broad groups: (1) those with a pre-existing paraphilia; (2) those whose deviant sexuality arises in the context of illness and/or its treatment; (3) those whose deviant sexuality is one manifestation of more generalized antisocial behaviour, and (4) factors other than the above. This classification provides a useful framework for evaluating and treating sexually offensive behaviours in schizophrenic patients. Copyright © 2004 Whurr Publishers Ltd. [source]

    Characteristics of spousal homicide perpetrators: a study of all cases of spousal homicide in Sweden 1990,1999

    Professor Henrik Belfrage PhD
    Background In Sweden 20 000 cases of assault against women are reported to the police every year. Method All data on the perpetrators of spousal homicide in Sweden between 1990 and 1999 were investigated (n = 164). A control group of all other perpetrators of homicide in Sweden during the same period, i.e. cases of homicide not committed in the context of spouse violence (n = 690) was used. All verdicts, as well as all material in the police investigations, including interviews with all of the police investigators, were analysed. Copies of police examinations of the suspects, and forensic reports from the autopsies, were also examined. Data on all registered criminality were collected from the National Police Register, and in cases where the perpetrators had been subject to forensic psychiatric examinations, those reports were obtained from the Swedish National Board of Forensic Medicine. In addition, the Psychopathy Checklist: Screening Version scores were rated from the forensic psychiatric examinations. Results There was a four times higher suicide rate among the spousal homicide perpetrators (24%, n = 40) compared with the perpetrators in the control-group (6%, n = 39, chi-squared = 55,42df = 1 , p < 0.001). Consequently, suicidal ideation must be considered as an important risk factor for spousal homicide. In 79% of the cases the spousal homicide perpetrators were subject to forensic psychiatric examinations. All except 5% were diagnosed with at least one psychiatric diagnosis, and 34% were sentenced to forensic psychiatric treatment. If it is assumed that the psychiatric morbidity was high in the 24% of the perpetrators who committed suicide, then 80% of all perpetrators of spouse homicide during the study period can be characterized as mentally disordered. ,Psychopathic' perpetrators, who generally are over-represented in most violent criminality, were comparatively uncommon. Only seven (4%) in the study group met the diagnostic criteria for psychopathy as measured with the PCL:SV. Discussion The group of spouse killers studied here fits the dysphoric/borderline group of spouse assaulters. This is a group that may benefit from treatment. Perhaps police officers could help identify this kind of spouse assaulter before a fatality occurs. Copyright © 2004 Whurr Publishers Ltd. [source]

    Does personality change and, if so, what changes?,

    Conor Duggan
    Background Although the question of whether or not personality changes is fundamental to much of what clinicians do, we do not appear to be very curious about the question itself. Method This paper considers three separate but related issues: (a) Does personality change? (b) If it does, then what changes? (c) How can we show that change has taken place? Costa and McCrea have produced a model of personality that helps to answer (a) and (b), as it distinguishes ,Basic Tendencies' from ,Characteristic Adaptations'. The former are largely innate, fixed dispositions that produce the latter (which are highly variable) depending on its interaction with differing environments. Thus, personality is both static and dynamic depending on its definition. It will also be argued that detecting change is complex as there are many alternative definitions of the relevant outcome variable. Moreover, measuring several different outcomes does not help as change in one measure is often not matched by a concordant change in another. Some practical examples are provided to support this position. Conclusions In the absence of a firm theoretical base, the author believes that only limited conclusions can be drawn about the efficacy of treatment in personality disorder. Copyright © 2004 Whurr Publishers Ltd. [source]

    Severe personality disorder emerging in childhood: a proposal for a new developmental disorder

    Eileen Vizard
    Background The concept of ,severe personality disorder' is currently applied to adults with a history of serious antisocial and offending behaviour. There is, however, no similar classification that can be applied to the sub-group of children and adolescents who display persistent and serious offending from an early age. This omission from diagnostic nomenclature prevents the appropriate early identification, assessment and management of these young people. Method This paper therefore proposes a new developmental disorder: ,severe personality disorder emerging in childhood'. The existing evidence base strongly supports the presence of a developmental trajectory from childhood to adult life for the small number of children who show early signs of severe personality disorder (SPD). Based on a review of the literature and the experience of working in a specialist, forensic Child and Adolescent Mental Health Service (CAMHS), a multi-factorial model is proposed that outlines the developmental trajectory of SPD. This model includes neurobiological, psychosocial, environmental and systemic factors, within a developmental framework, and contributes to a more developmentally appropriate understanding of the genesis of severe personality disorder. Copyright © 2004 Whurr Publishers Ltd. [source]

    Searching for a developmental typology of personality and its relations to antisocial behaviour: a longitudinal study of an adjudicated men sample

    Julien Morizot
    The search for an empirically based personality typology has regained the interest of researchers. To date, however, empirical inquiries have mainly been cross-sectional. In this study, an empirically based developmental typology of personality was identified using data from a prospective longitudinal study of a sample of men adjudicated during their adolescence and assessed on four occasions until midlife. Cluster analyses were performed on measures of disinhibition, negative emotionality, and extraversion. Four developmental types of personality were identified. The first was characterized by average scores in the three traits in adolescence that decreased linearly until midlife (39%). The second type displayed very high scores in disinhibition and negative emotionality in adolescence that decreased rapidly during early adulthood (24%). The third type was characterized by very high scores in disinhibition and negative emotionality that remained stable until midlife, while extraversion was average during adolescence and then decreased rapidly until midlife (17%). The fourth type was characterized by high scores in disinhibition and negative emotionality in adolescence that was followed by cycles of decreases and increases until midlife (20%). These four developmental types of personality seemed to be related to known antisocial behaviour trajectories. Copyright © 2003 Whurr Publishers Ltd. [source]

    Children, admitted to high security (special) hospital

    Adolescent Forensic Psychiatry, Claire Dimond Consultant in Child
    Introduction The Special Hospitals in England provide psychiatric treatment in high security. The aim of this study was to examine the demographics and background characteristics of children admitted to high security hospitals in England, using the special hospital case register. Method Forty-six children (the subject group) were admitted to a high security hospital under the MHA (1983) classification of disorder of mental illness and/or psychopathic disorder between 1983 and 1999, 33 (72%) of whom were male. A comparison group of adults was matched on sex, legal classification of detention and MHA 1983 classification of disorder. Results The children were admitted for a similar range of offences to those of the comparison group. However, the children had received convictions for criminal damage and violence at a significantly earlier age, they were more likely to have experienced a change in carer during their childhood, been placed in a children's home and were less likely to be living with a family member on their 16th birthday. Children admitted to special hospital experience a lot of disruption in their childhood and are extremely high users of multi-agency services as they grow up. Discussion Issues are raised regarding how to provide a developmentally sensitive service for children who require high security care. Copyright © 2003 Whurr Publishers Ltd. [source]

    Psychology brings justice: the science of forensic psychology,

    Gisli H. Gudjonsson Professor of Forensic Psychology
    In this paper the focus is on one aspect of forensic psychology: the development of psychological instruments, a social psychological model and assessment procedures for evaluating the credibility of witnesses and police detainees during interviewing. Clinically grounded case work and research has impacted on police interviewing and practice, the admissibility of expert psychological testimony and the outcome of cases of miscarriage of justice. After describing the research that laid the foundations for advancement of scientific knowledge in this area, a brief review is presented of 22 high-profile murder cases where convictions based on confession evidence have been quashed on appeal between 1989 and 2001, often primarily on the basis of psychological evidence. The review of the cases demonstrates that psychological research and expert testimony in cases of disputed confessions have had a profound influence on the practice and ruling of the Court of Appeal for England and Wales and the British House of Lords. The cases presented in this paper show that it is wrong to assume that only persons with learning disability or those who are mentally ill make unreliable or false confessions. Personality factors, such as suggestibility, compliance, high trait anxiety and antisocial personality traits, are often important in rendering a confession unreliable. Future research needs to focus more on the role of personality factors in rendering the evidence of witnesses and suspects potentially unreliable. Copyright © 2003 Whurr Publishers Ltd. [source]

    Mental health patients in criminal justice populations: needs, treatment and criminal behaviour

    J. Keene PhD Professor of Primary Care
    Background Government policy requires that health and social care agencies work more closely together and in partnership with the criminal justice system. There is a well-established relationship between crime and mental disorder. Method The Tracking Project provides for the first time in England the means of collating and analysing data on mental disorder (defined as receiving secondary care as patients of a Mental Health Trust) and crime (defined as all those charged with an offence). Data were collected over a three-year period for all individuals who had contact with the criminal justice system and mental health services in an English county. Results In a county population of 800,400, some 30,329 were offenders. More than a third had used a health or social care service during the three-year period; 8.0% were mentally disordered. Those offenders aged 25,64 and who contacted the police more than once were significantly more likely to be mentally disordered. Type of offence was also a relevant variable. The probation service showed broadly similar results. Discussion The research has provided for the first time substantive quantitative evidence of the relationship between crime and mental disorder. The results can be used as the basis for further work to target assessment and risk reduction measures at those most at risk. Copyright © 2003 Whurr Publishers Ltd. [source]

    Predictive, concurrent, prospective and retrospective validity of self-reported delinquency

    Darrick Jolliffe
    Background The self-report method is widely used to measure offending. Previous studies suggest that it is generally valid, but that its validity may be lower for blacks than for whites. Aim To assess the validity of self-reported offending in relation to court referrals, and to investigate how it varies with types of offences, sex and race. Method Annual court and self-report data were collected between ages 11 and 17 for eight offences in the Seattle Social Development Project, which is a prospective longitudinal survey of 808 youths. Results Self-reports predicted future court referrals. Predictive validity was highest for drug offences, for males and for whites, and lowest for females and Asians. The probability of youths with a court referral reporting offences and arrests was highest for drug offences, for males, for whites and for blacks. Retrospective ages of onset agreed best with prospective ages for drug offences, Asians and whites. More Asians than blacks or whites failed retrospectively to report offences that had been reported prospectively. Conclusions The validity of self-reports of offending was high, especially for drug offences, for males and for whites. Contrary to prior research, validity was high for black males. It was lowest for Asian females. Sex and race differences in validity held up after controlling for socioeconomic status. Differential validity probability did not reflect police bias. Copyright © 2003 Whurr Publishers Ltd. [source]

    A developmental test of the general deviance syndrome with adjudicated girls and boys using hierarchical confirmatory factor analysis

    Marc Le Blanc PhD (Criminology)
    Background Over the last 40 years, numerous studies have proposed that various deviant behaviours are part of a latent construct now labelled ,general deviance' by criminologists or ,problem behaviour' by psychologists. During that period, many studies have documented the presence of specific forms of deviance. However, no study has tested these two opposing views simultaneously, particularly with longitudinal data. Aims The objectives of this paper are the cross-cultural replication of the construct of general deviance for a French-speaking adjudicated sample of girls and boys and, specifically, the developmental replication of the general deviance syndrome. Method The age of onset is used as a developmental indicator of deviance instead of measures of participation or frequency. Results The results of EQS hierarchical confirmatory factor analyses supported the existence of the construct of general deviance. In addition, there is no gender gap in the structure of the general deviance syndrome. This paper reports a comprehensive test of the general deviance syndrome because of the use of 45 deviant behaviours and nine types of deviance classified into four categories. Copyright © 2003 Whurr Publishers Ltd. [source]

    The Liverpool Violence Assessment: an investigator-based measure of serious violence

    Rajan Nathan
    Background Antisocial personality disorder (ASPD) identifies adults with persistent offending behaviour and social dysfunction. However, it lacks discrimination within high-risk and criminal populations and gives little indication of an individual's history of violence. Existing measures of violence have significant limitations. The Liverpool Violence Assessment (LiVA) is an investigator-based standardized interview for measuring patterns of violence. Method A total of 61 male prisoners who had been sentenced for serious violent offences were interviewed using the LiVA and the Structured Clinical Interview for DSM IV antisocial personality disorder and alcohol and drug dependence. Official records of offending were examined. Results The inter-rater reliability for the LiVA was high. There were significant correlations between histories of violence assessed by the LiVA and official records, but the frequency of self-reported violence was much higher than in the official records. Antisocial personality disorder was associated with increased violence. However, analyses revealed marked variability of the levels of violence among those with antisocial personality disorder and contrasting patterns of association of violence with antisocial personality disorder depending on the context. Conclusion The LiVA is a reliable and valid measure of the patterns and characteristics of violence. The findings suggest that the causes of violence should be studied in their own right and not only as a feature of ASPD. Copyright © 2003 Whurr Publishers Ltd. [source]

    The probabilities of sex offender re-arrest

    Roderic Broadhurst Associate Professor
    Background Estimates of the probabilities of re-arrest for sex offenders apprehended in Western Australia between April 1984 and December 1994 are reported. Population and method Of the 116,151 distinct male persons arrested for the first time from 1984,94, 2785 were identified with at least one sex offence. Subjects on average were followed up for 5.7 years and assessed by criminal record, Aboriginality, bail status, age, occupation and penal intervention. Three criteria, rearrest for any, repeat sex or a violent offence are used to summarize the ,careers' of sex offenders. Results Overall ultimate probabilities of rearrest for any offence were 0.61, for a repeat sex offence 0.33 and for a violent offence 0.51. Probabilities of re-arrest for non-Aboriginal offenders were lower for all definitions. Younger offenders, Aborigines and those with prior arrest for non-sex offences had higher probabilities for any or violent rearrest but older offenders tended to have higher probabilities of repeat sex offending. Community supervision and imprisonment significantly reduced the ,rate' or speed of re-arrest. Discussion Actuarial risk assessments for low-probability high-consequence events such as dangerous recidivism are useful for identifying groups with a high probability of rearrest, assisting management of these groups and evaluating penal interventions. Copyright © 2003 Whurr Publishers Ltd. [source]

    Changes in patterns of excessive alcohol consumption in 25 years of high security hospital admissions from England and Wales

    Celia McMahon
    Background It is now generally acknowledged that alcohol abuse increases the risk of violence among people with major mental disorder. Studies in the 1980s and earlier, however, tended to report an inverse relationship between their alcohol use and violence. Aims A study was undertaken to test a hypothesis that among people with major mental disorder considered to pose a serious risk to others the likelihood of excessive alcohol consumption in a period leading up to a violent or dangerous act has increased over time. Methods Analysis was made of annual high security hospital admission cohort case register data of 1 January 1975 to 31 December 1999; alcohol use data were taken from interview and records, and problem drinking defined as consumption of alcohol in excess of 21 units per week during the 12 months prior to the index offence or act. Results There was a linear increase in the proportion of patients in five-year admission cohorts who had engaged in excessive alcohol consumption during the year prior to their index offence or act. The increase was steeper among women than men, but cut across all diagnosis and offending groups. It was strongly associated with increasing tendency to abuse illicit drugs. Conclusions The greater proportion of patients affected by excessive alcohol consumption occurred in spite of a reduction over the same period in admission of people in the diagnostic groups most likely to be implicated in substance misuse (personality disorder). This increased trend may simply reflect similar trends in the general population, but may also be associated with a lack of services or current consensus on appropriate treatment for patients whose mental illness is complicated by excessive alcohol use. Regardless, the trend suggests a growing need for ,dual diagnosis' services within and outside high security hospital. Copyright © 2003 Whurr Publishers Ltd. [source]

    Alcohol and violence and the possible role of serotonin

    Abdulla A.-B.
    Background There is undisputed evidence linking alcohol consumption and violence and other forms of aggressive behaviour, and also linking aggression with dysfunction of the brain indolylamine serotonin (5-hydroxytryptamine or 5-HT). Alcohol consumption also causes major disturbances in the metabolism of brain serotonin. In particular, acute alcohol intake depletes brain serotonin levels in normal (non-alcohol-dependent) subjects. On the basis of the above statements, it is suggested that, at the biological level, alcohol may induce aggressive behaviour in susceptible individuals, at least in part, by inducing a strong depletion of brain serotonin levels. Aims In this article, evidence supporting these interrelationships and interactions will be summarized and discussed, the alcohol,serotonin,aggression hypothesis will be reiterated, and potential intervention strategies will be proposed. Copyright © 2003 Whurr Publishers Ltd. [source]

    Alcohol use and negative affect in the offence cycle

    Andrew Day
    Introduction It is commonly acknowledged that, for many offenders, alcohol use is strongly associated with criminal behaviour. The belief held by many professionals that the two phenomena are associated, probably in a causal way, has led to the inclusion of alcohol use as a ,criminogenic need' in many settings where rehabilitation programmes are used to reduce recidivism. However, the mechanisms and pathways involved in the alcohol,crime link remain poorly understood. Argument and conclusion This paper reviews the literature relating to alcohol,offending links and draws some inferences about the role of alcohol use as a criminogenic need in offender rehabilitation. It is proposed that the bi-directional relationship between alcohol use and negative affective states is important in understanding the offence cycle, and that deficits in self-regulation not only characterize both alcohol misuse and negative affect but are also implicated in the offending behaviour itself. Copyright © 2003 Whurr Publishers Ltd. [source]

    The voice of detainees in a high security setting on services for people with personality disorder

    Sue Ryan
    Background British government Home and Health Departments have been consulting widely about service development for people with ,dangerous severe personality disorder' (DSPD). There has, however, been no consultation with service users, nor is there any user view literature in this area. Methods All people detained in one high security hospital under the legal classification of psychopathic disorder were eligible but those on the admission or intensive care wards were not approached. Views of service were elicited using a purpose designed semi-structured interview. The principal researcher was independent of all clinical teams. Confidentiality about patients' views was assured. Aims To establish views on services from one subgroup of people nominated by the government department as having ,DSPD'. Results Sixty-one of 89 agreed to interview. With security a given, about half expressed a preference for a high security hospital setting, 20% prison and 25% elsewhere, generally medium secure hospitals. Participants most valued caring, understanding and ,experience' among staff. An ideal service was considered to be one within small, domestic living units, providing group and individual therapies. Some found living with people with mental illness difficult, but some specified not wanting segregated units. Views were affected by gender and comorbidity. Conclusions As the sample were all in hospital, the emphasis on treatment may reflect a placement bias. All but five participants, however, had had experience of both health and criminal justice services, so were well placed to talk with authority about preferences. Copyright © 2002 Whurr Publishers Ltd. [source]

    Name change among offender patients: an English high security hospital sample

    Birgit Völlm Clinical Research Fellow
    Background There is scant literature on change of name among psychiatric patients but a more substantial amount on the use of aliases among offenders. No one to our knowledge has explored name changes among offender patients. Aim This study was undertaken to establish the prevalence of name change among high security hospital patients and to compare those who changed name with those who did not. Hypothesis It was hypothesized that name change would be associated with male gender, repeated offending and a diagnosis of personality disorder. Method The clinical records of all patients resident in one high security hospital on 31 January 2000 were searched. As all such patients are compulsorily detained, all name changes must be recorded. Any change prior to that date was also noted, together with basic demographic and diagnostic information; supplementary data were obtained from the special hospitals' case register. Results Seventy-one patients (17%) of the resident population changed names (exclusive of a woman changing her surname on marriage). Name changing was associated with disrupted upbringing. Patients with personality disorder were more likely to change names than those with psychosis, regardless of sex, age or ethnic group. Those with psychosis were more likely to select unusual or symbolic names. Conclusions On the evidence of previous literature, people from this serious offender patient population were more likely to change names than other psychiatric patients but less likely than non-mentally-disordered offenders. Changes by people with psychosis seemed related to their illness, whereas changes by those with personality disorder might reflect childhood disruptions in rearing patterns. Copyright © 2002 Whurr Publishers Ltd. [source]

    Childhood predictors of adult criminality: are all risk factors reflected in childhood aggressiveness?

    L. Rowell Huesmann
    Background Early aggressive behaviour is one of the best predictors of adult criminality. Aim To assess the degree to which family background variables, parental beliefs and behaviour and child intelligence predict child aggression and adult criminality. Method Data were used from the Colombia County Longitudinal Study, a longitudinal study of 856 children in third grade in New York, in 1959,60. Adult measures of criminal behaviour, child measures taken at age eight, child peer-nominated aggression, child's peer-nominated popularity, child's IQ and parental measures at eight years were used. Results Aggressive children were less intelligent, less popular, rejected more by their parents, had parents who believed in punishment, were less identified with their parents' self-image and were less likely to express guilt. As adults, more aggressive children with parents who were less well educated, experienced more marital disharmony and who seldom attended church were most at risk for arrest. However, after the effect of early aggression was controlled, most effects disappeared and only parents having a strong belief in punishment added significantly to risk of arrest by age 30; the only fact that then reduced the risk of arrest was having parents who attended church often. Both parental authoritarianism and child IQ reduced the risk of conviction for arrested children. Discussion Level of aggression at age eight is the best predictor of criminal events over the next 22 years. A clear implication is that the risk for criminality is affected by much that happens to a boy before he is eight years old. Preventive interventions need to target risk factors that appear to influence the development of early aggression. Copyright © 2002 Whurr Publishers Ltd. [source]

    Personality disorders in prisoners and their motivation for dangerous and disruptive behaviour

    Professor Jeremy W. Coid MD FRCPsych
    Objectives To examine the associations between DSM-III, axis II, personality disorder, motivation and disruptive behaviour in prisoners. Method Interviews were carried out with 81 prisoners in prison special units in England using research diagnostic instruments and an item sheet measuring disruptive behaviours and their motivations. Independent associations were established using logistic regression. Results Specific associations were established between psychopathy and axis II disorders with violent and disruptive behaviour and motivations for these behaviours. Conclusions The study supported a cognitive model explaining the functional association between personality disorder and antisocial behaviour. Personality disorders act as predisposing factors influencing the development of motivations and subsequently facilitate the enactment of disordered behaviour, in a linear progression. Assessment of personality disorder should be routine in disruptive and dangerous prisoners. Copyright © 2002 Whurr Publishers Ltd. [source]

    Offence typology and the interpersonal octagon: an exploratory analysis

    John Shine Principal Psychologist
    The PROQ2 is based on the interpersonal octagon. It has 96 items on eight scales. The mean score for Grendon prisoners has been found to be between that of a Student sample and that of a psychotherapy patient sample. This study found that among the prisoners sex offenders had the highest mean scores. This may suggest that sex offenders have a diminished capacity to form relationships with others. Copyright © 2002 Whurr Publishers Ltd. [source]

    Does self-control account for the relationship between binge drinking and alcohol-related behaviours?

    Alex R. Piquero
    Introduction Gottfredson and Hirschi's theory that there is an underlying factor accounting for all sorts of antisocial behaviour has attracted widespread theoretical and empirical attention. One of their most controversial statements is a ,generality' hypothesis, a notion that criminal, deviant and reckless acts are highly correlated because they are caused by individual differences in self-control. In this paper, we examine the extent to which self-control accounts for the relationship between two behaviours: binge drinking and involvement in alcohol-related behaviours, including criminal behaviour. Method Questionnaires were given to students at a southern US university. A final sample of 241 students (35% males, 91% whites, aged 17,40). One question concerned binge-drinking, 11 others related to other alcohol-related behaviour; a 24-item scale measured self-control and sex was recorded. A probit model was used to test the effect of low self-control on binge drinking and on other alcohol-related behaviours. It was found that self-control exhibits a positive effect on both. But binge drinking and other alcohol-related behaviours are correlated, so a further analysis using a bivariate probit model was undertaken using a naďve model (no covariates), an unconstrained model (allowing self-control to exert a unique effect on both outcomes), and a constrained model forcing self-control to be the same for both outcomes. Results Our results suggest that while low self-control is a significant predictor of both binge drinking and alcohol-related problems, it does not fully account for the relationship between the two outcomes. In addition, separate estimation for each sex reveal a substantively different pattern of results. Discussion Further research is needed to disentangle the differences between the sexes. Situational factors, especially in males, may account for adverse alcohol-related behaviours. Other measures of self-control are also needed. Copyright © 2002 Whurr Publishers Ltd. [source]

    The targets of violence committed by young offenders with alcohol dependence, marijuana dependence and schizophrenia-spectrum disorders: findings from a birth cohort

    Louise Arseneault
    Background: Estimates of who is most at risk from violence by people with mental illness rest mainly on identified patient samples. This study, without such selection bias, examined the targets of violence committed by young adults with as-yet untreated alcohol dependence, marijuana dependence, or schizophrenia-spectrum disorders, to determine the extent to which their victims were co-residents or non-household members. Methods: In a total birth cohort of 21-year-olds (n = 956), past-year prevalence of alcohol dependence, marijuana dependence and schizophrenia-spectrum disorders were diagnosed using standardized DSM-III-R interviews. None of the people with schizophrenia-spectrum disorder has been hospitalized in the past year. Past-year violence and victim targets were measured using self-reports. Results: Compared with controls, cohort members with substance dependence or schizophrenia-spectrum disorders had higher prevalence and frequency rates of assault against co-residents, against non-household members, and also robbery and gang fights. Out of 39, five individuals with schizophrenia-spectrum disorder committed violent street crimes. Persons with substance dependence had similar proportions of violence against co-resident and non-household members, but persons with schizophrenia-spectrum disorders tended to victimize co-residents more than others. Conclusions: At the age when they are most likely to contribute to the community's violence burden, young untreated offenders with alcohol or marijuana dependence or with schizophrenia-spectrum disorders assault not only co-residents, but others as well, and commit violent street crimes. Families, schoolteachers and primary care physicians have an important potentially preventive role in early identification and treatment of the disorders. Copyright © 2002 Whurr Publishers Ltd. [source]