Violence prevention in psychiatry: an umbrella review of interventions in general and forensic psychiatry

Relative risks of violence in psychiatric patients are high compared to the general population and existing evidence in non-psychiatric populations may not translate to reductions in violence in psychiatric populations. We searched 10 databases including Medline, EMBASE, CINAHL and Scopus, from inception until August 2015 for systematic reviews and meta-analyses of violence prevention interventions in psychiatry. Reviews were included if they used a hard outcome measure (i.e. police or hospital recorded violence, or reincarceration) and contained randomized or non-randomized controlled studies. Five reviews met our inclusion criteria (n = 8876 patients in total), of which four received a GRADE rating of ‘low’ or ‘very low’. Three randomized studies (n = 636) reported that therapeutic community interventions may reduce reincarceration in drug-using offenders with co-occurring mental illness (‘moderate’ GRADE rating). The lack of intervention research in violence prevention in general and forensic psychiatry suggests that interventions from non-psychiatric populations may need to be relied upon.     

Characteristics and offences of women with borderline personality disorder in forensic psychiatry: a multicentre study

Although female forensic patients diagnosed with borderline personality disorder (BPD) are generally considered taxing in clinical practice, little is known about their specific characteristics or offences. In this study, 156 female forensic psychiatric patients diagnosed with BPD were compared to 113 diagnosed otherwise. Information on demographic and psychiatric characteristics, victimization, index offences, and incidents during treatment was gathered from patient files. Risk factors for recidivism were assessed using the PCL-R and historical items of the HCR-20, including items from the new Female Additional Manual (FAM). Compared to non-BPD women, BPD women were more likely to have been abused as children and to have a history of outpatient treatment. While less likely to be convicted for (attempted) homicide, a higher percentage of BPD women was convicted for arson. Comorbid substance abuse was more frequent in the BPD group and incidents towards others and themselves were more violent in nature. The PCL-R and the H-scale of the HCR-20/FAM indicated several risk factors especially important for BPD women, such as poor behavioural control, impulsivity, and irresponsibility. The results support the clinical impression that women diagnosed with BPD are a subgroup within the female forensic psychiatric population, with specific focus points for treatment and management.     

特征表型信息SNP在法医学分析中的研究进展

以DNA为基础的STR和SNP遗传标记的检验,已广泛应用于各种个人识别、亲子鉴定和人口失踪案件。但现场DNA样本分型不能与相关个体匹配时,利用特征表型信息SNP则可能为侦查提供有价值线索。本文综述了近年来特征表型信息SNP在法医学应用中的研究进展,并简述其发展方向,旨在为相关研究和应用提供参考和借鉴。     

Interventions with women offenders: a systematic review and meta-analysis of mental health gain

Currently, a conjunction of policy, legislative change in health and social care and the criminal justice system, combined with funding for innovative services make it opportune to assess the evidence base for interventions with women offenders. Women offenders have a distinctive criminological, health and social profile and a gender specific approach to their difficulties is advocated. This systematic review and meta-analysis focus on mental health gain in adult women offenders in forensic health settings, criminal justice institutions and in the community, following therapeutic interventions. Interventions were assessed in terms of specific outcome measures of depression, trauma symptomatology and global mental health status. Comprehensive search strategies yielded 3018 articles, from which we obtained 199 full text articles. Seventeen articles were included in the final review, of which six were excluded from the meta-analysis as there was no comparator group. There is a modest, but increasing, body of evidence for the utility of some interventions, notably those addressing the consequences of earlier trauma, including interventions which also address comorbid substance misuse. This does not amount, to date, to a robust evidence base. Limitations of these studies are discussed and include small sample sizes, their restriction mainly to prison populations and that they were substantially undertaken in the US. Variations in outcome measures follow-up and the difficulties inherent in measuring change in this complex population are also detailed. However, the review delineates definite avenues for further work. To achieve this, those responsible for policy, practice and purchase of services should both be mindful of existing evidence and promote additional, high quality research into interventions which are designed around a coherent, theoretical approach.     

Ethical issues in child and adolescent forensic psychiatry: a review

Ethical challenges in child and adolescent forensic psychiatry arise, on the one hand, from the dilemmas commonly faced in forensic psychiatry with adult patients, such as the dual role of the forensic psychiatrist, questions of criminal responsibility, autonomy and competence and involuntary treatment, and, on the other, from the immaturity and dependent position of the minor. Child and adolescent forensic psychiatry deals with minors involved in crime, not only as offenders, but also as victims. In this review, we attempt to describe ethical challenges in child and adolescent psychiatry using as a frame of reference the principles of biomedical ethics according to Beauchamp and Childress.     

简易精神症状自陈量表对主观夸大精神症状的测试分析

目的 应用简易精神症状自陈量表检测法医精神鉴定中主观夸大精神症状的情况,并分析其测试结果。方法 对206名不同类型的法医精神鉴定的被鉴定人用该量表进行检测．并由两名鉴定专业人员对被鉴定人是否有主观夸大精神症状分别进行评定。结果 （1）以该量表判断主观故意或夸大精神症状的划界分（13分）对测试的被鉴定人进行检测,206例被鉴定人中有71例被判定为主观夸大精神症状（34．5％）。与专家评定的结果相比,量表评定的假阴性为19．8％,假阳性率为1．7％;总准确率为90．8％。（2）工伤和交通事故精神伤残理赔鉴定案例主观夸大精神症状的比例较高（51％）。结论 简易精神症状自陈量表是检测主观夸大精神症状的有效评定工具。     

RNA在法医学领域中的应用及研究进展

随着分子生物学的发展,遗传学证据在法庭科学领域的应用也愈加广泛.DNA技术已经在个体识别和亲权鉴定中发挥着重要作用,而RNA技术正表现出越来越广泛的应用前景.本文就RNA在推断死亡时间、血痕形成时间、损伤形成时间、死亡原因及体液来源等领域的应用进行综述.     

溺死法医学鉴定的研究新进展

综述了近年来在硅藻检验、水中浮游生物叶绿素（A）检测、血液化学和组织化学检验等方面的最新文献报道,并对各种溺死检验方法的优缺点进行了评价：在硅藻检验中,硝酸乙醇法、破机罐法及微波消解法,可缩短检验时间,提高办案效率;酶消化法及PCR法硅藻检出率高,适用于可疑水样中硅藻密度低等情况。早期器官组织中浮游生物叶绿素（A）、血液和组织中其他生化指标,可作为鉴定溺死的重要参考。微量元素锶检测可用于鉴定海水中溺死。另外,硅藻及其他浮游生物遗传多态性片断PCR,可望成为新的、灵敏的溺死检测方法。     

Vicious dogs part 2: criminal thinking, callousness, and personality styles of their owners

Every year over 885,000 dog bites require serious medical attention. Based on human injury and insurance claims, six dog breeds were designated as "vicious" (Akitas, Chows, Dobermans, Pit Bulls, Rottweilers, and Wolf-mixes). This study was conducted to expand on previous research examining antisocial tendencies and personality styles of people choosing to own vicious breeds. Seven hundred and fifty-four college students completed a questionnaire assessing type of dog owned, criminal thinking, callousness, personality, alcohol usage, and deviant lifestyle behaviors. Vicious dog owners reported significantly higher criminal thinking, entitlement, sentimentality, and superoptimism tendencies. Vicious dog owners were arrested, engaged in physical fights, and used marijuana significantly more than other dog owners. However, the homogeneous sample utilized could impact the generalizability of these findings. Choosing to own a vicious dog may be a "thin slice" indicator of more antisocial tendencies.     

Characteristics and personality profiles of first 100 patients admitted to a secure forensic adolescent hospital

Bluebird House is a mixed-gender adolescent medium-secure forensic unit. There is a paucity of data available about this unique patient group. We aimed to explore the demographic, clinical and personality characteristics of the first 100 patients admitted to a mixed-gender adolescent medium-secure forensic unit. We used a retrospective cross-sectional study of the first 100 consecutive patients admitted to Bluebird House. Demographic and clinical data were collected from the medical notes including the Millon Adolescent Clinical Inventory. The first 100 young people admitted to an adolescent medium-secure unit have had very high incident rates, particularly amongst the females. Incident rate was correlated with a history of sexual assault in female patients. The males were more likely to have been referred from custody and more likely to have a diagnosis of psychosis or autism. We describe similarities and differences to the first 100 admissions admitted to the first secure psychiatric unit for adolescents in Manchester over 20 years ago.     

测谎的发展历程及法医学应用前景

测谎技术越来越多地运用于协助侦查破案,成为打击和预防犯罪的重要手段之一。本文简述了它在古代的最初尝试以及近代心理-生理参数指标在测谎技术中的应用。尤其是现代多道生理记录仪的出现,使心理-生理参数指标更趋完善。随着人们对认知领域的深入探索,事件相关电位、脑功能核磁成像技术和事件相关-脑功能核磁成像技术在测谎领域的应用,使现代测谎技术的重心转移到对大脑活动的侦测方面,检测结果更为客观,更接近说谎的源头。本文介绍了从简单到复杂不同的测谎形式和各自的原理及目前发展最新动态,并分析了它在法医学应用的前景。     

Trait Anger,Physical Aggression,and Violent Offending in Antisocial and Borderline Personality Disorders

Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are common conditions in forensic settings that present high rates of violence. Personality traits related to the five‐factor model personality domains of neuroticism and agreeableness have shown a relationship with physical aggression in nonclinical and general psychiatric samples. The aim of the present investigation was to examine the association of these personality traits with violence and aggression in ASPD and BPD. Results revealed that trait anger/hostility predicted self‐reported physical aggression in 47 ASPD and BPD subjects (β = 0.5, p = 0.03) and number of violent convictions in a subsample of the ASPD participants (β = 0.2, p = 0.009). These preliminary results suggest that high anger and hostility are associated with physical aggression in BPD and ASPD. Application of validated, self‐report personality measures could provide useful and easily accessible information to supplement clinical risk assessment of violence in these conditions.     

肋软骨分析检验技术在法医学中的应用

传统法医人类学对肋软骨的分析检验仅限于形态学检验.近年来,法医影像学以及分子遗传学的发展丰富了人类肋软骨的分析检验技术,并且已经能够运用于法医学实践中.本文从肋软骨的组织学特性入手,综述了近年来肋软骨在法医人类学性别判定、年龄推断等方面的研究进展,以期为同行提供借鉴和参考.     

颈动脉钝性损伤法医学研究进展

颈动脉钝性损伤的发生率虽低,但死亡率高,易发生于交通事故、扼勒、缢吊、颈部直接外力作用和高坠等案例中。颈动脉钝性损伤有5种基础成伤机制：颈部直接外力作用,颈部过度伸展和旋转,颅底骨折碎片切割,口腔内扁桃体窝处直接外力作用,头胸部复合伤造成颈动脉被牵拉。国外相关研究文献和个案报道较多,而国内未见系统研究,不多的个案报道中,也有错误鉴定案例。本文对颈动脉钝性损伤的致伤方式、解剖学和生物学基础、成伤机制和法医学鉴定注意事项进行综述,希望能引起国内法医技术人员的重视,并为相关研究和应用提供参考。     

Antisocial personality disorder comorbid with borderline pathology and psychopathy is associated with severe violence in a forensic sample

Background: Evidence suggests the relationship between personality disorder (PD) and violence in offenders might be clarified by considering sub-groups of PD offenders defined by patterns of PD comorbidity. Aim: to identify patterns of PD comorbidity associated with severe violence, defined by its severity, quantity and age of onset (Violence Index: VI) in a forensic sample of 100 PD offenders. Methods: Correlations were first computed between VI and a range of personality and criminological variables; next, patients with antisocial/borderline comorbidity were compared with other PD patients; finally, regression analysis was conducted to identify unique predictors of VI. Results: The antisocial deviance factor of psychopathy and antisocial/borderline comorbidity were each significantly and independently associated with severe violence. Patients showing both a high psychopathy score and antisocial/borderline comorbidity had a significantly greater VI than those without these characteristics. Conclusion: PD patients with high psychopathy co-occurring with borderline and antisocial PDs show a criminal profile characterised by a high degree of serious violence.     

Either or? Reconciling Findings on Mental Health and Extremism using a Dimensional Rather than Categorical Paradigm

The background for this paper is the debate over what role mental illness plays in radicalization to violent extremism. While one camp points to cases of abnormal functioning of perpetrators, another argues that normal psychological mechanisms are central. Through a review of these perspectives, it becomes clear that mental illness cannot be ruled out as an epi‐phenomenon, but is not a necessary condition either. The paper draws on work in psychiatric nosology on dimensional and categorical conceptions of illness and argues that the perspectives in this literature reflect a categorical approach to normal and abnormal functioning. Under a dimensional perspective, findings converge. The paper concludes by showing how this new dimensional approach to the role of mental illness in radicalization has implications for the design of risk assessment tools and leads to the recommendation for stronger inter‐agency cooperation between mental health professionals, social services, and police and intelligence services.     

Suicidality in male prisoners: influence of childhood adversity mediated by dimensions of personality

This study aims to study the influence of childhood adversity on suicidal behavior in male prisoners. Including a random sample of 899 male prisoners (French National Mental Health Prison Survey, 2003), this paper studied suicidal ideations and suicide attempts using MINI criteria, and personality using Temperament and Character Inventory. Risk factors of suicidality were examined, and structural equations studied the influence of childhood trauma on suicidality, mediated by personality dimensions. The prisoners reported high levels of childhood adversity. More than a third reported recent suicidal ideations. Childhood adversity and dimensions of personality were associated with suicidality. Structural equations showed that childhood adversity was positively associated with suicidality, mediated by poor dimensions of character (affective stability, self-cooperativeness, and self-transcendence). In conclusion, these results confirm the importance of screening and treatment of childhood trauma among male prisoners. They suggest the importance to study dimensions of personality and tailor treatment to specific needs.     

Resettle: a significant new step in an emerging pathway that manages risk and addresses need in high-risk personality disordered offenders on their release into the community

Abstract

This paper will describe an innovative UK service development, Resettle, which is designed to address the needs and risks of personality disordered offenders who are released into the community from prison and whose high risks of harm and re-offending are linked to their personality disorder (PD). All the cases worked with are subject to Multi-Agency Public Protection Arrangements (MAPPA). This non-residential, intensive community-based service is nationally funded jointly by the Department of Health and Ministry of Justice, originally as part of the Dangerous and Severe Personality Disorder (DSPD) programme for high-risk offenders. Resettle became operational in 2008. It is currently being independently evaluated via a randomised control trial that is due to complete in March 2013. Formal outcome data are, therefore, not yet available, however, the developing model of intervention based on experience and learning to date is described alongside the policy and service context for this area of work.