Alexithymia in Dutch violent forensic psychiatric outpatients

Abstract

Until now alexithymia has not been investigated in Dutch low-educated offenders who are known for their violent behaviour. We therefore investigated a sample of aggressive forensic psychiatric outpatients, who are characterized by emotional dysregulation in conflict situations. For that purpose we used a Dutch questionnaire, the Bermond-Vorst Alexithymia Questionnaire (BVAQ; Vorst & Bermond, 2001), which we also administered in a sample of secondary vocational students for a comparison. Unfortunately, the five-factor structure of the BVAQ could not be confirmed in both samples, but in the patient sample the test-retest reliability of the total score turned out to be moderate, and meaningful correlations were found with measures of relevant personality domains and problem behaviours. When both samples were compared, patients were found to display significantly higher total scores on the BVAQ than the secondary vocational students, when controlled for age. Therefore, we concluded that alexithymia may contribute to the aggressive behaviour of violent forensic psychiatric outpatients. However, patients as well as students had much higher total scores on the BVAQ than found by Vorst and Bermond (2001) in a sample of Dutch psychology students. This indicates that alexithymia as measured by the BVAQ is also inversely related to educational level and perhaps to intelligence.     

司法精神病学鉴定后的处理情况调查

目的 为了维护社会安全和依法保障精神病人的合法权益，需要正确处理精神病违法者。实际上，人们对司法精神病学鉴定后的处理情况知之甚少。因此，进行此项调查研究。方法 采用邮寄调查问卷的方式对四川省５２个县市的１８３例精神病违法者进行调查。结果 在处置精神病违法者的机关中，公安局占７３．０８％，法院占２６．７２％。有责任能力组中有２．２２％被无罪释放；无责任能力组中有２．１０％被判邢；部分责任能力组中有１     

司法精神病学鉴定后的处理情况调查

目的为了维护社会安全和依法保障精神病人的合法权益，需要正确处理精神病违法者。实际上，人们对司法精神病学鉴定后的处理情况知之甚少。因此，进行此项调查研究。方法采用邮寄调查问卷的方式对四川省52个县市的183例精神病违法者进行调查。结果在处置精神病违法者的机关中，公安局占73．08％，法院占26．72％。有责任能力组中有2．22％被无罪释放；无责任能力组中有2．10％被判刑；部分责任能力组中有13．95％被无罪释放。结论公安局是处理精神病违法者的主要机构。存在不适当处置情况，尤其对部分责任能力者的处理更复杂、更困难。     

Principles of the forensic psychiatric assessment of exhibitionism

Incompetence of the existing approach to forensic psychiatric assessment of exhibitionism as well as the necessity for conducting the analysis of direct manifestations of perverse behaviour are shown. Dissimilar clinical manifestations of this kind of paraphilias are presented and its fixed, compulsive and impulsive variants are described. The necessity for singling out differential forensic psychiatric criteria depending on psychopathologic characteristics of exhibitionism is stressed.     

Domestically and generally violent forensic psychiatric outpatients: personality traits and behavior

A group of 63 domestically violent patients and a group of 103 generally violent patients at a Dutch forensic psychiatric outpatient clinic are examined with regard to personality traits and problem behaviors to develop treatment programs for domestically violent patients. The domestically violent patients are more unstable from a psychological viewpoint but not more inclined to anger than the average Dutch male. They report less anxiety in situations in which criticism can be given but more anxiety in situations in which someone can be given a compliment. When comparing domestically violent patients with generally violent patients, domestically violent patients score lower on anger as disposition and on aggressive behavior than the generally violent patients do. However, both groups do not differ from each other in their score on the dimension of psychopathy.     

HELP: an educational forensic psychiatric assessment program

This paper describes the establishment of an educational group, Health through Education in Law and Psychiatry (HELP), within an inpatient forensic psychiatric assessment service. Until recently HELP sessions have been provided twice weekly to suitable patients during their stay of some 30 days at the Metropolitan Toronto Forensic Service (METFORS). We first outline very briefly the function of METFORS, then describe the HELP project broadly, and finally discuss the rationale of the program in greater detail. Our point is that programs of this type form an added resource in assessment and in the early stages of treatment. We also argue that, along with the accepted clinical role in assessment, forensic psychiatrists and colleagues in related disciplines can serve a valuable role as teacher and therapist.     

司法精神病学鉴定中癫痫所致精神障碍的研究现状

癫痫与精神障碍在我国均是常见的多发病．如不及时而恰当地治疗，可发展为慢性病，迁延数年，严重者造成残疾，甚至终生不愈，从而对患者的身心健康、工作、学习、婚姻以及社会功能等等造成巨大影响。因此二者不仅是医学问题而且是社会问题。据6城市调查协作组（1982）的流行病学调查数据显示癫痫发病率是37／10万。患病率4．4‰．据此推算我国至少有癫痫患者500万～600万。根据世界卫生组织（1999）的统计．非传染性疾病占全球疾病负担的比重日益增加．其中精神障碍占全球疾病总负担的10．5％（中低收入国家）和23．5％（高收入国家）。所以二者消耗的卫生经济资源是惊人的，引起了各国专家学者的重视。而随着研究的深入．发现两者间存在某种必然的联系．癫痫人群的精神分裂症患病率为3％～7％．而精神分裂症在普通人群的患病率为1％。对该联系的认识首先由Morel（1860）介绍，发现有些癫痫患者出现发作性精神症状。Lernpert等（1990）研究表明66％的癫痫病人有精神异常，其中最多的是抑郁症状。两者间究竟存在怎样的内在联系并彼此相互作用的呢？长期以来一直成为各国学者的研究热点之一。     

司法精神病学鉴定中癫痫所致精神障碍的研究现状

癫痫与精神障碍在我国均是常见的多发病,如不及时而恰当地治疗,可发展为慢性病,迁延数年,严重者造成残疾,甚至终生不愈,从而对患者的身心健康、工作、学习、婚姻以及社会功能等等造成巨大影响,因此二者不仅是医学问题而且是社会问题。据6城市调查协作组(1982)的流行病学调查数据显示癫痫发病率是37/10万,患病率4.4‰,据此推算我国至少有癫痫患者500万～600万。根据世界卫生组织(1999)的统计,非传染性疾病占全球疾病负担的比重日益增加,其中精神障碍占全球疾病总负担的10.5%(中低收入国家)和23.5%(高收入国家)。所以二者消耗的卫生经济资源是…     

Substance use disorders in forensic psychiatric patients

There is a lack of detailed information on the role of substance use disorders (SUD) as a substantial factor in offences and treatment in forensic psychiatric patients. The aim of this study was to get a better understanding of these specifics. Clinical records of 193 male patients admitted to a Dutch forensic psychiatric hospital were scrutinized on anamnestic, diagnostic and risk assessment data. One of the central findings was that the prevalence of SUDs was high. Patients with an SUD had a more extensive criminal history, unstable and deviant lifestyle and higher risk of violent behavior than patients without a substance use disorder. No differences were found in duration of treatment, aggressive incidents and leave. Another important finding was that a distinction could be made between patients with substance use as a primary criminogenic risk factor and patients with substance use as a secondary risk factor. Although substance use is identified as a general risk factor, this study supports the idea of sub categorization of patients with an SUD and emphasizes the need for a different treatment approach. Further study is needed to identify specific treatment approaches, based on more differentiated profiles of these patients.     

The impact of forced forensic psychiatric confinement on composition and structure in the personal networks of personality-disordered forensic psychiatric patients

This study explored to what extent the composition and structure of personal networks of personality-disordered forensic psychiatric patients changed before and after forced confinement in a forensic psychiatric centre. Semi-structured in-depth interviews with 36 patients and selected members of their networks were examined. During forensic psychiatric treatment, patients reported a decrease in network size, in the number of high-risk network members, and in the number of social ties between these high-risk network members. Personal relationships were of shorter duration, with lower levels of contact frequency and reciprocity. No changes were observed in the patients’ companionship, practical and emotional support networks. During forensic psychiatric treatment, patients reported some new relationships, especially with persons outside the forensic psychiatric centre. Information on compositional and structural personal network factors over time helps forensic mental health professionals to properly assess and manage the important dynamic social network conditions associated with recidivism.     

The precarious practice of forensic psychiatric risk assessments

The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, “dangerousness” has been reworded into “risk”. Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of “mental disorder” and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.     

The presence of counsel at forensic psychiatric examinations

In virtually all situations involving forensic psychiatric assessments, the patient is represented by counsel. But does this fact entitle the lawyer to be present at the clinical evaluation? In a series of New York cases spanning a generation, judges have allowed presence of counsel at the psychiatric examination. The most common reason given for such a conclusion is to assure better cross-examination of the expert witness. Psychiatric evaluations mandated by law necessitate several guidelines different from those of the usual doctor/patient relationship. While we may have to accept the presence of attorneys in our consulting rooms, they should be observers only. To allow active intervention would distort the clinical process.