Fragmented pathways to care: the experiences of suicidal men

Using qualitative methods, this study examined how, and under what circumstances, suicidal men used mental health services. In particular, the analyses focused on fragmented pathways to care. Fifteen men with a history of suicidal and aggressive behaviors and a diagnosis of borderline personality disorder and/or antisocial personality disorder participated in semistructured interviews that consisted of questions about their mental health status and experiences with mental health and addiction services. Interviews were taped and transcribed. An iterative, inductive qualitative analytic process was used. Men followed a cyclical pattern wherein negative experiences with health care providers were said to be followed by avoidance of health care settings, crisis, and then by involuntary service utilization. Men identified five health care provider and three personal practices, and two types of episodes they believed to contribute to their fragmented pathways to care. Implementation of specialized interventions, and providing patients with more information and more opportunity to participate in decisions, may improve interactions between patients and providers and improve patients' mental health status.     

Development of a harmonised method for the profiling of amphetamines V: Determination of the variability of the optimised method

This paper is the fifth in a series of six in relation to the development of a harmonised method for the profiling of amphetamine [L. Aalberg, K. Andersson, C. Bertler, H. Borén, M.D. Cole, J. Dahlén, Y. Finnon, H. Huizer, K. Jalava, E. Kaa, E. Lock, A. Lopes, A. Poortman-van der Meer, E. Sippola, Development of a harmonised method for the profiling of amphetamines I. Synthesis of standards and compilation of analytical data, Forensic Sci. Int. 149 (2005) 219-229; L. Aalberg, K. Andersson, C. Bertler, M.D. Cole, Y. Finnon, H. Huizer, K. Jalava, E. Kaa, E. Lock, A. Lopes, A. Poortman-van der Meer, E. Sippola, J. Dahlén, Development of a harmonised method for the profiling of amphetamines II. Stability of impurities in organic solvents, Forensic Sci. Int. 149 (2005) 231-241]. The third paper [K. Andersson, K. Jalava, E. Lock, L. Aalberg, Y. Finnon, H. Huizer, E. Kaa, A. Lopes, A. Poortman-van der Meer, M.D. Cole, J. Dahlén, E. Sippola, Development of a harmonised method for the profiling of amphetamines III. Development of the gas chromatographic method, Forensic Sci. Int., in press] dealt with the optimisation of the gas chromatographic and detection methods whereas the fourth paper [K. Andersson, K. Jalava, E. Lock, Y. Finnon, S. Stevenson, L. Aalberg, H. Huizer, E. Kaa, A. Lopes, A. Poortman-van der Meer, M.D. Cole, J. Dahlén, E. Sippola, Development of a harmonised method for the profiling of amphetamines IV. Optimisation of sample preparation, Forensic Sci. Int., in press] concerned the optimisation of the extraction method prior to GC analysis. This paper is a study of the optimised method in order to determine its stability. Investigations of within and between day variations were carried out in four laboratories. Moreover, variations between laboratories were also determined. Both flame ionisation detector (FID) and MS detection were used. One laboratory studied nitrogen-phosphorous detector (NPD) detection as well. For this task, 12 batches of amphetamine were prepared. Six of them were synthesised via the Leuckart route, three via the nitrostyrene route and three via the reductive amination route [A.M.A. Verweij, Impurities in illicit drug preparations: amphetamine and methamphetamine, Forensic Sci. Rev. 1 (1989) 2-11]. Taking into account all studied target compounds and the average results from four laboratories, the within day variation was around 6% for FID and 5% for MS, the between days variation was around 10% for FID and 8% for MS. For NPD detection, within day variation was 5% and between days variation 9% (only one laboratory). Finally, the inter-laboratory variation was about 12% for FID (four laboratories) and 10% for MS (three laboratories).     

Filial Therapy with Victims of Family Violence: a Phenomenological Study

This research study examined the perceptions of parents, and victims of domestic violence, after receiving filial therapy. Specifically, parents were trained in a 10-week filial therapy model, Child–Parent Relationship Training. At the completion of the study, parents were given a semi-structured, open-ended style interview to gather information about their experiences. Themes emerged from the data participants provided, such as: experiencing increased warmth and trust in the child–parent relationship, changed parenting style, and decreased parental stress. Additionally, narratives reflect the positive influence the training had on parents’ perceptions of violence. A summary of the essence of the parent’s experiences is included.     

Social ties and short‐term self‐reported delinquent behaviour of personality disordered forensic outpatients

Purpose. In community‐based forensic psychiatry, patients' social ties are considered as protective factor in a risk management strategy. However, it is unknown whether these ties actually assist patients to refrain from re‐offending. We hypothesised a protective role for social ties in re‐offending behaviour. Methods. In a sample of forensic outpatients with a personality disorder (N = 55), the relationship between social ties (social contacts and participation in social institutions) and short‐term self‐reported re‐offences was studied within a prospective study design with a 6‐month follow‐up period. Results. Our results provide evidence for a protective function of club participation. For violent re‐offences, social institutions were protective and this protective function remained, even when a patient had network members with a criminal background. Except for work‐related contacts, social contacts did not provide protection. Conclusions. The protective effect of social ties, especially club participation, on desistance from re‐offending in forensic psychiatric patients merits further attention from researchers and clinicians.     

Evidence for Connections Between Prosecutor-Reported Marijuana Case Dispositions and Community Youth Marijuana-Related Attitudes and Behaviors

This article examines relationships between local drug policy (as represented by prosecutor-reported case outcomes for first-offender juvenile marijuana possession cases) and youth self-reported marijuana use, perceived risk, and disapproval. Interviews with prosecutors and surveys of 8th-, 10th-, and 12th-grade students in the United States were conducted in 2000. Analyses include data from 97 prosecutors and students from 127 schools in 40 states. Results indicate significant relationships between local drug policy and youth marijuana use and attitudes. In general, more-severe dispositions are associated with less marijuana use, higher disapproval rates, and increased perceptions of great risk. Associations primarily appear to be specific to marijuana-related outcomes. Results are discussed within the framework of both deterrence and broader social norms regarding substance use.     

Recent life events and subjective well-being of personality disordered forensic outpatients

PurposeThe majority of patients treated at forensic psychiatric outpatient facilities suffer from personality disorders, especially Cluster B disorders. Life events have been shown to influence subjective well-being, severity of psychopathology and delinquent behaviour of patients with different personality disorders. However, the influence of life events on subjective well-being of patients suffering from Cluster B personality disorders has rarely been studied. Following General Strain Theory and the dynamic equilibrium model, we hypothesised that negative life events would negatively influence subjective well-being, and that subjective well-being would change when an instability of life events occurs.MethodsFifty-six adult male forensic psychiatric outpatients were interviewed on their subjective well-being and filled out a self-report life event questionnaire, at three time-points, with an interval of three months. Life events were categorized along two dimensions: positive / negative and controllable / uncontrollable.ResultsPatients had a stable pattern of positive, negative controllable and uncontrollable life events. Positive controllable events did not have a stable pattern. Results indicated that only negative controllable events correlated negatively with subjective well-being. Furthermore, positive and positive controllable events correlated with a positive change in subjective well-being and uncontrollable events correlated negatively with this change.ConclusionsForensic psychiatric outpatients seem to experience a relatively stable ‘load’ of stressful life events, that does not influence change in subjective well-being. We did not find unequivocal support for General Strain Theory. In line with the dynamic equilibrium model, forensic outpatients seemed less used to positive controllable life events, which influenced positive change in subjective well-being. In outpatient forensic treatment, attempts to limit negative life events together with enhancing behaviour which results in positive events should be targeted. This might result in better lives for patients and in reduced criminal behaviour.     

Postmortem dismemberment/mutilation--medicolegal and criminalistic evaluation of the autopsies performed by the Institute of Legal Medicine at the Hanover Medical School

Among all the autopsies performed by the Institute of Legal Medicine at the Hanover Medical School between 1978 and 1998. 16 cases of postmortem dismemberment/mutilation were evaluable under criminalistic and medicolegal aspects. In the present study, particular attention was paid to the psychosocial circumstances of the perpetrator's and victim's lives and also to the classification of the different types of postmortem dismemberment/mutilation illustrated by case reports. Apart from an unfavourable personal life situation at the time of the offence, essential predisposing factors were: poor integration in society and family, occupational problems, drug abuse and mental diseases. As the interactions between these factors differ in every single case and may be combined with other factors, the analysis of such homicides should always be based on the assessment of the individual case.     

Obstructive or promoting? British views on German unification 1989/90

Six years after unification German public opinion still regards Britain as the ‘No‐saying’ nation which not only holds up further European integration but also never really wanted German unity to happen. This article argues that British attitudes to the process of German unification in 1989/90 were more diverse and generally more positive than an undue concentration on the views of Margaret Thatcher and her advisers may suggest. An analysis of Foreign Office policies and an examination of public and published opinion as well as of the debates in both Houses of Parliament reveal a constructive British stance on German unity and a substantial and real contribution of British diplomats to the Two‐plus‐Four process. Whereas the Foreign Office and Downing Street agreed on the major effects German unity would have on Britain's international standing, they differed about the way Britain should respond to the new challenges.