Antisocial features are not predictive of symptom exaggeration in forensic patients

Purpose

To investigate the predictive value of antisocial personality disorder (ASPD) and features of ASPD (i.e., lack of remorse, blame externalization, and deceitfulness) for symptom exaggeration.

Methods

A sample of forensic psychiatric patients (N = 57) was asked to complete several self‐report instruments (measuring symptom exaggeration, lack of remorse, blame externalization, and offense minimization) and a semi‐structured interview about their most recent offense. To quantify patients’ deceitfulness, the information collected via the semi‐structured interview was checked against the official records of patient's offenses. Additionally, patient's mental disorders and the extent to which patients denied their delinquency were determined by gathering clinician's judgement on this matter from patient records. The relation between symptom exaggeration and the potential predictors of symptom exaggeration was examined through correlational analyses and cross‐tabulation of prevalence rates of symptom exaggeration with prevalence rates of the potential predictors.

Results

Antisocial personality disorder was not a useful predicator of symptom exaggeration. Also, patients who showed little regret for their offenses, or tended to blame their offenses on external factors, or minimized their delinquency, or were inaccurate when reporting their delinquency, had similar levels of symptom exaggeration as those without these tendencies.

Conclusions

Neither ASPD nor antisocial traits, including lack of remorse, blame externalization, and deceitfulness, were meaningfully related to symptom exaggeration and therefore should have no place in the assessment of symptom validity or the detection of malingering. On the contrary; focusing on antisocial traits as indicators of symptom exaggeration is likely to result in large portions of misclassifications.     

Potentially Lethal Behaviors Associated With Rapid Eye Movement Sleep Behavior Disorder: Review of the Literature and Forensic Implications

Abstract:  Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by loss of the muscle atonia of REM sleep, with release of complex and violent behaviors that are often attempted dream-enactments. This study reviewed the literature on RBD with regard to potentially lethal behavior. A total of 39–41 clinical cases of RBD associated with potentially lethal behaviors to self and/or others were found, involving a child and adults of all age groups, that manifested as choking/headlock ( n  = 22–24), defenestration/near-defenestration ( n  = 7), and diving from bed ( n  = 10). A total of 80.8% ( n  = 21) were males; 19.2% ( n  = 5) were females; mean age was 65.6 ± (SD) 13.8 years (range: 27–81 years, and a child). (Gender/age data were not listed in the remaining cases.) An etiologic association of RBD with a neurologic disorder (or with pharmacotherapy of psychiatric disorders, n  = 4) was present in 21–23 patients. Thus, RBD carries well-documented, potential forensic consequences during RBD episodes that could possibly have been misinterpreted as suicidal or homicidal behavior.     

Social Networks and Social Control of Probationers with Co-Occurring Mental and Substance Abuse Problems

Probationers with co-occurring mental and substance abuse problems (PCPs) are both subject to considerable social control, and at high risk of probation failure. In this study, we screened 601 probationers for symptoms, interviewed 82 identified PCPs about their relationships, and then followed these PCPs for eight months to record treatment nonadherence and other probation violations. First, PCPs’ social networks were small, heavily comprised of professionals and opposing forces who engaged in risky behavior, and saturated with pressure to adhere to treatment. Second, the size and composition of PCPs’ social networks were more relevant to rule compliance than social support and undermining. Third, the quality of PCPs’ relationships was key: satisfying relationships with clinicians and, to a lesser extent, officers and the core network related to low perceived coercion, high treatment adherence, and low risk of future violations. In particular, having a likable clinician who engaged in participatory decision-making reduced the risk of violations. Implications for contextually sensitive risk reduction efforts are discussed.     

An Investigation of Posttraumatic Stress Disorder and Depressive Symptomatology among Female Victimsof Interpersonal Trauma

This study examined factors associated with PTSD-depression comorbidity among a sample of 162 adult female rape or assault victims with PTSD, as well as potential differential predictors of PTSD and depression severity. PTSD-only participants reported higher levels of childhood sexual abuse than those with comorbid PTSD and depression, and the PTSD/MDD group reported relatively more distorted trauma-related beliefs, dissociation, PTSD severity, and depression severity. Distorted trauma-related beliefs and dissociation were the strongest unique predictors of higher PTSD and depressive symptoms. Rates of PTSD and depression comorbidity did not appear to be a function of symptom overlap. Study findings suggest possible explanations for the high PTSD and depression comorbidity rates commonly found among victims of interpersonal violence. This research was supported in part by a grant to Patricia A. Resick from the National Institute of Mental Health (R02-MH51509).     

What a girl's gotta do: the labor of the biopolitical celebrity in austerity Britain

This article debunks the widespread view that young female celebrities, especially those who rise to fame through reality shows and other forms of media-orchestrated self-exposure, dodge “real” work out of laziness, fatalism, and a misguided sense of entitlement. Instead, the authors argue that becoming a celebrity in a neoliberal economy such as that of the United Kingdom, where austerity measures disproportionately disadvantage the young, women, and the poor, is not as irregular or exceptional a choice as previously thought, especially since the precariousness of celebrity earning power adheres to the current demands of the neoliberal economy on its workforce. What is more, becoming a celebrity involves different forms of labor that are best described as biopolitical, since such labor fully involves and consumes the human body and its capacities as a living organism. Weight gain and weight loss, pregnancy, physical transformation through plastic surgery, physical symptoms of emotional distress, and even illness and death are all photographically documented and supplemented by extended textual commentary, usually with direct input from the celebrity, reinforcing and expanding on the visual content. As well as casting celebrity work as labor, the authors also maintain that the workings of celebrity should always be examined in the context of wider cultural, social and real economies.     

逍遥归脾汤联合米氮平治疗恶劣心境40例

目的 观察中西医结合疗法治疗恶劣心境的临床疗效。方法 将80例恶劣心境（肝郁脾虚证）患者分为治疗组（逍遥归脾汤联合米氮平治疗）和对照组（单用米氮平治疗）,每组40例。治疗前及治疗第4周和第8周末,分别观察两组抑郁自评量表（self-rating depression scale,SDS）和汉密尔顿抑郁量表（Hamilton depression scale,HAMD）评分;治疗第8周末,观察并比较两组中医症状疗效和西医临床疗效。结果 治疗第4周和第8周末,两组SDS和HAMD评分均较治疗前显著降低（P＜0.01）;治疗第8周末,治疗组SDS和HAMD评分下降值显著大于对照组（P＜0.05,或P＜0.01）。治疗组在中医症状（包括精神抑郁、胸胁作胀、胸闷心悸、脘痞纳呆、善太息、月经不调、脉弦细）总有效率及西医临床总有效率方面显著优于对照组（P＜0.05,或P＜0.01）。结论 逍遥归脾汤联合米氮平治疗恶劣心境（肝郁脾虚证）的疗效优于单用米氮平。     

中成药治疗儿童注意缺陷多动障碍疗效和安全性的系统评价

目的 系统评价中成药治疗儿童注意缺陷多动障碍的疗效和安全性。方法 检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Cochrane Library、PsycINFO、Embase中所有关于中成药治疗儿童注意缺陷多动障碍的随机对照试验。根据预先设定的标准由两名研究者独立筛选,使用Review Manager 5.3软件进行纳入研究的偏倚风险评估和Meta分析。结果 最终23项研究共2 314个对象被纳入数据分析,未发现中成药与安慰剂比较的研究。中成药组与哌甲酯组的总有效率比较,差异无统计学意义（RR=1.06,95% CI为0.99～1.13,P=0.08）,但中成药组的不良反应总发生率低于哌甲酯组,差异有统计学意义（RR=0.14,95% CI为0.08～0.24,P<0.000 01）。中成药联合哌甲酯组总有效率高于哌甲酯组,差异有统计学意义（RR=1.17,95% CI为1.07～1.29,P=0.000 5）;两组不良反应总发生率的差异无统计学意义（RR=0.53,95% CI为0.24～1.17,P=0.11）。结论 中成药治疗儿童注意缺陷多动障碍疗效良好且不良反应少,但仍需要设计更合理的高质量随机对照研究,尤其是与安慰剂对照的研究来证实。     

Predictors of Child Abuse Potential in At-Risk Adolescents

Characteristics prevalent in known child abusers and in child victims of abuse (i.e., internalizing, externalizing, sociopathy, delinquency, and nonrational conflict-solving tactics) were examined as predictors of abuse potential in adolescents. The Child Abuse Potential (CAP) Inventory (Milner, 1986) was administered to male (n = 71) and female (n = 63) teenagers attending alternative educational sites due to behavioral problems or pregnancy. Regression analyses found unique variance in abuse potential contributed by youth (16%) and teacher (6%) reports of internalizing behavior, and youth reports of sociopathy (4%) and delinquency (4%) for a total of 33% of the variance (p < .0001, n = 91) after controlling for age, sex, and pregnancy status. Number of elevated predictors in each student was also related to increased abuse potential (r = .39, p < .001). Pregnancy status and SES were not independently associated with abuse potential. Conduct disorder as a probable precursor to future abusive behavior is suggested, and the use of the CAP with adolescents is discussed.     

头部外伤后精神损伤的法医学鉴定(附204例分析)

目的　研究颅脑外伤所致精神障碍的损伤程度评定标准。方法　通过对２０４ 例由司法部门委托进行法医学精神损伤程度鉴定实践,重点对颅脑外伤所致神经症的损伤程度评定标准及其他相关问题进行了讨论。结果　２０４ 例中,男、女比例无差异。年龄组以２１ ～３０ 岁（６３ 例） 、３１～４０ 岁（５３ 例） 居多。表明上述年龄组的社会活动多,受到伤害的可能性大;职业以工人、农民为多,文化程度相对较低。损伤原因以伤害（１０７ 例） 、交通事故（４９ 例） 为多。损伤与精神障碍间隔时间,半年以内１５２ 例,半年至１ 年为２３ 例,表明鉴定时间选择在１ 年内为佳。精神障碍的种类与性质：器质性精神障碍１０８ 例,占５２－８％ ;功能性精神障碍８４ 例,占４１－４％ ,其中外伤后神经症（ 含癔症３５ 例）６６ 例,占３２－３ ％ 。社会功能评定：无社会功能受损７７ 例,轻度受损４１ 例,明显受损８６ 例。神经系统检查：２０４ 例中有一过性神经体征３８ 例,有明显阳性体征６２ 例。损伤与精神障碍的关系：直接因果关系１０４ 例、间接因果关系６１ 例;条件相关３４ 例、无相关５ 例。损伤程度评定结果：重伤８５ 例,轻伤６７ 例,伤病关系评定４７ 例。结论　通过对２０４ 例头部外伤