Self-control strength in prison inmates with antisocial personality disorder

The present study aimed to examine the difference in self-control strength between individuals with and without antisocial personality disorder (ASPD) in a Chinese male prisoner sample. Thirty-seven male inmates who met the criteria for DSM-IV ASPD and 38 who did not were asked to watch a four-minute silent videotape of an interview, and ignore the words displayed on screen during the videotape to deplete their ego strength. A handgrip task was conducted both before and after watching the videotape, with participants’ time squeezing the handgrip being the dependent variable. Result showed a significant interaction between group (ASPD/no-ASPD group) and time (baseline/post-manipulation measure). The post-manipulation result was significantly worse than the baseline result for the ASPD group, but not for the no-ASPD group. These results indicate that tasks that contribute to ego depletion lead to a deficit of self-control strength in prisoners with ASPD.     

Probable posttraumatic stress disorder in a sample of urban jail detainees

This study examined the nature and extent of probable posttraumatic stress disorder (PTSD) among men in a substance abuse treatment program in a large urban jail. Specifically, it explored the prevalence of probable PTSD and other psychiatric problems among jail detainees, the types of trauma detainees experienced during different phases of their lives, and how those experiences might have contributed to the development of probable PTSD. Results showed that psychiatric problems were quite serious; nearly one-quarter of the sample reported previous psychiatric hospitalization, and nearly 10% were being currently treated with psychiatric medication. In addition, 21% of the sample met the criteria for probable PTSD, a rate five times greater than that in the general population. The current study suggests that the presence of probable PTSD among male detainees should be incorporated into the creation and implementation of jail-based behavioral healthcare services, including screening, assessment, and clinical interventions. Furthermore, in-custody drug treatment programs should adopt trauma-informed strategies for all program participants as the expected standard of care.     

反思精神障碍强制医疗的“危险性”原则

很多国家精神卫生立法在强制医疗人院标准方面都适用了“危险性”原则,我国《精神卫生法》也在其列。然而,“危险性”原则是基于三个错误的假设,因此实际上“危险性”原则可能会增加精神疾病对患者的伤害和较大程度增加社区危险的风险。本文呼吁参考Large及Richardson的观点及美国部分州与苏格兰精神卫生立法的实证经验,在“危险性”原则基础上补充“拒绝治疗的能力”评定作为精神障碍者强制医疗入院标准。     

Growing Up in Times of War: Unaccompanied Refugee Minors’ Assumptions About the World and Themselves

Abstract

The idea that assumptions about the world and the self can be damaged through traumatic experiences has proven to be useful in understanding posttraumatic reactions. This study investigated the World Assumptions of middle-eastern unaccompanied refugee minors (URMs) to contribute to a culturally sensitive theoretical perspective. Semistructured interviews were conducted and analyzed using inductive category development. All assumed aspects of World Assumptions—benevolence, meaningfulness, and self-worth—were found in the participants’ statements. Regarding meaningfulness, we detected a new subcategory, the principle of a metaphysical plan, which has implications for the mechanism by which religiosity protects World Assumptions in war-torn regions.     

The development and pilot testing of a family treatment court best practices assessment: The model standards implementation scale

In 2019, the family treatment court (FTC) best practice standards (the Standards) were published to clarify attributes of FTC programs associated with superior child, parent, and family outcomes. The Standards cover the breadth of FTC operations including program structure and leadership, substance use treatment and complementary services, and behavioral responses to participants. This study aimed to develop an instrument (the Model Standards Implementation Scale; “MSIS”) that stakeholders can use to assess implementation of the Standards by individual FTCs. The MSIS balances usability with scientific validity. Interrater reliability (IRR), internal consistency, and several types of validity were assessed. Results indicated moderate to strong IRR, high internal consistency, mixed known groups validity depending on Standard, and high convergent and divergent validity. Initial findings suggest good validity and usability of the MSIS for evaluating FTC Standards' implementation. Notably, the process of using the tool functioned to educate FTC team members on the Standards. Although implementation of the MSIS is a resource-intensive process, the opportunity to receive constructive feedback proved to be an effective incentive for initial and subsequent participation in the evaluation among FTCs. Future research is needed to examine predictive validity, including association between Standards' implementation and family outcomes in FTCs.     

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.     

Characteristics of male patients admitted to an adolescent secure forensic psychiatric hospital

This paper examines the characteristics of a group of 64 young men, who were consecutively admitted to Bluebird House, an NHS mixed gender, adolescent forensic, medium secure hospital. The characteristics examined focus on the young men’s clinical presentations, as informed by the Millon Adolescent Clinical Inventory, and their ICD10 (WHO 1992) diagnoses. The paper also examines the males’ route into, and out of, Bluebird House, as well as their risk profiles, especially with regards to others, as informed by Structured Assessment of Violence Risk in Youth findings and staff recorded incidents. Correlational analysis is performed to try and understand this population, with statistically significant findings highlighted. The discussion considers the trajectory for some of these young men into adult personality disorders, their presentation and prognosis compared to their female counterparts, and how their presentation contrasts with adult male forensic populations.     

Finding of Hyperostosis Frontalis Interna During the Autopsy Procedure: Forensic Issues

Hyperostosis frontalis interna is a common phenomenon, which may have been overrated in its significance in the past, and may, currently be underrated in its significance. We present three cases of hyperostosis frontalis interna found during medicolegal autopsies and discuss their forensic considerations. The patients were all middle‐aged women with metabolic and endocrine manifestations and psychiatric ailments; thickening of the inner table of the frontal bone of the skull was found during each autopsy. We describe the relationship between hyperostosis frontalis interna, metabolic manifestations, and neuropsychiatric symptoms as part of Morgagni‐Stewart‐Morel syndrome. There is still considerable disagreement in the scientific community as to whether this syndrome is a clinical entity. Nonetheless, awareness of Morgagni‐Stewart‐Morel syndrome can be of help in understanding the circumstances surrounding death. In some other cases, hyperostosis frontalis interna could be used by forensic pathologists as criteria for sexing and aging a skeleton.     

Homicidal Ideation and Individuals on the Autism Spectrum

Interest in the relationship between autism and violence has increased in recent years; however, no link has clearly been established between them. Researchers remain curious if autistic people with certain traits (e.g., a history of trauma) are at greater risk of violence than those individuals with autism alone. In this article, we detail two individuals with homicidal ideation (HI) admitted to inpatient psychiatric units who were found to have a diagnosis of autism without language impairment. These cases illustrate the need for mental health providers to consider autism in their differential diagnosis when evaluating an individual with HI. Broadly, we consider how an autistic individual could be susceptible to developing HI and explore treatments specific to autistic individuals that may be helpful in such cases.