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Vitacco MJ, Batastini AB, Smith C. Conditional release and cannabis use: Concerns and challenges for community reintegration. BEHAVIORAL SCIENCES & THE LAW 2022; 40:261-270. [PMID: 35474590 DOI: 10.1002/bsl.2574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/01/2022] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
This article, which serves as a perspective review, delves into the complexities of cannabis use among individuals preparing for or already on conditional release (CR). These complexities include an association between cannabis use and mental illness and dealing with the fact that the use of illicit substances, such as cannabis, is against CR rules, leading to potential revocation. A focus of this article is the deleterious effects cannabis and synthetic derivatives of cannabis can have for individuals on CR. The article concludes with six-specific recommendations for managing cannabis use in this population with a focus on careful and detailed risk assessments that considers the relationship between substance use and dangerousness, the role of protective factors, the need for a detailed conditional release plan, inpatient and community-based interventions aimed at increasing individual autonomy, and education on the dangers of cannabis use for both the treatment team and the insanity acquittee.
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Affiliation(s)
- Michael J Vitacco
- Department of Psychiatry and Health Behavior, Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, USA
| | - Ashley B Batastini
- Department of Counseling and Educational Psychology, Univeristy of Memphis, Memphis, Tennessee, USA
| | - Colin Smith
- Department of Counseling and Educational Psychology, Univeristy of Memphis, Memphis, Tennessee, USA
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Rossetto I, Clerici M, Franconi F, Felthous AR, Carabellese F, Di Vella G, Gandellini MG, Parente L, Carabellese F. Differences Between Readmitted and Non-readmitted Women in an Italian Forensic Unit: A Retrospective Study. Front Psychol 2021; 12:708873. [PMID: 34744870 PMCID: PMC8563585 DOI: 10.3389/fpsyg.2021.708873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
The main objective of this study was to compare readmitted (RW) and non-readmitted (NRW) female psychiatric patients after being conditionally or unconditionally released from Italian inpatient forensic psychiatry services, in order to identify variables that were significantly linked with readmission. This study included all patients who were discharged from the female Residences for the Execution of the Security Measure (REMS) of Castiglione delle Stiviere from January 2008 to June 2015 who were not readmitted until December 31, 2018 (48). In addition, data were collected on female patients who were discharged from the same REMS before 2008 and readmitted from January 2008 to December 2018 (42). A key finding of our study was that the readmission into a female REMS was positively associated with the presence of substance use disorders (SUD) and a primary diagnosis on Axis II. To a lesser extent, younger age, being unconditionally discharged when first released, having had a shorter length of inpatient stay and having committed a crime against property for the first REMS admission was also variables that were apparently linked with readmission. The present research continues the previous research on gender-specific mentally ill offenders. Hence, the decision to proceed separately with a sample of men only and one of women only. For all these reasons, young female patients with personality disorder and SUD perhaps should remain longer in REMS and be released with conditions. In most European countries, the length of stay depends on the clinical condition and risk assessment, with some exceptions where the courts set a maximum length of stay at the outset, as in Italy. All the factors listed above influence the risk assessment. Finally, from integrating these findings into the increasing international literature on conditional release and considering the recent changes in the Italian forensic treatment model, we recommend continuing research on individual risk and protective factors as well as risk assessment instruments on conditionally and unconditionally released inpatients with genders studied separately.
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Affiliation(s)
- Ilaria Rossetto
- Poli-REMS Castiglione delle Stiviere, ASST Mantova, Mantova, Italy
| | | | - Filippo Franconi
- Poli-REMS Castiglione delle Stiviere, ASST Mantova, Mantova, Italy
| | - Alan R Felthous
- Forensic Psychiatry Division, Department of Psychiatry and Behavioral Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Fulvio Carabellese
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | | | | | - Lia Parente
- Section of Criminology and Forensic Psychiatry, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Felice Carabellese
- Section of Criminology and Forensic Psychiatry, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
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Kapoor R, Wasser TD, Funaro MC, Norko MA. Hospital treatment of persons found not guilty by reason of insanity. BEHAVIORAL SCIENCES & THE LAW 2020; 38:426-440. [PMID: 32897589 DOI: 10.1002/bsl.2484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/08/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
After being found not guilty by reason of insanity (NGRI), individuals are typically admitted to a secure forensic hospital for evaluation and treatment. This patient population can pose a challenge to clinicians in the hospital setting due to significant violence risk, complex psychiatric presentations, and scrutiny from oversight boards and the public. This article reviews the scientific literature around several key aspects of hospital-based treatment of insanity acquittees, including the management of inpatient aggression, the provision of specific treatments to acquittees, the assessment of violence risk and readiness for release, and the process of community transition. The authors conclude that the existing literature is heavily weighted toward the study of risk assessment and recidivism, with relatively little attention paid to the study of therapeutic modalities and recovery-oriented care in this population.
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Affiliation(s)
- Reena Kapoor
- Law & Psychiatry Division, Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Tobias D Wasser
- Law & Psychiatry Division, Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St, New Haven, CT, 06520-8014, USA
| | - Michael A Norko
- Law & Psychiatry Division, Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
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Cohen AS, Fedechko T, Schwartz EK, Le TP, Foltz PW, Bernstein J, Cheng J, Rosenfeld E, Elvevåg B. Psychiatric Risk Assessment from the Clinician's Perspective: Lessons for the Future. Community Ment Health J 2019; 55:1165-1172. [PMID: 31154587 DOI: 10.1007/s10597-019-00411-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/13/2019] [Indexed: 01/30/2023]
Abstract
Accurate prediction of risk-states in Serious Mental Illnesses (SMIs) is critical for reducing their massive societal burden. Risk-state assessments are notably inaccurate. Recent innovations, including widely available and inexpensive mobile technologies for ambulatory "biobehavioral" data, can reshape risk assessment. To help understand and accelerate clinician involvement, we surveyed 90 multi-disciplinary clinicians serving SMI populations in various settings to evaluate how risk assessment is conducted and can improve. Clinicians reported considerable variability in conducting risk assessment, and few clinicians explicated their procedures beyond tying it to broader mental status examinations or interviews. Very few clinicians endorsed using currently-available standardized risk measures, and most reported low confidence in their utility. Clinicians also reported spending approximately half the time conducting individual risk assessments than optimally needed. When asked about improvement, virtually no clinicians acknowledged biobehavioral, objective technologies, or ambulatory recording. Overall, clinicians seemed unaware of meaningful ways to improve risk assessment.
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Affiliation(s)
- Alex S Cohen
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
| | - Taylor Fedechko
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Elana K Schwartz
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Thanh P Le
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Peter W Foltz
- Institute of Cognitive Science, University of Colorado, Boulder, USA
| | | | - Jian Cheng
- Analytic Measures Inc, Palo Alto, CA, USA
| | | | - Brita Elvevåg
- Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,The Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromsø, Norway
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Keune LH, de Vogel V, van Marle HJC. The evaluation stage of the Hoeven Outcome Monitor (HOM): Towards an evidence based groundwork in forensic mental health. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 51:42-53. [PMID: 28256255 DOI: 10.1016/j.ijlp.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study examined if a macro-, meso-, and micro outcome measurement instrument that constitutes the evaluation stage of a Dutch forensic psychiatric outcome monitor, the Hoeven Outcome Monitor (HOM), can provide a first step towards a more evidence based groundwork in forensic mental health. General, serious, very serious, special, and tbs meriting recidivism during treatment, after treatment, and overall were charted for forensic psychiatric patients discharged from a Dutch forensic psychiatric centre between 1999 and 2008 (N=164). Re-conviction data were obtained from the official Criminal Records System, and the mean follow-up time was 116.2months. First, the results showed that the macro-measurements provide comparative outcome measures to generate insight into the overall effectiveness of forensic psychiatric treatment. Second, the meso-measurements yielded clinically relevant treatment outcome data for all discharged patients to generate a complete view of treatment effectiveness. Finally, the micro-measurements allowed access to detailed patient and treatment effectiveness assessments that provides the empirical foundation to conduct aetiological research into the prediction and control of high-risk behaviour. Thus, an outcome measurement instrument in line with Evidence Based Medicine and best practice guidelines was designed that provides an empirically sound evaluation framework for treatment effectiveness, and an impetus for the development of effective interventions to generate an evidence based groundwork in forensic mental health.
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Affiliation(s)
- Lobke H Keune
- Research Department De Forensische Zorgspecialisten, P.O. Box 174, 3500 DA Utrecht, The Netherlands.
| | - Vivienne de Vogel
- Research Department De Forensische Zorgspecialisten, P.O. Box 174, 3500 DA Utrecht, The Netherlands.
| | - Hjalmar J C van Marle
- Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam DP-0424, The Netherlands; Erasmus School of Law Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam DP-0424, The Netherlands.
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