Distinct pathological profiles of inmates showcasing cluster B personality traits, mental disorders and substance use regarding violent behaviors

Personality Disorder Symptoms in Intermittent Explosive Disorder: A Latent Class Analysis

Intermittent explosive disorder (IED) is characterized by recurrent reactive aggression. IED is associated with significant personality pathology that is suggestive of higher levels of general personality disorder (PD). However, little is known about how personality factors impact the severity and presentation of IED. The present study employed a latent class analysis to assess for distinct PD symptom classes within IED and to evaluate whether these classes differed in terms of severity and behavioral presentation. Statistical and clinical indicators revealed a four-class model, with latent classes distinguished primarily on general levels of PD symptoms (low, moderate, high). However, the two moderate PD symptom classes were distinguished from other classes on avoidant PD. In addition, classes differed in terms of severity and presentation, suggesting important implications for both general PD and avoidant PD comorbidity within IED. Results provide further insight into the heterogeneity within IED and suggest a more nuanced approach in treating this serious condition.

Substance Use Disorders as a Critical Element for Decision-Making in Forensic Assertive Community Treatment: A Systematic Review

Introduction: The prevalence of substance use disorders in forensic populations is high. They are an important factor linked to negative outcomes in mentally ill offenders and are detrimental to forensic or non-forensic outcome measures. In contrast, substance use disorders are often underdiagnosed and undertreated, especially in forensic settings. Forensic Assertive Community Treatment is a forensic adaptation of regular assertive community treatment, combined with essential elements of forensic rehabilitation theories. Little is known however on the effectivity of forensic assertive community treatment when it comes to substance use disorders or what their exact role is on the outcome measures. In this paper, we explore how SUD is treated in Forensic assertive community treatment and how it relates to the forensic and non-forensic outcome measures. Methods: We performed a systematic review (PRISMA) of forensic Assertive community treatment teams that followed the main evidence-based principles of regular assertive community treatment and added basic elements of forensic rehabilitation. We analyzed articles the Psychinfo and Medline databases dating from 2005 to 2020. Fifteen studies fit the search criteria and were included in the analysis. The Quality of the studies was assessed using the Newcastle-Ottawa scale. Results: SUD was highly prevalent in all studies. Patients entered FACT through two pathways, either from a care continuum or directly from prison. The severity of SUD at intake emerges as a critical element when deciding which pathway to choose, as a high severity-score at the start of FACT follow-up was linked to recidivism. While differing in method all studies offered integrated SUD treatment. These included evidence-based techniques like CBT, therapeutic communities, and Substance Abuse Management Module. Though results on SUD outcomes were mixed 4 studies mentioned abstinence in 50-75%. The severity of SUD tended to increase initially and to stabilize afterwards. Conclusion: Severity of SUD at intake emerges as a decisive element in decision-making on entering FACT teams directly from prison or through a care-continuum. The ways to provide SUD treatment varied and outcomes for SUD were mixed. SUD was found to be detrimental to forensic and non-forensic outcome measures, such as recidivism or hospitalizations during FACT treatment.

Influence of prisoners' mental health on the relational climate of prisons

Introduction:

Entry into prison involves adapting to a prison culture that is sometimes altered by the effect of imprisonment. Prisons are overcrowded and hold large numbers of inmates suffering from mental disorders and difficulties of adaptation, who affect the delicate equilibrium of the prison environment and can worsen the relational climate.

Material and method:

Several bibliographical databases on the influence of the mental health of adult inmates on the prison relationship climate and existing interventions in this regard that have been published in the last 15 years were reviewed. This data was complemented by other information obtained from the online bibliographic indexes of the Ministry of the Interior.

Results:

There is little literature on the influence of mental health on the relational climate of prisons and existing interventions. However, what literature there is does respond to a current prison reality where inmates with mental health problems have an increased risk of victimization and also a greater predisposition to penitentiary misconduct that causes violations of rules and the consequent application of disciplinary sanctions that lead to segregation.

Discussion:

The dysfunctional behaviour of such inmates, as well as the stigmatized treatment they receive, negatively impact the prison social climate, generating pathological relational styles and distorting the prison environment. This creates a need for an adequate number of programs and interventions of sufficient quality to prevent and mitigate their consequences.

A longitudinal study of adaption to prison after initial incarceration

Much of the psychiatric literature about prisoners concerns the associations between psychiatric conditions and criminality. More recently, there has been increased psychiatric interest in the moral emotions (i.e., emotions related to the rightness or wrongness of an individual's actions) and their association with psychological problems and psychopathology. The role of moral emotions has never previously been studied in relation to prison adaptation on initial incarceration. Their impact in adaptation to prison life was studied longitudinally. Immediately after prison incarceration, 316 adult male offenders were assessed in relation to moral emotions, coping strategies, and somatization symptoms. After four months, information relating to their prison adaptation were recorded using official data. Findings showed that (i) offence-related shame correlated positively with somatization symptoms, distraction, and self-blame, and that (ii) offence-related guilt correlated positively with self-blame, and negatively with venting on emotion. The relationship between self-blame and somatization was partly mediated by offence-related shame and guilt. Previous research has demonstrated that moral emotions are associated with increased severity of psychopathology such as depression, suicidal ideation, and psychological problems generally. Therefore, it is important that psychiatrists are aware of the effect that moral emotions can have on psychological functioning. Implications for prison psychiatrists are discussed.