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Keulen-de Vos M, de Klerk A. Dutch forensic patients with and without intellectual disabilities: A comparison of demographic, offence, and diagnostic characteristics. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 126:104255. [PMID: 35504124 DOI: 10.1016/j.ridd.2022.104255] [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: 08/30/2021] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patients with an intellectual disability (ID) and offending histories constitute a challenging clinical group. The present study examined commonalities and differences in demographic, diagnostic and offence characteristics in patients with and without intellectual disabilities who were either convicted for violent or sexual offences and who resided in mandated care in the Netherlands. METHOD We compared 165 offenders with an ID to 249 offenders without an ID. We compared both groups by type of offence (i.e., sexual versus violent offence) using Mann-Whitney U-test or independent samples t-tests for continuous variables and Chi-square tests for categorical variables. RESULTS In general, forensic patients with an ID were younger at admission (U=357, z = -12.668, p < .001), had more prior convictions for violent offences (χ2(1)= 6.175, p = .013) and more prevalent diagnoses of substance abuse disorders (χ2(1)= 9.266, p = .002) than those without an ID. Similar results were found for patients with IDs with sexual offence histories. CONCLUSION A clear understanding of distinct characteristics of forensic patients with intellectual disabilities is crucial in understanding (sexual) violent behavior in this population as it mayassistclinicians in prioritizing interventionstrategies.
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Affiliation(s)
- Marije Keulen-de Vos
- Forensic Psychiatric Centre de Rooyse Wissel, Venray, The Netherlands; Radboud University, Faculty of Social Sciences, Nijmegen, The Netherlands.
| | - Anke de Klerk
- Forensic Psychiatric Centre de Rooyse Wissel, Venray, The Netherlands
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Keulen-de Vos M, de Vogel V. Do Changes in Emotional States Predict Therapy Alliance in Dutch Male Offenders in Mandated Clinical Care? INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:625-644. [PMID: 34002653 DOI: 10.1177/0306624x211013733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Therapy alliance has been studied largely in voluntary psychotherapy but less is known about its predictive factors for positive alliance and treatment outcome in forensic populations. The aim of this study was to examine the relationship between offenders' emotional states and therapy alliance. Moreover, we were interested in the predictive impact of emotional states early in treatment on alliance at 18 months into treatment. Self-ratings of emotional states and alliance by 103 male offenders, and therapist-ratings for therapy alliance were examined using hierarchical multiple regression analyses. Participants were primarily convicted for violent of sexual offenses, and were diagnosed with antisocial, borderline or narcissistic personality disorders. Healthy emotional states were predictive of mid-treatment agreement on therapy goals and therapist ratings on tasks within the therapy. Unhealthy emotional states were predictive of patient-rated agreement on tasks. Emotional states were not predictive for the reported therapist/patient bond or global alliance ratings. This study emphasizes the importance of healthy emotional states in treatment of offenders with personality disorders.
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Hierro TAD, Fernández MEP, Rodríguez JMA. Psicopatía, Agresión y Violencia: un Análisis de la Interrelación en una Muestra de Delincuentes. ANUARIO DE PSICOLOGÍA JURÍDICA 2021. [DOI: 10.5093/apj2021a25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Breaking down long-term chronic aggression within a forensic hospital system. CNS Spectr 2020; 25:216-222. [PMID: 32331057 DOI: 10.1017/s1092852919001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Historically, patients with multiple acts of aggression, or chronic aggressors, have been studied as one large group. It was our objective to subdivide this group into those patients who engage in physical aggression consistently over multiple years and see if common characteristics of chronic aggressors could classify patients into an aggressive or nonaggressive group. METHOD Within a forensic hospital system, patients who had committed 5 acts of physical aggression, per year, for 3 years (2010 and 2015) were reviewed. Data was collected on clinical and demographic characteristics that have shown to be associated with chronically aggressive patients and compared to nonaggressive matched controls. Data collection and analysis were completed to determine if the variables could classify patients into an aggressive or nonaggressive group. RESULTS Analysis showed that 2 variables, the presence of a cognitive disorder and a history of suicidal behaviors were significant in the univariate and multivariate analyses. The 2 variables were able to correctly classify 76.7% of the cases. CONCLUSION A cognitive disorder, a history of suicidal behavior, and increased age were factors associated with this subgroup of aggressive patients. Clinicians may want to explore treatment programs aimed at these clinical factors including cognitive rehabilitation and social cognition treatments, which have been shown to reduce aggression in cognitively impaired populations.
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Sebastian A, Retz W, Tüscher O, Turner D. Violent offending in borderline personality disorder and attention deficit/hyperactivity disorder. Neuropharmacology 2019; 156:107565. [DOI: 10.1016/j.neuropharm.2019.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/27/2019] [Accepted: 03/03/2019] [Indexed: 12/20/2022]
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Sancassiani F, Lecca ME, Pintus E, Moro MF, Caria R, Minerba L, Mela Q, Nardi AE, Machado S, d'Aloja E, Preti A, Carta MG. Could an Innovative Training Program Including Contact Sports and Counseling Help Young People With Traits of Psychopathy and A History of School Dropout? Clin Pract Epidemiol Ment Health 2019; 15:49-57. [PMID: 31043997 PMCID: PMC6463421 DOI: 10.2174/1745017901915010049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/11/2019] [Accepted: 02/17/2019] [Indexed: 11/22/2022]
Abstract
Background The aim was to assess the effects of a training program inclusive of contact sports and counseling on school dropout, quality of life (QoL) and psychopathologic symptoms in the youth with a history of school dropout and psychopathic personality traits. Methods The Experimental Group (EG) consisted of 32 subjects (male 90.6%; age 19.6±4.3 years); the Control Group (CG) consisted of an equal number matched for gender and age with the same psychological features. At the beginning of the experimental Training Program (T0), both cohorts were assessed by a diagnostic psychiatric interview (SCID ANTAS), the Short Form Health Survey (SF-12) to evaluate QoL, the Psychopathy Checklist - Revised (PCL-R) for the assessment of psychopathic traits, the Self Reporting Questionnaire (SRQ) to measure general psychopathology. At the end of the program (T1), the coorths were evaluated by SF-12 and SRQ. Results Twenty-seven subjects in the EG (84.4%) completed the course and underwent the evaluation at T1. The SF-12 score significantly increased from T0 to T1 in both groups, albeit this was more evident in the EG than in the CG, owing to an interaction between time and group. SRQ score significantly decreased in the EG from T0 to T1, while in the CG it did not, although the interaction between time and group was not significant. Conclusion The experimental training program was effective in improving QoL and countering school dropout in young citizens with psychopathic traits. Further studies are needed to clarify if such results are due to a relationship between the practical tasks approach including contact sports and an improvement in mentalization processes.
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Affiliation(s)
- Federica Sancassiani
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maria Efisia Lecca
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Elisa Pintus
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | | | - Roberto Caria
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Luigi Minerba
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Quirico Mela
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro, Rio de Janeiro - RJ, Brazil
| | - Sergio Machado
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro, Rio de Janeiro - RJ, Brazil.,Laboratory of Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program, Salgado de Oliveira University, Niterói - RJ, Brazil
| | - Ernesto d'Aloja
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
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Brunner F, Neumann I, Yoon D, Rettenberger M, Stück E, Briken P. Determinants of Dropout From Correctional Offender Treatment. Front Psychiatry 2019; 10:142. [PMID: 30967799 PMCID: PMC6440434 DOI: 10.3389/fpsyt.2019.00142] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
Research indicates that approximately one third of offenders admitted to social-therapeutic correctional facilities in Germany fail to complete treatment and that treatment dropout is linked to higher recidivism in both sexual and violent offenders. The purpose of this study was to examine determinants of treatment dropout in a social-therapeutic correctional facility in Germany. The sample consisted of 205 incarcerated adult male offenders (49.8% sexual, 38.1% non-sexual violent) admitted to correctional treatment. Completers and dropouts were compared on variables pertaining to demographics, offense type, substance abuse, psychopathy, risk, and protective factors. Univariate analyses showed that treatment dropouts demonstrated significantly higher scores on measures of risk and psychopathy and lower scores on protective factors. Logistic regression analyses identified unemployment, non-sexual violent index offense, higher risk scores (HCR-20), and Facet 1 (interpersonal deficits) of the Psychopathy Checklist-Revised (PCL-R) as significant predictors of treatment dropout. Surprisingly, substance abuse disorder was a negative predictor of dropout. With the exception of substance abuse, the results support the notion that treatment dropouts represent a group of high-risk offenders with particular treatment needs. Practical implications and suggestions for further research are discussed.
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Affiliation(s)
- Franziska Brunner
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Insa Neumann
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dahlnym Yoon
- Institute of Psychology, FernUniversität in Hagen, Hagen, Germany
| | - Martin Rettenberger
- Centre for Criminology (Kriminologische Zentralstelle - KrimZ), Wiesbaden, Germany.,Department of Psychology, Johannes Gutenberg-University (JGU), Mainz, Germany
| | - Elisabeth Stück
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ritter S, Platt LM. What's New in Treating Inpatients With Personality Disorders?: Dialectical Behavior Therapy and Old-Fashioned, Good Communication. J Psychosoc Nurs Ment Health Serv 2016; 54:38-45. [DOI: 10.3928/02793695-20151216-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/09/2015] [Indexed: 11/20/2022]
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Abracen J, Langton CM, Looman J, Gallo A, Ferguson M, Axford M, Dickey R. Mental health diagnoses and recidivism in paroled offenders. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2014; 58:765-779. [PMID: 23640808 DOI: 10.1177/0306624x13485930] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although the issue of mental illness among offender populations has received attention in the last number of years, there are a number of issues related to mental illness among such groups that require more study. One such topic relates to the association between mental illness, actuarially assessed risk of recidivism, and observed rates of reoffending. In the present investigation, file information was reviewed to determine the presence of a variety of mental health conditions. Actuarially based risk assessment data were also collected for participants as well as information regarding suspension, new charges, and convictions. A sample of 136 offenders housed in a halfway house operated by Correctional Service of Canada was included in the present investigation. Results indicated very high rates of serious mental illness in this high-risk population. Offenders with borderline personality disorder and attention deficit hyperactivity disorder were significantly more likely to recidivate or be suspended. Suspensions refer to administrative decisions to place an offender in jail due to problematic behaviour (typically involving a breach of his release conditions or new charges/convictions). Offenders with a diagnosis of paraphilic disorder were significantly less likely to recidivate or be suspended. Results are discussed in light of the available literature.
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Affiliation(s)
| | - Calvin M Langton
- Ryerson University, Toronto, Ontario, Canada University of Nottingham, UK
| | - Jan Looman
- Correctional Service of Canada, Toronto, Ontario, Canada
| | | | | | - Marsha Axford
- Correctional Service of Canada, Toronto, Ontario, Canada
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McGauley G, Ferris S, Marin-Avellan L, Fonagy P. The Index Offence Representation Scales; a predictive clinical tool in the management of dangerous, violent patients with personality disorder? CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2013; 23:274-289. [PMID: 24101409 DOI: 10.1002/cbm.1889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/09/2013] [Accepted: 08/09/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Forensic mental health professionals attach considerable importance to their patient's description of his or her index offence. Despite this, there is no systematic approach to examining and formulating the patient's offence narrative. AIM To use the index offence narratives and capacity to mentalize of violent offender-patients with personality disorder to develop a tool to predict their progress and to evaluate that tool. METHOD In a prospective, cohort study, the index offence narratives of 66 violent high security hospital patients with personality disorder were obtained from a semi-structured interview and used to generate the Index Offence Representational Scales (IORS). The predictive validity of these scales was investigated across a range of outcome variables, controlling for the association between initial and final value of the dependent variable. RESULTS The degree to which patients held internal representations of interpersonal violence and malevolence, as measured by the IORS, predicted subsequent violent behaviour. In contrast to their actual aggressive behaviour, these patients rated themselves as having fewer symptoms on the Symptom Checklist-90-R (SCL-90-R) and fewer problems in interpersonal relationships on the Inventory of Interpersonal Problems. A more empathic victim representation on the IORS predicted better engagement with treatment. CONCLUSIONS The IORS show promise for helping clinicians formulate the early institutional pathway of seriously violent people with personality disorder, particularly with respect to their overt aggression and prosocial engagement. Replication studies are, however, indicated.
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Affiliation(s)
- Gill McGauley
- Centre for Medical and Healthcare Education, St George's University of London and Central and North West London NHS Foundation Trust, London, UK
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Völlm B, Konappa N. The dangerous and severe personality disorder experiment--review of empirical research. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2012; 22:165-180. [PMID: 22711613 DOI: 10.1002/cbm.1833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND A pilot programme for the treatment of individuals with dangerous and severe personality disorder (DSPD) was established in the UK in 2001. A substantial investment had been made into research and evaluation of the initiative, but it is not clear what the outcomes of this research have been. AIM This study aimed to review empirical research on the DSPD programme. METHOD We conducted a systematic literature review by using electronic searches of the databases MEDLINE, PsycINFO and EMBASE, complemented by hand searches of key journals and websites. RESULTS We identified a total of 29 empirical research papers and three comprehensive research reports. Most studies were concerned with describing the DSPD population and confirmed that the projects targeted high-risk personality disordered offenders. Qualitative research identified a number of concerns regarding stigma, restrictiveness of the environment and indeterminate detention. Organisational enquiries recognised inefficiencies in assessment and treatment delivery. No high-quality trials were carried out of specific treatments or service environments. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The key question--what treatments are effective for high-risk personality disordered offenders--remains unanswered. More time would be needed to fully assess the impact of this programme, and similar future initiatives should allow longer observation periods.
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Affiliation(s)
- Birgit Völlm
- Section of Forensic Mental Health, Division of Psychiatry, University of Nottingham, Institute of Mental Health, Innovation Park, Triumph Road, Nottingham,UK.
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Howard R, Khalifa N, Duggan C, Lumsden J. Are patients deemed 'dangerous and severely personality disordered' different from other personality disordered patients detained in forensic settings? CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2012; 22:65-78. [PMID: 22161916 DOI: 10.1002/cbm.827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 07/19/2011] [Accepted: 11/07/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND In 1999, the UK government initiated a programme for the assessment and treatment of individuals deemed to have 'dangerous and severe personality disorder' (DSPD). After over 10 years of specialist service development, it is not clear whether DSPD patients represent a distinct group. AIMS The aim of this study was to establish whether people admitted to DSPD hospital units could be distinguished in presentation or personality traits from people with personality disorder admitted to standard secure hospital services. METHODS Thirty-eight men detained in high-security hospital DSPD units were compared with 62 men detained in conventional medium or high security hospital units, using the Psychopathy Checklist-Revised (PCL-R) and other standard personality disorder, clinical and offending measures. RESULTS Compared with their counterparts in standard services, the DSPD group had higher scores on PCL-R psychopathy, significantly more convictions before age 18 years, greater severity of institutional violence and more prior crimes of sexual violence. Regression analysis confirmed that only PCL-R Factor 1, reflecting core interpersonal and affective features of psychopathy, predicted group membership. CONCLUSION The DSPD group emerged as having higher psychopathy scores, but as there is currently no evidence that the core personality features of psychopathy are amenable to treatment, there is little justification for treating high-psychopathy forensic patients differently from those with other disorders of personality.
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Affiliation(s)
- Rick Howard
- Institute of Mental Health, Nottinghamshire Healthcare Trust & University of Nottingham, Nottingham, UK.
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