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Baldwin G, Beazley P. A systematic review of the efficacy of psychological treatments for people detained under the Mental Health Act. J Psychiatr Ment Health Nurs 2023. [PMID: 36655589 DOI: 10.1111/jpm.12897] [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] [Received: 08/05/2022] [Revised: 12/10/2022] [Accepted: 01/08/2023] [Indexed: 01/20/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: International reviews have looked at therapy outcomes for patients on mental health wards, showing it is associated with reduced emotional distress and readmission. Reviews have not looked at which specific treatments are most effective. No review has been done in England and Wales for patients detained specifically under the Mental Health Act. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE The paper gives an overview of the limited evidence in England and Wales. The paper shows which therapies have been measured. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Larger studies are needed across all types of patient wards in England and Wales with random allocation to types of therapy and longer-term follow-up. More studies are needed where researchers are not aware of the therapy being delivered. More studies need to use a mixture of patient and clinician outcome measures. Outcomes should also measure incident, readmission and reoffending rates. More evidence is needed from patients who are female, non-white and who are diagnosed with depression and anxiety. ABSTRACT INTRODUCTION: The efficacy of psychological interventions delivered under the Mental Health Act (1983) (MHA) in England and Wales is unclear. While meta-analyses have reviewed acute and forensic psychological interventions in wider geographical areas, there has been no review specifically in the unique MHA context. AIM A systematic review was conducted of psychological outcomes for inpatients detained under the MHA in England and Wales. METHOD Diagnoses and type of psychological intervention were not restricted, provided a psychological outcome measure was used. Studies were identified through APA PsychInfo, MEDLINE, CINAHL and Academic Search using a combination of key terms. Data extraction included effect direction, statistical significance, intervention type, format and duration, study size, inpatient setting, control group and study quality. RESULTS High-quality evidence was sparse. Some improvements were found in overall well-being, self-esteem, social functioning, problem-solving, substance use, anger, offending attitudes, fire-setting, violence, anxiety, depression, personality disorder and psychosis. However, the overall evidence base is lacking. DISCUSSION Larger-scale randomized controlled trials are needed across secure, acute and learning disability inpatient settings in England and Wales with longer term follow-up, blind assessors and both self-report and clinician-rated measures, as well as incident, readmission and reoffending rates. Greater representation is needed of females, non-white groups and affective disorders. CLINICAL IMPLICATIONS The efficacy of psychological interventions for inpatients detained under the MHA in England and Wales remains unclear. Clinicians are encouraged to use relevant outcome measures in relation to treatment goals, to monitor the efficacy of interventions being offered to this client group. RELEVANCE TO MENTAL HEALTH NURSING This paper highlights the current body of evidence for psychological interventions in inpatient settings within England and Wales, which is an environment in which mental health nursing plays an important role in patients' recovery. This evidence is also particularly important as there is a shift in clinical practice to training nursing staff to deliver some of the low-intensity psychological interventions, such as behavioural activation, solution-focussed therapy and motivational interviewing.
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Affiliation(s)
- George Baldwin
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, UK
| | - Peter Beazley
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, UK
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Gibbon S, Khalifa NR, Cheung NHY, Völlm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2020; 9:CD007668. [PMID: 32880104 PMCID: PMC8094166 DOI: 10.1002/14651858.cd007668.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review). OBJECTIVES To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also searched reference lists and contacted study authors to identify studies. SELECTION CRITERIA Randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment. The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called 'standard Maintenance'(SM) in some studies). Eight of the 18 psychological interventions reported data on our primary outcomes. Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD. Data were available from only 10 studies involving 605 participants. Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands. Study duration ranged from 4 to 156 weeks (median = 26 weeks). Most participants (75%) were male; the mean age was 35.5 years. Eleven studies (58%) were funded by research councils. Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%. Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention. One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention. Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence). One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up. Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. 'Driving whilst intoxicated' programme (DWI) + incarceration versus incarceration One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months. Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years. The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19). The certainty of the evidence for all outcomes was very low. Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants' level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention. Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU. Psychosocial risk management (PSRM; 'Resettle') versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison. It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour. Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies. This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.
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Affiliation(s)
- Simon Gibbon
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Najat R Khalifa
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Natalie H-Y Cheung
- Forensic Research, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Lucy McCarthy
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
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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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Baggio S, Fructuoso A, Guimaraes M, Fois E, Golay D, Heller P, Perroud N, Aubry C, Young S, Delessert D, Gétaz L, Tran NT, Wolff H. Prevalence of Attention Deficit Hyperactivity Disorder in Detention Settings: A Systematic Review and Meta-Analysis. Front Psychiatry 2018; 9:331. [PMID: 30116206 PMCID: PMC6084240 DOI: 10.3389/fpsyt.2018.00331] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Our main study objective was to provide an updated ADHD prevalence rate for PLD, including PLD in psychiatric units. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD. Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the MOOSE checklist. PubMed/Medline, PsycINFO, and Web of Sciences were searched combining "ADHD" and "prison" keywords and synonyms for articles published between January 1, 1966 and January 2, 2018. Potential sources of variation to the meta-analytic ADHD prevalence rate were investigated using meta-regressions and subgroups analyses. Results: The meta-analysis pooled 102 original studies including 69,997 participants. The adult ADHD prevalence rate was 26.2% (95% confidence interval: 22.7-29.6). Retrospective assessments of ADHD in childhood were associated with an increased prevalence estimate (41.1, 95% confidence interval: 34.9-47.2, p < 0.001). There was no significant difference in the prevalence estimate between screenings and clinical interviews in adulthood. Only three studies used the DSM-5 definition of ADHD and results were non-significantly different with other DSM versions. We found no difference according to participants' characteristics. Conclusion: Our results confirmed the high prevalence rate of ADHD among PLD, corresponding to a five-fold increase compared to the general population. In light of such high ADHD prevalence, our results reinforce the importance of addressing this critical public health issue by (i) systematically offering ADHD screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring, and care for ADHD during and after detention. These strategies may help reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention. Additionally, our study suggests that using screening scales may be a reliable way of assessing ADHD, although caution is needed because a complete evaluation by an experienced clinician is required to provide a formal diagnosis.
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Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Life Course and Social Inequality Research Centre, University of Lausanne, Lausanne, Switzerland
| | - Ana Fructuoso
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Marta Guimaraes
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Eveline Fois
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Diane Golay
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Candy Aubry
- Foundation TDAH-Insight and Association TDAH-ImPulse, Geneva, Switzerland
| | - Susan Young
- Division of Brain Sciences, Department of Medicine, Centre for Mental Health, Imperial College London, London, United Kingdom
| | | | - Laurent Gétaz
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Nguyen T Tran
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.,Faculty of Health, Australian Centre for Public and Population Health Research, University of Technology, Sydney, NSW, Australia
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Sedgwick O, Young S, Baumeister D, Greer B, Das M, Kumari V. Neuropsychology and emotion processing in violent individuals with antisocial personality disorder or schizophrenia: The same or different? A systematic review and meta-analysis. Aust N Z J Psychiatry 2017; 51:1178-1197. [PMID: 28992741 DOI: 10.1177/0004867417731525] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess whether there are shared or divergent (a) cognitive and (b) emotion processing characteristics among violent individuals with antisocial personality disorder and/or schizophrenia, diagnoses which are commonly encountered at the interface of mental disorder and violence. Cognition and emotion processing are incorporated into models of violence, and thus an understanding of these characteristics within and between disorder groups may help inform future models and therapeutic targets. METHODS Relevant databases (OVID, Embase, PsycINFO) were searched to identify suitable literature. Meta-analyses comparing cognitive function in violent schizophrenia and antisocial personality disorder to healthy controls were conducted. Neuropsychological studies not comparing these groups to healthy controls, and emotion processing studies, were evaluated qualitatively. RESULTS Meta-analyses indicated lower IQ, memory and executive function in both violent schizophrenia and antisocial personality disorder groups compared to healthy controls. The degree of deficit was consistently larger in violent schizophrenia. Both antisocial personality disorder and violent schizophrenia groups had difficulties in aspects of facial affect recognition, although theory of mind results were less conclusive. Psychopathic traits related positively to experiential emotion deficits across the two disorders. Very few studies explored comorbid violent schizophrenia and antisocial personality disorder despite this being common in clinical practice. CONCLUSION There are qualitatively similar, but quantitatively different, neuropsychological and emotion processing deficits in violent individuals with schizophrenia and antisocial personality disorder which could be developed into transdiagnostic treatment targets for violent behaviour. Future research should aim to characterise specific subgroups of violent offenders, including those with comorbid diagnoses.
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Affiliation(s)
- Ottilie Sedgwick
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,2 Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK
| | - Susan Young
- 2 Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK.,3 Centre for Mental Health, Department of Medicine, Imperial College London, London, UK
| | - David Baumeister
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ben Greer
- 2 Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK
| | - Mrigendra Das
- 2 Broadmoor Hospital, West London Mental Health Trust, Crowthorne, UK
| | - Veena Kumari
- 4 Research and Development, Sovereign Health Group, San Clemente, CA, USA
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Gudjonsson G. Hans Eysenck's theory on the ‘causes’ and ‘cures’ of criminality: A personal reflection. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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A meta-analysis and systematic review of the risks associated with childhood attention-deficit hyperactivity disorder on long-term outcome of arrests, convictions, and incarcerations. Clin Psychol Rev 2016; 48:32-42. [DOI: 10.1016/j.cpr.2016.05.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/27/2016] [Accepted: 05/22/2016] [Indexed: 11/21/2022]
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González RA, Gudjonsson GH, Wells J, Young S. The Role of Emotional Distress and ADHD on Institutional Behavioral Disturbance and Recidivism Among Offenders. J Atten Disord 2016; 20:368-78. [PMID: 23893535 DOI: 10.1177/1087054713493322] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to examine the role of emotional distress as well as ADHD symptomatology in explaining (a) recidivism, (b) behavioral disturbances in prison, and (c) violent and nonviolent offending. METHOD In all, 196 male prisoners from Aberdeen prison completed the Symptom Checklist-90, which examines various clinical symptoms and emotional distress. Current adult symptoms were assessed by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for ADHD. RESULTS Emotional distress and ADHD explained the variance in prison records of behavioral disturbance above and beyond antisocial personality (ASP) traits; however, much of the effect of emotional distress was mediated by ADHD symptoms. Only ADHD symptoms were significantly associated to history of violent offending, whereas ASP and age mostly explained nonviolent offenses and overall recidivism. CONCLUSION Our results provide support for the conceptual association between ADHD and its related emotional dimension with behavioral disturbance in prison, suggesting a link to reactive violence.
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Rampling J, Furtado V, Winsper C, Marwaha S, Lucca G, Livanou M, Singh SP. Non-pharmacological interventions for reducing aggression and violence in serious mental illness: A systematic review and narrative synthesis. Eur Psychiatry 2016; 34:17-28. [PMID: 26928342 DOI: 10.1016/j.eurpsy.2016.01.2422] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND For people with mental illness that are violent, a range of interventions have been adopted with the aim of reducing violence outcomes. Many of these interventions have been borrowed from other (offender) populations and their evidence base in a Serious Mental Illness (SMI) population is uncertain. AIMS To aggregate the evidence base for non-pharmacological interventions in reducing violence amongst adults with SMI and PD (Personality Disorder), and to assess the efficacy of these interventions. We chose to focus on distinct interventions rather than on holistic service models where any element responsible for therapeutic change would be difficult to isolate. METHODS We performed a systematic review and narrative synthesis of non-pharmacological interventions intended to reduce violence in a SMI population and in patients with a primary diagnosis of PD. Five online databases were searched alongside a manual search of seven relevant journals, and expert opinion was sourced. Eligibility of all returned articles was independently assessed by two authors, and quality of studies was appraised via the Cochrane Collaboration Tool for Assessing Risk of Bias. RESULTS We included 23 studies of diverse psychological and practical interventions, with a range of experimental and quasi-experimental study designs that included 7 Randomised Controlled Trials (RCTs). The majority were studies of Mentally Disordered Offenders. The stronger evidence existed for patients with a SMI diagnosis receiving Cognitive Behavioural Therapy or modified Reasoning & Rehabilitation (R&R). For patients with a primary diagnosis of PD, a modified version of R&R appeared tolerable and Enhanced Thinking Skills showed some promise in improving attitudes over the short-term, but studies of Dialectical Behaviour Therapy in this population were compromised by high risk of experimental bias. Little evidence could be found for non-pharmacological, non-psychological interventions. CONCLUSIONS The evidence for non-pharmacological interventions for reducing violence in this population is not conclusive. Long-term outcomes are lacking and good quality RCTs are required to develop a stronger evidence base.
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Affiliation(s)
- J Rampling
- Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Reaside Clinic, Birmingham, UK.
| | - V Furtado
- Birmingham and Solihull Mental Health NHS Foundation Trust, c/o Reaside Clinic, Birmingham, UK; Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick CV4 7AL, UK
| | - C Winsper
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick CV4 7AL, UK
| | - S Marwaha
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick CV4 7AL, UK
| | - G Lucca
- University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milano, Italy
| | - M Livanou
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick CV4 7AL, UK
| | - S P Singh
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick CV4 7AL, UK
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A national epidemiological study investigating risk factors for police interrogation and false confession among juveniles and young persons. Soc Psychiatry Psychiatr Epidemiol 2016; 51:359-67. [PMID: 26537245 PMCID: PMC4819598 DOI: 10.1007/s00127-015-1145-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/13/2015] [Indexed: 01/04/2023]
Abstract
PURPOSE The principal aims of this study are to identify risk factors associated with police arrest and false confessions and to investigate whether the severity of the ADHD condition/symptoms increases the risk. METHODS 22,226 young persons in Iceland anonymously completed self-report questionnaires screening for conduct disorder and ADHD. In addition, they stated whether they had a diagnosis of ADHD and had received ADHD medication, and their history of offending, police interrogation and false confession. Participants were stratified into two age groups, 14-16 and 17-24 years. RESULTS The older group was significantly more likely to have been interrogated by the police but the younger group were much more vulnerable to false confession during interrogation. Males were more likely to be at risk for both than females. The severity of the ADHD condition increased the risk of both interrogation and false confession. Negative binomial regressions showed that age, gender, conduct disorder, offending, and ADHD symptoms were all significant predictors of both interrogations and number of false confessions. Conduct disorder was the single best predictor of police interrogation, but the findings were more mixed regarding false confessions. Young people presenting with a combination of severe ADHD and comorbid conduct disorder had the worst outcome for both interrogation and false confessions. CONCLUSIONS The findings endorse the need for support of persons with ADHD to be put in place to ensure fair due process and to prevent miscarriages of justice.
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Attention-deficit-hyperactivity disorder and associated functional impairments in mentally disordered offenders. Psychiatry Res 2015; 230:387-93. [PMID: 26410772 DOI: 10.1016/j.psychres.2015.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 07/15/2015] [Accepted: 09/13/2015] [Indexed: 11/24/2022]
Abstract
This study examines the rate of attention-deficit-hyperactivity disorder (ADHD) and associated functional impairments in mentally disordered offenders (MDOs). One hundred and thirty-one male MDOs with a primary diagnosis of either severe mental illness (SMI) or personality disorder (PD) completed screening questionnaires for ADHD. If positive, they were invited for a comprehensive diagnostic interview. Additional data pertaining to self-rated impairments, and objective records of critical incidents and episodes of seclusion were obtained from patient records. Twenty-six patients screened positive (7 with SMI, 19 with PD). On further assessment, no SMI patients met criteria for ADHD. Four PD patients met criteria for persistent 'syndromatic' ADHD, whereas six met 'symptomatic' ADHD criteria, giving overall prevalence estimates of 8.6% and 12.9% respectively. Greater functional impairments were self-reported by the PD+ADHD screener positive group, compared with screener negative peers, with large effect sizes. A significant but small effect was found for spending longer in seclusion. Compared with population norms, a high rate of ADHD and associated impairments are present in MDO's with a primary diagnosis of PD. These individuals have complex needs and both pharmacological and non-pharmacological interventions are required for their rehabilitation.
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Young S, Khondoker M, Emilsson B, Sigurdsson JF, Philipp-Wiegmann F, Baldursson G, Olafsdottir H, Gudjonsson G. Cognitive-behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis. Psychol Med 2015; 45:2793-2804. [PMID: 26022103 PMCID: PMC4595859 DOI: 10.1017/s0033291715000756] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/23/2015] [Accepted: 04/01/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland. METHOD A total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive-behavioural therapy (CBT/MED) using the R&R2ADHD intervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment. RESULTS CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time. CONCLUSIONS The study provides evidence for the effectiveness of R&R2ADHD and demonstrates that there are differential effects over time for ADHD symptoms versus co-morbid problems, the latter taking longer to show positive effects.
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Affiliation(s)
- S. Young
- Division of Brain Sciences, Department of Medicine, Centre for Mental Health, Imperial College London, London, UK
- Broadmoor Hospital, West London Mental Health NHS Trust, Crowthorne, UK
- Reykjavik University, Reykjavik, Iceland
| | - M. Khondoker
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Applied Health Research, University College London, London, UK
| | - B. Emilsson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - J. F. Sigurdsson
- Reykjavik University, Reykjavik, Iceland
- Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | - F. Philipp-Wiegmann
- Broadmoor Hospital, West London Mental Health NHS Trust, Crowthorne, UK
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - G. Baldursson
- Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - H. Olafsdottir
- Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - G. Gudjonsson
- Broadmoor Hospital, West London Mental Health NHS Trust, Crowthorne, UK
- Reykjavik University, Reykjavik, Iceland
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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13
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Jotangia A, Rees-Jones A, Gudjonsson GH, Young S. A multi-site controlled trial of the R&R2MHP cognitive skills program for mentally disordered female offenders. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2015; 59:539-559. [PMID: 24293225 DOI: 10.1177/0306624x13512092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study aimed to evaluate the acceptability and efficacy of delivering the Reasoning and Rehabilitation Mental Health Program (R&R2MHP) to female mentally disordered offenders detained in medium and low secure hospital settings. Group treatment participants (N = 18) and control participants receiving treatment as usual (N = 20) completed self-report measures pre- and post-group. An informant measure of ward behavior was also completed by staff. Violent attitudes and locus of control were assessed at 3-month follow-up. Program completion was excellent (89%). A conservative intention-to-treat analysis found significant treatment effects post-group for positive problem-solving orientation, rational problem-solving style, and locus of control (medium-large effect), but no treatment effect for violent attitudes, anger, and ward behavior. At follow-up, a large treatment effect was found for locus of control. Ad hoc per protocol analyses found a large treatment effect for ward behavior. The findings provide preliminary support for the feasibility and utility of delivering R&R2MHP to females in secure psychiatric settings.
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Affiliation(s)
| | | | | | - Susan Young
- King's College London Institute of Psychiatry, UK Imperial College London, Centre for Mental Health, UK
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14
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Arnold LE, Hodgkins P, Caci H, Kahle J, Young S. Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder: a systematic review. PLoS One 2015; 10:e0116407. [PMID: 25714373 PMCID: PMC4340791 DOI: 10.1371/journal.pone.0116407] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 12/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background Evaluation of treatments for attention-deficit/hyperactivity disorder (ADHD) previously focused on symptom control, but attention has shifted to functional outcomes. The effect of different ADHD treatment periods and modalities (pharmacological, non-pharmacological, and combination) on long-term outcomes needs to be more comprehensively understood. Methods A systematic search of 12 literature databases using Cochrane’s guidelines yielded 403 English-language peer-reviewed, primary studies reporting long-term outcomes (≥2 years). We evaluated relative effects of treatment modalities and durations and effect sizes of outcomes reported as statistically significantly improved with treatment. Results The highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes. A majority of outcomes improved regardless of age of treatment initiation (60%–75%) or treatment duration (62%–72%). Studies with short treatment duration had shorter follow-up times (mean 3.2 years total study length) than those with longer treatment durations (mean 7.1 years total study length). Studies with follow-up times <3 years reported benefit with treatment for 93% of outcomes, whereas those with follow-up times ≥3 years reported treatment benefit for 57% of outcomes. Post-hoc analysis indicated that this result was related to the measurement of outcomes at longer periods (3.2 versus 0.4 years) after treatment cessation in studies with longer total study length. Conclusions While the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes. Older treatment initiation age or longer durations did not markedly affect proportion of improved outcomes reported, but measurement of outcomes long periods after treatment cessation may attenuate results.
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Affiliation(s)
- L. Eugene Arnold
- Research Unit on Pediatric Psychopharmacology, The Ohio State University, Columbus, Ohio, United States of America
| | - Paul Hodgkins
- Global Health Economics & Outcomes Research, Shire, Wayne, PA, United States of America
| | - Hervé Caci
- Hôpitaux Pédiatriques de Nice CHU Lenval, F-06200, Nice, France
| | - Jennifer Kahle
- BPS International, San Diego, CA, 92130, United States of America
- * E-mail:
| | - Susan Young
- Imperial College London, Centre for Mental Health, London, SW7 2AZ, United Kingdom
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15
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Young S, Sedgwick O, Perkins D, Lister H, Southgate K, Das M, Kumari V, Bishopp D, Gudjonsson GH. Measuring victim empathy among mentally disordered offenders: validating VERA-2. J Psychiatr Res 2015; 60:156-62. [PMID: 25466221 DOI: 10.1016/j.jpsychires.2014.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 12/30/2022]
Abstract
There are very few, if any, valid and victim-specific situation empathy measures available at present for use with mentally disordered offenders. The aim of this study was to validate a modified version (VERA-2) of the Victim Empathy Response Assessment (VERA) tool which was developed earlier (Young et al., 2008) to enable victim-specific situation empathy measurement in offenders. A total of 55 mentally disordered in-patients residing in a maximum security hospital were assessed on VERA-2 as well as on measures of antisocial personality traits, global affective empathy, violent cognitions, and reported remorse for the index offence. The VERA-2 cognitive and affective empathy scales were negatively correlated with antisocial personality traits and violent cognitions, and positively related to remorse for the index offence. Global affective empathy was positively related to VERA-2 affective empathy. Participants with a history of sexual offending had significantly higher cognitive empathy than other offenders. Acceptance of violence and remorse for the index offence were the best predictors of both cognitive and affective empathy. The findings suggest that the VERA-2 is a valid instrument for measuring victim empathy among mentally disordered offenders, and may prove useful in the context of future risk assessment and outcomes in this population.
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Affiliation(s)
- S Young
- Imperial College London, Centre for Mental Health, London W6 8LN, UK; Broadmoor Hospital, Crowthorne, Berkshire RG45 7EG, UK; Reykjavik University, Iceland.
| | - O Sedgwick
- Broadmoor Hospital, Crowthorne, Berkshire RG45 7EG, UK; King's College London, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, UK
| | - D Perkins
- Broadmoor Hospital, Crowthorne, Berkshire RG45 7EG, UK
| | - H Lister
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, UK
| | - K Southgate
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, UK
| | - M Das
- Broadmoor Hospital, Crowthorne, Berkshire RG45 7EG, UK
| | - V Kumari
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, UK
| | - D Bishopp
- Broadmoor Hospital, Crowthorne, Berkshire RG45 7EG, UK
| | - G H Gudjonsson
- Broadmoor Hospital, Crowthorne, Berkshire RG45 7EG, UK; King's College London, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, UK; Reykjavik University, Iceland
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16
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Young S, Gudjonsson GH, Goodwin EJ, Jotangia A, Farooq R, Haddrick D, Adamou M. Beyond the Gates: Identifying and Managing Offenders with Attention Deficit Hyperactivity Disorder in Community Probation Services. AIMS Public Health 2014; 1:33-42. [PMID: 29666825 PMCID: PMC5903397 DOI: 10.3934/publichealth.2014.1.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/12/2014] [Indexed: 11/18/2022] Open
Abstract
Research has indicated that, compared with the general population, the prevalence of offenders with ADHD in prison is high. The situation for offenders managed in the community by the Probation Service is unknown. This study aimed to bridge the gap in our knowledge by (1) surveying the awareness of probation staff about ADHD and (2) screening the rate of offenders with ADHD managed within the service. In the first study, a brief survey was circulated to offender managers working in 7 Probation Trusts in England and Wales asking them to estimate the prevalence of offenders with ADHD on their caseload, the presenting problems of these offenders and challenges to their management, and the training received on the treatment and management of offenders with ADHD. The survey had a return rate of 11%. Probation staff perceived that 7.6% of their caseload had ADHD and identified this group to have difficulties associated with neuropsychological dysfunction, lifestyle problems and compliance problems. They perceived that these problems hindered meaningful engagement with the service and rehabilitation. Challenges to their management were perceived to be due to both internal processes (motivation and engagement) and external processes (inadequate or inappropriate interventions). Few respondents had received training in the management of offenders with ADHD and most wanted more support. In the second study, a sub-sample of 88 offenders in one Probation Trust completed questionnaires to screen for DSM-IV ADHD in childhood and current symptoms. The screen found an estimated prevalence of 45.45% and 20.51% for childhood and adulthood ADHD respectively and these were strongly associated with functional impairment. Thus probation staff considerably underestimated the likely rate, suggesting there are high rates of under-detection and/or misdiagnosis among offenders with ADHD in their service. The results indicate that screening provisions are needed in probation settings, together with training for staff.
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Affiliation(s)
- Susan Young
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Charing Cross Campus, Imperial College London, Claybrook Centre, 37 Claybrook Road, London W6 8LN, UK
- Broadmoor Hospital, Crowthorne, UK
| | - Gisli H Gudjonsson
- Broadmoor Hospital, Crowthorne, UK
- Institute of Psychiatry, King's College London, UK
| | | | - Amit Jotangia
- Institute of Psychiatry, King's College London, UK
- North London Forensic Service, Barnet, Enfield & Haringey Mental Health Trust, UK.
| | - Romana Farooq
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, UK
| | | | - Marios Adamou
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, UK
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17
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C-Y Yip V, Gudjonsson GH, Perkins D, Doidge A, Hopkin G, Young S. A non-randomised controlled trial of the R&R2MHP cognitive skills program in high risk male offenders with severe mental illness. BMC Psychiatry 2013; 13:267. [PMID: 24498962 PMCID: PMC3853927 DOI: 10.1186/1471-244x-13-267] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 10/10/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The growing popularity of offending behavior programs has led to the interest of whether such programs are effective with mentally disordered offenders. This study aimed to evaluate the effectiveness of the Reasoning and Rehabilitation program adapted for offenders with severe mental illness (R&R2 MHP). METHODS A sample of 59 adult high risk males detained in a high secure hospital completed questionnaires at baseline and post treatment to assess violent attitudes, anger, coping processes and social problem-solving. An informant measure of social and psychological functioning, including disruptive behavior, was completed by staff at the same time. The data of 30 patients who participated in the group condition were compared using intention to treat analysis with 29 controls who received treatment as usual. RESULTS 80% of group participants completed the program. In contrast to controls, significant medium-large treatment effects were found at outcome on self-reported measures of violent attitudes, social problem-solving and coping processes. Improvements were endorsed by informant ratings of disruptive behavior, social and psychological functioning. CONCLUSIONS The R&R2MHP had a comparatively low dropout rate and was effective in a sample of high risk mentally disordered offenders requiring detention in high security. Future research should use a randomized controlled design. TRIAL REGISTRATION Current Controlled Trials ACTRN12613000216718.
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Affiliation(s)
- Vivienne C-Y Yip
- Department of Forensic and Neurodevelopmental Sciences, PO23, King’s College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK,Broadmoor Hospital, Crowthorne, UK
| | - Gisli H Gudjonsson
- Broadmoor Hospital, Crowthorne, UK,Department of Psychology, PO77, King's College London, Henry Wellcome Building, De Crespigny Park, London SE5 8AF, UK
| | | | | | | | - Susan Young
- Department of Forensic and Neurodevelopmental Sciences, PO23, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
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18
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Rees-Jones A, Gudjonsson G, Young S. A multi-site controlled trial of a cognitive skills program for mentally disordered offenders. BMC Psychiatry 2012; 12:44. [PMID: 22607165 PMCID: PMC3464877 DOI: 10.1186/1471-244x-12-44] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 05/07/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The effectiveness of offending behaviour programs in forensic mental health settings is not well established. Thus this study aimed to evaluate the Reasoning and Rehabilitation Mental Health program (R&R2 MHP) among a mentally disordered offender (MDO) population. METHODS A sample of 121 adult males drawn from 10 forensic mental health sites completed questionnaires at baseline and post-treatment to assess violent attitudes, locus of control, social problem-solving and anger. An informant measure of social and psychological functioning, including disruptive behaviour, was completed by unit staff at the same time. At three month follow-up patients completed again the violent attitudes and locus of control questionnaires. The data of 67 patients who participated in the group condition were compared with 54 waiting-list controls who received treatment as usual. RESULTS 78% of group participants completed the program. In contrast to controls, significant treatment effects were found at outcome on self-reported measures of violent attitudes, rational problem-solving and anger cognitions. Improvements were endorsed by informant ratings of social and psychological functioning within the establishments. At follow-up significant treatment effects were found for both violent attitudes and locus of control. CONCLUSIONS R&R2 MHP was effective in a sample of MDOs and had a comparatively low drop-out rate. Future research should use a randomized controlled design.
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Affiliation(s)
- Angharad Rees-Jones
- University of Birmingham, Birmingham, UK,King's College London, Institute of Psychiatry, London, UK
| | | | - Susan Young
- King's College London, Institute of Psychiatry, London, UK
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