The Nepean Belief Scale (NBS) as a tool to investigate the intensity of beliefs in anorexia nervosa: psychometric properties of the Italian version

BACKGROUND

People with anorexia nervosa (AN) show a peculiar impairment of insight regarding their condition, often manifesting a denial of extreme emaciation and sometimes hiding or underreporting socially undesirable abnormal eating patterns. Sometimes the intensity of the beliefs held by patients with AN reach a delusional intensity.

OBJECTIVES

In this study, the Italian version of the Nepean Belief Scale was applied to a sample of patients diagnosed with AN to investigate the intensity of their beliefs and convictions and its clinical correlates.

METHODS

The Nepean Belief Scale (NBS) was translated and adapted to Italian and applied to a sample of patients diagnosed with AN based on the Structured Clinical Interview for DSM-5 (SCID-5).

RESULTS

The Italian version of the 5-item NBS showed excellent reliability. Convergent validity was proved by negative association with levels of insight measured with the Schedule for the Assessment of Insight in Eating Disorders. Beliefs of delusional intensity were reported by 10% of participants. Those with a greater intensity of beliefs, either overvalued or delusional ideas, were more likely to report poorer general cognitive performances on the Montreal Cognitive Assessment. No association was observed between NBS score and age, body mass index, symptoms of eating disorders, body dissatisfaction, or levels of depression. Fear of weight gain and control seeking were the most often reported themes at the NBS.

CONCLUSIONS

The Italian version of the NBS is a reasonably reliable, valid, and usable tool for the multidimensional assessment of insight in AN. Level of evidence Level III, Evidence obtained from well-designed cohort or case-control analytic studies.

Exploration of factors influencing court outcomes in cases involving minors as victims in Ghana

BACKGROUND

The factors that influence positive court outcomes for cases of child sexual abuse (CSA) have been studied in other contexts but very few such studies exist for Sub-Saharan countries. Knowledge of how such cases fare in these court systems is, however, important for a global assessment of such outcomes.

OBJECTIVE

The study explored the predictive effect of the victim, complainant; offender and offence characteristics, and length of the trial on case disposition and dropout.

METHODS, PARTICIPANTS AND SETTING

Three hundred and eighty-nine (389) closed court files related to child sexual abuse in Ghana were reviewed and analyzed.

RESULTS

The findings show that the number of court sittings (length of trial) and complainant characteristics predict negative outcomes for CSA cases in Ghana. Specifically, convictions were less likely to occur where caregivers were the complainants (OR = 0.45), and when there were longer court sittings (OR = 0.95). Victim, offender, and offence characteristics, however, did not influence case outcomes.

CONCLUSIONS

This study is one of the first studies using actual court data to predict the outcome of cases in CSA in Ghana, and makes recommendations for the support of children and caregivers through the court process.

The effects of forensic mental health reports on decisions about guilt in the Netherlands: An experimental approach

In the Netherlands, in approximately 30% of the more serious criminal cases, a pretrial forensic mental health report (FMHR) is requested to inform the court whether a mental disorder was present at the time of alleged crime, whether this disorder affected behavior and decision-making at the time of the offense and how this disorder may affect future (criminal) behavior. While informative for sentencing decisions, information about mental disorders or risk is irrelevant for the question whether the defendant committed the alleged crime. Yet based on cognitive psychological theory of evidence evaluation and integration, we hypothesized that information in an FMHR would affect the evaluation of evidence as well as the ultimate decision about guilt. Using an experimental vignette study among 200 law and criminology students with manipulation of the presence and content of an FMHR, we found a main effect of the presence of an FMHR report on decisions about guilt. The proportion of guilty verdicts increased with almost 20% when an FMHR was present compared to when this report was absent, irrespective of the type of disorder (schizophrenia or personality disorder) or level of recidivism risk (low or high) present in the report. We did not find support for our hypothesis that this effect could be explained by assimilation of other available evidence. Implications for further research and practice are discussed.

A detailed analysis of pediatric surgical malpractice claims in Germany: what is the probability of a pediatric surgeon to be accused or convicted?

AIM OF THE STUDY

Pediatric surgeons treat a vulnerable population in which unfavorable outcome can lead to substantial long-term costs, placing them at risk for malpractice claims. This study aims to characterize the frequency and circumstances in which malpractice claims were successfully brought against pediatric surgeons in Germany over the last 5 years.

MATERIALS AND METHODS

Anonymous data on medical treatment errors and payments were acquired from the Federal Chamber of Physicians from 2014 through 2018 and analyzed for most frequent diagnoses and circumstances that resulted in accusation or conviction. Those claims that were successfully rebutted were compared to as controls. Lifetime risk for being involved in litigation and its outcome was calculated.

RESULTS

There were 129 medical malpractice claims over the 5-year observation period. Medical error was confirmed in 56 cases (43%); the rest were successfully appealed. The risk of the prototypical German pediatric surgeon to be accused was 5.24% and to be convicted 2.27% per year in practice. The most common reasons for conviction (alone or in combination) were surgical-technical errors (23%), treatment delay (21%), insufficient workup (17%), incorrect diagnosis (17%), and incomplete consent (16%).The most frequent circumstances leading to a conviction were trauma (27%), inguinal hernia (7%), circumcision (7%), testicular torsion (7%), acute abdomen (7%), and appendicitis (5%).

CONCLUSION

Over a 40-year career, pediatric surgeons in Germany face an average calculated risk of 2.1 to be accused and 0.9 to be convicted of malpractice claims. Certain circumstances pose higher risks for litigation than others. Knowledge of these patterns may help practitioners avoid medicolegal confrontation.

How much would eliminating drug crimes decrease racial/ethnic gaps in criminal conviction?

Since the 1970s, criminal justice contact has become an increasingly common event in early adulthood, and disproportionately so for African American men. Policymakers often argue that reducing drug-related conviction rates is among the easiest ways to reduce racial/ethnic disparities in incarceration. These arguments are often backed by statistics that convey the number of drug offenders in contact with the criminal justice system at a given point in time. Unfortunately, we know little about the extent to which over-time conviction risk and associated racial/ethnic disparities may be affected by drug-related policy changes. Using a novel application of the single decrement life table to analyze data from the National Longitudinal Survey of Youth 1997 (NLSY97), I present a quantitative thought experiment to consider the extent to which the elimination of drug-related offenses would affect racial/ethnic disparities in men's cumulative probability of conviction by age 30. Consistent with prior research, results indicate that black men are at disproportionately higher risk of ever experiencing a drug-related conviction, and of experiencing a drug-related conviction at each conviction instance. More surprising, however, is the finding that while the removal of drug sentencing may significantly impact racial/ethnic disparities associated with conviction, only a relatively small proportion of those ever convicted would avoid conviction altogether in the absence of drug-related sentencing.

Relevance of medical reports in criminal investigations of cases of suspected child abuse

If a case of physical child abuse is suspected in Germany, the general feeling is often that "it does not matter whether you make a report or not" because, generally, no conviction is made anyway. This study investigates the juridical analysis of complaint cases of physical child abuse [criminal complaint parag. 225 StGB (German penal code) with filial victim]. It focuses on the doctor's role and the impact of their practice in relation to a later conviction. It is based on the analysis of 302 files of the enquiry from 2004-2009 from the department of public prosecution in Cologne, Germany. Besides general epidemiological data on the reporting person, the affected child and the presumed offender, the documents were reassessed for the relevance of medical reports for successful convictions. Only 7% (n = 21) of 302 complaints led to a conviction. In 38.1% (n = 8) of those cases, a medical report was mentioned as a piece of evidence, and just in two cases a (legal) medical report was quoted and mentioned as relevant for the conviction. 50% of the complaint cases with legal medical expertise led to a trial. In contrast, only 30.2% with a common medical report and 7.3% without a report led to a trial. The results show how a medical report existed in only a few cases. In those cases, the rate of performed trials was higher than for those without a medical report, but the report played a minor part when reasoning a verdict.

Subjective competence breeds overconfidence in errors in psychosis. A hubris account of paranoia

BACKGROUND AND OBJECTIVES

Overconfidence in errors is a well-replicated cognitive bias in psychosis. However, prior studies have sometimes failed to find differences between patients and controls for more difficult tasks. We pursued the hypothesis that overconfidence in errors is exaggerated in participants with a liability to psychosis relative to controls only when they feel competent in the respective topic and/or deem the question easy. Whereas subjective competence likely enhances confidence in those with low psychosis liability as well, we still expected to find more 'residual' caution in the latter group.

METHODS

We adopted a psychometric high-risk approach to circumvent the confounding influence of treatment. A total of 2321 individuals from the general population were administered a task modeled after the "Who wants to be a millionaire" quiz. Participants were requested to endorse one out of four response options, graded for confidence, and were asked to provide ratings regarding subjective competence for the knowledge domain as well as the subjective difficulty of each item.

RESULTS

In line with our assumption, overconfidence in errors was increased overall in participants scoring high on the Paranoia Checklist core paranoia subscale (2 SD above the mean). This pattern of results was particularly prominent for items for which participants considered themselves competent and which they rated as easy.

LIMITATIONS

Results need to be replicated in a clinical sample.

DISCUSSION

In support of our hypothesis, subjective competence and task difficulty moderate overconfidence in errors in psychosis. Trainings that teach patients the fallibility of human cognition may help reduce delusional ideation.

Changes in delusional dimensions and emotions over eight weeks of antipsychotic treatment in acute patients

Delusional experiences can be considered on a range of dimensions including conviction, distress, preoccupation, and disruption, which have been shown to be related to depression and anxiety. This study aimed to test the hypotheses that delusional conviction is less responsive to antipsychotic treatment than delusional distress and preoccupation, and that depression and anxiety reduce alongside improvements in delusional dimensions. Forty acutely ill inpatients with delusions were assessed during their early stage of antipsychotic treatment. Interview data were analysed using mixed models for repeated measures. There was a significant reduction in psychotic symptoms over eight weeks, after controlling for baseline dosage of antipsychotics. We found no differential rate of improvement across delusional dimensions, and all dimensions improved over time. However, conviction ratings remained relatively high throughout the eight weeks. There was no significant improvement in anxiety and depression, and delusional preoccupation covaried with anxiety and depression throughout eight weeks, suggesting a relationship between emotional and delusional processes during the early recovery phase of psychosis.