The Factor Structure and Validity of the Psychopathy Checklist-Short Version When Used With Autistic Psychiatric Inpatients.

The Psychopathy Checklist Short Version (PCL:SV) is a brief measure of psychopathy. This study aimed to assess the reliability and validity of the PCL:SV with autistic adults detained in inpatient psychiatric care. Data were collected from 282 autistic adults at two time points separated by 12-months.

The effect of environmental change, planned and unplanned life events on the long-term outcome of common mental disorders.

Purpose: To examine the nature of positive and negative environmental change on clinical outcome in 210 patients presenting with anxiety and depression and followed up over 30 years.

Methods: In addition to clinical assessments, major environmental changes, particularly after 12 and 30 years, were recorded in all patients by a combination of self-report and taped interviews. Environmental changes were separated into two major groups, positive or negative, determined by patient opinion.

Matching ICD-11 personality status to clinical management in a community team-The Boston (UK) Personality Project: Study protocol.

Epidemiological studies show 30% to 50% of all patients in community mental health teams have personality disorders. These are normally comorbid with other psychiatric disorders, often as Galenic syndromes, and are seldom identified. In the Boston (UK) Personality Project all patients under a community health service in Boston in Lincolnshire will be asked to agree to have their personality status assessed using scales recording the new ICD-11 classification, together with clinical ratings, social function and satisfaction.

Galenic syndromes: combinations of mental state and personality disorders too closely entwined to be separated.

Many mental disorders are linked to personality, but this is rarely recognised in clinical practice. It is suggested here that when the links are very close, the two can be joined. Galenic syndromes are so named because Galen was the first physician to recognise the links between personality and disease.

Specialist teams as constituted are unsatisfactory for treating people with personality disorders.

It is now becoming standard practice in most advanced economies to provide specialist services for those with personality disorder. Such services, almost exclusively, provide complex well-structured psychological interventions lasting many months for a small number of those with borderline personality disorder pathology. The evidence suggests that these treatments are effective but they can only be provided for a small number of people.

A comparison of long-term medium secure patients within NHS and private and charitable sector units in England.

Background: In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital services were conceived as for up to 2 years' inpatient stay, but numbers of longer stay patients have been rising.

Looking from the outside: No substitute for rigorous evaluation.

Looking in from the outside, what would the ordinary person expect of forensic mental health services? I suggest that there are three questions he or she would ask: (a) Are there public health measures that can be introduced to prevent those with mental disorder going on to commit crimes? (b) Can we identify in advance the individual who is likely to go on and commit a violent act because of his or her mental health difficulties, and prevent that or limit damage? (c) If a seriously harmful act has already been committed, what interventions might prevent a repetition? All of these questions are about prevention of an untoward event in the future and anticipate knowledge. How secure can we be that current forensic mental health practitioners can make adequately evidenced responses? I fear that examination of current literature would indicate that they and their academic colleagues would fall short of these expectations. Reasons for this are undoubtedly numerous.

Executive function, attention, and memory deficits in antisocial personality disorder and psychopathy.

Antisocial personality disorder (ASPD) and psychopathy attempt to represent individuals demonstrating callousness and disregard for others. ASPD has been criticized for capturing a heterogeneous population whilst missing the essence of the diagnosis by neglecting interpersonal/affective deficits which measures of psychopathy include. This heterogeneity in operationalizations has led to diverse findings without clear understanding of what characterizes this broader population.

Characteristics and Pathways of Long-Stay Patients in High and Medium Secure Settings in England; A Secondary Publication From a Large Mixed-Methods Study.

Many patients experience extended stays within forensic care, but the characteristics of long-stay patients are poorly understood. To describe the characteristics of long-stay patients in high and medium secure settings in England. Detailed file reviews provided clinical, offending and risk data for a large representative sample of 401 forensic patients from 2 of the 3 high secure settings and from 23 of the 57 medium secure settings in England on 1 April 2013.

Psychoeducation and Problem Solving (PEPS) Therapy for Adults With Personality Disorder: A Pragmatic Randomized-Controlled Trial.

We compared psychoeducation and problem solving (PEPS) therapy against usual treatment in a multisite randomized-controlled trial. The primary outcome was social functioning. We aimed to recruit 444 community-dwelling adults with personality disorder; however, safety concerns led to an early cessation of recruitment.

A systematic review and synthesis of outcome domains for use within forensic services for people with intellectual disabilities.

Background: There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals.

Aims: This study identified and developed the domains that should be used to measure treatment outcomes for this population.

Method: A systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis.

Managing uncertainty in the clinical prediction of risk of harm: Bringing a Bayesian approach to forensic mental health.

Predicting the likelihood of harm posed by mentally disordered offenders remains controversial. It is proposed that a Bayesian approach may help quantify the uncertainty surrounding such prediction. An example of this approach quantifying the risk of breast cancer in the event of a positive mammogram is provided.

Psychoeducation with problem-solving (PEPS) therapy for adults with personality disorder: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manualised intervention to improve social functioning.

Background: If effective, less intensive treatments for people with personality disorder have the potential to serve more people.

Objectives: To compare the clinical effectiveness and cost-effectiveness of psychoeducation with problem-solving (PEPS) therapy plus usual treatment against usual treatment alone in improving social problem-solving with adults with personality disorder.

Design: Multisite two-arm, parallel-group, pragmatic randomised controlled superiority trial.

Iatrogenic harm from psychological therapies--time to move on.

The problem of adverse effects of psychotherapy has been recognised for decades, yet research on causes and prevention of harm has failed to progress. There is confusion between different definitions and a lack of systematic recording and reporting. A new framework for moving this field forward is proposed.

Pharmacological interventions for those who have sexually offended or are at risk of offending.

Background: Sexual offending is a serious social problem, a public health issue, and a major challenge for social policy. Victim surveys indicate high incidence and prevalence levels and it is accepted that there is a high proportion of hidden sexual victimisation. Surveys report high levels of psychiatric morbidity in survivors of sexual offences.

Development and validation of a treatment progress scale for personality disordered offenders.

Background: There is a need for a measure to evaluate change in treatment for offenders with a personality disorder, and the Progress Rating Scale (PRS) was developed to meet this need taking account of multiprofessional input.

Method: The PRS comprises six process and five non-process items developed via thematic analysis of routine CPA patient treatment reports at a forensic Personality Disorder Service. Rating for items was fully standardized and operationalized with revisions aiming to maximize inter-rater agreement reflecting good face and content validity.

The recording of adverse events from psychological treatments in clinical trials: evidence from a review of NIHR-funded trials.

Background: There is a concern in the literature that harm from interventions is insufficiently documented in clinical trials in general, and in those assessing psychological treatments in particular. A recent decision by a trial steering committee to stop recruitment into a randomized controlled trial (RCT) of a psychological intervention for personality disorder led to an investigation of the recording of harm in trials funded by the National Institute for Health Research (NIHR).

Methods: The protocols and final reports of all 82 NIHR trials funded between 1995 and 2013 were examined for the reporting of adverse events.

Defence styles in a sample of forensic patients with personality disorder.

Background: Ego defences, often considered central to clinical work, have received surprisingly little attention in the forensic literature.

Method: In this exploratory study, 114 male inpatients completed the Defence Style Questionnaire (DSQ) following their admission to a specialist personality disorder (PD) service. Change in DSQ scores over time was examined using mixed effects models for those (n = 48) remaining in treatment for at least 18 months.

The influence of admission characteristics on outcome: evidence from a medium secure forensic cohort.

Objective: Outcomes for any mental health service will vary with the characteristics of those admitted as well as with the clinical provision of the service itself. This study aims to explore, for a medium secure forensic service in England, temporal changes in (1) characteristics of those admitted and (2) outcome after discharge and (3) to examine whether such changes are related.

Method: Baseline characteristics and reconviction outcomes were derived from multiple data sources for 550 first admissions to a medium secure forensic unit for a 20-year period.

Re-offending in forensic patients released from secure care: the role of antisocial/borderline personality disorder co-morbidity, substance dependence and severe childhood conduct disorder.

Background: Research suggests that a particular externalising phenotype, manifested in a developmental trajectory from severe childhood conduct disorder through early-onset substance abuse to adult antisocial/borderline personality disorder co-morbidity, may increase risk of antisocial behaviour in general and criminal recidivism in particular.

Aim: This study aims to test the hypothesis that antisocial/borderline co-morbidity together with the triad of substance dependence, severe conduct disorder and borderline pathology would result in an increased risk of criminal recidivism.

Methods: Fifty-three men who had been assessed and treated in a secure hospital unit were followed up after they had returned to the community.

Psychological interventions for adults who have sexually offended or are at risk of offending.

Background: Sexual offending is a legal construct that overlaps, but is not entirely congruent with, clinical constructs of disorders of sexual preference. Sexual offending is both a social and a public health issue. Victim surveys illustrate high incidence and prevalence levels, and it is commonly accepted that there is considerable hidden sexual victimisation.