Predictive validity of the PCL-R for offenders with intellectual disability in a high security hospital: treatment progress.

Background: Among mainstream offenders, the severe personality disorder of psychopathy has considerable importance as a construct. The disorder has long been associated with failure to make treatment progress. Previous work has identified that psychopathy as a disorder occurs in samples of offenders with intellectual disability (ID), and suggests that the Psychopathy Checklist - Revised (PCL-R: Hare, 1991, 2003) as a measure of the disorder has adequate reliability and validity (Morrissey et al.

Characteristics of offenders referred to a medium secure NHS personality disorder service: the first five years.

Background: As new services for offenders with personality disorder emerge in the UK, there is interest in the methods of assessments and characteristics of patients admitted.

Aim: To evaluate use of selection criteria for admission to a dedicated personality disorder service within medium secure hospital provision in the UK, and to test for features that discriminate between those admitted and those rejected.

Method: A structured multidisciplinary assessment was administered to offenders referred to a new personality disorder service in a medium secure psychiatric unit.

Convergent validity of the aberrant behavior checklist and behavior problems inventory with people with complex needs.

The current study aimed to replicate and extend Rojahn et al. [Rojahn, J., Aman, M.

How is personality disorder linked to dangerousness? A putative role for early-onset alcohol abuse.

This paper questions the assumption that personality disorder and dangerousness are causally linked, and suggests that insofar as a relationship between them exists, it is mediated by early-onset alcohol abuse. The latter, by impairing the function of prefrontal cortex during adolescence, a critical period of its development, putatively leads to deficits in goal-directed behaviour and emotional self-regulation that place the individual at high risk of becoming chronically antisocial in adulthood. Evidence is adduced in support of the hypothesis from the literature on: (i) the comorbidity of personality disorder and alcohol abuse; (ii) frontal lobe deficits in psychopaths; and (iii) life-course persistent offenders.

Professionalizing action research--a meaningful strategy for modernizing services?

Background: This paper outlines how a specific action research approach can be used to secure practice development in services which have found sustained change difficult. For the purpose of this paper discussion focuses upon using professionalizing action research (a form of action research) to secure transformation in acute inpatient mental health services. This speciality has experienced long-term difficultly in meaningful practice change.

Sex offenders' response to treatment and its association with recidivism as a function of psychopathy.

This study examined the relationship between recidivism and ratings of response to specialized cognitive behavioral treatment conducted in a prison setting among 418 sex offenders released to the community for an average follow-up period of over 5 years. As well as testing for a main effect for treatment ratings, the potential role of psychopathy assessed using the Psychopathy Checklist--Revised (PCL-R) as a moderator of response to treatment was investigated. Ratings of response to treatment failed to predict either serious (violent including sexual) or sexual recidivism.

A comparison of offenders with intellectual disability across three levels of security.

Background: A number of authors have described, with disparate results, the prevalence of people with intellectual disability and their characteristics, in a range of offender cohorts defined by service use. These have included high security, a range of criminal justice services and community services. There is a need for research comparing cohorts of offenders with intellectual disabilities across different settings.

Dose-effect relations and responsive regulation of treatment duration: the good enough level.

This study examined rates of improvement in psychotherapy as a function of the number of sessions attended. The clients (N=1,868; 73.1% female; 92.

Does the non-randomized controlled study have a place in the systematic review? A pilot study.

Background: A major issue in any systematic review is deciding which trials or studies to include and which to exclude. The Cochrane Collaboration and similar respected organizations have traditionally viewed the randomized trial (RCT) as the only acceptable evidence on treatment outcome. However, many systematic reviews are indeterminate because they include insufficient RCTs whilst they reject large numbers of non-randomized controlled studies.

Prosecuting psychiatric inpatients--where is the thin blue line?

Violence by psychiatric inpatients is under-reported and the involvement of the police is limited. No research has specifically investigated the views of the police force in this area. Ten senior police officers were interviewed using a semi-structured format to elucidate their views.

Parental loss before the age of 16 years: a comparative study of patients with personality disorder and patients with schizophrenia in a high secure hospital's population.

There is a considerable body of literature supporting an association between separation from parent in childhood and later personality disorder. This study compares a 10-year cohort of high secure hospital patients who had either a personality disorder or schizophrenia, but with no other significant psychiatric comorbidity. The information source was the Special Hospitals Case Register.

Sertraline as a treatment for PTSD: a systematic review and meta-analysis.

Objective: Post-traumatic stress disorder (PTSD) is one of the most prevalent psychological disorders. Methods to alleviate its symptoms range from 'talking therapies' to pharmaceutical interventions. Our objective was to carry out a systematic review of the effectiveness of sertraline, an SSRI, as a treatment for PTSD.

Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: a pragmatic and non-contemporaneous comparison.

Objective: To examine the effectiveness of an eighteen-month treatment based on dialectical behaviour therapy (DBT) targeting anger and violence, on a group of male forensic patients.

Method: Eight male forensic patients in a high security hospital who met the criteria for borderline personality disorder measured by the Personality Assessment Inventory underwent 18 months of treatment. They completed three psychometric tests at pre-, mid- and post-treatment and at a six-month follow up.

Motivating factors for male forensic patients with personality disorder.

Introduction: Treatability is currently a crucial component for detention under the Mental Health Act (England and Wales) for the Psychopathic Disorder (personality disorder) classification and there is continuing debate about the nature and assessment of treatability of individuals with personality disorder. Previous research has identified motivation to engage in treatment as a significant factor in the assessment of treatability; however, motivation is not a static predictor but a state of readiness or eagerness to change, which may fluctuate from one time or situation to another. While previous studies have explored factors within the individual that are used to assess treatability, this study aims to explore what, if any, aspects of an inpatient forensic setting influence patients' motivation to engage in treatment.

Experiences of parents with a son or daughter suffering from schizophrenia.

Parents of 22 patients diagnosed with schizophrenia, and receiving care in a secure forensic setting, were interviewed to elicit their views on the causes of the disorder, the emotional burden and the helpfulness of others when seeking support. Pathological parenting theories of causation were rated the least important, and biological and life-event models the most. Stress, loss and fear were the most commonly reported reactions.

The voice of detainees in a high security setting on services for people with personality disorder.

Background: British government Home and Health Departments have been consulting widely about service development for people with ' dangerous severe personality disorder' (DSPD). There has, however, been no consultation with service users, nor is there any user view literature in this area.

Methods: All people detained in one high security hospital under the legal classification of psychopathic disorder were eligible but those on the admission or intensive care wards were not approached.

The importance of good record-keeping for nurses.

Good record-keeping is a mark of the skilled and safe practitioner, yet allegations concerning shortcomings in nurses' record-keeping were the second most common category of hearing brought before the UKCC in 2000-2001. The absence of accurate records makes it difficult for practitioners to prove they provided appropriate care should they be asked to do so in a professional or legal hearing. This is particularly pertinent since litigation against health professionals is increasing rapidly.

Boxing clever.

Debates about banning boxing crop up regularly. Organisations representing nurses, such as the RCN and Unison, have generally steered clear of a formal position on the subject, however the British Medical Association favours a total ban. Its arguments concentrate on the possible adverse medical consequences, but ignore sociological, cultural and alternative ethical viewpoints.

Significance-testing the validity of idiographic methods: a little derangement goes a long way.

We present an experimental design for validating idiographic data and the mathematical basis for subjecting this to statistical hypothesis testing. The method involves matching descriptions of four or more objects to the people from which they arose. If four or more can be matched, this is unlikely (p < 0.

Proposals for managing dangerous people with severe personality disorder: new legislation and new follies in a historical context.

Current proposals in England and Wales to ' capture' an ill-defined group of anti-social and violent people within the widest possible definition of mental disorder, and thereby to detain them under proposed new mental health legislation, is criticized and critiqued on intellectual, ethical and pragmatic grounds. The view is taken that psychiatrists must utterly reject these proposals which, if adopted, would make them primarily agents of social control. Psychiatrists and other mental health professionals must fight to retain the essentials of ethical and effective treatment earned trust and primary responsibility to the individual patient which these proposals seek to undermine and pervert.

Risk assessment in offenders with intellectual disability: the evidence base.

A review of the current literature on risk assessment and management in offenders with intellectual disability (ID) revealed little direct evidence for the specific population. Theoretical models and non-ID populations have been abstracted and adapted, but not validated, for those with ID. The varying conceptual frameworks of risk, and its assessment and management, must be considered in context.