Caroline Greaves

Predictors and profiles of treatment non-adherence and engagement in services problems in early psychosis

Treatment adherence in early psychosis individuals is considered problematic. Some studies have tried to understand reasons for medication non-adherence in this population, though few have also considered engagement in services. We conducted a cross-sectional study with 118 early psychosis individuals, assessing multiple constructs (symptoms, insight, personality traits, alliance, childhood trauma, substance abuse, social functioning and sociodemographics) suggested in the literature as potentially linked to medication adherence or engagement in services. Forward Wald logistic regression suggested that more positive symptoms, having witnessed violence as a child and high agreeableness as a personality trait predicted poor medication adherence. Forward linear regression revealed that physical abuse as a child, lack of knowledge regarding consumer rights, difficulties in building an alliance, low neuroticism and high agreeableness predicted poor service engagement. Profiles of non-adherers or low service engagement were strongly linked to childhood trauma, and high agreeableness, as well as more severe symptoms and poor alliance. Males with histories of legal problems were also more prevalent in both groups. No significant differences were found for insight or substance abuse. Overall, individuals with early psychosis who adhered less to treatment in general could have issues with trusting authority and place more importance on peer acceptance. Results are presented in light of the existing literature and clinical implications are discussed.

Forensic psychiatric inpatients and aggression: an exploration of incidence, prevalence, severity, and interventions by gender.

BACKGROUND Previous investigations suggest that women judged to be not criminally responsible on account of mental disorder (NCR-MD) differ markedly from their male counterparts in important ways, underscoring the necessity of subsequent study. OBJECTIVE The goal of the present study was to inform our understanding of the presenting profile of female forensic psychiatric patients and contrast their risk of inpatient aggression with their male counterparts. METHOD The population of patients assessed and/or treated at a secure Canadian forensic psychiatric hospital were available for study. In total, 527 patients had complete data and were part of intensive retrospective file reviews; inpatient aggression was evaluated using the Overt Aggression Scale. RESULTS Women were no less likely than men to have a violent index offence and to perpetrate inpatient aggression. Examining the range of aggressive behaviours and severity levels did little to increase the relevance of gender to inpatient risk. DISCUSSION Female forensic patients represent a highly selected subgroup of women with exceptional clinical and behavioural challenges and associated treatment needs.

Early psychosis and aggression: Predictors and prevalence of violent behaviour amongst individuals with early onset psychosis

Studies in the area of psychosis and violence to date suggest that those who suffer from psychosis are at higher risk for perpetration of such aggressive behaviours. In fact, it has been suggested that variables such as substance use and personality may mediate this relationship. Other variables, such as childhood physical abuse, might also be implicated in the etiology. In the current study, a sample of one hundred and eighteen participants with a primary diagnosis of psychosis were interviewed and prevalence rates for aggressive experiences were as follows: history of trouble with the law (45%), history of emotional abuse (9.6%), physical abuse (38.8%), and sexual abuse (60.2%). With regard to perpetration, 69.6% reported verbal or physical aggression (69.6%), and further, 61% reported problems with substances. Logistic regression procedures were used with a number of the variables under study and relationships were evidenced between psychopathy scores, history of abuse, and regular drug use. History of child abuse was related to violence history, with those who were victims of child abuse being more likely to be violent in later life. In addition higher scores on the psychopathy measure were linked with violence history. This study was a first step towards identifying persons suffering from a mental illness who may be at risk for violence by identifying who, among first episode clients, may be more likely to perpetrate violent behaviours. Targeted interventions and strategies may be further refined so that individuals receiving mental health services may be better served.

Resilience and successful community reintegration among female forensic psychiatric patients: A preliminary investigation

Research on resiliency and recovery in forensic psychiatric patients is still limited. Information pertaining to factors associated with successful community reintegration would contribute to a more comprehensive assessment of functioning and informed treatment planning that fits within a recovery approach of service provision. Using a retrospective design involving file reviews and a 3-year follow-up period, the authors investigated the rate of successful/unsuccessful community reintegration (defined by the presence or absence of an absolute discharge/readmission to hospital) in female forensic psychiatric patients (N = 48). The study evaluated the extent to which the risk and protective factors captured in the Short-Term Assessment of Risk and Treatability (START) predicted a range of positive and negative outcomes in the study sample. Results showed that 47.9% of the women qualified as having successfully reintegrated into the community, with the remaining 52.1% qualifying as still being in recovery. Successful individuals possessed significantly more protective factors and significantly fewer risk factors than individuals still in recovery. Furthermore, both the vulnerability and the strength scale of the START demonstrated good predictive validity, however we did not find evidence of incremental validity of the strength scale.

What Influences Perceptions of Procedural Justice Among People with Mental Illness Regarding their Interactions with the Police

According to procedural justice theory, a central factor shaping perceptions about authority figures and dispute resolution processes is whether an individual believes they were treated justly and fairly during personal encounters with agents of authority. This paper describes findings from a community-based participatory research study examining perceptions of procedural justice among sixty people with mental illness regarding their interactions with police. The degree to which these perceptions were associated with selected individual (e.g., socio-demographic characteristics), contextual (e.g., neighborhood, past experiences), and interactional (e.g., actions of the officer) factors was explored. The results of regression analyses indicate that the behavior of police officers during the interactions appears to be the key to whether or not these interactions are perceived by people with mental illness as being procedurally just. Implications of these findings for improving interactions between the police and people with mental illness are discussed.

'Wasn't me!' A field study of the relationship between deceptive motivations and psychopathic traits in young offenders

Purpose. Evaluating truthfulness is an integral part of any forensic assessment. Unfortunately, the motives underlying the use of deceptive strategies by offenders and how these may be mediated by personality are not well established, particularly in adolescent samples. Accordingly, the aim of the present study was to identify different deception-related motivations in a sample of juvenile offenders, with special emphasis placed on the relationship between these motivations and psychopathic traits.Methods. Archived file and videotaped information for 60 Canadian federal juvenile offenders were reviewed in order to identify real-life (spontaneous) patterns of deceptive motivations.Results. It was found that there were significant differences between the low, medium, and high groups across psychopathic traits for the motivations of (1) lies to obtain a reward; (2) to heighten self-presentation; and (3) for duping delight.Conclusions. Not only were juvenile offenders found to lie for a variety of reasons, but also psychopathy was found to mediate the specific motivational patterns leading to offender perpetrated deception. The relevance of these findings to the assessment of truthfulness in offender populations is discussed. Language: en

A comparison of treatment adherence in individuals with a first episode of psychosis and inpatients with psychosis.

In predicting treatment compliance in individuals with severe mental illness, research has focused on variables such as substance abuse, personality, history of child abuse, and symptomatology, although these relationships have not been investigated in great detail in individuals at the onset of mental illness. To better understand these correlates of treatment compliance, two samples were examined: a sample of 117 individuals presenting with a first episode of psychosis and a more chronic forensic sample of 65 participants recruited from a psychiatric hospital. These samples were investigated for service engagement in terms of violence history, substance abuse, symptom severity, psychopathic traits and history of childhood abuse. Linear regressions performed for the first episode sample revealed that childhood physical abuse was the strongest predictor of poor service engagement, followed by problems with alcohol, a history of physical violence, any history of violence and higher psychopathic traits. Linear regression revealed for the forensic group that a lower level of service engagement was most strongly predicted by a history of childhood abuse and a higher score on the Brief Psychiatric Rating Scale (BPRS). Results are presented in light of the existing literature and clinical implications are discussed.