Erik Bulten

Effects of nutritional supplements on aggression, rule-breaking, and psychopathology among young adult prisoners.

In an earlier study, improvement of dietary status with food supplements led to a reduction in antisocial behavior among prisoners. Based on these earlier findings, a study of the effects of food supplements on aggression, rule-breaking, and psychopathology was conducted among young Dutch prisoners. Two hundred and twenty-one young adult prisoners (mean age=21.0, range 18-25 years) received nutritional supplements containing vitamins, minerals, and essential fatty acids or placebos, over a period of 1-3 months. As in the earlier (British) study, reported incidents were significantly reduced (P=.017, one-tailed) in the active condition (n=115), as compared with placebo (n=106). Other assessments, however, revealed no significant reductions in aggressiveness or psychiatric symptoms. As the incidents reported concerned aggressive and rule-breaking behavior as observed by the prison staff, the results are considered to be promising. However, as no significant improvements were found in a number of other (self-reported) outcome measures, the results should be interpreted with caution.

Measuring criminal thinking styles: The construct validity and utility of the PICTS in a Dutch prison sample

Purpose: Criminal thinking and thinking styles are important areas in the assessment and treatment of offenders. The Psychological Inventory of Criminal Thinking Styles (PICTS: Walters, 2005) is designed to assess such criminal thinking styles. In the current study, the associations between criminal thinking styles on the one hand, and criminal histories, personality traits, and mental disorders of Dutch prisoners on the other, were explored. The aim is to test the reliability and construct validity of the PICTS in a population of male Dutch detainees. Methods: A sample of 191 randomly selected male prisoners of a large Dutch correctional institution were assessed by means of the PICTS, NEO-PI-R, and the MINI psychiatric interview. Prison inmates with very severe psychiatric symptoms and severe disruptive behaviours were excluded. Results: The psychometric qualities of the PICTS were found to be fair-to-good. The construct validity of the PICTS was supported by various convergent results with the criminal antecedents of the offenders, as well as with the scores on the scales measuring personality traits and psychiatric disorders. Conclusions: The associations between criminal thinking styles on the one hand and personality traits, antisocial personality disorder, and mental disorders on the other were rather strong. The current results suggest that the PICTS may be a valid and useful tool for assessing criminal thinking styles.

Demographic and Personality Characteristics of Internet Child Pornography Downloaders in Comparison to Other Offenders

This research study was conducted to map out the demographic and psychological aspects of Internet child pornography offenders. The backgrounds, characteristics, and MMPI profiles of 22 Internet child pornography offenders were statistically compared to those of 112 perpetrators of other offenses. In comparison to the other sexual offenders, the Internet child pornography offenders turned out to be significantly younger on average, were single and lived alone in most cases, and more often appeared to have no children of their own. It should be noted that the variables of age, being single, living alone, and not having children are associated to one another. Furthermore, no specific MMPI profile was found for Internet child pornography offenders compared to other sexual offenders.

Assessing Aggressive Behavior in Forensic Psychiatric Patients: Validity and Clinical Utility of Combining Two Instruments

OBJECTIVES Accurate observation of aggressive behavior among forensic psychiatric patients requires valid instruments. This study examines the validity and clinical utility of combining the social dysfunction and aggression scale (SDAS) and staff observation aggression scale revised (SOAS-R). METHODS Nurses weekly obtained SDAS scores of 127 patients, resulting in 6.124 assessments. Aggressive incidents were documented by the SOAS-R. Internal consistency, subscale structure, interobserver reliability of the SDAS, and convergent validity with SOAS-R were analyzed. CONCLUSION A three-factor solution was found. Interobserver reliability was moderate, and good convergent validity was found. The SDAS, in conjunction with the SOAS-R, monitors changes in aggressiveness and may contribute to the prevention of aggressive behavior.

Psychometric properties of the forensic inpatient quality of life questionnaire: quality of life assessment for long-term forensic psychiatric care.

A substantial group of forensic psychiatric patients require (life)long forensic psychiatric care. Instead of aiming at re-entry into society, treatment in long-term forensic psychiatric care (LFPC) is principally aimed at medical and psychiatric care and optimising quality of life (QoL). To assess QoL in LFPC, the influence of both the mental disorder and the restrictive context should be considered. Therefore, a new instrument was developed: the Forensic inpatient QoL questionnaire (FQL). The FQL is based on the results of concept-mapping with patients and staff within LFPC. The main purpose of this study is to evaluate the psychometric properties of the FQL. One hundred and sixty-three FQLs, filled out by 98 male long-term forensic psychiatric patients, were included for testing reliability and content validity. For testing construct validity, 53 patients additionally completed the World Health Organisation Quality of Life-Brief version and 50 of them the Affect Balance Scale. Outcomes indicate that the FQL has good psychometric properties. Fifteen of the 16 FQL domains showed adequate to good reliability (Cronbachs α range .69–.91) and 9 domains met the criteria for homogeneity. Content validity was demonstrated by exploratory factor analysis, which revealed a three-factor structure: social well-being, physical well-being and leave. Construct validity was supported by 59% correctly hypothesised inter- and intrascale Pearsons correlation coefficients. Good psychometric properties and its clinical-based development make the FQL a valid and useful instrument for QoL assessment in LFPC. The FQL could therefore contribute to evidence-based and more advanced treatment programmes in LFPC.

Relationships of diet-related blood parameters and blood lead levels with psychopathology and aggression in forensic psychiatric inpatients

BACKGROUND Earlier studies have suggested associations between diet-related blood parameters and both aggression and psychopathological symptoms, but little is known about this in forensic psychiatric inpatients. AIM This article aims to explore the levels of diet-related blood parameters and their relationship to aggressive behaviour and/or psychopathology among Dutch forensic psychiatric inpatients. METHODS Minerals, vitamins, lead and fatty acid levels were measured in blood samples from 51 inpatients, well enough to consent and participate in the study, from a possible total of 99. Levels of aggression and psychopathology were assessed using questionnaires, observation instruments and clinical data. Associations between blood parameters and behavioural measures were calculated. RESULTS Low average levels of vitamin D3 and omega (ω)-3 fatty acids were found, with nearly two-thirds of the patients having below recommended levels of D3 , while vitamin B6 levels were high. Magnesium, iron, zinc, copper and lead were overall within reference values, but copper/zinc ratios were high. Several significant associations between levels of fatty acid measures and both aggression and psychopathology were observed. CONCLUSION In our sample of forensic psychiatric inpatients, fatty acids - but not mineral or vitamin levels - were associated with aggression and psychopathology. A potentially causal link between fatty acids and aggression could be tested in a randomised, placebo-controlled trial of fish oil supplements. General health of such patients might be improved by better vitamin D status (increased sun exposure and/or supplement use) and better ω-3 fatty acid status (oily fish or fish oil consumption), but discouraging unnecessary self-prescription of B vitamins where necessary. Copyright

Substance use disorders in forensic psychiatric patients.

There is a lack of detailed information on the role of substance use disorders (SUD) as a substantial factor in offences and treatment in forensic psychiatric patients. The aim of this study was to get a better understanding of these specifics. Clinical records of 193 male patients admitted to a Dutch forensic psychiatric hospital were scrutinized on anamnestic, diagnostic and risk assessment data. One of the central findings was that the prevalence of SUDs was high. Patients with an SUD had a more extensive criminal history, unstable and deviant lifestyle and higher risk of violent behavior than patients without a substance use disorder. No differences were found in duration of treatment, aggressive incidents and leave. Another important finding was that a distinction could be made between patients with substance use as a primary criminogenic risk factor and patients with substance use as a secondary risk factor. Although substance use is identified as a general risk factor, this study supports the idea of sub categorization of patients with an SUD and emphasizes the need for a different treatment approach. Further study is needed to identify specific treatment approaches, based on more differentiated profiles of these patients.

Associations of multiple trauma types and MAOA with severe aggressive behavior and MAOA effects on training outcome

Previous research showed that the disposition to react with disproportionate aggression in adults is influenced by an interaction between a variant in the X-chromosomal monoamine oxidase A gene (MAOA) and early traumatic events. Such studies have often focused on a single type of trauma, whereas we know that experiencing multiple trauma types is associated with more detrimental consequences. The differential susceptibility hypothesis suggests that individuals who are most susceptible to adversity, are also most likely to benefit from supportive experiences in childhood. Differences in susceptibility are thought to be partly genetically driven. In the present study we explored whether a genotype of MAOA linked to lower expression of the gene (MAOA-L) modified the effect of multiple types of trauma on aggression and/or altered responsiveness to treatment among adults with severe aggression. Forensic psychiatric outpatients (FPOs) (N=150) receiving treatment for aggression regulation problems were recruited. Traumatic events and aggression were measured using self-report. FPOs with multiple trauma types and those with the MAOA-L allele reported more severe levels of aggression. No interaction effects between MAOA genotype and trauma emerged. There were no differences in response to the intervention between FPOs with and without the MAOA-L variant, whereas FPOs with a single type of trauma showed the slowest reduction of aggression. FPOs with multiple types of trauma reported the highest levels of aggression over the course of treatment. Future research is needed to elucidate this association in further detail. The current study emphasized the importance of early recognition of early traumatic events.

Characteristics and Needs of Long-Stay Forensic Psychiatric Inpatients: A Rapid Review of the Literature

ABSTRACT This rapid review summarizes currently available information on the definition, prevalence, characteristics, and needs of long-stay patients within forensic psychiatric settings. Sixty nine documents from 14 countries were identified. Reports on what constitutes “long-stay” and on the characteristics of long-stay patients were inconsistent. Factors most frequently associated with longer stay were seriousness of index offence, history of psychiatric treatment, cognitive deficit, severity of illness, diagnosis of schizophrenia or psychotic disorder, history of violence, and history of substance misuse. Although some countries are developing specific long-stay services, there is presently no consensus on what might constitute “best practice” in such settings.

Treatment responsivity of aggressive forensic psychiatric outpatients

Aggression replacement training (ART) is widely used to reduce aggression. Results regarding its effectiveness, however, are inconclusive regarding adults and specific populations displaying severe aggression. The current open uncontrolled treatment study aimed at assessing the social skills and anger control modules of the ART to reduce aggression in forensic psychiatric outpatients (FPOs). Furthermore, characteristics associated with treatment outcome and dropout were examined. The results suggested that aggression changed during the ART. In addition, higher baseline levels of trait aggression were associated with greater reductions of aggression, whereas more cognitive distortions were associated with less reduction. Treatment dropouts were characterized by higher levels of psychopathic traits, proactive aggression, and more weekly substance use. As there was a considerable amount of dropout; it is important to assess risk of dropping out of treatment and, subsequently, improve treatment motivation. This might enhance treatment adherence which may lead to a more successful reduction of aggression.