Graham D. Glancy

Individual predictors of traumatic reactions in firefighters

Increasingly, theorists and researchers in the area of trauma are pointing to the importance of individual differences in resilience and vulnerability as key determinants of the intensity and duration of trauma-related symptoms. Determining the relative influence of individual predictors is important for the further development of theoretical models for understanding trauma responses and for the subsequent development of intervention strategies that are sensitive to individual differences. This study explores the influence of individual factors and social support on traumatic reactions in firefighters exposed to tragic events in the line of duty. A total of 164 Australian firefighters completed questionnaires targeting locus of control, self-efficacy, patterns of interpersonal relating, social support and level of emotional distress. Results indicate that individuals with feelings of insecurity, lack of personal control, and alienation from others were more likely to experience higher levels of depression and posttraumatic stress symptoms subsequent to exposure to traumatic events on the job.

The psychometric properties of the Competency Interview Schedule

One of the most contentious issues in medical and legal practice is how to reliably assess the mental competence of individuals who consent or refuse psychiatric treatment. Current legislation does not provide clear definitions of what constitutes competence or incompetence to make a treatment decision. As a preliminary attempt to operationalize the concept of competency, we have developed a 15 item questionnaire. The present study reports on the psychometric properties of the instrument. Test-retest and interrater reliability results were good. The instrument was internally consistent and discriminated between individuals found competent and incompetent by the treating physician.

Pedophilia and heterosexuality vs. homosexuality

In the context of a search for testable etiological theories of pedophilia, the relationship of pedophilia to partner sex preference was investigated. The proportional prevalences of gynephilia and androphilia were compared with the proportional prevalences of sexual offenders victimizing female children and of such offenders against male children. Since pedophilia either does not exist at all in women, or is extremely rare, only men were included in the study. We derived the proportional prevalence of androphilia from a review of the main pertinent studies, including Gebhards reassessment of the study by Kinsey et al. particularly of the section on gynephilia vs. androphilia. The numbers of heterosexual vs. homosexual offenders against children were derived from the studies by Mohr et al., by Gebhard et al., and from a group of 457 sex offenders against children seen in the course of several years at the Department of Behavioural Sexology of the Clarke Institute of Psychiatry. There was a large difference between the proportion of prevalences of heterosexual vs. homosexual offenders against children on the one hand and the proportional prevalences of gynephilia vs. androphilia, on the other. This difference suggests that the development of erotically preferred partner sex and partner age are not independent of each other and that in pedophilia, the development of heterosexuality or homosexuality is brought about by factors different from those operative in the development of androphilia or gynephilia.

The Clinical Use of Risk Assessment

In this paper, we argue that risk assessment should be considered a part of daily clinical psychiatric practice. We discuss the advantages and disadvantages of various risk assessment procedures. In the event that a high risk for violence is present, we advise on strategies for discharging our duty to protect the public. Finally, by way of an illustrative case, we apply theory to practice and discuss the issues of risk management and risk reduction essential to a modern approach to psychiatry.

Confidentiality in crisis : Part I: The duty to inform

Objective: To discuss the ethical and legal imperatives to protect third parties from harm in circumstances often believed to be protected by doctor-patient confidentiality. Method: A review of recent legislative changes and legal decisions pertaining to a psychiatrists duty to warn. Conclusion: The current legislative and legal climate presents many risks to the concept of doctor-patient confidentiality. Psychiatrists must carefully consider any guarantees of confidentiality made to patients and must discuss the limits of confidentiality when obtaining consent for treatment.

Physicians Who Commit Sexual Offences: Are They Different from other Sex Offenders?

Objective: To determine if physician sex offenders differ significantly from other sex offenders by using a control group and assessing both groups with reliable and valid instruments. Method: Nineteen male physician sex offenders were compared with 19 male sex offender control subjects, matched on offence type, age, education, and marital status. Both groups were compared with a general sample of sex offenders (n = 2125). The 3 groups were compared on sexual history and preference, substance abuse, mental illness, personality, history of crime and violence, neuropsychological impairment, and endocrine abnormalities. Results: Physicians in this study were highly educated and older, forming a statistically significant subgroup of sex offenders. The majority of physician sex offenders suffered from a sexual disorder (68.4%), as did the other 2 groups. Physicians showed more neuropsychological impairment and endocrine abnormalities and less antisocial behaviour than did the general sample of sex offenders but did not differ from the matched control group. Physician offenders who sexually assaulted their patients did not differ from those who had nonpatient victims. Conclusions: Despite differences in age, education, and occupation between physician sex offenders and sex offenders in general, the same assessment procedures can be recommended for examining both groups. Although the sample size is small, results suggest that physicians who commit sexual offences should be scrutinized by phallometric assessment of sexual deviance and especially for neurological and endocrine abnormalities.

Confidentiality in crisis: Part II--Confidentiality of treatment records.

Objective: To discuss the implications of recent legislative changes and court decisions in Canada that have placed the privacy of psychiatric records information at risk. New areas of exposure include client access to clinical information provided by family members, parental access to childrens records, and court access to clinical records in civil, criminal, and family law matters. Method: A review of recent legislative changes and court decisions pertaining to access to psychiatric records. Conclusion: At present, psychiatric records can no longer be regarded as confidential. Recent changes in the concept of privilege of treatment records necessitates several changes in psychiatric practice regarding informed consent to treatment, content of clinical records, and responses to demands for information.

Families of firesetters

Abstract Although many studies of firesetters have noted abnormalities in their families of origin, few of these have primarily addressed the family dynamics. In this study, we have attempted to identify a pattern of family dynamics particular to families of arson offenders and discuss implications for practice.

Empathy and Its Influence on Sexual Misconduct

A deficit in empathy is generally regarded as a factor that contributes to the occurrence of sexual offenses and sexual boundary violations. As a result, many experts recommend empathy training as a part of any program that attempts to reduce recidivism among offenders. Considerable controversy exists, however, with regard to the definition of empathy, the actual influence of empathy on sociopathic behavior, and whether empathy can indeed be taught. This article provides a review of the literature concerning some of these controversial issues, concluding with a proposed model for empathy training for professionals who engage in sexual misconduct based on the theoretical and empirical data available. The model incorporates the following four key aspects of empathy training: developing cognitive awareness, enhancing emotional responsiveness, self-awareness, and modeling of empathic responses.

The Psychiatric Aspects of Solitary Confinement

Abstract Mental health workers who work in correctional facilities frequently have to assess and treat clients in solitary confinement (SC). SC is used as a procedure in correctional facilities for a variety of reasons including punishment, protection of the person, security of the institution, or for more intensive observation. In this article we have taken a fresh and critical view of the literature to attempt to delineate the effects of SC on mental health. The research in this area reveals mixed findings. Some studies extrapolate findings from social isolation experiments and the findings from prisoner of war (POW) camps. Many other studies have severe limitations. Most of the better studies suggest that SC is not harmful to the majority of people but conclude that some may be less resilient due to their personality construct or perhaps due to mental illness. Further research is needed to clarify this issue.