Jim Aage Nøttestad

The Prevalence and Nature of Intellectual Disability in Norwegian Prisons.

BACKGROUND The objective of the study was to calculate the prevalence of inmates with intellectual disabilities (ID), and identify historical, medical and criminological characteristics of a certain impact. METHODS A random sample of 143 inmates from a Norwegian prison cross sectional sample was studied. The Hayes Ability Screening Index (HASI) was validated with the Wechsler Abbreviated Scale of Intelligence (WASI). RESULTS The prevalence of inmates with ID, IQ < 70, was 10.8%. Some essential characteristics of inmates with ID were more frequent medication for mental disorders, a higher number of imprisonments, less drug abuse and less education than the other inmates. The results indicated that the HASI is a valid tool for screening of ID for the Norwegian inmates. CONCLUSIONS The prevalence of ID in Norwegian inmates is significant, measured by WASI and HASI. Identification, rehabilitation and care, concerning an intellectual handicap, are mostly absent in the Norwegian criminal justice system.

Forensic issues in intellectual disability

Purpose of review The present paper reviews some of the most significant findings in the field of forensic issues related to intellectual disability over the last 2 years. Recent findings Recent publications have explored the prevalence and assessment of intellectual disabilities in the criminal justice system, as well as individual characteristics of intellectual disabled offenders. Service by the criminal justice system and treatment of intellectual disabled offenders have also been explored. New insights into violence and sexual offences have been achieved, however identification and evidence-based treatment of intellectual disabled offenders are not widely explored issues. Summary Progress in treatment studies, studies of the function of the criminal justice system and risk assessments have resulted in improvements in these aspects during recent years. The wide range of services involved in successful initiatives has been addressed, but some crucial aspects still receive too little attention. Differences between countries and cultures have not been emphasized, and the progress that has been achieved seems to be confined to countries with a clear policy and organized services for offenders with intellectual disabilities.

Narcissism in patients admitted to psychiatric acute wards: its relation to violence, suicidality and other psychopathology

BackgroundThe objective was to examine various aspects of narcissism in patients admitted to acute psychiatric wards and to compare their level of narcissism to that of an age- and gender-matched sample from the general population (NORM).MethodsThis cross-sectional study interviewed 186 eligible acute psychiatric patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). The patients filled in the Narcissistic Personality Inventory-21 item version (NPI-21), The Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale. High and low narcissism was defined by the median of the total NPI-21 score. An age- and gender-matched control sample from the general population also scored the NPI-21 (NORM).ResultsBeing male, involuntary admitted, having diagnosis of schizophrenia, higher self-esteem, and severe violence were significantly associated with high narcissism, and so were also low levels of suicidality, depression, anxiety and GAF scores. Severe violence and high self-esteem were significantly associated with high narcissism in multivariable analyses. The NPI-21 and its subscales showed test-retest correlations ≥0.83, while the BPRS and the HADS showed lower correlations, confirming the trait character of the NPI-21. Depression and suicidality were negatively associated with the NPI-21 total score and all its subscales, while positive association was observed with grandiosity. No significant differences were observed between patients and NORM on the NPI-21 total score or any of the NPI subscales.ConclusionNarcissism in the psychiatric patients was significantly associated with violence, suicidality and other symptoms relevant for management and treatment planning. Due to its trait character, use of the NPI-21 in acute psychiatric patients can give important clinical information. The similar level of narcissism found in patients and NORM is in need of further examination.

Prevalence of intellectual disabilities in Norway: Domestic variance

Based on national registers, the prevalence of intellectual disability (ID) in Norway is estimated to be 0.44 per 100 inhabitants. This study aimed to examine geographic and urban-rural differences in the prevalence of ID in Norway. Methods A survey based on the national register. Financial transfers intended to provide equal services to people with ID are based on these reports. Results A higher prevalence was found in the North region of Norway. A negative correlation between the population density and the prevalence of ID was also found. Conclusion There was considerable geographic and urban-rural differences in the prevalence of ID, which may be attributable to not only the large diversity of services, but also some other factors. The results were discussed with respect to the deinstitutionalisation progress, resource-intensive services and costs. Differences also reflect some problems in diagnosing ID in people having mild ID.

Violence and Sexual Offending Behavior in People with Autism Spectrum Disorder who have Undergone a Psychiatric Forensic Examination

The increased awareness of Autism Spectrum Disorders (ASD) over the last few decades as well as the potential association between ASD and offending behaviors has spurred a need for increased research in this area. In order to explore any possible relationship between ASD and violent or sexual crime the present study examines all forensic examination reports over a 10-yr. period in Norway where the charged persons were diagnosed with ASD and charged with either a violent (N = 21) or a sexual (N = 12) offense. Differences between these two groups regarding previous contact with child welfare and confessions to the offense were found. There was also a tendency toward more severe mental health problems and less intellectual problems among the violent offenders than the sexual offenders.

Psychometric examination and normative data for the Narcissistic Personality Inventory 29 item version

The Narcissistic Personality Inventory (NPI) is commonly used in empirical studies of narcissism. Few population-based studies have been published. Our aim was to do a confirmatory factor analysis (CFA) of the NPI 29 item version with a four-factor structure, in two population-based samples and in a patient sample, and present normative population-based data. The NPI-29 was filled in by 324 respondents from the Norwegian population, 231 from the Swedish population and 167 Norwegian psychiatric patients. The four-factor structure of the NPI-29 with Leadership/Power, Exhibitionism/Self-admiration, Superiority/Arrogance and Uniqueness/Entitlement was reproduced in these samples. The CFA models showed good fit indices in all samples. Mean scores on the NPI-29 and four subscales hardly differed between the samples. For the NPI-29 total score and factors, few significant differences were observed. CFA of the samples supported the factor structure of the NPI-29 formerly identified by principal component analysis of the Swedish population sample.

Under the Surface The Dynamic Interpersonal and Affective World of Psychopathic High-Security and Detention Prisoners

The present study yields an in-depth examination of the interpersonal and affective world of high-security and detention prisoners with possible (Psychopathy Checklist: Screening Version [PCL:SV] ≥ 13) and strong (PCL:SV ≥ 18) indications of psychopathy. A group of male inmates (n = 16) was compared with noncriminal and non–personality disordered controls (n = 35) on measures of self and other (Young Schema Questionnaire–Short Form [YSQ-SF], Inventory of Interpersonal Problems–Circumplex Scales [IIP-C]), and the experience and regulation of affect (Positive and Negative Affect Schedule [PANAS], Emotion Control Questionnaire 2 [ECQ2]). Results confirm the established grandiose, dominant, and callous characteristics of the psychopath (PCL:SV, Structured Clinical Interview for DSM-IV Axis II Disorders [SCID-II], DSM-IV and ICD-10 Personality Questionnaire [DIP-Q], IIP-C), while demonstrating personal distress and important nuances and variations in psychopathic offenders’ interpersonal and affective functioning (YSQ-SF, PANAS, ECQ2, SCID-II, DIP-Q). These preliminary findings support, expand, and challenge the ordinary portrayal of the psychopath and, if replicated in larger samples, point to a need for an expansion or reformulation of the concept, measurement, and treatment of psychopathy.

Validation of the Norwegian version of Hayes Ability Screening Index for mental retardation.

The Hayes Ability Screening Index was developed primarily to provide a short, effective screening test to indicate possible mental retardation amongst persons who come in contact with the criminal justice system. This study examined the validity of a Norwegian version in a sample of 73 subjects. 45 were male and 28 were female (M = 33.3 yr, SD=12.5; range = 17 to 60 years) consecutively selected from patients referred for neuropsychological examination. The Wechsler Adult Intelligence Scale (WAIS-III) was the criterion of validity. The correlation of .81 between scores on the WAIS-III and the Hayes Index was significant. At a stated cut-off score of 85, the sensitivity was 100% and specificity 57%. A suggested alternative cut-off score of 81 obtained a sensitivity of 95% and specificity of 72%. These results indicate that the Hayes Ability Screening Index is a useful, valid, and time-saving tool for screening of mental retardation for the Norwegian population.

Offending profiles of individuals with autism spectrum disorder: A study of all individuals with autism spectrum disorder examined by the forensic psychiatric service in Norway between 2000 and 2010

This study examined the characteristics of adults with autism spectrum disorder who have undergone a forensic examination and explored any relationships between the diagnosis and the offence. The reports described 41 men and 7 women. The autism spectrum disorder was diagnosed late (mean age: 25.3 years), and 22 of the 48 cases were diagnosed with autism spectrum disorder for the first time by the forensic experts. The education level and employment status were low. Family networks were close, but social networks outside the family were limited. Co-morbid diagnoses were common, and more than half of the group knew their victims. The examined individuals constitute a vulnerable and heterogeneous group, as do offenders within other diagnostic categories. Unlike most others who commit criminal acts, the majority of the individuals with autism spectrum disorder in this study showed no evidence of substance abuse, had a close relationship to their victims and were willing to confess to the accused crime. No clear association between the characteristics of autism spectrum disorder and the criminal act were identified, but in most cases, autism spectrum disorder characteristics, such as idiosyncratic comprehensions and obsessions appeared to be related to the motive for the offence.

Validation and adaptation of the Norwegian version of Hayes Ability Screening Index for intellectual difficulties in a psychiatric sample

Background: Intellectual disabilities (ID) among psychiatric patients have traditionally been neglected. A lack of convenient instruments and competency in ID may have worsened the conditions and treatment availability for these patients. Aims: Validation and adaptation of a screening instrument for ID (Hayes Ability Screening Index; HASI) in a psychiatric hospital setting. Methods: This is a cross-sectional study of 50 psychiatric patients in two Norwegian psychiatric hospitals comparing results of the HASI with the Wechsler Abbreviated Scale of Intelligence (WASI). Results: The HASI correlated well with the standard IQ test used (r= 0.67, P< 0.001). At a stated cut-off score of 85, the HASI had a sensitivity of 100% and specificity of 34%. Conclusions: The HASI is a valid and time-saving screening instrument for ID among psychiatric patients. The prescribed cut-off score, however, resulted in a large number of false positives.