Kirsten Rasmussen

The Brøset Violence Checklist Sensitivity, Specificity, and Interrater Reliability

The Brøset Violence Checklist (BVC) assesses confusion, irritability, boisterousness, verbal threats, physical threats, and attacks on objects as either present or absent. It is hypothesized that an individual displaying two or more of these behaviors is more likely to be violent in the next 24-hour period. All 109 consecutive referrals to four psychiatric inpatient acute units during a 2-month period were included in the study. Ratings were performed at the time of admission and three times a day for each patient—once for each working shift. Interrater reliability was adequate. Thirty-four separate incidences of violence occurred. Comparisons between ratings performed in the 24-hour interval before the incident and all other ratings suggested moderate sensitivity and good specificity of the instrument. It is concluded that the BVC is a useful instrument in predicting violence within the next 24-hour period and that the psychometric properties of the instrument are satisfactory.The Broset Violence Checklist (BVC) assesses confusion, irritability, boisterousness, verbal threats, physical threats, and attacks on objects as either present or absent. It is hypothesized that an individual displaying two or more of these behaviors is more likely to be violent in the next 24-hour period. All 109 consecutive referrals to four psychiatric inpatient acute units during a 2-month period were included in the study. Ratings were performed at the time of admission and three times a day for each patient—once for each working shift. Interrater reliability was adequate. Thirty-four separate incidences of violence occurred. Comparisons between ratings performed in the 24-hour interval before the incident and all other ratings suggested moderate sensitivity and good specificity of the instrument. It is concluded that the BVC is a useful instrument in predicting violence within the next 24-hour period and that the psychometric properties of the instrument are satisfactory.

ADHD in adults: A study of clinical characteristics, impairment and comorbidity

In this study, we explored the clinical characteristics, impairment and comorbidity in a sample of 45 adult patients with attention-deficit/hyperactivity disorder (ADHD). The collection of data is based on a naturalistic, retrospective approach using medical records documenting a comprehensive assessment of the patients. The sample was severely impaired in terms of academic achievement, employment and criminality, and had very high levels of comorbidity, especially alcohol and drug abuse, antisocial personality disorder and depression. Despite a high degree of contact with child psychiatric services in childhood, very few were diagnosed with ADHD, and many had a long period of psychiatric treatment as adults before the ADHD diagnosis was made. ADHD is in this sample of adults associated with severe impairment and comorbidity, and the connection between impairment and lack of proper diagnosis and treatment is discussed.

Functional impairment and occupational outcome in adults with ADHD.

Objective: ADHD is associated with poor functional outcomes. The objectives were to investigate the prevalence of functional impairment and occupational status in a clinically referred sample of adults with ADHD and explore factors predicting occupational outcome. Method: A sample of 149 adults with a confirmed diagnosis of ADHD participated in the present study. Cross-sectional data were collected from the participant’s medical records and from self-report questionnaires. A multiple regression model was applied to identify possible predictors of occupational outcome. Results: Only 22.2% had ordinary work as their source of income, compared with 72% in the general population. The most prevalent comorbid disorders were lifetime depression (37.8%), substance abuse (28.1%), and alcohol abuse (23.3%). Age at first treatment with central stimulants and inattentiveness negatively predicted occupational outcome. Conclusion: Adult ADHD was associated with lower educational attainment and lower level of employment. Later age of first central stimulant treatment and higher inattentiveness ratings were associated with lower level of employment.

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.

Untreated ADHD in Adults Are There Sex Differences in Symptoms, Comorbidity, and Impairment?

Objective: To analyze sex differences among adult, never-treated patients referred for central stimulant treatment of ADHD. Method: Data for 600 consecutive patients from northern Norway referred for evaluation by an expert team during 7 years were analyzed. General background information, diagnostic and social history, and symptom profiles were compared between previously never-treated men and women. Results: The sex ratio was skewed. Of the previously untreated patients, more than 20% fell outside societys ordinary vocational activities or social benefit system. Most patients had the combined form, one third the inattentive type, and only 2% the hyperactive/impulsive subtype. Abuse and criminality were more common among men, and affective, eating, and somatization disorders were more common among women. Otherwise few sex differences were found. Conclusion: AD/HD symptom intensity and subtypes did not differ between the sexes and was unrelated to age. Symptom intensity was linked with criminality, abuse, and other psychiatric problems, differentially for the two sexes. (J. of Att. Dis. 2009; 12(4) 353-360)

Aggressive and Non-Aggressive schizophrenics: Symptom profile and neuropsychological differences

Abstract Thirteen aggressive schizophrenic patients (AS) from a maximum security psychiatric unit were compared to 13 non-aggressive schizophrenic patients (NAS) and to 13 healthy controls (HC), using case history data, ratings of psychopathy, schizophrenic symptoms, and neuropsychological tests. The AS had spent more time in prison than the NAS, had more crime and substance abuse among 1st degree relatives, had earlier problem onset, and scored significantly higher on psychopathy. There were no significant differences in schizophrenic symptoms between the two patient groups. The NAS group performed more poorly than the other two groups on most of the neuropsychological tests. However, on some frontal lobe sensitive tasks, the AS group was most impaired. The data suggest that the AS do not have a “double dose” of neuropsychological impairment, but rather the reverse. However, they do display a specific pattern of neuropsychological dysfunction that is consistent with frontal lobe dysfunction.

Individual Rather Than Situational Characteristics Predict Violence in a Maximum Security Hospital

Assaults on staff in a maximum security psychiatric hospital were analyzed over a 6.5-year period. During that time, 94 patients were admitted to the unit. Fifty-two (55%) of the patients engaged in assaultive behavior, generating 1,945 incident reports. A small number of patients was responsible for a large share of the incidents. Serious incidents were rare. Incidents were evenly distributed throughout the day, week, and year. Patients who attacked less often caused more serious harm, showed a decrease in assaults over time, and the preceding events suggested that the violence was functional. For assaultive patients, it was difficult to identify a preceding event, the preceding events that were identified seemed more unreasonable, and the frequency of assault was constant over time. Assaultive patients were more often women, had more positive and borderline symptoms, were younger, and scored lower on psychopathy and depressive symptoms.

Psychopathy as a Risk Factor for Violent Recidivism: Investigating the Psychopathy Checklist Screening Version (PCL:SV) and the Comprehensive Assessment of Psychopathic Personality (CAPP) in a Forensic Psychiatric Setting

A robust relationship has been established between psychopathy and violence, and psychopathy is considered essential in the process of violence risk assessment. This study presents data on a patient sample from a forensic psychiatric unit in Denmark. All patients were assessed for psychopathy using the Psychopathy Checklist Screening Version (PCL:SV) and the Comprehensive Assessment of Psychopathic Personality (CAPP). After a follow-up period of 5.7 years, recidivism outcomes were obtained from the Danish National Crime Register. Both psychopathy measures were related to a more severe and versatile criminal career as well as to violent recidivism. Overall, the predictive accuracy of violent recidivism of the two measures was good, and no significant difference was found in terms of predictability. The newly developed CAPP could be a promising clinical risk management tool in terms of its comprehensiveness. Its validity needs to be further explored, but at least its ability to predict violence similar to the PCL:SV is supported by the present study.

Treatment of adult ADHD: Is current knowledge useful to clinicians?

Psychostimulant drugs have for decades been considered the cornerstone of ADHD treatment. Non-stimulant drugs have also been reported successful. However, many controlled studies exclude patients with comorbidities typical for patients seen in clinical setting. Many patients are also considered non-responders to medication. Current knowledge might not be directly useful to clinicians. The present article reviews the literature on pharmacological and psychotherapeutic treatment in adult ADHD emphasizing comorbidity and other clinically important factors, as well as ADHD specific outcomes. Thirty-three relevant studies of pharmacotherapy and three studies of psychotherapy were included. Most subjects had little current comorbidity, but some studies included subjects with substance use disorder. Significant effect of treatment on ADHD symptoms was found in most studies using pharmacotherapy and all studies of psychotherapy. Both positive and negative effects on comorbid anxiety and depression measures were reported. Pharmacotherapy did not seem to have effect on substance use disorder. Few pharmacotherapy studies conducted any long-term follow-up; two studies that did, found that most subjects had discontinued medication. A clear-cut dose-respons relationship was not substanciated. In conclusion, clinicians have good support for both pharmacological and psychotherapeutic treatment of ADHD in adults, but should take additional measures to deal with comorbidities as well as treatment adherence.

Risk Assessment: The Value of Structured Professional Judgments

International research suggests that using formalized risk assessment methods may improve the predictive validity of professionals’ predictions of risk of future violence. This study presents data on forensic psychiatric patients discharged from a forensic unit in Denmark in year 2001–2002 (n =107). All patients were assessed for risk of future violence utilizing a structured professional judgment model: the HCR-20 violence risk assessment scheme. After a follow-up period of 5.6 years, recidivism outcome were obtained from the Danish National Crime Register. Overall, the predictive validity of the HCR-20 was good. The structured final risk judgment had the highest predictive accuracy of violent recidivism and was superior to the HCR-20 used in an actuarial manner. At the individual item level, a higher number of the dynamic items were significantly predictive of violent recidivism compared to static items. In sum, the findings support the use of structured professional judgment models of risk assessment and in particular the HCR-20 violence risk assessment scheme. Findings regarding the importance of the (clinical) structured final risk judgment and the individual dynamic items strengthen the use of this scheme in clinical practice.