Marinus Spreen

Inter-Rater and Test-Retest Reliability, Internal Consistency, and Factorial Structure of the Instrument for Forensic Treatment Evaluation

In this study, the Instrument for Forensic Treatment Evaluation (IFTE) is introduced. The IFTE includes 14 dynamic items of the risk assessment scheme HKT-R and eight items specifically related to the treatment of forensic psychiatric patients. The items are divided over three factors: protective behavior, problematic behavior and resocialization skills. Inter-rater reliability and test-retest reliability ranged from moderate to almost perfect in a Dutch population of 232 forensic patients. Factor analysis largely confirmed the factor structure. The IFTE is evaluated to be a reliable routine outcome monitoring instrument for supporting and indicating inpatient forensic psychiatric treatment evaluations and processes.

Influence of Music Therapy on Coping Skills and Anger Management in Forensic Psychiatric Patients: An Exploratory Study

The effect of music therapy on anger management and coping skills is an innovative subject in the field of forensic psychiatry. This study explores the following research question: Can music therapy treatment contribute to positive changes in coping skills, anger management, and dysfunctional behavior of forensic psychiatric patients? To investigate this question, first a literature review is offered on music therapy and anger management in forensic psychiatry. Then, an explorative study is presented. In the study, a pre- and post-test design was used with a random assignment of patients to either treatment or control condition. Fourteen participants’ complete datasets were collected. All participants received “treatment as usual.” Nine of the participants received a standardized, music therapy anger management program; the five controls received, unplanned, an aggression management program. Results suggested that anger management skills improved for all participants. The improvement of positive coping skills and diminishing of avoidance as a coping skill were measured to show greater changes in music therapy participants. When controlling for the exact number of treatment hours, the outcomes suggested that music therapy might accelerate the process of behavioral changes.

Victim ranking among sex offenders

Abstract A previous exploratory study of the Child Molester Empathy Measure (CMEM) focused on the difference between offenders’ normal level of general empathy and the way in which a sample of Dutch offenders viewed their own victims. The authors found that, regardless of their level of general victim empathy, all offenders thought that their own victims were better off than the unknown victims of sexual offences. In order to study this ranking phenomenon more closely, the authors replicated the study procedure with Dutch and Australian offenders. The authors rated each offenders responses for three child victims on the CMEM on an n-dimensional column vector and compared these data with their answers to the same questions related to two adult victims. The results are presented in this paper.

High and Low Aggressive Narcissism and Anti-social Lifestyle in Relationship to Impulsivity, Hostility, and Empathy in a Group of Forensic Patients in the Netherlands

In a group of 148 violent offenders, 14 offenders were diagnosed as psychopaths (PCL-R score 30+); 46 as middle group psychopaths (PCL-R score 21–29); and 88 as non-psychopaths (PCL-R score −21). To measure impulsivity, empathy, and hostility in the three groups, clinical diagnoses of psychologists and psychiatrists were used and classified in the HKT-30. Based on Hares PCL-R classification, psychopaths scored more problematic on impulsivity, empathy, and hostility than the middle group and non-psychopaths. Differences between the middle and psychopathic group were small. Individuals who scored high on Factors 1 and 2 showed significantly more problematic behavior on impulsivity, empathy, and hostility than individuals with a low score. Empathy and hostility contributed significantly to the prediction of Factor 1 (high aggressive narcissism; R2 = 22%), and empathy and impulsivity contributed significantly (not for impulsivity but meaningful) to the prediction of Factor 2 (high antisocial lifestyle; R2 = 22%).

The role of personal social networks in risk assessment and management of forensic psychiatric patients

Social network factors are usually not accounted for in the clinical practice of risk assessment/management.This article introduces a social network analysis as an instrument to systematically chart the relationships and personal networks of forensic psychiatric patients. During the period 2005 to 2007, the so-called Forensic Social Network Analysis (FSNA) was developed in a Dutch forensic psychiatric hospital. A case study describes the FSNA concepts and shows the benefits of using FSNA as a practical tool for assessment and management of individual risk behavior.

Predictive Validity of the HKT-R Risk Assessment Tool: Two and 5-Year Violent Recidivism in a Nationwide Sample of Dutch Forensic Psychiatric Patients

This study has examined the predictive validity of the Historical Clinical Future [Historisch Klinisch Toekomst] Revised risk assessment scheme in a cohort of 347 forensic psychiatric patients, which were discharged between 2004 and 2008 from any of 12 highly secure forensic centers in the Netherlands. Predictive validity was measured 2 and 5 years after release. Official reconviction data obtained from the Dutch Ministry of Security and Justice were used as outcome measures. Violent reoffending within 2 and 5 years after discharge was assessed. With regard to violent reoffending, results indicated that the predictive validity of the Historical domain was modest for 2 (area under the curve [AUC] = .75) and 5 (AUC = .74) years. The predictive validity of the Clinical domain was marginal for 2 (admission: AUC = .62; discharge: AUC = .63) and 5 (admission: AUC = .69; discharge: AUC = .62) years after release. The predictive validity of the Future domain was modest (AUC = .71) for 2 years and low for 5 (AUC = .58) years. The total score of the instrument was modest for 2 years (AUC = .78) and marginal for 5 (AUC = .68) years. Finally, the Final Risk Judgment was modest for 2 years (AUC = .78) and marginal for 5 (AUC = .63) years time at risk. It is concluded that this risk assessment instrument appears to be a satisfactory instrument for risk assessment.

Concurrent and Predictive Validity of the Instrument for Forensic Treatment Evaluation : From Risk Assessment to Routine, Multidisciplinary Treatment Evaluation

Besides assessment of forensic patients’ risk of future violence and criminogenic needs, knowledge on their responsivity to treatment is equally important. However, instruments currently used for risk assessment are not sensitive enough for treatment evaluation. Therefore, the Instrument for Forensic Treatment Evaluation (IFTE) was developed. The IFTE is a treatment evaluation tool, which uses the dynamic risk items of the Dutch risk assessment tool, the HKT-R (Historical, Clinical, Future–Revised). The IFTE has an extended answering scale, which makes it more sensitive for measuring change and enables clinicians to monitor patients’ responsivity to treatment closely. This study examines the concurrent and predictive validity of the IFTE. We found moderate to strong correlations between IFTE items and HKT-30 items (the HKT-30 is the predecessor of the HKT-R), with work and therapy attendance, and positive drug tests. In addition, we found moderate to modest correlations between some IFTE items and work and therapy attendance in a 6-month follow-up period and modest to high discriminative power for some IFTE items for violence and drug use 6 months after the measurement. Given its good reliability and validity properties, and comprehensive but short-term nature, implementation of the IFTE in forensic practice likely improves individual treatment of forensic psychiatric patients and has high potential for risk management purposes.

Formalizing Clinical Decisions in Individual Treatments : Some First Steps

A fundamental problem in forensic psychology practice is the lack of formal statistical methods to support team decisions about an individual patients progress during intramural treatment. It is common practice to base decisions about the progress of a treatment on subjective clinical impressions of therapists. In this article, an approach is proposed that can be seen as a contribution to bridge the gap between formal statistical decision making and subjective clinical decision making. To formalize decisions in individual treatments, we have elaborated a statistical decision technique based on degrees of belief. In this article, this so-called N = 1 analysis is explained and illustrated by a hypothetical case.

Neurofeedback as a Treatment for Impulsivity in a Forensic Psychiatric Population With Substance Use Disorder: Study Protocol of a Randomized Controlled Trial Combined With an N-of-1 Clinical Trial

Background Impulsivity and substance use disorder (SUD) are strongly interconnected, with persons scoring high on impulsivity being more vulnerable to develop substance abuse, facing more challenges for successful treatment, and being more prone to engage in criminal behavior. Studies have shown that impulsivity and craving for substances are strongly correlated. Neurofeedback is an effective treatment to reduce impulsive behavior. This study intends to determine to what extent a neurofeedback-intervention that is aimed at reducing impulsivity can also reduce levels of craving in forensic patients with SUD and comorbid Axis I and/or II diagnoses. Objective The main objective of this study is to investigate to what extent a reduction in impulsivity by a sensorimotor rhythm (SMR)-neurofeedback intervention will lead to a reduction in craving in a population of forensic psychiatric patients with a diagnosis of SUD. Methods Participants will be male SUD patients with various comorbidities residing in an inpatient forensic treatment facility approached through treatment supervisors for participation. Participants have tested positive for drug use in the past 24 months. The study consists of 2 parts: a randomized controlled trial (RCT) and a n-of-1 clinical series. In the RCT, 50 patients will be randomly assigned to an intervention (n=25) or a control (n=25) condition. Patients in the intervention group will receive 20 SMR neurofeedback sessions aimed at reducing impulsivity; participants in the control group receive treatment-as-usual (TAU). Additionally, 4 in depth n-of-1 clinical trials will be conducted where effects of an SMR neurofeedback intervention will be compared to effects of sham neurofeedback. Results Results of this study are expected by the end of 2017. Conclusions This protocol describes the design of a study testing the effects of an impulsivity-based neurofeedback protocol among forensic patients with SUD and various comorbidities. We expect a significant reduction in impulsive behavior, level of craving, and actual drug-use for participants receiving the SMR neurofeedback protocol. The n-of-1 approach might help to explain effects possibly found in the RCT study since it allows for a more direct focus on treatment effects by following participants more closely and thereby being able to directly attribute behavioral and neurophysiological change to the SMR neurofeedback protocol employed. ClinicalTrial Dutch National Trial Register NTR5386; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5386 (Archived by WebCite at http://www.webcitation.org/6nXLQuoLl)

The personal social networks of personality disordered forensic psychiatric patients

Summary There has hardly been any examination of the personal social networks of personality disordered forensic psychiatric patients leading up to, and at the time of their offence. To shed light on this question, 36 male inpatients were interviewed by forensic social workers about their social contacts in the period in which they committed their crime. Network size, roles, social support, investment, structure and potential risks were investigated. Findings At the time of their offence, patients were in contact with a variety of social network members, especially family members, who also happened to be the most likely victims of the patients’ offences. Patients received social support; almost half of the social supporters had potential risk factors (criminal record, psychiatric problems, drug use, etc.). Applications This study shows the complexity of the social factors involved with criminal behavior. Theoretically, good network conditions do not necessarily imply a low risk for each individual case. Forensic social workers should frequently check if there are significant changes in the patients network, such as access to victims, instability of relationships, a lack of personal support and the influence of high-risk network members.