Mitchell K. Byrne

Anger in prisoners: women are different from men

Anger can contribute to offending behaviour and to behavioural difficulties in prison environments. As such, training in self-management of anger has been a common strategy in an attempt to reduce such behaviours. However, the vast majority of research into anger in offenders has been conducted using male participants. This has led to a lack of knowledge specific to the treatment needs of angry female prisoners. This paper investigates the extent to which a sample of Australian female offenders differs from Australian male offenders in their expression and experience of anger. Fifty women and 121 men were given the State-Trait Anger Expression Inventory [Spielberger, C.D. (1991). State-Trait Anger Expression Inventory: STAXI Professional Manual. Florida: Psychological Assessment Resources] and the Novaco Anger Scale [Novaco, R. W. (1994). Anger as a risk factor for violence among the mentally disordered. In J. Monohan, & H. J. Steadman (Eds.), Violence and mental disorder. Chicago: University of Chicago Press]. The data collected from female participants was then contrasted with identical data collected from male inmates in the separate study [Howells, K., Day, A., Bubner, S., Jauncey, S. (2000). Anger needs and treatment responsivity in male prisoners. Unpublished manuscript: University of South Australia.]. Results indicated significant main effects for gender in a majority of the subscales of the two measures, with significant differences found in both the experience and expression of anger for male and female prisoners. The results are discussed in terms of the implications for correctional service providers with respect to the specific psychological needs of female offenders.

The Psychological Needs of Women Prisoners: Implications for Rehabilitation and Management

The rehabilitation and management of women offenders in prison are topics which continue to elicit concern, controversy and, often, disillusionment based on the failure of previous policies and initiatives. In this paper we argue rehabilitation and management should be based on the established needs of women prisoners and, in particular, on the Responsivity principle (adapting programs and methods to the gender-specific needs and requirements of women). Our review of the literature indicates major problems of psychological and psychiatric morbidity, including psychiatric disorder (especially posttraumatic stress disorder; PTSD), substance abuse, personality disorders, sexual/physical abuse and self-harm. The implications of such findings for good practice are discussed.

EEG in adults with Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (AD/HD) is the most common psychiatric disorder of childhood, but it is becoming increasingly apparent that more than half the childhood sufferers will continue to manifest symptoms of the disorder as adults. While the EEG of children with AD/HD has been extensively examined, comparatively little research has been conducted into the EEG of adults with the disorder. This study thus investigated the EEG of 20 adult males with AD/HD, and an age- and gender-matched control group, during an eyes-closed resting condition. The EEG was Fourier transformed to provide absolute and relative power estimates for the delta, theta, alpha and beta bands. The AD/HD group had significantly less absolute delta and more relative theta, across the entire scalp, than the control group. In absolute beta, the AD/HD group had less power at the midline, and an enhancement in power in the right posterior region. These results are similar to those found in children with AD/HD, and may suggest the presence of a processing deficit. A right posterior elevation in beta activity was also found, which could be related to the ongoing presence of reading disabilities in these subjects.

Enhancing medication adherence: clinician outcomes from the Medication Alliance training program

Objective: Patient nonadherence to psychiatric medication is a key cause of relapse but clinicians do not appear to possess specific adherence skills. We sought to demonstrate that a brief training program on medication adherence strategies could improve the adherence skills, attitudes and knowledge of mental health clinicians. Methods: Twenty-three Tasmanian mental health workers were provided a 3 day training workshop on strategies to enhance patient adherence to medications (Medication Alliance). Pre- and post-training measures were taken of clinician knowledge about adherence strategies, ability to identify predictors of nonadherence, attitudes toward working with nonadherent patients, and optimism about treatment outcomes for patients. Videotapes of clinicians demonstrating key adherence therapy skills were also collected before and after training and blind-rated by two experienced therapists. Results: A series of paired samples t-tests indicated significant improvements in skills, knowledge and attitudes. Conclusions: Compared with similar studies in the UK, Medication Alliance was found to be an effective and efficient training program. However, there is a need for further research to assess maintenance of training effects over time and patient outcomes.

THE LEVEL OF SERVICE INVENTORY-REVISED (LSI-R) A Useful Risk Assessment Measure for Australian Offenders?

This study examined the Level of Service Inventory—Revised (LSI-R) with Australian offenders. Normative statistics, offender need characteristics, and the predictive utility of the LSI-R were assessed using a sample of more than 78,000 administrations. No gender differences were apparent on the LSI-R total score, although female offenders scored higher than male offenders on the Finance and Family/Marital subscales. Significant sentence order differences (community, custodial, and a combination of community and custodial) were found, especially on the Criminal History, Education/Employment, and Companions subscales and the LSI-R total score. Bivariate correlations and logistic regression analyses indicated that different subscales were predictive of reoffending by sex and sentence orders. Overall, the assessment instrument indicated modest predictive validity, with varying results for the different offender groups. Female offenders serving combinations of community and custodial sentence orders, however, revealed unexpected findings. Discussions of the results, implications, and recommendations for further research are presented.

Nurse's beliefs and knowledge about medications are associated with their difficulties using patient treatment adherence strategies

Background: The attitudes and beliefs of patients toward their treatment have been found to be an important factor in treatment outcome, particularly as it relates to treatment adherence. There are also suggestions that knowledge, attitudes and beliefs held by nurses about treatments may also be important influences on treatment outcome but there has been little research relating these to specific clinical behaviour. Aims: This study explored the knowledge and beliefs of nurses toward neuroleptic medications in the treatment of severe mental ill health with the view to identifying specific nurse training needs. Method: A convenience sample of 64 nurses was given an anonymous questionnaire. Measures taken were then related to perceived difficulties using standard adherence strategies with patients. Results: The results suggested a relationship between knowledge and attitudes such that poor knowledge and attitudes were associated with greater difficulty using standard clinical interventions. Conclusions: Poor knowledge and negative attitudes toward medications impede the effective use of adherence strategies. This study highlights the need for specific nurse training programs and further research into the educational needs of nurses. Declaration of interest: This research was financed in part by a grant from the Australian Quality use of Medicines (Grant number SG497).

Level of Service Inventory–Revised: Assessing the Risk and Need Characteristics of Australian Indigenous Offenders

Actuarial risk assessments have been criticized for their insensitivity to the unique risk/needs profiles of minority offenders. This study investigated the offender need characteristics and the predictive utility of the Level of Service Inventory–Revised (LSI-R) for Australian Indigenous offenders. Indigenous offenders scored higher on every LSI-R subscale and the total score compared to non-Indigenous offenders. Indigenous male offenders also indicated specific needs related to education and employment whereas living arrangement and constructive leisure time needs were apparent for female offenders. Associations with antisocial companions provided the best predictor of re-offending for Indigenous male offenders, while familial discord best predicted re-offending for Indigenous female offenders. Furthermore, issues concerning constructive leisure time were relevant for all Indigenous offenders, but not for non-Indigenous offenders. Results are discussed in terms of the sensitivity debate of generic actuarial risk assessment, cultural differences between offender groups, and implications for treatment/rehabilitation.

Baseline Omega-3 Index Correlates with Aggressive and Attention Deficit Disorder Behaviours in Adult Prisoners

Background There is emerging evidence that the supplementation of omega-3 contributes to a decrease in aggressive behaviour in prison populations. A challenge of such research is achieving statistical power against effect sizes which may be affected by the baseline omega-3 index. There are no published data on the blood omega-3 index with studies of this kind to assess the variability of the blood omega-3 index in conjunction with aggression and attention deficit assessments. Objective To determine if the variance of the omega-3 index is correlated with aggressive and attention deficit behaviour in a prison population. Design 136 adult male prisoners were recruited from South Coast Correctional Centre (SCCC), NSW Australia. A 7 point categorisation was used to quantify levels of aggressive behaviour (4 weeks) from individual SCCC case notes, whereby higher scores correspond to increasingly aggressive behaviour. Study participants completed the Aggression Questionnaire (AQ) and the Brown’s Attention Deficit Disorder Scales (BADDS), provided a blood sample for erythrocyte fatty acid analysis using gas chromatography and the omega-3 index was calculated. Results The baseline omega-3 index ranged from 2.3% to 10.3%, indicating that some participants already had substantial omega-3 intake, however a median of 4.7% indicated a lower overall omega-3 intake than the general Australian population. Assessment of aggressive and attention deficit behaviour shows that there were negative correlations between baseline omega-3 index and baseline aggression categorisation scores (r = −0.21, P = 0.016); total AQ score (r = −0.234, P = 0.011); Anger (r = -0.222 p = 0.016); Hostility AQ (r = −0.239, P = 0.009); indirect aggression (r = −0.188 p = 0.042); total BADDS (r = −0.263, p = 0.005); Activation (r = −0.224, p = 0.016); Attention (r = −0.192, p = 0.043); Effort (r = −0.253, p = 0.007); Affect (r = −0.330, p = 0.000) and Memory (r = −0.240, p = 0.010). Conclusions There is a high variability in omega-3 status of a NSW prison population, and inmates with lower omega-3 index were more aggressive and had higher ADD scores.

Training inpatient mental health staff how to enhance patient engagement with medications: Medication Alliance training and dissemination outcomes in a large US mental health hospital

RATIONALE, AIMS AND OBJECTIVES The Medication Alliance training programme has previously been shown to be effective in enhancing clinician knowledge, attitudes and skills in regard to non-adherent individuals in a community-based psychiatric setting. The current study attempts to replicate these findings in an inpatient setting and assess the feasibility of dissemination using a train-the-trainer model. METHOD One hundred and thirteen staff from four wards at an inpatient psychiatric facility attended Medication Alliance training workshops over 3 days. Two wards comprised an expert trained group (n = 67); and the remaining two wards made up a novice trained group (n = 46). The novice trained group attended training 6 months after the expert group, and were trained by selected trainees from the expert group. Participants completed a package of questionnaires both before and after their training to determine if Medication Alliance resulted in any changes in knowledge, attitudes and skills. RESULTS Paired t-tests showed significant improvements across both groups for knowledge, attitudes and one skill domain following training in Medication Alliance. There were no differences at baseline between groups and analysis of post-test scores yielded no significant difference between the groups in terms of training effect for knowledge, attitudes or skills. CONCLUSIONS Medication Alliance can be successfully implemented in an inpatient setting, enhancing knowledge, attitudes and at least some skill domains of staff in dealing with non-adherent patients. The equivalence of results between the expert and novice trained training groups suggests that Medication Alliance may be more broadly disseminated using a cost-effective train-the-trainer model.

The Level of Service Inventory-Revised (Lsi-R) and Australian Offenders Factor Structure, Sensitivity, and Specificity

The Level of Service Inventory—Revised (LSI-R) assesses the risk of reoffending and identifies criminogenic need characteristics of offenders. Despite the assessment’s popularity, its factor structure remains under-researched. Inconsistency in published research may be attributed to the misuse, and inappropriate statistical analyses, of the LSI-R subscale scores. The present study explored the factor structure of the LSI-R, at the item level, using a sample of Australian offenders. Binary exploratory factor analysis found a five-factor solution for male offenders and a four-factor solution for female offenders. Using these data to “recalibrate” the LSI-R, sensitivity and specificity comparisons of the original and modified LSI-R were undertaken. With specific attention to Indigenous status and types of sentence orders served, sensitivity and specificity improvements were observed. Findings are discussed in terms of the value of exploring latent constructs and validating assessment tools, as well as the potential impact on the management and rehabilitation of Australian offenders.