Najat Khalifa

The use of telepsychiatry within forensic practice : A literature review on the use of videolink

While telepsychiatry – the use of telecommunication technologies to deliver mental health services from a distance – ought to have particular applicability to forensic work, little is known about its effectiveness in such settings. We reviewed the literature on the forensic applications of telepsychiatry, aiming to provide a summary and determine its effectiveness. We searched several relevant databases for reports published between 1998 and 2006 of forensic applications of telepsychiatry. The existing literature provides some preliminary evidence for the effectiveness of telepsychiatry in the forensic arena. However, as there are some serious methodological limitations such as lack of control groups, small sample sizes, and limited outcome evaluation, its utility can only be regarded as preliminary. Telepsychiatry is a feasible mode of health care delivery in areas relevant to the practice of forensic psychiatry. Further research is needed to determine its effectiveness and identify barriers to its use among forensic psychiatrists.

Transcranial magnetic stimulation for geriatric depression: Promises and pitfalls.

As the global population gets older, depression in the elderly is emerging as an important health issue. A major challenge in treating geriatric depression is the lack of robust efficacy for many treatments that are of significant benefit to depressed working age adults. Repetitive transcranial magnetic stimulation (rTMS) is a novel physical treatment approach used mostly in working age adults with depression. Many TMS trials and clinics continue to exclude the elderly from treatment citing lack of evidence in this age group. In this review, we appraise the evidence regarding the safety and efficacy of rTMS in the elderly. A consistent observation supporting a high degree of tolerability and safety among the elderly patients emerged across the Randomised Controlled Trials and the uncontrolled trials. Further, there is no reliable evidence negating the utility of rTMS in the elderly with depression. We also identified several factors other than age that moderate the observed variations in the efficacy of rTMS in the elderly. These factors include but not limited to: (1) brain atrophy; (2) intensity and number of pulses (dose-response relationship); and (3) clinical profile of patients. On the basis of the current evidence, the practice of excluding elderly patients from TMS clinics and trials cannot be supported.

Forensic telepsychiatry in the United Kingdom

Forensic telepsychiatry remains in its infancy in the United Kingdom. This article sets out to describe how it can be used within a community forensic service, and the future challenges ahead in the United Kingdom. It looks at relevant academic, governmental, and legal resources and is designed as a scholarly reflection by clinicians rather than as a formal literature review.

Antisocial personality disorder comorbid with borderline pathology and psychopathy is associated with severe violence in a forensic sample

Background: Evidence suggests the relationship between personality disorder (PD) and violence in offenders might be clarified by considering sub-groups of PD offenders defined by patterns of PD comorbidity. Aim: to identify patterns of PD comorbidity associated with severe violence, defined by its severity, quantity and age of onset (Violence Index: VI) in a forensic sample of 100 PD offenders. Methods: Correlations were first computed between VI and a range of personality and criminological variables; next, patients with antisocial/borderline comorbidity were compared with other PD patients; finally, regression analysis was conducted to identify unique predictors of VI. Results: The antisocial deviance factor of psychopathy and antisocial/borderline comorbidity were each significantly and independently associated with severe violence. Patients showing both a high psychopathy score and antisocial/borderline comorbidity had a significantly greater VI than those without these characteristics. Conclusion: PD patients with high psychopathy co-occurring with borderline and antisocial PDs show a criminal profile characterised by a high degree of serious violence.

The relationship between childhood conduct disorder and adult antisocial behavior is partially mediated by early-onset alcohol abuse

Early-onset alcohol abuse (EOAA) was previously found to both mediate and moderate the effect of childhood conduct disorder (CD) on adult antisocial behavior (ASB) in an American community sample of young adults (Howard, R., Finn, P. R., Gallagher, J., & Jose, P. (2011). Adolescent-onset alcohol abuse exacerbates the influence of childhood conduct disorder on late adolescent and early adult antisocial behavior. Journal of Forensic Psychiatry and Psychology. Advance online publication. doi:10.1080/14789949.2011.641996). This study tested whether this result would generalize to a British forensic sample comprising 100 male forensic patients with confirmed personality disorder. Results confirmed that those in whom EOAA co-occurred with CD showed the highest level of personality pathology, particularly Cluster B traits and antisocial/borderline comorbidity. Those with co-occurring CD with EOAA, compared with those showing only CD, showed more violence in their criminal history and greater recreational drug use. Regression analysis showed that both EOAA and CD predicted adult ASB when covariates were controlled. Further analysis showed that EOAA significantly mediated but did not moderate the effect of CD on ASB. The failure to demonstrate an exacerbating effect of EOAA on the relationship between CD and ASB likely reflects the high prevalence of CD in this forensic sample. Some implications of these findings are discussed.

Beliefs about Jinn, black magic and evil eye in Bangladesh: the effects of gender and level of education

The study was aimed to examine beliefs among 320 attendees of a large University Hospital in Dhaka about Jinn, black magic and evil eye among Muslims in Bangladesh, using a self-completed questionnaire. The majority believed in the existence of Jinn (72%) and in Jinn possession (61%). In contrast, a relatively smaller proportion believed in the existence of black magic and evil eye (50% and 44%, respectively). Women were more likely than men to believe in the existence of Jinn and to cite religious figures as the treating authority for diseases attributed to affliction by black magic. Participants with a higher educational attainment were less likely than those with lower attainment to believe in jinn possession; or to believe that Jinn, black magic, or evil eye could cause mental health problems. Mental health care practitioners need to be mindful of these beliefs to achieve the best outcome for their patients.

Impaired Pavlovian conditioned inhibition in offenders with personality disorders.

Certain types of violent offending are often accompanied by evidence of personality disorders (PDs), a range of heterogeneous conditions characterized by disinhibited behaviours that are generally described as impulsive. The tasks previously used to show impulsivity deficits experimentally (in borderline personality disorder, BPD) have required participants to inhibit previously rewarded responses. To date, no research has examined the inhibition of responding based on Pavlovian stimulus–stimulus contingencies, formally “conditioned inhibition” (CI), in PDs. The present study used a computer-based task to measure excitatory and inhibitory learning within the same CI procedure in offenders recruited from the “personality disorder” and the “dangerous and severe personality disorder” units of a high-security psychiatric hospital. These offenders showed a striking and statistically significant change in the expression of inhibitory learning in a highly controlled procedure: The contextual information provided by conditioned inhibitors had virtually no effect on their prepotent associations. Moreover, this difference was not obviously attributable to nonspecific cognitive or motivational factors. Impaired CI would reduce the ability to learn to control associative triggers and so could provide an explanation of some types of offending behaviour.

Individual placement and support (IPS) for patients with offending histories: the IPSOH feasibility cluster randomised trial protocol

Introduction People with involvement in forensic psychiatric services face many obstacles to employment, arising from their offending, as well as their mental health problems. This study aims to assess the feasibility of conducting a randomised controlled trial (RCT) to evaluate the effectiveness of individual placement and support (IPS), in improving employment rates and associated psychosocial outcomes in forensic psychiatric populations. IPS has been found consistently to achieve employment rates above 50% in psychiatric patients without a history of involvement in criminal justice services. Methods/design This is a single-centre feasibility cluster RCT. Clusters will be defined according to clinical services in the community forensic services of Nottinghamshire Healthcare NHS Foundation Trust (NHCT). IPS will be implemented into 2 of the randomly assigned intervention clusters in the community forensic services of NHCT. A feasibility cluster RCT will estimate the parameters required to design a full RCT. The primary outcome is the proportion of people in open employment at 12-month follow-up. Secondary outcome measures will include employment, educational activities, psychosocial and economic outcomes, as well as reoffending rates. Outcome measures will be recorded at baseline, 6 months and 12 months. In accordance with the UK Medical Research Council guidelines on the evaluation of complex interventions, a process evaluation will be carried out; qualitative interviews with patients and staff will explore general views of IPS as well as barriers and facilitators to implementation. Fidelity reviews will assess the extent to which the services follow the principles of IPS prior, during and at the end of the trial. Ethics and dissemination Ethical approval was obtained from the East Midlands Research Ethics Committee-Nottingham 1 (REC reference number 15/EM/0253). Final and interim reports will be prepared for project funders, the study sponsor and clinical research network. Findings will be disseminated through peer-reviewed journals, conferences and event presentations. Trial registration number NCT02442193; Pre-results.

Is delusional ideation a critical link in the nexus between personality disorder and violent offending

Evidence suggests that consideration of personality disorder (PD) severity, incorporating both externalising and internalising features of PD, might help to clarify the PD – violence relationship; moreover, that separate developmental pathways might link externalising and internalising personality pathology with criminal violence. This study of 96 forensic patients with confirmed PD and a history of violent offending addressed the question of whether delusional ideation, measured by the Peters Delusions Inventory, might play a significant role in the link between severe PD and criminal violence. Severe PD, defined by summing scores across DSM-IV PD criteria, was significantly associated with delusional thinking, with violence, and with high levels of both externalising and internalising personality features. Delusional thinking was associated with violence via internalising but not externalising PD features, suggesting that the link between severe PD and violence may be partly mediated by delusional thinking.

Is PCL-R psychopathy associated with either type or severity of personality disorder?

The extent to which assessment of personality disorders (PDs), and trans-diagnostic measures of PD severity, can capture the variance in psychopathy measured by the Psychopathy Checklist-Revised (PCL-R) was examined in 100 forensic patients with a history of violent offending. Correlational and linear regression analyses were carried out to establish whether (i) combinations of PDs would predict PCL-R scores for each of its two factors, interpersonal–affective (F1) and antisocial deviance (F2); (ii) ‘acting out’, a putative measure of externalising maladjustment that transcends PD categories, would predict PCL-R scores. Results showed that narcissistic and avoidant PDs contributed significantly to the prediction of F1, but only antisocial PD contributed to the prediction of F2. ‘Acting out’ predicted both F1 and F2, suggesting that core features of PCL-R psychopathy are embedded within and across different PD diagnoses. Results are discussed in relation to different sub-types of psychopathy described in the literature.