Retrying Leopold and Loeb: A Neuropsychological Perspective

They called it the crime of the century; in 1924 in Chicago two brilliant, well-educated, and wealthy young men kidnapped and murdered a 14-year-old boy and killed him for the thrill of it . Expert testimony was presented by several well-known psychiatrists and psychologists, but even with all their clinical insights, none could reach a conclusion about the causal relation between their disturbed childhoods and a violent senseless crime. In fact, the well-known criminal defense attorney Clarence Darrow made little mention of the extensive psychiatric and psychological workups, and the judge did not deal with it in his sentencing. A review of the findings does suggest a delusional disorder for one of the defendants and psychopathy for the other; the interaction of these two disordered personalities led to a perfect storm a confluence of factors that only in combination could result in the brutal crime. Recent developments in neuropsychology allow us to see how these two disordered personalities interacted; the neuropsychological basis of delusional disorder and of psychopathy will be explored in this presentation along with a re-imagined closing argument by their attorney

Hepatitis C Virus Cascades of Care in the era of Direct-Acting Antiviral Therapy

Background: Hepatitis C virus (HCV) infection is a global public health problem. Ongoing monitoring of HCV care cascades is recommended to evaluate HCV elimination goals. Aims: Specific aims included: (1) evaluation of HCV care cascade using systematic review of global literature, and in New South Wales (NSW), Australia, (2) evaluation of HCV care cascade and its associated factors during pre-DAA (2011-2015) and DAA (2016-2018) eras, (3) factors associated with timely HCV RNA testing and treatment initiation during the DAA era, and (4) factors associated with DAA retreatment. Methods: In Chapter Two, we conducted a systematic review of global literature related to HCV care cascade from January 2014 to December 2019. In Chapters Three to Five, NSW HCV notifications linked to several administrative datasets was used to evaluate: (1) HCV care cascade during pre-DAA and DAA eras, (2) factors associated with timely HCV RNA testing, defined as testing within four weeks of HCV notification and timely treatment initiation, defined as treatment within six months of notifications, and (3) factors associated with retreatment, defined as initiation of different DAA any time after end of initial treatment date, or initiation of same DAA 28 days after last dispensation of initial treatment. Data was analysed using logistic regression. Key findings: Globally, only 11 countries reported HCV care cascade with DAA treatment uptake varied from 95% in Iceland to 8% in Sweden. In NSW, factors associated with timely HCV RNA testing and treatment initiation included age (≥ 30 years), male sex, non-Aboriginal ethnicity, country of birth Australia, and no history of drug dependence. During 2011-2012, 2013-2015, and 2016-2018, 29%, 48%, and 64% received HCV RNA testing; and 0.6%, 5%, and 38% initiated treatment, respectively. Birth cohort 1945-1964 (vs. ≥1965), males, non-Aboriginal ethnicity, and HCV/HIV co-infection were consistently associated with higher treatment uptake. In NSW, DAA retreatment was only 2.2% during 2016-2018. Early discontinuation of initial treatment had the strongest association with retreatment. Conclusion: Expanded efforts including the implementation of culturally appropriate strategies to reduce vulnerabilities among females, those born overseas, and Aboriginal population are recommended to promote HCV care cascade in NSW, Australia

Problemas de salud mental y sucesos vitales estresantes en mujeres en situación sin hogar: una adaptación del Protocolo Unificado para el Tratamiento Transdiagnóstico de los Trastornos Emocionales

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Psicología, leída el 22/06/2021Over the years, empirical evidence suggests that people experiencing homelessness particularly females disproportionately experience Stressful Life Events (SLEs) and mental health problems (Padgett et al., 2012; Phipps et al., 2019). Both SLEs and mental health problems are key factors in understanding the etiology and maintenance of homelessness (Nilsson et al., 2019; Padgett et al., 2012). However, few studies have focused exclusively on these issues with regards to women experiencing homelessness (e.g., Duke & Searby, 2019), and even fewer have done so in Spain. Further, most programs and social policies target structural, rather than psychological, factors contributing to homelessness (e.g., housing, employment reintegration, and legal support; Baxter et al., 2019; Wickham, 2020). Although such programs may indirectly improve psychological symptoms, there is a dearth of evidence-based psychological treatments developed specifically to target mental health problems in this population (Speirs et al.,2013). In addition, the majority of interventions do not adequately consider the problems and needs of women experiencing homelessness, a vulnerable subgroup with idiosyncratic characteristics (Luchenski et al., 2018; Speirs et al., 2013)...A lo largo de los años, la evidencia empírica sugiere que las personas en situación sin hogar, especialmente las mujeres, experimentan un gran número de Sucesos Vitales Estresantes (SVEs) y problemas de salud mental (Padgett et al., 2012; Phipps et al., 2019).Tantos los SVEs como los problemas de salud mental, son factores claves para entenderla etiología y el mantenimiento del sinhogarismo (Nilsson et al., 2019; Padgett et al.,2012). Sin embargo, pocos estudios se han centrado exclusivamente en estos temas en mujeres en situación sin hogar (ej. Duke & Searby, 2019), y aún menos en España. Además, la mayoría de los programas y políticas sociales hasta la fecha se han centradoen los factores estructurales proporcionando alojamiento, reinserción laboral y apoyo legal, en vez de a los factores psicológicos (Baxter et al., 2019; Wickham, 2020). Aunque algunas de esas intervenciones pueden mejorar indirectamente los síntomas psicológicos, existe una falta de tratamientos psicológicos basados en la evidencia desarrollados específicamente para abordar los problemas de salud mental en esta población (Speirs et al., 2013). Además, la mayoría de estas intervenciones no tienen en cuenta de forma más específica, los problemas y necesidades de las mujeres en situación sin hogar, a pesar de ser un subgrupo vulnerable con características idiosincrásicas (Luchenski et al., 2018)...Fac. de PsicologíaTRUEunpu

Criminal Justice and Mental Health : An Overview for Students

The intersection of crime and mental health has been a long-standing issue spanning across many decades, even centuries. In more recent times, professionals in the United States have begun to detail the “cracks” within the criminal justice system with better precision, especially in relation to inmates with mental health concerns. Unfortunately, despite the recognition of these cracks and their potential “fixes,” the implementation of change continues to be a struggle. The federal system, state system, and local county/parish jail system each have their own obstacles to overcome. Furthermore, these systems do not always work together for the common cause of public health for various reasons. Even further, integrating the mental health system into the criminal justice system at these levels can at times seem impossible; yet, the capacity for coordinated change has never been more possible. This text serves to educate students and professionals not only on the system of interconnected cracks, but also on the recommendations and innovations set forth by different interests at varying levels of the said system. All of the answers may not have been discovered yet, but the impetus for change is on the horizon for those with mental illness in the criminal justice system. The hopes of change begin with discussion on the problems, particularly in a historical context. This text seeks to be that vehicle for change in the future to ensure the care and safety of justice-involved individuals with mental illness

Inventing Psychiatric Drug Maintenance

This dissertation explores a major change in the way the maintenance of recovery from mental illness was authoritatively represented between the mid 1950s and the present. A shift from individual case reports to clinical trials as medicines authoritative knowledge-framework made possible a view of mental health as something to be achieved then maintained pharmaceutically. Through a controversial experiment that both produced and studied responders to maintenance drugs, it became possible to assess maintenance drugs in terms of an idealized, optimized state, rather than in relation to a personalized baseline. This new, idealized understanding of mental health emerged in the early 1970s and operated alongside traditional concepts of psychiatric diagnosis and prognosis, where each disease category implied an expected trajectory that interventions could only temporarily alter, for example by sedating or restraining. It harmonized with a managerial style of thinking among mental hospital psychiatrists who imagined a future in which medicated inmates would flow and circulate through institutions, achieving live release, rather than sedimenting into long-term custodial care. Pharmaceutically-maintained mental health unfolded in treatment phases, in the margins of epidemiological diagrams, in the minds eye of life insurance company medical directors as financial payouts due to suicide, in the pages of medical journals devoted to narrative medicine and in the decisions of physicians considering self-reporting to medical regulators. Mental health achieved and maintained with drugs, viewed from the perspective of business or occupational risk managers was seen as inherently untrustworthy, fragile, and at risk of failing. The result was on the one hand, a medical discourse that confidently represented and even promoted the idea that mental health could be pharmacologically maintained, and on the other a discourse of corporate risk management that saw fragility and risk among anyone who used mind altering drugs. Diverging from studies that isolate specific categories of mental illness, the dissertation bridges histories of pharmacology, medical epistemology, insurance, and professionalization. It shows how a science of maintenance psychiatric drugs evolved to favor the interests of its makers, while at the same time stacking the odds against the very consumers it claimed to serve

A Phenomenological Study of Uninsured Individuals’ Primary Healthcare Experiences at Nurse-Managed Clinics in Mississippi

The purpose of this phenomenological research study is to describe the lived experience of uninsured individuals accessing and receiving healthcare at nurse-led primary care clinics. This study is grounded in the existential phenomenological philosophy of Merleau-Ponty and guided by research procedures developed by Thomas and Pollio (2002). The study answers the question: What is the meaning of the patient’s perception of their lived healthcare experience as an uninsured individual? The research design methodology included a purposeful, convenience sample to recruit participants. Nine participants comprising five women and four men, ranging in age from 34 to 65, were interviewed to elicit perceptions of their primary care clinic experiences as uninsured patients, living in profound poverty in Mississippi. This study allowed patients to describe figural aspects of their experiences of accessing and receiving healthcare in nurse-managed clinics. Data analysis included reading and exploring each transcript for meaning units, patterns, and global themes in developing a thematic structure. The researcher and the Transdisciplinary Phenomenology Research Group agreed upon the final thematic structure. Four figural themes emerged: (1) A Safe Place, (2) “They Make You Feel Like You are a Loved Human Being,” (3) “They Just Ain’t in a Rush” versus “In and Out,” and (4) My Whole Body is Being Considered. Study rigor was maintained through bracketing, data saturation, peer debriefing, member checking, and the use of direct quotes to support findings. This study contributes to a deeper understanding and awareness of patients’ healthcare experiences, and may help to improve services for this economically disadvantaged population. Such research findings could help support and provide new information regarding best practices for population health outcomes among targeted populations. Findings also add to the evidence-base of nursing literature with implications for education, practice, and policy in nursing