Full and equal equality

Purpose: This commentary takes the article, “Participation of adults with learning disabilities in the 2015 United Kingdom General Election”, as a jumping-off point for considering a tension between the aim of full and equal equality for all people with disabilities as set out in the Convention on the Rights of Persons with Disabilities and more traditional beliefs, that on occasion, it is necessary to deny legal autonomy of men and women with intellectual disabilities in order to protect them. The paper aims to discuss these issues. Design/methodology/approach: This issue is explored by reviewing the multiple and often conflicting ways in which disability and intellectual disability are conceptualised. Findings: Given the multiple and contradictory ways in which both disability and intellectual disability are understood, any discussion of the rights of persons with disabilities is going to be highly problematic. Originality/value: Equal recognition before the law and the presumption that all persons with intellectual disabilities can – with support – make autonomous decisions could be treated as an empirical question

Firesetting and arson in individuals with autism spectrum disorder : a systematic PRISMA review

Purpose: The present review aims to identify studies which have investigated arson or firesetting in individuals with ASD. Design/methodology/approach: A systematic PRISMA review was conducted. Findings: The present review highlighted the relatively little research that has been conducted to date exploring firesetting or arson in individuals with ASD. Eleven papers were identified in the present review study. Six were cases studies and five were empirical studies. The case studies identified in the review highlighted some of the ASD symptomology which may contribute to this type of criminal behaviour. Also, the empirical studies indicate that there is a higher prevalence of individuals with ASD who engage in such criminal behaviours. Research limitations/implications: There is an urgent need to further empirical research in this area and for there to be an increased awareness and understanding of how ASD can contribute to arson and firesetting in both a legal and clinical context. Originality/value: This is the first review, to the author’s knowledge, to explore the literature on firesetting or arson in individuals with ASD

A systematic PRISMA review of individuals with autism spectrum disorder in secure psychiatric care : prevalence, treatment, risk assessment and other clinical considerations

Purpose – Patients with autism spectrum disorder (ASD) present with specific assessment, specific difficulties, needs and therapeutic issues and therefore are a challenging group for forensic services. Given the challenge that individuals with ASD present to forensic services, the suggested increase in the number of this group within this setting and the relatively little amount of research which suggests they face a number of difficulties within the prison environment, the purpose of this paper is to identify and review all the studies which have been carried out investigating any aspect of ASD in relation to secure hospital settings. Design/methodology/approach – Seven internet-based bibliographic databases were used for the present review. The review followed the Preferred Reporting Items for Systematic reviews andMeta-Analyses guidelines. Findings – A total of 12 studies were included in this review; 3 looked at the prevalence of ASD in secure psychiatric hospitals. One study evaluated the clinical utility of the AQ screening tool to assess self-reported autistic traits in secure psychiatric settings. Three explored any type of characteristics of patients with ASD detained in secure psychiatric hospitals. One study investigated the experiences or quality of life of patients with an ASD detained in secure psychiatric care. Two studies investigated awareness, knowledge and/or views regarding patients with ASD held by staff working within secure psychiatric hospitals. Lastly, three studies (one of which was also included in the prevalence category above) looked at the effectiveness of interventions or treatment of patients with ASD in secure psychiatric hospitals. Clinical recommendations and future research directions are discussed. Originality/value – To the author’s knowledge, this is the first review to explore what research has been carried out looking specifically at patients with ASD in relation to secure forensic settings. Keywords: Autism spectrum disorder, Secure hospital, Asperger’s syndrome, High secure psychiatric hospital, HSPC, Secure forensic setting

Pervasive exposure to violence and posttraumatic stress disorder in a predominantly African American Urban Community: The Detroit neighborhood health study

Exposure to traumatic events is common, particularly among economically disadvantaged, urban African Americans. There is, however, scant data on the psychological consequences of exposure to traumatic events in this group. We assessed experience with traumatic events and posttraumatic stress disorder (PTSD) among 1,306 randomly selected, African American residents of Detroit. Lifetime prevalence of exposure to at least 1 traumatic event was 87.2% (assault = 51.0%). African Americans from Detroit have a relatively high burden of PTSD; 17.1% of those who experienced a traumatic event met criteria for probable lifetime PTSD. Assaultive violence is pervasive and is more likely to be associated with subsequent PTSD than other types of events. Further efforts to prevent violence and increase access to mental health treatment could reduce the mental health burden in economically disadvantaged urban areas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89475/1/20705_ftp.pd

Differential response to right unilateral ECT in depressed patients: impact of comorbidity and severity of illness [ISRCTN39974945]

BACKGROUND: Recent electroconvulsive therapy (ECT) efficacy studies of right unilateral (RUL) ECT may not apply to real life clinics with a wide range of patients with major depressive episodes. METHODS: The study included two groups of patients. In addition to a homogeneous group of patients with major depression according to DSM-IV criteria with severity of the major depressive episode > 16 scores on 17-item Hamilton Rating Scale for Depression (HDRS) (Group 1, n = 16), we included a heterogeneous group of patients with less severe major depressive episodes or with a variety of comorbid conditions (Group 2, n = 24). We randomly assigned the patients to an RUL ECT treatment dosed at 5 or 2.5 times seizure threshold with an intent-to-treat design. The outcomes measured blindly were HDRS, number of treatments, and Mini-Mental State Examination (MMSE). The patients were considered to have responded to treatment if the improvement in HDRS score was at least 60% and they had a total score of less than ten. RESULTS: The Group 2 patients responded poorer (8% vs. 63%), and had more often simultaneous worsening in their MMSE scores than Group 1 patients. The differences in the outcomes between the two different doses of RUL ECT treatment were not statistically significant. CONCLUSIONS: ECT effectiveness seems to be lower in real-life heterogeneous patient groups than in homogeneous patient samples used in experimental efficacy trials

Incidence of dementia and cognitive impairment, not dementia in the united states

Objective: Estimates of incident dementia, and cognitive impairment, not dementia (CIND) (or the related mild cognitive impairment) are important for public health and clinical care policy. In this paper, we report US national incidence rates for dementia and CIND. Methods: Participants in the Aging, Demographic, and Memory Study (ADAMS) were evaluated for cognitive impairment using a comprehensive in‐home assessment. A total of 456 individuals aged 72 years and older, who were not demented at baseline, were followed longitudinally from August 2001 to December 2009. An expert consensus panel assigned a diagnosis of normal cognition, CIND, or dementia and its subtypes. Using a population‐weighted sample, we estimated the incidence of dementia, Alzheimer disease (AD), vascular dementia (VaD), and CIND by age. We also estimated the incidence of progression from CIND to dementia. Results: The incidence of dementia was 33.3 (standard error [SE], 4.2) per 1,000 person‐years and 22.9 (SE, 2.9) per 1,000 person‐years for AD. The incidence of CIND was 60.4 (SE, 7.2) cases per 1,000 person‐years. An estimated 120.3 (SE, 16.9) individuals per 1,000 person‐years progressed from CIND to dementia. Over a 5.9‐year period, about 3.4 million individuals aged 72 and older in the United States developed incident dementia, of whom approximately 2.3 million developed AD, and about 637,000 developed VaD. Over this same period, almost 4.8 million individuals developed incident CIND. Interpretation: The incidence of CIND is greater than the incidence of dementia, and those with CIND are at high risk of progressing to dementia, making CIND a potentially valuable target for treatments aimed at slowing cognitive decline. ANN NEUROL 2011;Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86941/1/22362_ftp.pd

Improving estimation of the prognosis of childhood psychopathology; combination of DSM-III-R/DISC diagnoses and CBCL scores [IF: 2.7]

Objective: To compare the predictive validity of the clinical-diagnostic and the empirical-quantitative approach to assessment of childhood psychopathology, and to investigate the usefulness of combining both approaches. Method: A referred sample (N=96), aged 6 to 12 years at initial assessment, was followed up across - on average - a period of 3.2 years. It was assessed to what extent DISC/DSM-III-R diagnoses - representing the clinical-diagnostic approach, and CBCL scores - representing the empirical-quantitative approach, predicted the following signs of poor outcome: outpatient/inpatient treatment, or parents' wish for professional help for the child at follow-up, disciplinary problems in school, and police/judicial contacts. Results: Both diagnostic systems added significantly to the prediction of poor outcome, and neither of the two systems was superior. Use of both systems simultaneously provided the most accurate estimation of the prognosis, reflected by the occurrence of future poor outcome. Even diagnostic concepts that are generally regarded as relatively similar, such as ADHD (DSM) and attention problems (CBCL), or conduct disorder (DSM) and delinquent behavior (CBCL), appeared to differ in their ability to predict poor outcome. Conclusions: The present study supports the use of the empirical-quantitative approach and the clinical-diagnostic approach simultaneously, both in research and in clinical settings, to obtain a comprehensive view of the prognosis of psychopathology in children. © Association for Child Psychology and Psychiatry, 2004