Faces and Facets:Variability of Emotion Recognition in Psychopathy Reflect its Affective and Antisocial Features

Psychopathy consists of a constellation of affective-interpersonal features including lack of empathy, callousness, manipulativeness and interpersonal charm, impulsiveness and irresponsibility. Despite its theoretical and predictive value in forensic contexts, the relationships between the psychometric dimensions of psychopathy, including its antisocial features, and the construct’s neuropsychological characteristics remain uncertain. In this study, 685 personality-disordered prisoners with histories of serious violent or sexual offenses were assessed for psychopathy before completing a computerized and well-validated assessment of the ability to recognize emotional expressions in the face. Prisoners with more of the affective features of psychopathy, and prisoners with more of its antisocial manifestations, showed relatively poor recognition accuracy of fearfulness and disgust. These relationships were independent and modest but were still evident following correction for demographic features (e.g., ethnicity and socioeconomic status), mental illness (e.g., substance and alcohol misuse), personality disorders (other than antisocial personality disorder) and treatment status. By contrast, the associations between these dimensions of psychopathy and emotion recognition were diminished by controlling for cognitive ability. These findings demonstrate that variability in the ability of high-risk personality-disordered prisoners to recognize emotional expressions in the face—in particular, fear and disgust—reflects both the affective and antisocial aspects of psychopathy, and is moderated by cognitive ability. (PsycINFO Database Record (c) 2017 APA, all rights reserved

Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol

Background: Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In 2018, the Care Quality Commission reported that over half the 4,400 mental health inpatient rehabilitation beds in England were provided by the independent sector. They raised concerns that the length of stay and cost of independent sector care was double that of the NHS and that their services tended to be provided much further from people’s homes. However, there has been no research comparing the two sectors and we therefore do not know if these concerns are justified. The ACER Study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) is a national programme of research in England, funded from 2021 to 2026, that aims to investigate differences in inpatient mental health rehabilitation provided by the NHS and independent sector in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness. Methods: ACER comprises a:1) detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) qualitative investigation of patient, family, staff and commissioners’ experiences of the two sectors; 3) cohort study comparing clinical outcomes in the two sectors over 18 months; 4) comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is ‘successful rehabilitation’ defined as a) being discharged from the inpatient rehabilitation unit without readmission and b) inpatient service use over the 18 months. Discussion: The ACER study will deliver the first empirical comparison of the clinical and cost-effectiveness of NHS and independent sector inpatient mental health rehabilitation services. Trial registration: ISRCTN17381762 retrospectively registered

Comorbidity of hypertrophic cardiomyopathy with depression: how the psychiatric disease can influence the morbidity and the mortality of the cardiac patient

One of the main causes of sudden death, especially in youth, is hypertrophic cardiomyopathy, a hereditary disease that mainly means hypertrophy of the left or/ and the right ventricular cavity of the heart (WHO / ISFC) On the other hand, of the most common psychiatric disorders are mood disorders, particularly depressive disorders. Many factors interact in the manifestation of depressive symptomatology. Biological, neuroendocrinological, neyroanatomical, neuroimmunological, metabolical and genetic components, compose the complexity of the disease known as depression. Additional factors such as stressful life events have the power to set off and culminate depressive symptomatology. Such symptomatology concerns the psychical as well as the physical dimensions of the individual. Commorbidity of depressive disorders and organic diseases is a common occurrence of great importance. These are different nosological entities that may appear at the same time or one may precede the other. Commorbidity of depression and cardiovascular diseases is of the best studied. A lot of studies conclude that they are strongly related, as well as that the psychiatric illness may interfere in the prognosis of the physical disease. Unfortunately, in the field of inherited cardiovascular diseases there is poor evidence. There are only a small number of surveys concerning the quality of life of patients with dilated and hypertrophic cardiomyopathy. The main purpose of the present study is to investigate the possibility of relation between depression and hypertrophic cardiomyopathy, a specific type of inherited cardiomyopathy. In patients already diagnosed with hypertrophic cardiomyopathy we wanted to investigate the possibility of increased incidence of depressive symptomatology comparing to the general population. Furthermore, we wanted to find out if and how depressive symptomatology can influence the clinical features, complications and mortality in those patients. 121 patients with hypertrophic cardiomyopathy were participated in the study. Specialist cardiologists from EKKAN (Greek Center of Cardiology for Athletes and Youth) were responsible for patients’ diagnosis of the cardiac disease, the risk stratification for sudden death as well as their follow up. For the diagnosis of depressive symptomatology BDI, CES-D and SCID for DSMIII-IIIR were used. We found that patients with hypertrophic cardiomyopathy are more depressed than the general population. We also found that there is no relation between depressive symptomatology and the severity of the cardiac disease. Patients in high risk of sudden death are not more depressed. Furthermore, it seems to be no relation between the risk stratification for sudden death and the present or future patients’ depressive symptomatology. In addition, time from diagnosis of the cardiac disease is not related to a person’s depressive status. Because of the limitations of the study (group’s size, duration of the study) we cannot make any suggestions regarding mortality. We therefore conclude that patients with hypertrophic cardiomyopathy are more depressed than the general population. Additionally, there is no relation between depressive symptomatology and risk stratification for sudden death or the time from the diagnosis of the heart disease.Μια από τις συχνότερες αιτίες αιφνίδιου θανάτου είναι η υπερτροφική μυοκαρδιοπάθεια, η οποία ορίζεται ως ανεξήγητη υπερτροφία της αριστερής ή/ και της δεξιάς κοιλίας της καρδιάς. (WHO / ISFC) Πρόκειται για τη συχνότερη αιτία νεανικού αιφνίδιου θανάτου. Επιπροσθέτως, από τις πιο συχνές ψυχιατρικές διαταραχές της εποχής μας είναι οι διαταραχές της διάθεσης, και μάλιστα οι καταθλιπτικές διαταραχές. Υπάρχουν πολλοί παράγοντες που αλληλεπιδρούν έτσι ώστε να εκδηλώσει το άτομο καταθλιπτική συμπτωματολογία. Βιολογικές, νευροενδοκρινικές, νευροανατομικές, νευροανοσολογικές, μεταβολικές και γενετικές συνιστώσες συνθέτουν την πολύπλοκη νόσο που καλείται κατάθλιψη. Διάφοροι παράγοντες, όπως τα ψυχοπιεστικά γεγονότα ζωής, έχουν τη δύναμη να πυροδοτήσουν και να εξάρουν την καταθλιπτική συμπτωματολογία. Μια συμπτωματολογία που αφορά τόσο στην ψυχική όσο και τη σωματική διάσταση του ατόμου. Αρκετά συχνά, το άτομο με καταθλιπτική νόσο πάσχει και από κάποιο οργανικό νόσημα. Οι δυο αυτές διαφορετικές νοσολογικές οντότητες μπορεί να εμφανιστούν συγχρόνως ή η μια να προηγείται της άλλης. Τα νοσήματα του καρδιαγγειακού συστήματος αποτελούν την κατηγορία εκείνη των νοσημάτων που είναι από τα καλύτερα μελετημένα όσων αφορά στην συνύπαρξή τους με κατάθλιψη. Πλήθος ερευνών έχει δείξει τη σαφή τους συσχέτιση καθώς και το πώς η ψυχική νόσος επηρεάζει την πορεία και την πρόγνωση του καρδιοπαθούς. Στον τομέα όμως των κληρονομικών καρδιαγγειακών νοσημάτων, οι μόνες έρευνες που έχουν γίνει περιορίζονται στην μελέτη της ποιότητας ζωής των ατόμων με διατατική και υπερτροφική μυοκαρδιοπάθεια. Σκοπός της παρούσας έρευνας είναι να διερευνηθεί το ενδεχόμενο ύπαρξης σχέσης μεταξύ κατάθλιψης και ενός συγκεκριμένου τύπου καρδιοπάθειας, της υπερτροφικής μυοκαρδιοπάθειας. Θεωρώντας δεδομένη την ύπαρξη υπερτροφικής μυοκαρδιοπάθειας θέλαμε να διερευνήσουμε αν αυτή συνεπάγεται μεγαλύτερη επίπτωση καταθλιπτικής συμπτωματολογίας στους ασθενείς. Επιπροσθέτως, δευτερευόντως, θέλαμε να αξιολογήσουμε την επίδραση της καταθλιπτικής συμπτωματολογίας στην κλινική εικόνα, την εμφάνιση επιπλοκών και τη θνησιμότητα ασθενών πασχόντων από υπερτροφική μυοκαρδιοπάθεια. Τον υπό μελέτη πληθυσμό αποτέλεσαν 121 ασθενείς πάσχοντες από υπερτροφική μυοκαρδιοπάθεια. Η καρδιακή νόσος καθώς και η διαστρωμάτωση του κινδύνου για αιφνίδιο θάνατο διαγνώσθηκαν από καρδιολόγους ειδικούς στις κληρονομικές καρδιαγγειακές παθήσεις (Ελληνικό Κέντρο Καρδιολογίας Αθλητών και Νέων, ΕΚΚΑΝ). Για την εκτίμηση της καταθλιπτικής συμπτωματολογίας χρησιμοποιήθηκαν οι κλίμακες BDI, CES-D και η δομημένη κλινική συνέντευξη για την κατάθλιψη (SCID for DSM III - IIIR). Διαπιστώσαμε ότι οι ασθενείς με υπερτροφική μυοκαρδιοπάθεια είναι περισσότερο καταθλιπτικοί από το γενικό πληθυσμό. Η καταθλιπτική συμπτωματολογία δε φαίνεται να συνδέεται με τη σοβαρότητα της καρδιακής νόσου και οι ασθενείς που θεωρούνται υψηλού κινδύνου για αιφνίδιο θάνατο δεν είναι πιο καταθλιπτικοί από τους υπόλοιπους. Φαίνεται επίσης πως η διαστρωμάτωση του κινδύνου για αιφνίδιο θάνατο δεν επηρεάζει ούτε την παρούσα αλλά ούτε και την μελλοντική ψυχική κατάσταση του ατόμου. Επιπροσθέτως, ο χρόνος που έχει περάσει από την αρχική διάγνωση της καρδιακής νόσου δε σχετίζεται με τη συναισθηματική κατάσταση του ατόμου. Λόγω του μεγέθους του δείγματος και του περιορισμένου χρόνου παρακολούθησης δε μπορούμε να πιθανολογήσουμε συσχέτιση μεταξύ της ύπαρξης καταθλιπτικής συμπτωματολογίας και της επίδρασής της στη θνησιμότητα του καρδιοπαθούς. Συμπερασματικά, από την παρούσα έρευνα φαίνεται πως οι ασθενείς με υπερτροφική μυοκαρδιοπάθεια είναι περισσότερο καταθλιπτικοί από το γενικό πληθυσμό. Η εμφάνιση καταθλιπτικής συμπτωματολογίας φαίνεται να είναι ανεξάρτητη από τη διαστρωμάτωση του κινδύνου για αιφνίδιο θάνατο αλλά και από το χρόνο που έχει περάσει από τη διάγνωση της καρδιακής νόσου

Mental illness that is difficult to classify: a case study

A case is presented of a man who has been detained in secure psychiatric hospitals for the majority of his life. Although his index offence was minor he has a long history of violence. The patient has collected a vast number of diagnoses over the years. His treatment demonstrates a role for clozapine in ameliorating violent behaviour and aggression. We conceptualise this as being linked to the properties of this drug. From the patient’s history we believe that reserpine may have had a similar effect to clozapine regarding mental state and reduction of violent behaviour. This case illustrates the consequences of inaccurate diagnosis and therefore the provision of adequate treatment. It highlights that the continuity of care and the communication of information is essential for the patient’s quality of life. It also illustrates how the use of certain antipsychotics may prove essential in the control of violence so that institutionalisation can be prevented

Borderline personality disorder and violence in the UK population: categorical and dimensional trait assessment

Background: Borderline personality disorder (BPD) is characterised by difficulties with impulse control and affective dysregulation. It is unclear whether BPD contributes to the perpetration of violence or whether this is explained by comorbidity. We explored independent associations between categorical and dimensional representations of BPD and violence in the general population, and differential associations from individual BPD criteria. // Methods: We used a representative combined sample of 14,753 men and women from two British national surveys of adults (≥16 years). BPD was assessed using the Structured Clinical Interview II- Questionnaire. We measured self-reported violent behaviour in the past 5 years, including severity, victims and locations of incidents. Associations for binary, dimensional and trait-level exposures were performed using weighted logistic regression, adjusted for demography and comorbid psychopathology. // Results: Categorical diagnosis of BPD was associated only with intimate partner violence (IPV). Associations with serious violence leading to injuries and repetitive violence were better explained by comorbid substance misuse, anxiety and antisocial personality disorder (ASPD). However, anger and impulsivity BPD items were independently associated with most violent outcomes including severity, repetition and injury; suicidal behaviours and affective instability were not associated with violence. Both trait-level and severity-dimensional analyses showed that BPD symptoms might impact males and females differently in terms of violence. // Conclusions: For individuals diagnosed BPD, violence is better explained by comorbidity. However, BPD individual traits show different pathways to violence at the population level. Gender differences in BPD traits and their severity indicate distinct, underlying mechanisms towards violence. BPD and traits should be evaluated in perpetrators of IPV