Emotional, cognitive and behavioral self-regulation in forensic psychiatric patients:Changes over time and associations with childhood trauma, identity and personality pathology

The construct of self-regulation is of particular interest to the forensic psychiatric practice due to its associations with both clinical and criminal outcomes, as well as recidivism. However, research on different components of self-regulation within forensic psychiatric practice is rare. The current study aimed to gain knowledge on the construct of self-regulation in a sample of forensic psychiatric patients (N = 94). Firstly, by investigating change of emotional, behavioral and cognitive self-regulation over the course of 12 months in state-mandated care in a treatment facility. Secondly, by looking at the associations between these three elements of self-regulation and childhood trauma, identity dysfunction and personality pathology. Repeated measures ANOVA showed little to no difference in average self-regulation over time (only for behavioral regulation), and rank-order stability was relatively high in most cases. Path analysis showed that: emotion regulation was associated with all outcomes; behavioral regulation with all except childhood trauma and detachment; and cognitive regulation only with antagonism and negative affectivity. Findings suggest short-term changes are unlikely and indicate relative importance of emotional, and to some extent behavioral regulation for clinical practice. However, due to sample size restrictions, interpretations should be made with caution

Excellence in forensic psychiatry services:International survey of qualities and correlates

Background Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development. Aims To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security.Method A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire. Results Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score. ConclusionsLarger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.</p

[Determining security need in forensic psychiatric patients: HoNOS-Secure and DUNDRUM-1].

BACKGROUND: Forensic psychiatric patients can be treated in different security levels. Clear criteria to estimate the required security level or transfer to a less secure setting are not yet available. A literature review shows that, of the few instruments that are used internationally, the DUNDRUM and the HoNOS-Secure are the most promising. AIM: To investigate whether these instruments can be used in Flemish forensic psychiatric settings. METHOD: DUNDRUM-1 scores were collected for 150 internees. The psychometric qualities of the scale were examined. In a subpopulation, the DUNDRUM-1 was compared with the HoNOS-Secure. RESULTS: The psychometric properties of the DUNDRUM-1 were good and exceeded those of the HoNOS-Secure. CONCLUSION: The DUNDRUM-1 is an instrument that can help clinicians and judges to better - and in a more transparent way - substantiate their decision-making to secure care. However, further research regarding the practical applicability is needed.status: publishe

Farmacotherapie bij seksuele gedragsstoornissen en verstandelijke beperking

Abstract: Achtergrond Seksuele gedragsstoornissen bij personen met een verstandelijke beperking vormen verscheidene uitdagingen, ondanks ontwikkelingen in behandelmogelijkheden en risicotaxatie. Het gebruik van libidoremmende behandelingen in deze populatie is controversieel en onderzoek is niet eenduidig over de geschiktste behandelingsstrategie. Doel Toelichten van farmacotherapie bij seksuele gedragsstoornissen bij personen met een verstandelijk beperking en de medische en ethische overwegingen daarbij. Methode Via een literatuurstudie een overzicht geven van de literatuur, dat vervolgens aan de klinische praktijk werd getoetst. Resultaten We vonden een tekort aan wetenschappelijke onderbouwing van de effectiviteit van farmacotherapie bij seksuele gedragsstoornissen en verstandelijke beperking. Het routinegebruik van libidoremmende medicatie is gecontra-indiceerd. Voor het opstarten van androgeendeprivatietherapie zijn er medische en ethische richtlijnen en contra-indicaties gepubliceerd die gerespecteerd dienen te worden in de algemene populatie. De noodzakelijkheid van farmacotherapie dient nauw gemonitord te worden en aangevuld met psychotherapeutische zorg gericht op de seksuele vaardigheden, attitudes en kennis van de pati\uebnt. Een onderscheid dient gemaakt te worden tussen seksuele gedragsstoornissen van het \u2018parafiele type\u2019 en van het \u2018seksueel onaangepaste of na\uefeve type\u2019. Conclusie Multidisciplinaire evaluatie, risicotaxatie en een ge\uefndividualiseerde benadering zijn de hoekstenen van een kwaliteitsvolle behandeling van seksuele gedragsstoornissen bij personen met een verstandelijke beperking

The importance of context: An ESM study in forensic psychiatry

Experience Sampling Method (ESM) is a structured diary technique assessing variations in thoughts, mood, and psychiatric symptoms in everyday life. Research has provided ample evidence for the efficacy of the use of ESM in general psychiatry but its use in forensic psychiatry has been limited. Twenty forensic psychiatric patients participated. The PsyMate™ Device emitted a signal 10 times a day on six consecutive days, at unpredictable moments. After each “beep,” the patients completed ESM forms assessing current context, thoughts, positive and negative affect, and psychotic experiences. Stress was measured using the average scores of the stress related items. Compliance rate was high (85% beeps responded). Activity stress was related to more negative affect, lower positive affect, and more psychotic symptoms. This finding was restricted to moments when a team member was present; not when patients were alone or with other patients. ESM can be useful in forensic psychiatry and give insights into the relationships between symptoms and mood in different contexts. In this study activity-related stress was contextualized. These findings can be used to personalize interventions