Interpersonal functioning deficits in association with DSM-IV personality disorder dimensions

PURPOSE: According to DSM, interpersonal functioning deficits are a main criterion for the general definition of personality disorders (PDs), but some PD diagnoses do not appear to be related to impaired interpersonal functioning. Social deficits have rarely been studied in all PD dimensions to date. METHODS: We analyzed 511 adults aged 20-41 years from the general population of the canton of Zurich, Switzerland, using data from the Epidemiology Survey of the Zurich Programme for Sustainable Development of Mental Health Services (ZInEP). PD dimensions were measured with a questionnaire and indicators of interpersonal functioning with a semi-structured interview. Associations were analyzed with generalized linear models. RESULTS: All PD dimensions were significantly associated with various indicators of interpersonal functioning deficits, such as distress and conflicts in friendships and partnership, feeling lonely, few close friends, and reduced social support. Schizotypal and borderline PD were relatively strongly associated with distress in friendships when compared with other PD dimensions. Furthermore, both dimensions were significantly related to all indicators of interpersonal functioning deficits. CONCLUSIONS: Subjects scoring high on any PD dimension reported considerable deficits in interpersonal functioning as characterized by a solitary lifestyle, conflictual and distressful social relations, and lack of social support. All DSM-IV PDs are associated with poor interpersonal functioning, but there is some evidence that schizotypal and borderline symptomatology affects deficits in social interactions even more profoundly and pervasively than other PD dimensions

Use of assessment instruments in forensic evaluations of criminal responsibility in Norway

Objectives Assessment instruments are often used to enhance quality and objectivity in therapeutic and legal settings. We aimed to explore the use of instruments in Norwegian reports of forensic evaluations of criminal responsibility; specifically, whether this use was associated with diagnostic and forensic conclusions. Methods Our study has an exploratory cross-sectional design. We examined 500 reports filed with the Norwegian Board of Forensic Medicine in 2009–2018 regarding defendants indicted for the most serious violent crimes. The first author coded data from all reports according to a registration form developed for this study. Two co-authors then coded a random sample of 50 reports, and inter-rater reliability measures were calculated. The first author coded 41 reports for calculation of intra-rater reliability. Descriptive statistics are presented for the use of assessment instruments, and a generalized linear mixed model (GLMM) was used to estimate associations between the use of instruments and diagnostic and forensic conclusions. Results Instruments were used in 50.0% of reports. The Wechler’s Adult Intelligence Scale (WAIS), Historical Clinical Risk-20 (HCR-20), and the Structured Clinical Interview for DSM disorders (SCID I), were used in 15.8, 13.8, and 9.0% of reports, respectively. The use of instruments increased from 36% in 2009 to 58% in 2015; then decreased to 49% in 2018. Teams of two experts wrote 98.0% of reports, and 43.4% of these teams comprised two psychiatrists. In 20.0% of reports, the diagnostic conclusion was schizophrenia, and in 8.8% it was other psychotic disorders. A conclusion of criminal irresponsibility was given in 25.8% of reports. Instruments were more often used in reports written by teams that comprised both a psychiatrist and a psychologist, compared to reports by two psychiatrists. The use of instruments was strongly associated with both diagnostic and forensic conclusions. Conclusion Instruments were used in 50% of reports on forensic evaluations of criminal responsibility in Norway, and their use increased during the study period. Use of instruments was associated with diagnostic and forensic conclusions

Commitment or expertise? Technocratic appointments as political responses to economic crises

Why do prime ministers or presidents appoint non-elected experts, also known as technocrats, during economic crises? Do they appoint them for their expertise or for their commitment to pro-market reforms? Answering this question is crucial for understanding and predicting the longer-term role of technocrats in democracies. With the aid of unique data on the political and personal background of finance ministers in 13 parliamentary and semi-presidential European democracies we show that commitment, not expertise is the primary drive of technocratic appointments during major economic crises. Technocrats are preferred over experienced politicians when the latter lack commitment to policy reform. An important implication of our findings is that technocratic appointments to top economic portfolios in West European countries are unlikely to become the norm outside economic crises, assuming economic crises are short-lived and not recurring