Psykopaattiset piirteet ja niiden suhde psykopatologiaan suomalaisilla nuorilla yleisväestössä, nuorisopsykiatrisen avohoidon potilailla sekä oikeuspsykiatrisessa nuorisorikollisaineistossa

The construct of psychopathy is formed by a constellation of specific interpersonal (lying, manipulation and grandiosity), affective (callousness, low emotion) and behavioral (irresponsibilty, impulsivity) traits. Current conceptualizations view psychopathy as a developmental neuropsychological disorder and as a malicious version of the extremes of normal personality traits. Psychopathic traits are relatively stable over time, from childhood through adolescence to adulthood. Thus, there has been an increase in interest to apply the construct of psychopathy to children and adolescents. The present study aimed:1)to study the psychometric properties of the Finnish versions of two self-assessments for psychopathic traits, 2)to explore gender differences in the traits, 3)to investigate relation of the traits to other forms of psychopathology, 4)to assess the prevalence of limited prosocial emotions (LPE) and the ability of this specifier to reveal adolescents high on psychosocial problems, 5)to compare self-assessed psychopathic traits between Finnish and Dutch community boys and girls, 6)to compare self-assessed psychopathic traits between female adolescent psychiatric outpatients and community girls, 7)to explore how those traits relate to psychiatric disorders in female outpatients, and 8)to assess psychopathic traits and related background variables in forensic psychiatry sample of girls charged with severe violent offenses in comparence with age- and offense-matched boys. The Finnish community data comprised 370 9th graders from secondary schools and 155 female students from vocational and high schools. Dutch data comprised 776 adolescents from the upper grades of secondary schools in the Netherlands. The outpatient data consisted of 163 female patients of adolescent psychiatric policlinics. The forensic psychiatric data comprised 25 girls and their age- and offense-matched male counterparts. The Youth Psychopathic traits Inventory (YPI), Antisocial Process Screening Device - Self Report (APSD-SR), Youth Self Report and Psychopathy Checklist - Youth Version were used. Forensic psychiatric examination reports and patient files were reviewed. Both the YPI and the APSD-SR are promising screening tools for psychopathic traits in community, though somewhat weak to catch the affective deficits; the YPI showed slightly better properties than the APSD-SR. Community boys scored significantly higher than girls in overall psychopathic traits. The traits correlated with externalizing and internalizing problems, similarly in boys and girls. LPE were common in community youth, and they did not designate those with psychosocial problems from those without. Culture-related differences in juvenile psychopathic traits seem to exis, but the research should be replicated in other cross-national samples before generalizing the conclusions. Psychiatric outpatient girls showed more impulsive and irresponsible lifestyles than community girls. Girls with externalizing psychopathology excibited more affective deficits than did girls in the community. Psychopathic traits in girls were associated with psychopathology and especially with externalizing psychiatric disorders. The psychiatric examination of outpatient girls would likely benefit from screening for psychopathy. In the forensic sample, approximately every third girl showed high traits of psychopathy, and no significant gender difference in the prevalence was observed. With regard to the underlying factor and item scores, girls were less antisocial than boys, but their interpersonal relationships were more unstable. Compared to boys, girls more often had a history of child sexual abuse, and their victims were more often family members or current or ex-partners. Interventions should take into account these special features of severely violent offending girls.Psykopatia-käsite muodostuu joukosta vuorovaikutukseen (lipevyys, valehtelu, manipulatiivisuus), tunne-elämään (armottomuus, heikko kyky tuntea empatiaa, tunnekylmyys) sekä käyttäytymiseen (stimulushakuisuus, impulsiivisuus ja vastuuttomuus) liittyviä luonteenpiirteitä. Nykykäsityksen mukaan psykopatia on kehityksellinen neuropsykiatrinen häiriö. Psykopaattiset piirteet nähdään jatkumona, ja psykopatia edustaa sen patologista ääripäätä. Viime aikoina psykopatia-käsite on siirtynyt enenevässä määrin aikuispsykiatriasta lasten- ja nuorisopsykiatriaan, koska psykopaattiset piirteet ovat osoittautuneet pitkittäistutkimuksissa suhteellisen pysyviksi. Tutkimuksessa pyrittiin: 1) arvioimaan kahden suomen kielelle käännetyn nuorten psykopaattisia piirteitä mittaavan itsearviointimittarin psykometrisiä ominaisuuksia,2)selvittelemään psykopaattisten piirteiden sukupuolieroja ja 3) suhdetta muihin psykososiaalisiin ongelmiin yleisväestönuorilla, 4)tutkimaan DSM 5 tautiluokituksessa määritellyn käytöshäiriön alatyypin - rajoittuneet prososiaaliset tunteet (RPT) - esiintyvyyttä yleisväestönuorilla sekä sitä, erotteleeko ko. alatyyppi ne nuoret, joilla on psykososiaalisia ongelmia niistä, joilla niitä ei ole, 5)vertaamaan psykopaattisten piirteiden määrää ja laatua suomalaisen ja hollantilaisen yleisväestönuorten välillä, 6)vertaamaan psykopaattisia piirteitä nuorisopsykiatriseen avohoitoon tyttöpotilailla ja yleisväestön tytöillä, 7)tutkimaan psykopaattisten piirteiden ja psykiatristen häiriöiden välistä suhdetta nuorisopsykiatriseen avohoidon tyttöpotilailla, 8)arvioimaan vakavaan väkivaltaan syyllistyneiden tyttöjen psykopaattisia piirteitä ja psykopatiaan liittyviä taustatekijöitä sekä vertailemaan kyseisiä tyttöjä ikä- ja rikosnimike-vakioituihin poikiin. Yleisväestöä edusti 370 9-luokkalaista sekä 155 ammattikoululaista ja lukiolaista tyttöä. Hollantilainen aineisto muodostui 776 peruskoulun yläasteen viimeisiä luokkia käyvästä nuoresta. Kliininen aineisto muodostui 163 kolmen nuorisopsykiatrian poliklinikan 15-17 vuotiaista tyttöpotilaista. Nuorisorikollisaineiston muodostivat 25 15-17-vuotiasta tyttöä sekä heidän poikapuoliset verrokkinsa. Mittareina toimivat Youth Psychopathic traits Inventory (YPI) Antisocial Screening Device- Self Report (APSD-SR), Youth Self Report ja Psychopathy Checklist-Youth Version. Avohoidon potilasaineiston psykiatriset diagnoosit kerättiin sähköisistä sairauskertomuksista ja oikeuspsykiatrisessa aineistossa mielentilatutkimuslausunnot luettiin. Sekä YPI että APSD-SR osoittautuivat toimivaksi mittareiksi, nuorten psykopaattistenpiirteiden arvioinnissa, ja YPI oli hieman parempi. Molemmat itsearviointimittarit olivat jossain määrin heikkoja löytämään tunnekylmiä piirteitä, joskin YPI toimi tässäkin suhteessa paremmin. Yleisväestössä pojilla oli enemmän psykopaattisia piirteitä kuin tytöillä. Ne piirteet korreloivat positiivisesti sekä eksternalisoiviin että internalisoiviin ongelmiin. RPT olivat varsin yleisiä yleisväestönuorilla. Ilmiö ei erotellut nuoria, jotka kokivat psykososiaalisia ongelmia niistä nuorista, joilla ei ollut kyseisiä ongelmia. Vertailu hollantilaiseen aineistoon osoitti, että nuorten psykopaattisiin piirteisiin vaikuttaa myös kulttuuri. Löydös tulee varmentaa uusilla kansainvälisillä vertailutöillä. Avohoidon tyttöpotilaat erosivat yleisväestön tytöistä psykopaattisten piirteiden suhteen, ja ne piirteet liittyivät merkittävästi psykiatrisiin häiriöihin, erityisesti externalisoiviin. Psykopaattisten piirteiden kartoittaminen itsearviointilomakkeella on asianmukaista osana nuorisopsykiatrista tutkimusjaksoa. Oikeuspsykiatria-aineistossa joka kolmas tyttö osoitti psykopaattisia piirteitä. Sukupuolten välillä ei ollut merkittävää eroa kokonaispisteissä, mutta tytöillä oli vähemmän antisosiaalisuutta ja enemmän ihmissuhteiden epävakautta. Heillä oli useammin seksuaalista hyväksikäyttöä lapsuudessa ja heidän uhrinsa olivat useammin perheenjäseniä tai seurustelukumppaneita

Do seriously offending girls differ from their age- and offence type-matched male counterparts on psychopathic traits or psychopathy-related background variables?

Background: More research is needed to improve our understanding of the manifestation of psychopathic traits in violently offending girls. Our aim here was to assess psychopathic traits and psychopathy-related background variables in a Finnish nationwide consecutive sample of girls charged with violent crimes and referred to a pretrial forensic psychiatric examination. These girls were then compared to their male counterparts. Methods: The forensic psychiatric examination statements of 15-to 17-year-old juveniles who underwent a pretrial forensic psychiatric examination over a 31-year period (1980-2010) were reviewed. For each non-psychotic girl with a normal IQ (n = 25), an age-and offence type-matched male control was randomly selected. Offence and offender characteristics were collected from the forensic psychiatric examination reports, and a file-based assessment of psychopathic traits was performed using the Hare psychopathy checklist-youth version. Results: Approximately every third girl exhibited high traits of psychopathy, and no significant difference was observed between the genders. Focusing on the underlying factor and item scores, the girls scored significantly lower than boys on the Antisocial factor. Their interpersonal relationships were significantly more unstable and they significantly more often exhibited a history of child sexual abuse. During the index offence the girls were significantly less frequently intoxicated, and their victims were significantly more often family members or current or ex-intimates but significantly less often strangers. Conclusions: Although violently offending girls and boys do not differ on psychopathy total scores, significant gender differences exist on underlying factor and item scores as well as in background-and offence-related variables. Interventions should take into account these special features of violent girls.Peer reviewe

Short report: self-reported psychopathic traits in Finnish and Dutch samples of non-referred adolescents: exploration of cultural differences

Background: Culture-related differences in psychopathic traits have been reported for adults, but for adolescents such knowledge is lacking. The aim of this cross-national study was to compare self-reported psychopathic traits between Finnish and Dutch samples of mid-adolescent community youth. Methods: The Youth Psychopathic traits Inventory (YPI) was filled in by 372 Finnish and 474 Dutch 15- to 16-year-old pupils. As gender-specific differences exist in psychopathic traits, we analyzed the data separately for boys and girls. Results: Dutch boys scored significantly higher than Finnish boys on total and all dimensional scores of the YPI as well as on most sub-dimensional scores. Dutch girls scored significantly higher than Finnish girls on the Affective dimension and on the two corresponding sub-dimensions: remorselessness and callousness. Finnish girls scored significantly higher on grandiosity, which loads to the Interpersonal dimension of the YPI. Conclusions: Our findings suggest that culture influences the manifestation of psychopathic traits already in adolescence and that this relation is more prominent in boys

The Relationship between Self-rated Psychopathic Traits and Psychopathology in a Sample of Finnish Community Youth: Exploration of Gender Differences

Peer reviewe

Self-reported psychopathic traits among non-referred Finnish adolescents : psychometric properties of the Youth Psychopathic traits Inventory and the Antisocial Process Screening Device

Background: In general psychiatric services, cost benefit screening instruments for psychopathic traits in adolescents are needed. The aim of the present study was to study the psychometric properties of the Finnish versions of the Youth Psychopathic traits Inventory (YPI) and the Antisocial Process Screening Device (APSD-SR) in community youth. As gender-specific differences exist in psychopathic traits, we analyzed the data separately in girls and boys. Methods: The YPI and the APSD-SR were administered to 372 9th graders (174 boys and 198 girls) with a mean age of 15.06 years (SD 0.28). Cronbach's alphas were used to study internal consistency. The factor structures of the self assessments were studied using both Confirmatory Factor Analysis (CFA) and Principal Component Analysis (PCA). Results: In both self-assessments, boys scored significantly higher in the total scores, Interpersonal and Affective dimension scores as well as in most sub-dimensions. In the YPI, the alpha values for total and dimensional scores ranged from 0.55 to 0.91 in boys and from 0.74 to 0.89 in girls and, in the APSD-SR, respectively, from 0.38 to 0.78 and from 0.29 to 0.78. In CFA, the three-factor model produced poor fit for both self-assessments. For the ten sub-dimensions of the YPI, the PCA suggested two factors. Extending the model into three components showed sub-dimension loadings according to the original dimensions. For the APSD-SR, the PCA revealed a five-factor structure in the male sample and a six-factor one in the female group. When limiting the model to a three factor-model, we obtained a structure, which resembled the original dimensions. Conclusions: Both the YPI and the APSD-SR are promising tools of screening for psychopathic features in Finnish community youth. The YPI turned out to be slightly better than the APSD-SR in both reliability and factor structure. However, the original three-factor models did not find support. Both self-assessments were somewhat weak for tapping the callous-unemotional traits of the psychopathic character, but, again, the YPI worked better than the ASPD-SR. Both self assessments revealed significant gender differences in psychopathic character traits.Peer reviewe

A novel outpatient treatment model for patients with severe and enduring anorexia nervosa: an observational study of patient characteristics, treatment goals, and treatment course

Abstract Background Approximately 20–30% of people with anorexia nervosa develop an enduring form of the disorder. In the present study a newly developed outpatient treatment unit for patients with severe and enduring anorexia nervosa was described. The treatment model is flexible, patient-centered, and aims at enhancing quality of life, maintaining medical stability, and minimizing harm. Treatment contents, patient characteristics, treatment goals, and course of treatment from the first five years of operation were described and analyzed. Methods The participants (N = 22) consisted of all referrals resulting in an assessment or treatment period at the unit between May 2017 and May 2022. All participants were women. The study was a registry study. Information regarding patient characteristics, treatment goals, and the course of treatment was gathered from medical records. Results On average, the participants had had a diagnosed eating disorder for 12.80 years, and self-reported eating disorder symptoms for 19 years. Their symptomatology included severe eating disorder symptoms, psychiatric comorbidities, extreme underweight, and co-occurring medical conditions. Their treatment goals commonly concerned improving physical health, reducing eating disorder symptoms, improving psychological well-being, and improving quality of life. The majority of participants for whom this information was available benefited from the treatment (60%) and their treatment goals were met or partly met (66.6%), as measured by evaluations made by the patient or the treatment team. More than two thirds (69.2%) of the participants for whom this information was available remained weight stable or showed an increase in BMI. Conclusions This observational study suggests that many individuals with severe and enduring anorexia nervosa may benefit from flexible treatment, aiming at supporting quality of life. The results highlight the importance of coordinating and integrating the treatment of severe and enduring anorexia nervosa and co-occurring psychiatric disorders as well as medical complications. Further research and international dialogue about the how treatment for this vulnerable patient group should best be organized is called for. Trial registration Trial registration number: NCT05708404. Date of registration: 01/23/2023 (retrospectively registered)

Effects of family-based treatment on adolescent outpatients treated for anorexia nervosa in the Eating Disorder Unit of Helsinki University Hospital

Abstract Background Family therapy for adolescent anorexia nervosa (AN) has stronger evidence of efficacy in comparison with individual therapy, and family-based treatment (FBT) is the most evaluated in numerous randomized clinical trials. However, few studies have focused on how FBT performs outside of research settings. The current study is the first to assess clinical outcomes of FBT for adolescent AN in Finland, in a specialized outpatient clinic. Aim The naturalistic outcome of outpatient FBT for adolescent AN was investigated. Methods Fifty-two female patients and their families who received FBT at a tertiary eating disorders unit participated in the study. Data on their pre-treatment parameters, treatment details, and condition at the end of treatment (EOT) was collected from their medical records. Results At EOT, a majority (61.5%) had achieved a full weight restoration [percentage of expected body weight (%EBW) ≥ 95%]. Participants with an %EBW ≥ 95 at EOT had a significantly higher pre-treatment %EBW than those with an EBW < 95% at EOT. Participants with an EBW ≥ 95% at EOT showed significantly higher total weight gain during the treatment period, a higher rate of regular menstrual periods at EOT, significantly lower rates of dietary restrictions, and less cognitive or behavioral symptoms of the eating disorder overall, compared to participants who did not achieve a normal body weight. In 22 cases (42.3%), there was no need for further treatment at the end of FBT. Participants who needed further treatment after FBT, compared to those who did not, showed significantly higher rates of psychiatric comorbidity, history of mental health treatment, and need for psychopharmacological treatment. Conclusions In this naturalistic study, and in line with previous studies, FBT for AN appeared to be an effective and sometimes sufficient intervention, especially for patients with milder weight deficit and less severe psychiatric comorbidities. The results show that FBT can be successfully implemented in Finland and suggest that training more ED clinicians in FBT would be beneficial. Trial registration: The study was retrospectively registered on February 8th, 2023, in ClinicalTrials.gov Protocol Registration and Results System, identifier: NCT05734573