Violent victimisation of psychiatric patients: a Swedish case–control study

The intriguing question of how mental disorder and violence relate to each other has become an epic academic debate. During the last decades, there has been a change in direction of the debate on individuals with mental disorder, with a greater focus on violent victimization than violent behaviour towards others. Up until now, no Swedish study has investigated the frequency of violent behaviour among general psychiatric patients undergoing psychiatric treatment. Moreover, no Swedish study so far has investigated the relative risk of victimization in general psychiatric patients, in comparison to the general population. The aim of this dissertation was to investigate these issues and to validate the risk assessment method Classification of Violence Risk (COVR)™. Method: In study I, general psychiatric patients were recruited from two public psychiatric hospitals in Stockholm County (n=390). The control group consisted of gender- and age-matched subjects recruited from an annual national survey of living conditions, (conducted by Statistics Sweden) (n=1170). Studies II-IV consisted of prospective follow-ups on 331 patients. At baseline, clinical and socio-demographic variables were collected and a COVR assessment was conducted. Follow-up included telephone interviews with the patients and collaterals 10 and 20 weeks after baseline. Violent behaviour was self-reported and in addition, data was collected from a national criminal register. Results: Twenty percent of the patients had been victimised during the year preceding inclusion. The relative rate of victimization was six times higher in patients compared to controls. Women appeared to be most vulnerable with a 10-fold risk increase (Study I). The base rate of violent behaviour was 5.7% and a receiver operating curve analysis (ROC) showed that the area under the curve (AUC) for COVR was 0.77. The gender gap concerning violent behaviour among the general population was not replicated, since there was no significant gender difference with respect to violent acts 20 weeks after discharge. The predictive validity of the COVR software was comparable between females and males. There was an overlap between offenders and victims among psychiatric patients (Studies II-IV). Conclusions: The risk of being subjected to violence is high among Swedish psychiatric patients. The findings are most pronounced for female patients. Research, clinicians and social policy should target the problem of victimization. The base rate of violent behaviour towards others is relatively low among general psychiatric patients in Sweden. Therefore, prediction is difficult. Violent behaviour was uncommon in female as well as male patients and there were no gender differences. The COVR software could significantly predict violent behaviour and its validity was comparable to other risk assessment tools. COVR predicted violent behaviour with the same precision in both genders. The overlap between offenders and victims should be taken into account in both research and clinical settings

Interpersonal trauma and its relation to childhood psychopathic traits : what does ADHD and ODD add to the equation?

Acknowledgements Thank you to the parents and young people who participated in the CATSS-9 studies.Peer reviewedPublisher PD

Gendered Expressions of Psychopathy : Correctional Staffs' Perceptions of the CAPP and CABP Models

It has been suggested that psychopathy and borderline personality disorder (BPD) are associated and that they could be differently gendered variants of the same underlying phenotype. This study explored gender-specific perceptions of the Comprehensive Assessment of Psychopathic Personality (CAPP) and the Comprehensive Assessment of Borderline Personality (CABP). Correctional staff (n = 87) were asked to rate the prototypicality of these models for women and men with psychopathy. The results provide further support for the CAPP model as a promising conceptualization of psychopathy. Findings show few gender differences and lend support to psychopathy and BPD as overlapping constructs

Pinhole SPECT imaging of dopamine transporters correlates with dopamine transporter immunohistochemical analysis in the MPTP mouse model of Parkinson's disease

The in vivo analysis of dopaminergic degeneration in animal models of Parkinson's disease (PD), using pinhole single photon emission computed tomography (SPECT), ideally should afford a serial study design, enabling the analysis of the degenerative process as well as the potential neuroprotective and/or restorative properties of drugs over time in living animals. Previously, we demonstrated that striatal dopamine transporter (DAT) levels in rats could be analyzed reproducibly, using pinhole SPECT with the DAT probe [(123)I]N-omega-fluoropropyl-2beta-carbomethoxy-3beta-{4-iodophenyl}nortropane (FP-CIT). However, the capacity of this approach to accurately detect a range of striatal DAT levels in the most widely used animal model of PD, i.e., the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated mouse, remains to be determined. For this purpose, various levels of DAT were induced by treating c57BL/6J mice for 1, 3, or 5 days with MPTP (25 mg/kg ip), respectively. [(123)I]FP-CIT SPECT scans were performed 5 days after the last MPTP injection. Mice were perfused 6 days after the last MPTP injection, and the SPECT data were compared to ex vivo striatal and nigral DAT levels as measured by immunohistochemistry within the same animals. The analysis of striatal DAT levels using SPECT and DAT immunohistochemistry yielded highly comparable results on the percentage of DAT reduction in each MPTP group. The in vivo data showed a decrease of specific striatal to non-specific binding ratios by 59%, 82%, and 76% in mice treated for 1, 3, and 5 days, respectively. Moreover, a strong, positive correlation was observed between the in vivo and ex vivo parameters. The present study provides the first evidence that [(123)I]FP-CIT pinhole SPECT allows the accurate detection of a range of striatal DAT (i.e., losses of approximately 60-80%) levels in mice. Since such large dopaminergic lesions could be detected, this SPECT method may at least be useful for analyzing neuroprotective treatment with a clear-cut positive (i.e., complete protection) or negative (i.e., not any protection) effect. Whether this method is also useful for analyzing more subtle effects of neuroprotective treatment (partial protection) remains to be established, by studying mice with small dopaminergic lesions

Examination of the triarchic assessment procedure for inconsistent responding in six non-English language samples

The Triarchic Assessment Procedure for Inconsistent Responding (TAPIR; Mowle et al., 2016) was recently developed to identify inattentiveness or comprehension difficulties that may compromise the validity of responses on the Triarchic Psychopathy Measure (TriPM; Patrick, 2010). The TAPIR initially was constructed and cross-validated using exclusively English-speaking participants from the United States; however, research using the TriPM has been increasingly conducted internationally, with numerous foreign language translations of the measure emerging. The present study examined the cross-language utility of the TAPIR in German, Dutch, Swedish, and Italian translations of the TriPM using 6 archival samples of community members, university students, forensic psychiatric inpatients, forensic detainees, and adolescents residing outside the United States (combined N = 5,404). Findings suggest that the TAPIR effectively detects careless responding across these 4 translated versions of the TriPM without the need for language-specific modifications. The TAPIR total score meaningfully discriminated genuine participant responses from both fully and partially randomly generated data in every sample, and demonstrated further utility in detecting fixed “all true” or “all false” response patterns. In addition, TAPIR scores were reliably associated with inconsistent responding scores from another psychopathy inventory. Specificity for a range of tentative cut scores for assessing profile validity was modestly reduced among our samples relative to rates previously obtained with the English version of the TriPM; however, overall the TAPIR appears to demonstrate satisfactory cross-language generalizability