Cognitive-motivational, interpersonal, and behavioral functioning in relationship to treatment and research engagement in forensic patients with ADHD

Objectives:  To provide more insight into treatment and research responsivity in offenders with attention-deficit hyperactivity disorder (ADHD). Method: Via self-reports and patients' scores on cognitive computer tasks, it was examined whether poorer cognitive-motivational, interpersonal, and behavioral functioning were related to treatment no-shows, longer treatment time duration intervals, and no-show at the research appointment in 52 forensic outpatients with ADHD (Mage = 35.3, SD = 9.38). Treatment adherence was tracked for 10 appointments after research participation.  Results:  Regression analyses showed that higher self-reported impulsivity was associated with research no-show, and more alcohol use with longer treatment time intervals. Yet, self-reported delay aversion was associated with fewer treatment no-shows, and, uncontrolled for alcohol use, impulsivity was associated with shorter treatment time intervals in a subsample of patients.  Conclusions:  These preliminary results indicate that externalizing behaviors increase the risk for nonadherence in forensic ADHD patients, but that cognitive-motivational problems also motivate patients to be more engaged

Monitoring Risk Behaviors by Managing Social Support in the Network of a Forensic Psychiatric Patient:A Single-Case Analysis

This prospective case study examines changes over time in the social support network of a forensic psychiatric patient diagnosed with attention deficit hyperactivity disorder (ADHD). The focus is on the functional and dysfunctional influences of the patient’s social support dynamics on his risk behavior during mandatory policlinic treatment. A structured Forensic Social Network Analysis interview was conducted with the patient and two of his network members at four time points in his treatment process. The patient’s social supporters, their structural network position, and their risk are pooled and labeled through a triad census method. The number of practical and emotional supporters decreased over time in the network of the patient, which also resulted in a decrease of high-risk practical and emotional supporters. The size and composition of financial support in the network of the patient remained almost stable. Monitoring and analyzing social support using the triad census method provides valuable insights for individual risk management purposes. Keywords: social support, forensic psychiatry, risk management, triad census method, forensic attention deficit hyperactivity disorder (ADHD), case stud

The generalizability of psychotherapy efficacy trials in major depressive disorder: an analysis of the influence of patient selection in efficacy trials on symptom outcome in daily practice

Abstract Background Treatment guidelines for major depressive disorder (MDD) are based on results from randomized clinical trials, among others in psychotherapy efficacy trials. However, patients in these trials differ from routine practice patients since trials use stringent criteria for patient selection. It is unknown whether the exclusion criteria used in psychotherapy efficacy trials (PETs) influence symptom outcome in clinical practice. We first explored which exclusion criteria are used in PETs. Second, we investigated the influence of commonly used exclusion criteria on symptom outcome in routine clinical practice. Methods We performed an extensive literature search in PubMed, PsycInfo and additional databases for PETs for MDD. From these, we identified commonly used exclusion criteria. We investigated the influence of exclusion criteria on symptom outcome by multivariate regression models in a sample of patients suffering from MDD according to the MINIplus from a routine clinical practice setting (n=598). Data on routine clinical practice patients were gathered through Routine Outcome Monitoring. Results We selected 20 PETs and identified the following commonly used exclusion criteria: ‘a baseline severity threshold of HAM-D≤14’, ‘current or past abuse or dependence of alcohol and/or drugs’ and ‘previous use of medication or ECT’. In our routine clinical practice sample of patients suffering from MDD (n=598), presence of ‘current or past abuse of or dependence on alcohol and/or drugs’ had no significant influence on outcome.‘Meeting a baseline severity threshold of HAM-D≤14’ and ‘previous use of medication or ECT’ were associated with better outcome, but the explained variance of the models was very small (R2=2-11%). Conclusions The most consistently used exclusion criteria are not a major threat to the generalizability of results found in PETs. However, PETs do somewhat improve their results by exclusion of patients with minor depression and patients who used antidepressants prior to psychotherapy.</p

A motivator game for forensic vigilance training: Exploring the potential of the card game ROTBEESTEN?! as compared to treatment as usual

In the field of forensic mental healthcare, forensic vigilance is an im-portant skill of healthcare professionals to deal with criminal behaviour of pa-tients. The facilitated, collaborative card game ROTBEESTEN?! was developed to motivate professionals to enrol in forensic vigilance training. A controlled ex-periment was conducted with professionals from a Dutch forensic mental healthcare facility to explore the potential of the motivator game. The control condition involved ‘treatment as usual’: an oral presentation followed by a group discussion. Questionnaires, interviews and observations were used to measure certain participant characteristics, the quality of the game, and the user experience in both conditions. Respondents expressed significantly higher pref-erences for active, experiential learning styles than for learning from theoretical sources. In addition, respondents evaluated the quality of the game positively. Finally, respondents reported significantly higher scores on four out of five di-mensions of (game) experience in the experimental condition than in the control condition. Limitations of the study include a low response rate to the post-questionnaires. As a result, the effects of both the game and presentation could not be established reliably. From the results, we may conclude that the game ROTBEESTEN?! was evaluated more positively and has more potential to moti-vate participants for follow-up training activities than ‘treatment as usual’ (an oral presentation). These findings are in line with the preferred learning styles reported. Games seem promising tools to motivate (healthcare) professionals to enrol in training activities. Future research will establish if indeed the game’s motivating effects exceed those of an oral presentation.Policy AnalysisGame La