Impaired processing of threat in psychopathy: A systematic review and meta-analysis of factorial data in male offender populations.

BACKGROUND: Psychopathy is a personality disorder characterised by two underlying factors. Factor 1 (affective and interpersonal deficits) captures affective deficits, whilst Factor 2 (antisocial and impulsive/disorganised behaviours) captures life course persistent antisocial behaviours. Impaired processing of threat has been proposed as an aetiologically salient factor in the development of psychopathy, but the relationship of this impairment to the factorial structure of the disorder in adult male offenders is unclear. OBJECTIVES: To investigate whether threat processing deficits are characteristic of psychopathy as a unitary construct or whether such deficits are specifically linked to higher scores on individual factors. DATA SOURCES: A systematic review of the literature was conducted by searching PubMed, Web of Science and PsycINFO. METHODS: Studies were included if they (1) reported physiological measures of threat response as the primary outcome measure (2) indexed psychopathy using a well-validated clinician rated instrument such as the PCL-R (3) investigated male offenders between 18 and 60 years of age (4) reported threat processing analyses using both Factor 1 and Factor 2 scores (5) provided sufficient data to calculate effect sizes and (6) were published in English-language peer-reviewed journals. We identified twelve studies with data on 1112 participants for the meta-analysis of the relationship with Factor 1 scores, and nine studies with data on 801 participants for the meta-analysis of the relationship with Factor 2 scores. We conducted the meta-analyses to calculate correlations using random-effects models. RESULTS: PCL-R/SV Factor 1 scores were significantly and negatively related to threat processing indices (r = -0.22, (95%CI [-0.28, -.017]). Neither PCL-R/SV Factor 2 scores (r = -0.005, 95%CI [-0.10, 0.09]), nor PCL-R total score (r = -0.05, (95%CI [-0.15, -0.04]) were related to threat processing indices. No significant heterogeneity was detected for the Factor score results. CONCLUSIONS: The meta-analyses of the distinct psychopathy factors suggest that the threat processing deficits observed in male offenders with psychopathy are significantly associated with higher scores on Factor 1. A similar relationship does not exist with Factor 2 scores. Our findings highlight the importance of investigating the potentially discrete relationships between aetiological variables and the two factor constructs in the disorder.

Psychological and psychosocial interventions offered to forensic mental health inpatients: a systematic review.

OBJECTIVE: To examine the evidence for the use of psychological and psychosocial interventions offered to forensic mental health inpatients. DESIGN: CINAHL, MEDLINE, PsycINFO, ScienceDirect and Web of Science databases were searched for research published in English between 1 January 1990 and 31 May 2018. OUTCOME MEASURES: Disturbance, mental well-being, quality of life, recovery, violence/risk, satisfaction, seclusion, symptoms, therapeutic relationship and ward environment. There were no limits on the length of follow-up. ELIGIBILITY CRITERIA: We included randomised controlled trial (RCT) studies of any psychological or psychosocial intervention in an inpatient forensic setting. Pilot or feasibility studies were included if an RCT design was used.We restricted our search criteria to inpatients in low, medium and high secure units aged over 18. We focused on interventions considered applicable to most patients residing in forensic mental health settings. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias. RESULTS: 17 232 citations were identified with 195 full manuscripts examined in detail. Nine papers were included in the review. The heterogeneity of the identified studies meant that meta-analysis was inappropriate. The results were presented in table form together with a narrative synthesis. Only 7 out of 91 comparisons revealed statistically significant results with no consistent significant findings. The most frequently reported outcomes were violence/risk and symptoms. 61% of the violence/risk comparisons and 79% of the symptom comparisons reported improvements in the intervention groups compared with the control groups. CONCLUSIONS: Current practice is based on limited evidence with no consistent significant findings. This review suggests psychoeducational and psychosocial interventions did not reduce violence/risk, but there is tentative support they may improve symptoms. More RCTs are required with: larger sample sizes, representative populations, standardised outcomes and control group interventions similar in treatment intensity to the intervention. PROSPERO REGISTRATION NUMBER: CRD42017067099.

Does video recording inhibit crime suspects? Evidence from a fully randomized field experiment.

In partnership with a small city police department, we randomly informed or did not inform 122 crime suspects that their interrogations were being video-recorded. Coding of all sessions indicated that camera-informed suspects spoke as often and as much as did those who were not informed; they were as likely to waive Miranda at the outset and later; they were as likely to make admissions and confessions, not just denials; and they were perceived no differently by detectives on a range of dimensions. Looking at distal outcomes, we observed no differences in ultimate case dispositions. In terms of policy and practice, results did not support the hypothesis that recording-even when transparent, as required in 2-party consent states-inhibits suspects or alters case dispositions. At least for now, this conclusion is empirically limited to situations in which cameras are concealed and to interrogations that do not involve juveniles, homicides, or drug crimes, which we a priori excluded from our sample. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Reliability and Validity of START and LSI-R Assessments in Mental Health Jail Diversion Clients.

Risk assessment instruments are increasingly used in mental health jail diversion programs. This study examined the reliability and validity of Short-Term Assessment of Risk and Treatability (START) and Level of Service Inventory-Revised (LSI-R) assessments overall and by client race. Research assistants completed START and LSI-R assessments for 95 diversion clients. Arrests and jail days were collected via official records and self-report 3, 6, 9, 12, and 18 months after baseline. Assessments demonstrated good interrater reliability and convergent validity. START strength total scores and LSI-R risk estimates were the strongest predictors of recidivism. Total scores and risk estimates did not differ as a function of client race, but there were some differences in accuracy of START vulnerability and LSI-R total scores and risk estimates in predicting jail days (but not arrests), over shorter follow-ups. No such differences were found for START strength total scores across any follow-up period or recidivism measure.

Integrating risk and dangerousness in specific legal contexts: Clarifying concepts and justifying interventions.

Several legal interventions under the police power and parens patriae functions of the state depend partially on judgments that an individual is dangerous. Psychological research regarding risk assessment can provide relevant evidence regarding the appropriate application of these interventions. Developing, interpreting, and presenting relevant research regarding risk assessment in a manner that enhances the ability of courts to make accurate determinations of dangerousness requires clarification of the risk presented by this individual and explanation of how this person generates this risk. Testimony regarding such research can enhance the ability of the courts to make accurate judgments regarding the relationship between the risk presented and the justification for the specific intervention at issue. This article examines the justificatory functions of judgments of dangerousness for various police power and parens patriae interventions in order to clarify the manner in which psychological research and testimony can contribute to the ability of the courts to accurately assess the risk presented by an individual in making a judgment of dangerousness for a specific form of legal intervention.

Understanding Tattoos in Medicolegal Assessments.

Tattoos have held different meanings throughout history, with particular significance in cultural, social, and clinical contexts. Psychiatrists have long been interested in understanding the relevance of the tattooed body in a clinical or forensic evaluation and in settling on interpretive models that hold reliable value. Some studies have indicated that tattoos may be associated with markers of high-risk behaviors, mental illness diagnosis, and personality disorders. We attempt to provide an updated and comprehensive guide for forensic evaluators, so they can incorporate the observation of tattoos into their assessments with a review of the scientific literature that supports the interpretations and places them in context. The association between tattoos and risk, mental health, or behavioral implications is not as clear or linear as one might initially imagine, and mental health professionals should have a sophisticated understanding of the practice.

Criminal profiling as expert witness evidence: The implications of the profiler validity research.

The use and development of the investigative tool colloquially known as criminal profiling has steadily increased over the past five decades throughout the world. Coupled with this growth has been a diversification in the suggested range of applications for this technique. Possibly the most notable of these has been the attempted transition of the technique from a tool intended to assist police investigations into a form of expert witness evidence admissible in legal proceedings. Whilst case law in various jurisdictions has considered with mutual disinclination the evidentiary admissibility of criminal profiling, a disjunction has evolved between these judicial examinations and the scientifically vetted research testing the accuracy (i.e., validity) of the technique. This article offers an analysis of the research directly testing the validity of the criminal profiling technique and the extant legal principles considering its evidentiary admissibility. This analysis reveals that research findings concerning the validity of criminal profiling are surprisingly compatible with the extant legal principles. The overall conclusion is that a discrete form of crime behavioural analysis is supported by the profiler validity research and could be regarded as potentially admissible expert witness evidence. Finally, a number of theoretical connections are also identified concerning the skills and qualifications of individuals who may feasibly provide such expert testimony.

Psychosis and Substance Use: Implications for Conditional Release Readiness Evaluations.

In Foucha v. Louisiana (1992), the United States Supreme Court ruled that individuals adjudicated not guilty by reason of insanity (NGRI) could not remain in a forensic hospital if they were no longer mentally ill and dangerous. Since this decision, a variety of important questions have arisen related to the insanity defense and what should happen to insanity acquittees post-adjudication. This article provides an analysis of clinical issues confronting forensic examiners when psychosis as a result of substance abuse is the underlying condition supporting an insanity defense. To accomplish this analysis, this article provides the reader with a review of literature showing the complex relationship between psychosis and substance abuse. Second, this article investigates how substance-induced psychosis may impact both insanity opinions and subsequent conditional release decisions. Third, the article aims to provide research-driven information to assist clinicians in conducting conditional release evaluations. Finally, this paper provides a model for evaluating dangerousness in the context of conditional release evaluations. Given the substantial comorbidity between substance abuse and psychosis, it is critical for researchers and clinicians to consider potential effects of substance abuse when evaluating insanity acquittees for conditional release, especially as substance use relates to future dangerousness. Copyright © 2016 John Wiley & Sons, Ltd.

Are Child Abusers Sexually Attracted to Submissiveness? Assessment of Sex-Related Cognition With the Implicit Association Test.

Child sexual abuse is associated with social anxiety, low self-esteem, and intimacy deficits. This, in combination with the core belief of a dangerous world, might suggest that child abusers are sexually attracted to submissiveness. The Implicit Association Test (IAT) was used to examine this hypothesis. Results indicated that child abusers have a stronger sexual preference for submissiveness than rapists, although there were no differences between child abusers and non-sexual offenders. Multinomial logistic regression analysis revealed that submissive-sexy associations have incremental value over child-sex associations in differentiating child abusers from other offenders. The predictive value of both implicit associations was explored by correlating IAT scores with measures for recidivism risk, aggression, and interpersonal anxiety. Child abusers with stronger child-sex associations reported higher levels of interpersonal anxiety and hostility. More research on implicit cognition in sex offenders is required for a better understanding of what these and similar implicit measures are exactly measuring and what role implicit cognition may play in sexual offending.

Does Change on the MOLEST and RAPE Scales Predict Sexual Recidivism?

The purpose of the current study was to examine whether the MOLEST and RAPE scales and change on these measures predicted sexual recidivism in a sample of 146 adult male sexual offenders who participated in a high-intensity treatment program while incarcerated. The majority of subjects had functional scores on the MOLEST and RAPE scales prior to treatment. Of those who had dysfunctional pre-treatment scores, the majority made significant gains. However, the MOLEST and RAPE scales did not significantly predict sexual recidivism. This was the case for pre-treatment scores, post-treatment scores, and change scores. Our findings are generally not consistent with the view that these measures assess dynamic risk factors for sexual recidivism. However, this is the first published study to examine the predictive validity of these scales and more rigorous research is needed before firm conclusions can be drawn.

Contested Boundaries: psychiatry, disease, and diagnosis.

Since the 19th century, we have come to think of disease in terms of specific entities--entities defined and legitimated in terms of characteristic somatic mechanisms. Since the last third of that century, we have expanded would-be disease categories to include an ever-broader variety of emotional pain, idiosyncrasy, and culturally unsettling behaviors. Psychiatry has been the residuary legatee of these developments, developments that have always been contested at the ever-shifting boundary between disease and deviance, feeling and symptom, the random and the determined, the stigmatized and the value-free. Even in our era of reductionist hopes, psychopharmaceutical practice, and corporate strategies, the legitimacy of many putative disease categories will remain contested. The use of the specific disease entity model will always be a reductionist means to achieve necessarily holistic ends, both in terms of cultural norms and the needs of suffering individuals. Bureaucratic rigidities and stakeholder conflicts structure and intensify such boundary conflicts, as do the interests and activism of an interested lay public.

Forensic neuropsychology and expert witness testimony: An overview of forensic practice.

Neuropsychologists are frequently asked to serve as expert witnesses in an increasing number of legal contexts for civil and criminal proceedings. The skills required to practice forensic neuropsychology expand upon the knowledge, skills, and abilities developed by clinical neuropsychologists. Forensic neuropsychologists acquire expertise in understanding the roles and various functions of the legal system, as well as their role in addressing psycholegal questions to assist fact finders in making legal decisions. The required skills and the unique circumstances for clinical neuropsychologists pursing forensic work are reviewed.

You can't do that! Hugo Münsterberg and misapplied psychology.

This article examines a false start in the application of psychology to the law. While there had been expert testimony from physicians in criminal and civil cases in America since the nineteenth century, forensic psychology first emerged in the early twentieth century. Following European traditions of experimental psychology, Hugo Münsterberg applied the nascent science of memory research to the assessment of witness credibility. A brilliant and popular Harvard professor, Münsterberg touted his technique of word-association to determine truth. Forensic psychology's development was stalled by resistance from within legal authorities, including John Henry Wigmore, the leading expert on evidence. However, Münsterberg was a sensation in popular media. In this article, the authors examine early attempts to import experimental psychology into the courtroom and the arguments against them. Not only were Münsterberg's findings premature, they touched on a forbidden domain for witnesses: fact finding. While sincere, he learned that the determination of truth lay within the province of juries and judges, not psychologists. Thus, the application of psychology to the law was delayed. The authors review the lessons from Münsterberg's false start and comment on developments in the admissibility of scientific testimony.

Entrevista de crianças e adolescentes em contexto policial e forense: uma perspectiva do desenvolvimento / Investigative interviewing of children and adolescents: a developmental perspective

Conhecer as diferentes etapas do desenvolvimento humano é uma competência essencial para o entrevistador em contexto policial e forense. É imprescindível adaptar a entrevista em função da avaliação das competências da testemunha. Este artigo caracteriza as etapas do desenvolvimento humano ao longo da infância e adolescência, destacando o desenvolvimento da memória e outras competências relevantes para a entrevista de testemunhas. Analisou-se ainda a adequabilidade de várias metodologias utilizadas para este fim, salientando algumas diretrizes fundamentais para a condução de uma boa entrevista. Por fim, focou-se na Entrevista Cognitiva Melhorada enquanto técnica promissora para entrevistar crianças e adolescentes. Pretende-se não apenas rever de forma crítica a literatura existente, mas também construir um guia para os profissionais desta área.

Knowing the different developmental stages is an essential skill for the forensic or police interviewer. It is crucial to adapt the interview according to the witness developmental assessment. This article describes the stages of human development throughout childhood and adolescence, with particular emphasis on the development of memory and other skills involved in the interview process. The appropriateness of several methodologies used for interviewing child witnesses is discussed, as well as some fundamental guidelines for conducting a good interview. Lastly, the article focuses on the Enhanced Cognitive Interview as a promising technique for interviewing children and adolescents. The aim of this study is not only to critically review the existing studies, but also to write a guide for professionals in this area.

DSM-5: Challenging diagnostic testimony.

The Diagnostic and Statistical Manual of Mental Disorders' (DSM) 60-year evolution has not been particularly linear nor cumulative with respect to the process of its construction, its stated purpose, its framework, and inclusion of specific disorders. We consider DSM-5's stated purpose in light of the manual's explicit cautions and other complications encountered when presenting diagnoses in the course of psychological expert testimony under the applicable rules of evidence. This review considers the extent to which DSM-5 bears up under numerous criticisms when employed for forensic purposes and points out challenges that the expert should anticipate when offering diagnostic opinions underpinned by DSM-5 generally and by neurocognitive disorders in particular.

Decision-making in post-acquittal hospital release: how do forensic evaluators make their decisions?

A large number of individuals are acquitted of criminal charges after being found "not guilty by reason of insanity." Most of these individuals are hospitalized and later seek hospital discharge under a court-ordered provision called conditional release ("CR"). Courts rely on opinions from forensic evaluators to determine acquittees' readiness for CR. However, how evaluators make these decisions are unknown. Eighty-nine CR readiness evaluators from nine states were surveyed to understand which factors evaluators prioritize and to understand evaluators' assessment methodologies and their beliefs about the CR process itself. Little uniformity was found among evaluators on any aspect of the decision-making process. Evaluators utilized a wide variety of methodologies when making their decisions on readiness for CR. Moreover, evaluators' conceptualizations of the CR process itself varied widely. The results highlight the difficulty and confusion evaluators face when conducting CR readiness evaluations, and demonstrate the need for enhanced training, statutory guidance, and standardized evaluation protocols for these evaluations.

Performance of Hispanic inmates on the Spanish Miller Forensic Assessment of Symptoms Test (M-FAST).

The few psychological assessment measures commercially available for the assessment of Spanish-speaking populations lack strong empirical foundation. This is concerning given the rising numbers of Spanish speakers entering the forensic and correctional systems for whom valid assessment is difficult without linguistically and culturally appropriate measures. In this study, we translated and adapted the Miller Forensic Assessment of Symptoms Test (M-FAST) into Spanish. The general purpose of this study was to investigate the psychometric, linguistic, and conceptual equivalence of the English- and Spanish-language versions of the M-FAST in a sample of 102 bilingual Hispanic incarcerated males. Participants were randomly assigned to one of three feigning conditions (honest, uncoached, or coached) and completed the M-FAST in both English and Spanish on two separate occasions. Both language versions were psychometrically, linguistically, and conceptually equivalent.

Treating the untreatable: a single case study of a psychopathic inpatient treated with schema therapy.

From its first conceptualization in modern psychiatry, psychopathy has been considered difficult if not impossible to treat. Schema Therapy (ST) is a psychotherapeutic approach that has shown efficacy in patients with borderline personality disorder. ST has recently been adapted for personality disordered forensic patients, including patients with high levels of psychopathy. The present case study examined the process of individual ST, combined with movement therapy and milieu therapy by the nursing staff, with a forensic inpatient with psychopathic features (Psychopathy Checklist-Revised total score = 28.4). The patient had been sentenced to a mandatory treatment order in relation to a sexual assault. We assessed change using independent assessments of psychopathic traits, cognitive schemas, and risk-related behaviors over the 4-year treatment period and a 3-year follow-up. We also assessed the quality of the working alliance. Reliable change analyses showed significant improvements in psychopathic traits, cognitive schemas, and risk-related outcomes. At 3 years posttreatment, the patient was living independently outside of the forensic institution without judicial supervision and he had not reoffended. While many questions remain about the effectiveness of psychotherapeutic treatment for psychopathic patients, our study challenges the view that they are untreatable.

Same score, different message: perceptions of offender risk depend on Static-99R risk communication format.

The popular Static-99R allows evaluators to convey results in terms of risk category (e.g., low, moderate, high), relative risk (compared with other sexual offenders), or normative sample recidivism rate formats (e.g., 30% reoffended in 5 years). But we do not know whether judges and jurors draw similar conclusions about the same Static-99R score when findings are communicated using different formats. Community members reporting for jury duty (N = 211) read a tutorial on the Static-99R and a description of a sexual offender and his crimes. We varied his Static-99R score (1 or 6) and risk communication format (categorical, relative risk, or recidivism rate). Participants rated the high-scoring offender as higher risk than the low-scoring offender in the categorical communication condition, but not in the relative risk or recidivism rate conditions. Moreover, risk ratings of the high-scoring offender were notably higher in the categorical communication condition than the relative risk and recidivism rate conditions. Participants who read about a low Static-99R score tended to report that Static-99R results were unimportant and difficult to understand, especially when risk was communicated using categorical or relative risk formats. Overall, results suggest that laypersons are more receptive to risk results indicating high risk than low risk and more receptive to risk communication messages that provide an interpretative label (e.g., high risk) than those that provide statistical results.

Neurocriminology: implications for the punishment, prediction and prevention of criminal behaviour.

Criminal behaviour and violence are increasingly viewed as worldwide public health problems. A growing body of knowledge shows that criminal behaviour has a neurobiological basis, and this has intensified judicial interest in the potential application of neuroscience to criminal law. It also gives rise to important questions. What are the implications of such application for predicting future criminal behaviour and protecting society? Can it be used to prevent violence? And what are the implications for the way offenders are punished?