Epidemiology of classic psychedelic substances: results from a Norwegian internet convenience sample.

Objective: In recent years, there has been a renewed interest in investigating the use of classic psychedelics such as psilocybin and lysergic acid diethylamide (LSD) in the treatment of mental disorders and substance use disorders. However, knowledge about the epidemiology of classic psychedelics in the Nordic countries is limited. Methods: We recruited adult, Norwegian participants who have had a memorable experience after taking a classic psychedelic substance. They filled in an anonymous internet survey with 119 items covering matters related to recreational use of psychedelics using a secure, web-based application. Data are presented by using descriptive statistics (frequencies, means, and standard deviations). Results: We recruited 841 participants, 770 (72% male; 88% 45 years or younger) of which were included in the data analysis. The intentions behind taking the psychedelic substance were mainly recreational (46.1%) or therapeutic (42.3%). Most participants reported that their most memorable experience was with psilocybin. As in modern era clinical trials, most participants were well-prepared before, did processing during, and did integration work after the experience, whereas only a minority were supported by a therapist. Self-perceived symptoms of various mental disorders and substance use disorders were prevalent in the sample. Most subjects reported improvements in their condition. Although adverse reactions were usually mild and short-lived, 4.2% lasted for 1 year or more. Persisting flashbacks were present for a year or more among 2.9% of the participants. Conclusion: In this cross-sectional sample of Norwegian, self-selecting adults, we shed light on what characterizes the most memorable experience with a classic psychedelic substance, including short- and long-term risks and benefits. For the most part, the psychedelic experience led to improvements in self-perceived symptoms of mental disorders and substance use disorders. However, a small subset experienced persisting adverse reactions.

Mental Health, Well-Being, and Adolescent Extremism: A Machine Learning Study on Risk and Protective Factors.

We examined the relationship between adolescents' extremist attitudes with a multitude of mental health, well-being, psycho-social, environmental, and lifestyle variables, using state-of-the-art machine learning procedure and nationally representative survey dataset of Norwegian adolescents (N = 11,397). Three key research questions were addressed: 1) can adolescents with extremist attitudes be distinguished from those without, using psycho-socio-environmental survey items, 2) what are the most important predictors of adolescents' extremist attitudes, and 3) whether the identified predictors correspond to specific latent factorial structures? Of the total sample, 17.6% showed elevated levels of extremist attitudes. The prevalence was significantly higher among boys and younger adolescents than girls and older adolescents, respectively. The machine learning model reached an AUC of 76.7%, with an equal sensitivity and specificity of 70.5% in the test dataset, demonstrating a satisfactory performance for the model. Items reflecting on positive parenting, quality of relationships with parents and peers, externalizing behavior, and well-being emerged as significant predictors of extremism. Exploratory factor analysis partially supported the suggested latent clusters. Out of the 550 psycho-socio-environmental variables analyzed, behavioral problems, individual and social well-being, along with basic needs such as a secure family environment and interpersonal relationships with parents and peers emerged as significant factors contributing to susceptibility to extremism among adolescents.

The Effect of the NorGeP-NH on Quality of Life and Drug Prescriptions in Norwegian Nursing Homes: A Randomized Controlled Trial.

BACKGROUND: The effect of the Norwegian General Practice-Nursing Home (NorGeP-NH) criteria has never been tested on clinical outcomes in nursing home (NH) residents. We performed a cluster-randomized trial in Norwegian NHs and tested the effect of NorGeP-NH on QoL (primary outcome), medication prescriptions, and physical and mental health (secondary outcomes) for the enrolled residents; Methods: Fourteen NHs were randomized into intervention NHs (iNHs) and control NHs (cNHs). After baseline data collection, physicians performed NorGeP-NH on the enrolled residents. We assessed the difference between cNHs and iNHs in the change in primary outcome from baseline to 12 weeks and secondary outcomes from baseline to eight and 12 weeks by linear mixed models; Results: One hundred and eight residents (13 lost to follow-up) and 109 residents (nine lost to follow-up) were randomized to iNHs and cNHs, respectively. Difference in change in QoL at 12 weeks between cNHs and iNHs was not statistically significant (mean (95% CI)): -1.51 (-3.30; 0.28), p = 0.101). We found no significant change in drug prescriptions over time. Difference in depression scores between cNHs and iNHs was statistically significant after 12 weeks. CONCLUSIONS: Our intervention did not affect QoL or drug prescriptions, but reduced depression scores in the iNHs. NorGeP-NH may be a useful tool, but its effect on clinical outcomes may be scarce in NH residents. Further studies about the effectiveness of NorGeP-NH in other healthcare contexts and settings are recommended.

Do prescription rates of psychotropic drugs change over three years from nursing home admission?

BACKGROUND: In this longitudinal study, we describe how psychotropic drugs (PTDs) are prescribed in nursing home (NH) patients from admission and over a 3-year period, to understand which clinical and environmental factors are associated with PTD prescription. METHODS: We used data from the Resource Use and Disease Course in Dementia - Nursing Home (REDIC-NH) study, examining physical and mental health, dementia, and PTD prescription during a 3-year period from admission to a NH. Data were collected every six months. At baseline, we included 696 participants from 47 Norwegian NHs. We presented prevalence, incidence, and deprescribing rates of PTD prescriptions for each assessment point. We calculated the odds of receiving PTDs and used a generalized linear mixed model to analyze the variables associated with a change in odds throughout the 3-year period. RESULTS: PTD prescriptions were frequent throughout the 3-year period. Antidepressants had the highest prescription rates (28.4%-42.2%). Every PTD category had the highest incidence rate between admission and six months, and antipsychotics had the highest values (49.4%). Deprescribing rates were comparable between assessment points. The odds of antipsychotic prescriptions were lower for older people (OR = 0.96, 95%CI:0.92-0.99, p = 0.023). People with more severe dementia had lower odds of being prescribed sedatives/hypnotics (OR = 0.89, 95%CI:0.85-0.94, p < 0.001). CONCLUSIONS: PTDs, particularly antidepressants, are widely prescribed over time to NH patients. Older patients are less likely to receive antipsychotics. A higher severity of dementia decreases the odds of being prescribed sedatives/hypnotics. Close attention should be paid to PTD prescriptions during long-term NH stay to avoid prolonged and excessive treatment with these types of drugs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01920100 .

Does Psychotropic Drug Prescription Change in Nursing Home Patients the First 6 Months After Admission?

OBJECTIVES: To explore the course of psychotropic drug (PTD) prescription from admission (BL) to 6-month follow-up (6m) in Norwegian nursing homes (NHs). To examine how clinical variables, such as neuropsychiatric symptoms (NPS), cognition, physical health, and NH characteristics at BL are associated with prescription rates at 6 months. DESIGN: An observational longitudinal cohort study (data from the Resource Use and Disease Course in Dementia-Nursing Home study) designed to examine the course of dementia, psychiatric and somatic diseases, and drug prescriptions in NH patients during the first 6 months after admission. SETTING AND PARTICIPANTS: We included 696 patients at admission to 47 representative Norwegian NHs. METHODS: Demographic and clinical characteristics at BL and 6m are presented. Dementia severity was assessed by the Clinical Dementia Rating scale and the Functional Assessment Staging of Alzheimer's Disease scale. Final diagnosis was made by 2 of the authors (G.S. and S.B.) according to ICD-10 criteria. Prevalence, incidence, and persistence rates of PTD prescriptions for people with dementia are presented. Generalized mixed models were used to identify possible predictors for the course of PTD prescription from BL to 6m. RESULTS: Prescription rates of antidepressants, antipsychotics, anxiolytics, sedatives, and hypnotics increased in people with dementia from BL (67.5% received at least 1 PTD) to 6m (74.0% received at least 1 PTD). Younger age and higher Neuropsychiatric Inventory-affective subsyndrome score at BL were associated with higher odds of antidepressant prescription, whereas patients with higher comorbidity at BL had lower odds of receiving antidepressants, both at BL and 6m. Higher Neuropsychiatric Inventory-affective subsyndrome scores at BL were associated with higher odds of sedative and hypnotic prescription at both assessment points. CONCLUSIONS AND IMPLICATIONS: PTD prescription rates increase from BL to 6m. Medication appropriateness should be frequently evaluated after admission to optimize PTD prescriptions.

Identification With a Violent and Sadistic Aggressor: A Rorschach Study of Criminal Debt Collectors.

This study examined personality functioning in a group of 27 incarcerated criminal debt collectors as assessed by the Rorschach Inkblot Method (RIM; Rorschach, 1921/1942) and the Psychopathy Checklist-Revised (PCL-R; Hare, 2003 ). To explore whether these individuals represent a distinct subgroup within the violent offender population, we compared them to a group of incarcerated homicide offenders (n = 23) without a previous history of significant violence and a group who had committed less serious violent crimes (n = 21). Results revealed significantly more Rorschach indicators of past trauma (Trauma Content Index), aggressive urges (Aggressive Potential) and identification (Aggressive Content) among the debt collectors than the 2 other groups. In addition, debt collectors displayed significantly more interpersonal interest (Sum Human content), and significantly higher scores on the PCL-R. Our findings suggest that the debt collector might be viewed as a hostile variant of psychopathy.

Psychological Treatment of Sexual Offenders Against Children: A Meta-Analytic Review of Treatment Outcome Studies.

Numerous meta-analyses and reviews have been conducted on the effectiveness of psychological treatment of sexual offenders in reducing recidivism, but no meta-analysis has been done on sexual offenders against children (SOAC) specifically. A moderate treatment effect has been shown in several evaluations of general sexual offenders, while many scholars maintain that the question remains unanswered until an adequate number of effectiveness studies with a strong research design have been carried out. In this meta-analysis, we evaluated 14 studies selected and coded according to Collaborative Outcome Data Committee (CODC) criteria. They included 1,421 adult offenders in psychotherapy and 1,509 nontreated controls, with a minimum average follow-up period of 3 years, published in peer-reviewed journals in 1980 or later. Recidivism was defined as rearrest or reconviction. Study quality was classified into strong, good, weak or rejected. The analysis revealed a treatment effect size of r = .03 for nine studies evaluated as Good or Weak, while all studies yielded an effect size of r = .08, including five studies classified as Rejected. The results show that the available research cannot establish any effect of treatment on SOAC. Despite a large amount of research, only a tiny fraction of studies meet a minimum of scientific standards, and even fewer provide sensible and useful data from which it is possible to draw conclusions.

Under Skinner's skin: gauging a behaviorist from his Rorschach protocol.

Behaviorism and psychodynamic psychology have been regarded as polar opposites. Contrary to popular belief, B. F. Skinner took an interest in Freud and many of his concepts, and agreed to be tested with the Rorschach method and the Thematic Apperception Test by Roe in her study of scientists (Roe, 1953 ). We looked for signs of creativity defined as complex responses, an intriguing emotional tone, novelty, and liveliness. Skinner displayed an enormous number of responses characterized by simplicity, an intellectualized tone, a driven quality rather than creative complexity, and a sense of strained social relationships and lack of liveliness. The findings are in line with Roe's study of other scientists. Skinner's intellectual productivity and high ambition fits well with the commanding figure history describes.

The Personality of a Nonperson: Gauging the Inner Skinner.

B. F. Skinner is consistently rated as one of the most important figures in the history of psychology. Much has been said about his character, some of it strongly negative. Yet little is known about what kind of man he really was. Drawing on information from published sources, archival material, and people who knew him, we used "blind" raters to assess Skinner's score on the Big Five personality factors. We found that Skinner was a highly conscientious man and highly open to experience. He was also somewhat neurotic and somewhat extraverted but neither agreeable nor disagreeable. The resulting personality profile was compared with meta-analytic results concerning scientists versus nonscientists, creative scientists versus noncreative scientists, and artists versus nonartists. In general, Skinner's personality profile was consistent with findings regarding those of other notable scientists.

The Wartegg Zeichen Test: a literature overview and a meta-analysis of reliability and validity.

All available studies on the Wartegg Zeichen Test (WZT; Wartegg, 1939) were collected and evaluated through a literature overview and a meta-analysis. The literature overview shows that the history of the WZT reflects the geographical and language-based processes of marginalization where relatively isolated traditions have lived and vanished in different parts of the world. The meta-analytic review indicates a high average interscorer reliability of rw = .74 and high validity effect size for studies with clear hypotheses of rw = .33. Although the results were strong, we conclude that the WZT research has not been able to establish cumulative knowledge of the method because of the isolation of research traditions.

Are large drawings signs of psychological expansion or effects of drawing skills? A critical evaluation of Wartegg drawing size categories in a Finnish sample.

In the Wartegg Drawing Completion Test, drawings which are larger than the norm size are interpreted as signs of the personality trait of expansion. The popular handbook by Wass and Mattlar (2000) includes a graphic presentation of the size norms. We scored 351 test blankets into the size categories small, normal and large following these norms. Only 14% of the drawings fitted into the category of normal size, while 13% were small and 73% were large. We also evaluated the test blankets according to drawing ability into five categories and found a high correlation between large size and drawing ability. The results show a need to re-evaluate the direct link between large size and expansion, as well as a need to modify the size norms.

Rorschach variables and Big Five scales as predictors of military training completion: a replication study of the selection of candidates to the naval special forces in Norway.

We tested 140 male candidates at the Naval Special Forces (NFS) of Norway on the Rorschach (Exner, 2003; Rorschach, 1921/1942) and the Norwegian version of the Big Five personality dimensions (Engvik & Føllesdal, 2005). Rorschach variables significantly correlated with training completion (effect sizes of r(e) = .14-.25), whereas none of the Big Five factors or facets did. The combination of Rorschach and Big Five variables framed in the illusory mental health concept provided strong predictive ability. Testing under stress produced slightly higher predictive validity coefficients between the Rorschach variables and pass-fail than under calm testing. The findings support the results of Hartmann, Sunde, Kristensen, and Martinussen (2003), indicating that Rorschach variables and indications of good mental health may be valid predictors of NFS training.

Psychopathic and nonpsychopathic violent offenders on the rorschach: discriminative features and comparisons with schizophrenic inpatient and university student samples.

We examined discriminant and convergent validity of theoretically relevant Rorschach Comprehensive System (CS) variables (Exner, 2003) and Meloy and Gacono's (1992) aggression variables in distinguishing between imprisoned violent offenders (VO) who were psychopathic (P-VO) and nonpsychopathic (NP-VO) under psychiatric treatment, schizophrenic inpatients (ISs), and university students (USs). A total of 7 of 12 variables discriminated significantly between P-VO and NP-VO, which suggests more aggressive, cognitive, and interpersonal disturbances among P-VO. We also found significant differences between VOs, ISs, and USs. Logistic regression analyses revealed that AgPast accumulated incrementally in the classification of P-VO versus NP-VO, and AgC accumulated incrementally in the classification of VO versus IS when entered after CS variables. The findings support the view that psychopathy is a distinctive form of antisocial personality disorder (Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association, 1994) organized at a more severe pathological level.

Reanalysis of the Grønnerød (2003) Rorschach temporal stability meta-analysis data set.

I reanalyzed the Grønnerød (2003) Rorschach temporal stability meta-analysis data with a theoretically driven hierarchical regression analysis. I also examined the intrarater reliability of initial coding decisions and verified their consistency. In the new regression analyses, retest period strengthened its influence on stability, whereas methodological factors showed a tendency toward influence. The new results are more in line with the results from Grønnerød's (2004) psychotherapy change meta-analysis results.

Rorschach assessment of changes following psychotherapy: a meta-analytic review.

I examined Rorschach assessment of personality changes following psychotherapy. I conducted a comprehensive literature search to find all studies using the Rorschach method at least twice for the same participant in connection with psychotherapy. I conducted meta-analyses for 38 samples, and I performed regression analyses to identify moderating factors. Across all Rorschach scores, the total weighted sample effect size was r = .26, and nearly half the variables obtained effect sizes higher than .30. Several moderating factors were found. Most important, effect sizes increased with longer and more intensive therapy. More concern for interscorer reliability was associated with larger effect sizes, whereas a higher degree of scorer blinding was associated with smaller effect size magnitudes. Predicted levels of change based on the regression models indicated substantial increases in effect size with longer therapies. The data indicate that many elements in the Rorschach are valid indicators of change despite the poor reputation the method has acquired within psychotherapy research.

Temporal stability in the Rorschach method: a meta-analytic review.

The temporal stabilities of the Rorschach method scoring systems were investigated. A comprehensive literature search was conducted to find all test-retest studies, both regular and from control samples in therapy evaluation studies. Meta-analyses were conducted for samples, individual entries, and variables in 36 samples. Separate analyses were made for 10 samples using the Comprehensive System (CS; Exner, 1993). The temporal stability was high, especially those obtained from regression model predictions. The CS consistently shows higher stability than other systems, whereas increasing retest intervals leads to decreasing stability. Shortcomings of the available studies are highlighted and discussed, and recommendations are given for design and methodology.