Effects of hydrogen gas inhalation on L-DOPA-induced dyskinesia.

L-3,4-dihydroxyphenylalanine (L-DOPA)-induced dyskinesia is a side effect of Parkinson's disease treatment and it is characterized by atypical involuntary movements. A link between neuroinflammation and L-DOPA-induced dyskinesia has been documented. Hydrogen gas (H2) has neuroprotective effects in Parkinson's disease models and has a major anti-inflammatory effect. Our objective is to test the hypothesis that H2 inhalation reduces L-DOPA-induced dyskinesia. 15 days after 6-hydroxydopamine lesions of dopaminergic neurons were made (microinjection into the medial forebrain bundle), chronic L-DOPA treatment (15 days) was performed. Rats were exposed to H2 (2% gas mixture, 1 h) or air (controls) before L-DOPA injection. Abnormal involuntary movements and locomotor activity were conducted. Striatal microglia and astrocyte was analyzed and striatal and plasma samples for cytokines evaluation were collected after the abnormal involuntary movements analysis. H2 inhalation attenuated L-DOPA-induced dyskinesia. The gas therapy did not impair the improvement of locomotor activity achieved by L-DOPA treatment. H2 inhalation reduced activated microglia in the lesioned striatum, which is consistent with the observed reduced pro-inflammatory cytokines levels. Display of abnormal involuntary movements was positively correlated with plasma IL-1ß and striatal TNF-α levels and negatively correlated with striatal IL-10 levels. Prophylactic H2 inhalation decreases abnormal involuntary movements in a preclinical L-DOPA-induced dyskinesia model. The H2 antidyskinetic effect was associated with decreased striatal and peripheral inflammation. This finding has a translational importance to L-DOPA-treated parkinsonian patients' well-being.

Actuarial risk assessment of sexual offenders: The psychometric properties of the Sex Offender Risk Appraisal Guide (SORAG).

The Sex Offender Risk Appraisal Guide (SORAG) is one of the most commonly used actuarial risk assessment instruments for sexual offenders. The aims of the present field study were to examine the predictive validity of the German version of the SORAG and its individual items for different offender subgroups and recidivism criteria in sexual offenders released from the Austrian Prison System (N = 1,104; average follow-up period M = 6.48 years) within a prospective-longitudinal research design. For the prediction of violent recidivism the German version of the SORAG yielded an effect size of AUC = .74 (p < .001, 95% CI = .70-.78). The predictive accuracy for general and violent recidivism was slightly higher than for general sexual and sexual hands-on recidivism. The effect sizes were found to be higher for the child molester sample than for rapists. However, the differences were significant only for general recidivism (z = 2.48, p = .001). Further analyses exhibited the SORAG to have incremental predictive validity beyond the VRAG and the PCL-R, and to remain the only significant predictor for violent recidivism once all 3 instruments were forced into a combined regression model. Twelve out of the 14 SORAG items were found to have a significant positive relationship with violent recidivism. The comparison of the relative and absolute risk indices between the Austrian and the Canadian samples showed that the normative data distribution yielded more (absolute risk indices) or less (relative risk indices) meaningful differences between the 2 countries. (PsycINFO Database Record

Genital Responses to Rape Vignettes Among Young Men: The Influence of Mood and Directed Attention.

Although it is clear that men with a history of sexual assaults against women produce higher relative genital responses to rape vignettes in the laboratory than do men without such a history, it remains unclear what aspects of the vignettes are eliciting these responses, and whether the genital responses are affected by situational factors. The antisocial tendencies hypothesis states that many men are inhibited by cues of violence, suffering, and coercion in rape vignettes, but other men, particularly antisocial and sexually aggressive men, are not so inhibited. In this study, we investigated whether the hypothesized inhibition to rape vignettes among nonoffenders could be affected by manipulation of mood and directed attention. A total of 48 young men were exposed to audio-recorded vignettes describing mutually consenting and nonviolent sexual interactions, mutually consenting and violent sexual interactions, nonconsenting and violent sexual interactions, and nonsexual and nonviolent social interactions (within-subjects). Participants were randomly assigned to a mood manipulation designed to induce a happy, neutral, or sad mood (between-subjects). All were asked to pay attention to either sex words or violent words while listening to the vignettes (within-subjects). As is typically observed, genital responses were lower (inhibited) when vignettes included cues of violence or nonconsent. Both happy and sad mood inductions reduced this inhibition, so that men induced into a happy or sad mood showed greater relative responding to cues of violence or nonconsent compared with men in a neutral mood. The attention manipulation had no significant effect. Results suggest that genital responses to rape cues can be situationally influenced, but not necessarily as predicted by the antisocial tendencies hypothesis.

Weight Gain and Its Correlates Among Forensic Inpatients.

OBJECTIVE: We investigated changes in weight, body mass index (BMI), and other indices of the metabolic syndrome in forensic inpatients. Weight gain associated with newer antipsychotics (APs) is well established in the general psychiatric population. METHODS: We examined the medical records of 291 men admitted to a forensic hospital at admission and again at discharge or 365 days later if still in hospital. We also recorded diagnosis and smoker status on admission and quantified psychotropic treatment and adherence, physical activity, and daytime occupation during the hospitalization. RESULTS: On admission, 33% were obese and 22% of the 106 patients for whom sufficient data were available met criteria for metabolic syndrome. Among patients staying at least 30 days, 60% were weighed again before discharge but repeated blood pressure and waist circumference measures were uncommon, even among those at greatest risk. The 122 forensic inpatients with sufficient information gained an average of 12% of their body weight and 40% increased by at least 1 BMI category, gaining an average of 3.67 kg per month. Weight gain was associated with duration of time and was not attributable to being underweight on admission, diagnosis of schizophrenia, atypical AP treatment, medication adherence, or having been a smoker. CONCLUSIONS: Patients gained weight during forensic hospitalization independent of medication use. We recommend further research using consistent measurement and wider sampling of both metabolic syndrome indicators and its individual and systemic causes in forensic populations.

Evidence for risk estimate precision: implications for individual risk communication.

Actuarial risk assessment instruments using well-established predictor variables measured at the individual level (e.g., age, criminal history, psychopathy) discriminate well between recidivists and non-recidivists across diverse samples. Data indicating the relative risk of recidivism can inform policy decisions about allocating resources according to risk within a correctional system, consistent with the first of the risk-need-responsivity (RNR) principles. Evidence for the precision of absolute risk as applied to an individual based on scores from many samples, however, has proven challenging. In this paper, we present a study examining the association of actuarial risk estimate precision with sample size using the Post Conviction Risk Assessment (PCRA; Lowenkamp et al., 2013), in samples of up to 26,642 offenders. Results indicate that the precision of individual estimates can be demonstrated with sufficient sample size. We believe that the implications of absolute risk for the communication of an individual offender's risks have been poorly understood. We argue that the purpose of individual-level risk communication is to ensure the effective application of policy, which requires matching a new case to aggregate data. We illustrate how an offender's risk might thus be communicated, and conclude that this function is distinct from management of an individual's criminogenic needs and identification of effective and suitable treatments.

Progress in violence risk assessment and communication: hypothesis versus evidence.

We draw a distinction between hypothesis and evidence with respect to the assessment and communication of the risk of violent recidivism. We suggest that some authorities in the field have proposed quite valid and reasonable hypotheses with respect to several issues. Among these are the following: that accuracy will be improved by the adjustment or moderation of numerical scores based on clinical opinions about rare risk factors or other considerations pertaining to the applicability to the case at hand; that there is something fundamentally distinct about protective factors so that they are not merely the obverse of risk factors, such that optimal accuracy cannot be achieved without consideration of such protective factors; and that assessment of dynamic factors is required for optimal accuracy and furthermore interventions aimed at such dynamic factors can be expected to cause reductions in violence risk. We suggest here that, while these are generally reasonable hypotheses, they have been inappropriately presented to practitioners as empirically supported facts, and that practitioners' assessment and communication about violence risk run beyond that supported by the available evidence as a result. We further suggest that this represents harm, especially in impeding scientific progress. Nothing here justifies stasis or simply surrendering to authoritarian custody with somatic treatment. Theoretically motivated and clearly articulated assessment and intervention should be provided for offenders, but in a manner that moves the field more firmly from hypotheses to evidence.

What does it mean when age is related to recidivism among sex offenders?

Age is a robust predictor of recidivism and an item on actuarial tools commonly used to predict sexual violent recidivism among sex offenders. However, little is known about whether or how much offenders' risk diminishes as a result of aging. In the first of two studies, we examined the sexual and violent recidivism of 533 sex offenders who were over age 50 on release. Age at index offense was at least as good at predicting both outcomes as was age at release, and age at index offense provided at least as much incremental validity in the prediction of violent recidivism to scores on a brief static actuarial tool. Neither age added incrementally to static score in the prediction of sexual recidivism. The second study examined how well age at first offense, age at index offense, and age at release predicted violent recidivism among 527 sex offenders aged 13 to 79 at release. Age at first offense predicted best. When age was removed from score on the Sex Offender Risk Appraisal Guide, all ages added incrementally but age at release least to SORAG score. When participants were divided into quartiles based on age at index offense, there was no evidence from any quartile that age at release predicted violent recidivism better than age at first offense. The authors concluded that age at release is a poor index of within-subject changes in risk of sexual or violent recidivism. No adjustment to a sex offender's score on a comprehensive actuarial tool that includes age at first or index offense should be made simply because the offender is older.

Implementing Residential Integrated Treatment for Co-occurring Disorders.

Objective: Much is now known about effective treatment for co-occurring substance abuse and psychiatric difficulties and many evidence-based practice recommendations have been disseminated. Implementation of these recommended interventions in daily clinical practice has been more of a struggle. This article describes successful implementation of integrated treatment for co-occurring disorders in a small residential program. Methods: A traditional 28-day addiction service was transformed into a 3-month integrated treatment program and 155 individuals with co-occurring disorders agreed to participate in its evaluation. The transformation entailed a completely new manualized service, training in a number of clinical interventions for all program clinicians, ongoing clinical supervision, and formal measurement of clients' backgrounds, substance abuse, quality of life, mental health symptoms, self-esteem, and satisfaction with the program. We also obtained collateral informants' reports on participants' symptoms, substance use, and quality of life. Fidelity to the treatment model was continuously assessed, as were participants' knowledge and skill acquisition. In addition, impact of the implementation on the program clinicians' morale and attitudes toward evidence-based practices was assessed, as was staff turnover and per diem costs. Results: Despite very problematic clinical and sociodemographic histories, the 86 participants who completed the program showed clinically significant mental health symptom improvement, acquisition of knowledge and skill, and high self-esteem and satisfaction with the program. Program fidelity, clinician morale, commitment to the program, and attitudes toward evidence-based practice were uniformly high. These successes were achieved while maintaining the lowest per-inpatient day cost of all hospital inpatient units. Conclusions: The findings support the contention that evidence-based integrated treatment can be implemented with fidelity in regular clinical practice to the benefit of participants, staff, and the hospital. Our experience was that having a scientist-practitioner working as a staff member on the program to lead the implementation was a key element. Future reports will focus on longer-term follow-up of substance use and quality of life outcomes.

Validation of and revision to the VRAG and SORAG: the Violence Risk Appraisal Guide-Revised (VRAG-R).

The violence risk appraisal guide (VRAG) was developed in the early 1990s, and approximately 60 replications around the world have shown its utility for the appraisal of violence risk among correctional and psychiatric populations. At the same time, authorities (e.g., Dawes, Faust, & Meehl, 1989) have argued that tools should be periodically evaluated to see if they need to be revised. In the present study, we evaluated the accuracy of the VRAG in a sample of 1,261 offenders, fewer than half of whom were participants in the development sample, then developed and validated a revised and easier-to-score instrument (the VRAG-R). We examined the accuracy of both instruments over fixed durations of opportunity ranging from 6 months to 49 years and examined outcome measures pertaining to the overall number, severity, and imminence of violent recidivism. Both instruments were found to predict dichotomous violent recidivism overall and at various fixed follow-ups with high levels of predictive accuracy (receiver operating characteristic areas of approximately .75) and to significantly predict other violent outcomes.

Psychopathy, adaptation, and disorder.

In a recent study, we found a negative association between psychopathy and violence against genetic relatives. We interpreted this result as a form of nepotism and argued that it failed to support the hypothesis that psychopathy is a mental disorder, suggesting instead that it supports the hypothesis that psychopathy is an evolved life history strategy. This interpretation and subsequent arguments have been challenged in a number of ways. Here, we identify several misunderstandings regarding the harmful dysfunction definition of mental disorder as it applies to psychopathy and regarding the meaning of nepotism. Furthermore, we examine the evidence provided by our critics that psychopathy is associated with other disorders, and we offer a comment on their alternative model of psychopathy. We conclude that there remains little evidence that psychopathy is the product of dysfunctional mechanisms.

Bayes and base rates: what is an informative prior for actuarial violence risk assessment?

Bayes' theorem describes an axiomatic relationship among marginal and conditional proportions within a single "experiment." In many ways, it has been fruitful to greatly extend this idea to the task of drawing inferences from data much more generally. Commonly, what matters is how all prior knowledge is revised (or not) by new findings resulting in posterior (sometimes "subjective") probabilities. And, to address many important problems, it is sensible to conceive of probability in such subjective terms. However, some commentators in the domain of violence risk assessment have assumed an analogous axiomatic relationship among marginals (i.e., priors in the form of base rates) observed in one study and conditionals (i.e., posteriors in the form of revised rates) expected in a separate study or assessment context. We present examples from our own research to suggest this assumption is generally unwarranted and ultimately an unaddressed empirical matter.

Weapon use increases the severity of domestic violence but neither weapon use nor firearm access increases the risk or severity of recidivism.

Use of weapons is a risk factor for domestic violence severity, especially lethality. It is not clear, however, whether access to firearms itself increases assault severity, or whether it is characteristic of a subgroup of offenders who are more likely to commit severe and repeated domestic assault. This reanalysis of 1,421 police reports of domestic violence by men found that 6% used a weapon during the assault and 8% had access to firearms. We expected that firearm use would be rare compared to other weapons and that actual weapon use rather than firearm access would increase the severity of domestic assaults. Firearm access was associated with assault severity, but this was mostly attributable to use of nonfirearm weapons. Weapon use was associated with older age, lower education, and relationship history as well as to assault severity. Victims were most concerned about future assaults following threats and actual injuries. Although firearm access and weapon use were related to actuarial risk of domestic violence recidivism, neither predicted the occurrence or severity of recidivism. We conclude that, consistent with previous research in the United States and Canada, firearm use in domestic violence is uncommon even among offenders with known firearm access. Weapon use is characteristic of a subgroup of offenders who commit more severe domestic violence, and seizure of weapons may be an effective intervention.

Nepotistic patterns of violent psychopathy: evidence for adaptation?

Psychopaths routinely disregard social norms by engaging in selfish, antisocial, often violent behavior. Commonly characterized as mentally disordered, recent evidence suggests that psychopaths are executing a well-functioning, if unscrupulous strategy that historically increased reproductive success at the expense of others. Natural selection ought to have favored strategies that spared close kin from harm, however, because actions affecting the fitness of genetic relatives contribute to an individual's inclusive fitness. Conversely, there is evidence that mental disorders can disrupt psychological mechanisms designed to protect relatives. Thus, mental disorder and adaptation accounts of psychopathy generate opposing hypotheses: psychopathy should be associated with an increase in the victimization of kin in the former account but not in the latter. Contrary to the mental disorder hypothesis, we show here in a sample of 289 violent offenders that variation in psychopathy predicts a decrease in the genetic relatedness of victims to offenders; that is, psychopathy predicts an increased likelihood of harming non-relatives. Because nepotistic inhibition in violence may be caused by dispersal or kin discrimination, we examined the effects of psychopathy on (1) the dispersal of offenders and their kin and (2) sexual assault frequency (as a window on kin discrimination). Although psychopathy was negatively associated with coresidence with kin and positively associated with the commission of sexual assault, it remained negatively associated with the genetic relatedness of victims to offenders after removing cases of offenders who had coresided with kin and cases of sexual assault from the analyses. These results stand in contrast to models positing psychopathy as a pathology, and provide support for the hypothesis that psychopathy reflects an evolutionary strategy largely favoring the exploitation of non-relatives.

The sexual responses of sexual sadists.

On average, rapists show greater relative genital responses to rape stories than do nonrapists in the laboratory. It has been suggested that this robust group difference is explained by the fact that many rapists are sexually sadistic. It is not clear, however, what the critical cues underlying rapists' genital responses are, because rape stories used in previous research include a mix of sadistic cues of violence and victim injury as well as cues of victim resistance and nonconsent. The present study was conducted to identify the critical cues producing self-identified sadists' sexual responses, and thereby to test sexual sadism as an explanation of rapists' arousal pattern. The present study was also conducted to develop a new phallometric test for sexual sadism for research and clinical applications, given evidence of poor diagnostic reliability and validity. Eighteen self-identified male sadists, 22 men with some sadistic interests who did not meet all of our sadist criteria, and 23 nonsadists (all recruited from the community) were compared in their genital and subjective responses to a new set of stories that disentangle violence/injury cues from resistance/nonconsent cues. The three groups differed in both their genital and subjective responses: using indices of relative responding, sadists responded significantly more to cues of violence/injury than nonsadists and men with some sadistic interests. The group difference for cues of nonconsent was not significant. The results suggest that sexual sadism primarily involves arousal to violence/injury in a sexual context rather than resistance/nonconsent.

Explaining the erectile responses of rapists to rape stories: the contributions of sexual activity, non-consent, and violence with injury.

In phallometric research, rapists have a unique pattern of erectile responses to stimuli depicting sexual activities involving coercion and violence. In this study, we attempted to determine the cues that control rapists' erectile responses to rape stories in the laboratory. A total of 12 rapists and 14 non-rapists were exposed to recorded audio scenarios that systematically varied with regard to the presence or absence of three orthogonally varied elements: sexual activity and nudity, violence and injury, and expression of non-consent. As expected from prior research, an index computed by subtracting participants' greatest mean responses to stories describing mutually consenting sexual activity from their greatest mean responses to stories describing rape was much higher among rapists than non-rapists. Both groups showed larger responses when stories involved sexual activity and nudity, but neither group exhibited a preference for cues of violence and serious injury, or for cues of non-consent. The element that produced the larger group difference, however, was the presence or absence of active consent. The results indicated that a sexual interest in (or indifference to) non-consent is at least as central to accounting for the unique sexual orientation of rapists as is sexual responding to violence and injury.

Adolescents who have sexually offended: is phallometry valid?

It is unclear whether deviant sexual preferences distinguish adolescents who commit sex offenses in the same way that such deviance characterizes adult sex offenders. We compared male adolescents (mean age = 15 at the time of a referral sex offense), matched adult sex offenders, and normal men (adult nonoffenders or nonsex offenders). We hypothesized the following: phallometric responses of the adolescents would be similar to those of adult sex offenders and would differ from normals; adolescents with male child victims would exhibit greater evidence of sexual deviance than those whose only victims were female children; among adolescents who had molested children, those with a history of sexual abuse would exhibit more evidence of sexual deviance than those with no such history; and phallometric measures would predict recidivism. With some notable exceptions or qualifications, results confirmed the hypotheses. Phallometry has valid clinical and research uses with adolescent males who commit serious sex offenses.

How nonrecidivism affects predictive accuracy: evidence from a cross-validation of the Ontario Domestic Assault Risk Assessment (ODARA).

Prediction effect sizes such as ROC area are important for demonstrating a risk assessment's generalizability and utility. How a study defines recidivism might affect predictive accuracy. Nonrecidivism is problematic when predicting specialized violence (e.g., domestic violence). The present study cross-validates the ability of the Ontario Domestic Assault Risk Assessment (ODARA) to distinguish subsequent recidivists and nonrecidivists among 391 new cases with less extensive criminal records than previous cross-validation samples, base rate=27%, ROC area=.67. Excluding ambiguous nonrecidivists increases the base rate to 33%, ROC area=.74. Random samples of 50 recidivists and 50 unambiguous nonrecidivists yield ROC areas from .71 to .80. Published norms significantly underestimate official recidivism. Ambiguous nonrecidivism is prevalent and leads to underestimating base rates and predictive accuracy.

Sexual preferences and recidivism of sex offenders with mental retardation.

By some accounts, sex offenders with mental retardation commit sex offenses against children because the offenders lack sexual knowledge or are socially and intellectually immature rather than because of sexually deviant interests. By other accounts, these offenders exhibit pedophilic sexual interests. In this study, phallometrically determined sexual interests, recidivism, and choices of victims of 69 sex offenders with mental retardation are examined and compared with those of 69 sex offenders of average or higher IQ. Consistent with hypotheses, sex offenders with mental retardation exhibit more deviant preferences for prepubertal children, male children, and young children than do the comparison offenders. They are also more likely to have had a prepubertal victim, a prepubertal male victim, and a very young victim. They are no more likely than the comparison offenders to exhibit preferences for extremely coercive sex with children or to exhibit deviant adult activity preferences, nor are they more likely to recidivate violently. Results support the idea that pedophilia is a disorder of neurodevelopment and point to the importance of risk assessments that include assessing sexual preferences among sex offenders with mental retardation.