Who Are the Victims of NGRI Acquittees? A Study of Belgian Internees.

BACKGROUND: The limited literature on victim characteristics of offenders found not guilty by reason of insanity (NGRI) shows that most victims are adults who are known to the offender. It is currently unclear whether victims are mainly male or female or whether there are differences in the type of victims according to the offenders' psychiatric disorder. METHOD: Victim characteristics were retrospectively collected from 362 NGRI acquittees, and the influence of psychiatric diagnoses on victim profiles was examined. RESULTS: Victims were mainly adult acquaintances and were equally likely to be male or female. Family members and caregivers were the most frequent type of acquaintance victims. Further analyses suggest that these victim characteristics are similar for perpetrators with different psychiatric diagnoses. CONCLUSION: Victimization of strangers and minors was unlikely in NGRI offenders.

Risk Factors Associated With Inpatient Violence During Medium Security Treatment.

Violence is a common phenomenon both in regular and forensic psychiatric settings, and has a profound impact on staff and other patients. Insight into the individual risk factors associated with violence in forensic psychiatric settings is rare and is therefore the subject of this research. A retrospective file study in three medium security units in Flanders was conducted to compare non-violent inpatients with inpatients who engaged in (verbal and physical) violent behavior. Binary logistic regression analyses were used to examine which variables contributed independently to the risk of violence. The results showed that absconding during treatment was independently associated with physical violence. A personality disorder diagnosis and general non-compliance with treatment were associated with verbal violence. Both types of violence predicted early termination of treatment. Contrary to previous research, the results from the risk assessment tools were not associated with inpatient violence. Clinical implications are discussed and include, among others, that clinicians should remain vigilant for early warning signs of non-compliance during treatment.

Critical incidents and judicial response during medium security treatment.

This study examined inpatient incidents in three Flemish forensic medium security units and analyzed the subsequent judicial reactions to these incidents. During medium security treatment, incidents were reported for more than half of the participants. The most frequently registered incidents were non-violent in nature, such as absconding and treatment non-compliance. The base rate for physically violent incidents was low. Although crime-related incidents during medium security treatment were rarely prosecuted and adjudicated, the base rate of revocation - and hence drop-out from treatment - as a result of these incidents was high.

[Abolition of the internment of convicted prisoners in Belgium: clinical implications]. / Klinische implicaties van afschaffing van de ministeriële internering in België: onderzoek naar profiel van Vlaamse geïnterneerden-veroordeelden.

BACKGROUND: According to article 21 of the current Belgian law regarding the protection of society, the ministry of Justice can transfer a convicted prisoner to the Commission for the Protection of Society if that prisoner develops a severe mental illness in the course of a prison sentence. The proposed abolition of this article is raising concerns in psychiatric hospitals which are not equipped to deal with dangerous forensic patients.
AIM: To explore the profiles of convicted internees and to find out to what extent they differ from the profiles of regular internees.
METHOD: Convicted internees (n = 48) and regular internees (n = 483) treated in one of the Flemish medium security units were compared on the basis of demographic, clinical and risk factors.
RESULTS: Compared to regular internees, convicted internees suffered from more serious psychiatric problems and showed a more severe risk profile.
CONCLUSION: The abolition of article 21 presents regular psychiatric hospitals with new challenges.

Reconviction and revocation rates in Flanders after medium security treatment.

AIM: To examine the criminal outcome of Flemish forensic psychiatric patients ('internees') after medium security treatment. Also, the effect of conditional release on recidivism of two subgroups (internees under conditional release and internees who received unconditional release) was examined. METHOD: Reconviction rates and revocation rates were collected for all participants. Kaplan-Meier survival analyses were used to investigate recidivism rates while controlling for time at risk. RESULTS: During the 10-year period, 502 offenders were discharged from medium security treatment. Over a follow-up period averaging 3.6years, 7.4% of discharged patients were reconvicted or received a new 'not guilty by reason of insanity' (NGRI) verdict for a violent offence. One-quarter of the population had their conditional release revoked. Part of the study population was granted unconditional release. Reconviction rates were higher after unconditional release in comparison to conditional release. CONCLUSIONS: The results of this study suggest that the court supervision of NGRI patients in Flanders is effective in protecting the community from further offending.

Psychometric properties of an informant personality questionnaire (the HAP) in a sample of older adults in the Netherlands and Belgium.

In geriatric psychiatry, informant reports are often important due to cognitive problems and related impaired insight and judgment. Informant questionnaires to identify personality traits among older adults are sparse. The Dutch informant personality questionnaire (the HAP) is especially developed to address this need. The objective of this study is the psychometric evaluation of the HAP among older adults in the Netherlands and Belgium. We investigated the internal consistency, gender differences, the test-retest and inter-rater reliability, the factorial structure, and the concurrent validity. Informants completed the HAP ratings of nursing home residents (n = 385) and elderly psychiatric patients (n = 204). The internal consistency of the scales is good. Medium gender differences on three scales were found in the population Psychiatry. The inter-rater and test-retest reliability are good to excellent. There are significant similarities between a number of HAP scales and dimensions of the Big Five. The congruence between the factor structures in both samples is very high. We labeled the three factors externalizing/antagonistic, internalizing/neurotic, and compulsive. The HAP meets the need for validated and reliable informant instruments for personality assessment among older adults in geriatric psychiatry. The content scales of the questionnaire address traits of the premorbid personality. Therefore, the HAP might be useful for personality assessment and selecting treatment options in mental healthcare and can be applied in scientific research in the area of personality aspects in late life.

[Assisted suicide in psychiatry; current situation and notes on a recent case]. / Hulp bij zelfdoding in de psychiatrie; stand van zaken en bespreking van een recente casus.

BACKGROUND: The Dutch legal system grants psychiatric patients the right to assisted suicide but imposes strict conditions. The matter, however, remains controversial. Many psychiatrists are reluctant to become involved in assisted suicide because they are not familiar with the procedure that has to be followed, nor are they clear about the precise meaning of 'acting responsibly'. AIM: To provide an overview of the procedure to be followed and of the criteria to be met when a psychiatrist is wondering whether to grant a patient's request for assistance with suicide. METHOD: We analyse the law, jurisprudence and medical ethics and the special problems that arise in the case of psychiatric patients. RESULTS: We describe the developments in law and psychiatric practice which have led to greater recognition of the autonomy of the patient. The final decision depends on an assessment of the patient's competence and his ability to articulate his request clearly and on the hopelessness engendered by unbearable suffering. CONCLUSION: In the future there may be an increase in the number of cases of assisted suicide in psychiatry now that procedures and criteria have been established which are in accordance with the Dutch legal system.

The relation between dimensions of normal and pathological personality and childhood maltreatment in incarcerated boys.

The relation between subtypes of maltreatment and dimensions of personality and personality pathology was investigated in a representative sample of 142 incarcerated Dutch male juveniles. Normal personality dimensions were assessed with the Big Five Inventory, the Dimensional Assessment of Personality Pathology-Basic Questionnaire for Adolescents was used to measure pathological personality dimensions, and the Childhood Trauma Questionnaire was used to assess childhood maltreatment. The five maltreatment subtypes were found to be differentially and uniquely related to the normal and pathological personality dimensions in juvenile delinquents. The association between the abusive subtypes and Emotional Dysregulation depended on the co-occurrence of neglect. It was concluded that subtypes of maltreatment are distinctively related to dimensions of personality and personality pathology, possibly due to specific gene-environment interactions. Further research on this interplay is needed to be able to recognize genetic vulnerability. Early identification of children at risk could aid to limit the long-term consequences of maltreatment.

To what extent does age influence the reporting of life events?

A study of life events reporting was carried out among 64 depressed and 74 non-depressed patients. The results show that age as well as depression can affect the number and type of reported life events. The younger age group (less than 45 years) reported more events than the older group, and the depressed patients reported more events than their non-depressed counterparts. The younger group also listed more desirable events than their elders. There was no evidence of an interaction between diagnosis and age.

Anhedonia, suicide ideation and dexamethasone nonsuppression in depressed patients.

In the search for a valid analysis of a number of operationalised symptoms common to depressive behaviour, a study was performed comprising 46 patients showing depressive symptoms, according to operationalised criteria and as part of which all agreed to undergo the following tests: (a) psychiatric: Present State Examination; (b) psychological: Hamilton Rating Scale, Montgomery-Asberg Rating Scale, State-Trait Anxiety Inventory, Beck Suicide Ideation Scale, Chapman Anhedonia Scale, Mood Scale, Sleep Quality Scale, Activities Scale, Social Support Scale, Questionnaire on Recently Experienced Events and the Paykel Life Events Interview; and (c) biochemical: Dexamethasone Suppression (DEX) Test. After gathering different depressive subgroups, based on operationalised symptoms, a dichotomy was made in the distributions of the (an)hedonia, suicide ideation and DEX-(non) suppression scores. This study may indicate that anhedonia, suicide ideation and DEX-nonsuppression are the opening to the identification of a subgroup of depressed patients. This symptom complex could not definitely be identified on the basis of existing DSM-III diagnostic entities, because of the known fact that this method of classification is not appropriate for our purposes in revealing pathophysiological processes. It is suggested, therefore, that these symptoms might prove to be the anchor-point from which to reach a better insight into the aetiology and pathogenesis (i.e. the final common pathway) of depression.

Method and technique of life events research in depression and anxiety.

Methodological aspects still have a decisive impact on the putative etiological role of life events in clinical research. Questions of a diagnostic nature also serve to complicate this kind of research still further, in this present review in particular, when it deals with depression and/or anxiety. The relationship between life events and disturbed behavior also depends on additional variables, such as personality factors and social support. It is for this reason that detailed specification of the concepts used in life events research would seem to be necessary. And finally--when more than two variables are present--the simultaneous application of a number of statistical models is worthy of recommendation.

Psychic coping behaviour and the role of social support.

After defining the social support concept this article discusses some studies of its significance in relation to psychic functioning. Correct conception and operationlisation of social support is urged. Only then can some aspects of social support be studied in the clinical and the epidemiological perspective.

The assessment of life events: self-administered questionnaire versus interview.

Two methods of assessing life events (interview and self-administered questionnaire) were applied in a study attempting to determine the range of application of the 2 procedures. The results obtained in 55 psychiatric in-patients indicate that in a number of categories more events were detected by self-report questionnaire than by interview, while in a few categories more were reported by interview. In the discussion it is delineated that, although both methods have their own importance, the problems of differences of events reported by interview and by self-report are likely to be mainly in the use of self-report methods. It would seem that the sensitivity of both methods differs in relation to the character of the event: acute or process-related.