Liraglutide 3.0 mg once daily for the treatment of overweight and obesity in patients hospitalised at a forensic psychiatric department: A 26-week open-label feasibility study.

INTRODUCTION: Overweight and obesity constitute a major concern among patients treated at forensic psychiatric departments. The present clinical feasibility study aimed at investigating the extent to which glucagon-like peptide 1 receptor agonist (GLP-1RA) treatment with once-daily liraglutide 3.0 mg could be a feasible pharmacological treatment of these conditions in patients with schizophrenia spectrum disorders hospitalised in forensic psychiatry. METHODS: The 26-week, open-label feasibility study included participants aged 18-65 years diagnosed with a severe mental illness and hospitalised at a forensic psychiatric department. At the time of inclusion, all participants fulfilled the indication for using liraglutide as a treatment for overweight and obesity. Participants' baseline examinations were followed by a 26-week treatment period with liraglutide injection once daily according to a fixed uptitration schedule of liraglutide, with a target dose of 3.0 mg. Each participant attended seven visits to evaluate the efficacy and adverse events. The primary endpoint was the number of "completers", with adherence defined as >80% injections obtained in the period, weeks 12-26. Determining whether liraglutide is a feasible treatment was pre-defined to a minimum of 75% completers. RESULTS: Twenty-four participants were included in the study. Sex, male = 19 (79.2%). Mean age: 42.3 [25th and 75th percentiles: 39.1; 48.4] years; body mass index (BMI): 35.7 [31.7; 37.5] kg/m2; glycated haemoglobin (HbA1c): 37 [35; 39] mmol/mol. Eleven out of 24 participants (46%) completed the study. For the completers, the median net body weight loss after 26 weeks of participation was -11.4 kg [-15.4; -5.9]. The net difference in HbA1C and BMI was -2.0 mmol/mol [-4; -1] and -3.6 kg/m2 [-4.7; -1.8], respectively. The weight change and reduction in HbA1c and BMI were all statistically significant from baseline. CONCLUSION: The study did not confirm our hypothesis that liraglutide is a feasible treatment for a minimum of 75% of the patients initiating treatment with liraglutide while hospitalised in a forensic psychiatric department. The high dropout rate may be due to the non-naturalistic setting of the clinical trial. For the proportion of patients compliant with the medication, liraglutide 3.0 mg was an efficient treatment for overweight.

Risk and protective factors in risk assessment: Predicting inpatient aggression in adult males detained in a forensic mental health setting.

Structured clinical risk assessments represent a preferred means of assessing levels of aggression risk at different times and in different individuals. Increasing attention has been given to capturing protective factors, with sound risk assessment critical to high-secure forensic mental health care. The aim was to assess the predictive value of the HCR-20v3 for aggression risk and the long-term care pilot version of the SAPROF (the SAPROF-LC-pilot) in a high-secure forensic mental health inpatient population and to determine the incremental value of protective over risk factors. Participants were adult males detained in a high secure forensic mental health service, with a primary diagnosis of schizophrenia and/or personality disorder. The focus was on examining hospital based aggression (self- and other-directed) at two time points; up to 6 months (T1) and between 7 and 12 months (T2). The HCR-20V3 and SAPROF-LC-pilot demonstrated good predictive validity but with variability across subscales and aggression types/periods. Historical factors of the HCR-20V3 and External factors of the SAPROF-LC-pilot failed to predict, aside from a medium effect at T1 for verbal aggression and self-harm, for Historical factors. There was evidence for protective factors adding to prediction over risk factors alone, with the integration of protective and risk factors into a risk judgement particularly helpful in improving prediction accuracy. Protective factors contributed to risk estimates and particularly if integrated with risk factors. Combining risk and protective factors has clear predictive advantages, ensuring that protective factors are not supplementary but important to the aggression assessment process.

Widening the net: Use of social media data in personal injury and disability evaluations.

A central tenet of forensic mental health assessment is the use of multiple sources of data. Traditionally, these sources have included clinical interviews with and observations of the examinee, written records review, psychological test data, and interviews with collateral sources. Data from social media and social networking sites (SNS) is now widely used in civil litigation. However, existing professional practice standards and guidelines do not specifically address the use of SNS data. This leaves forensic mental health evaluators with little guidance as to why, when and how to incorporate SNS data into their evaluations. We review the extant literature on the use of SNS and other social media data in personal injury and disability cases, including legal, ethical, and practical considerations, with the goal of providing forensic mental health practitioners with a framework for making decisions about when and how to incorporate these data into their evaluations and opinions. We advocate caution in conducting independent searches of social media and the Internet, and in making inferences about internal states based on SNS postings. To illustrate these points, we include a case study.

How online data informs forensic mental health evaluations of sexual behavior: An overview.

The Internet plays a pervasive role in modern life including the expression of human sexuality and sexual offending. A range of online sexual activities may be of interest in forensic mental health evaluations (FMHE), including those which are clearly illegal or those which are legal but functionally problematic. Online sexual offenses will clearly prompt forensic evaluators to consider the role of the Internet in these offending behaviors. The Internet may also be relevant in forensic evaluations of contact sexual offending including informing on history of mixed or cross-over offending, and Internet-facilitated contact offenses. A review of Internet-data may span several online domains, many of which provide the user with substantial anonymity and would likely not be available to the evaluator unless provided through the process of discovery. Early guidelines for the review of Internet-data in FMHEs have been proposed and support the Internet as a useful source of collateral data in the conduct of forensic evaluations of sexual behavior.

Forensic neuropsychological assessment.

With its firm establishment as a neuropsychology subspecialty, forensic neuropsychological assessment is integral to many criminal and civil forensic evaluations. In addition to evaluating cognitive deficits, forensic neuropsychologists can provide reliable information regarding symptom magnification, malingering, and other neurocognitive and psychological issues that may impact the outcome of a particular legal case. This article is an overview and introduction to neuropsychological assessment in the forensic mental health context. Major issues impacting the current practice of forensic neuropsychology are summarized, and several examples from case law are highlighted.

Staff experiences with videoconferences during the COVID-19 pandemic in forensic psychiatry outpatients.

AIM: To describe staff experiences with the use of videoconferences with forensic psychiatric outpatients during the COVID-19 pandemic. METHOD: Semi-structured interviews with staff at forensic community services in the Region of Southern Denmark. RESULTS: Nine semi-structured staff interviews were conducted. Two main themes were identified through thematic analysis: Challenges due to technical uncertainty and the Use of videoconferences as support in clinical assessment and treatment. The second main theme also included a number of subthemes: Lack of opportunity for observation of a patient's overall situation; Compromise of nurses' professionalism; Limitation of disturbing stimuli means more focus on the conversation; Telephone contact vs. video contact-pros and cons; Expectations reflect attitudes; and Will professionalism be changed based on organizational and political perspectives? CONCLUSION: Staff opinions on use of videoconferences in psychiatric patients differed. The nurses in particular were concerned about whether professionalism could be maintained. Others experienced patients focusing more on the conversation when it took place via video because there were fewer disturbing elements. In general, expectations seem to influence attitudes toward using videoconferences.

I'm Great! I'm no good .: A case illustration of drama therapeutic work with a male offender of domestic violence in a forensic outpatient setting.

Treating perpetrators of aggressive behavior, like verbal aggression, intimidation, and bullying behavior resulting in aggressive incidents with others, is difficult. This group is often diagnosed with personality disorders and when legal measures applied, they are more often treated in a forensic setting for their problems. This article presents the case of a 54-year-old man, diagnosed with Borderline personality disorder, narcissistic and antisocial traits, mild depressive symptoms, and loss and grief, who has voluntarily had treatment in a forensic outpatient center to reduce aggression and change destructive patterns in relationships. Hating, judging, and self-defeating were the main reasons why the patient found himself ending up in the same situation repeatedly. The client received individual drama therapy sessions. The drama therapeutic approach included schema therapeutic elements, such as schema mode work with cards, as well as roleplay, imagery (with rescripting), improvisation, and psycho drama elements. As a result of drama therapy, the client reported less (active) aggression, less aggression in his relationships (partners/children/friends), but also an increased level of loneliness, and mild depressive symptoms. The client was more in touch with his vulnerability and was able to behave in a more adequate healthy way in relationships. Although self-esteem was still building up, there was a decrease of aggression and less conflict-seeking behavior as a result. Risk assessment tools (FARE-2 & HONOS) and Schema therapy scales (YSQ and SMI) were used pre- and posttreatment confirming the improvements. This case promotes the use of dramatherapy in forensic outpatient care to be valuable in lowering risk recidivism and changing deeply rooted behavioral patterns.

Application of Facial Expression Analysis Technology in Violence Risk Assessment of Individuals with Mental Disorders in Supervised Settings.

OBJECTIVES: To explore the association between violent behaviors and emotions in individuals with mental disorders, to evaluate the application value of facial expression analysis technology in violence risk assessment of individuals with mental disorders in supervised settings, and to provide a reference for violence risk assessment. METHODS: Thirty-nine male individuals with mental disorders in supervised settings were selected, the participant risk of violence, cognitive function, psychiatric symptoms and severity were assessed using the Modified Overt Aggression Scale (MOAS), the Historical, Clinical, Risk Management-Chinese version(HCR-CV), the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). An emotional arousal was performed on the participants and the intensity of their emotions and facial expression action units was recorded before, during and after the arousal. One-way analysis of variance (ANOVA) was used to compare the differences in the intensity of emotions and facial expression action units before, during and after the arousal. Pearson correlation analysis was used to calculate the correlations between the intensity of the seven basic emotional facial expressions and the scores of the assessment scales. RESULTS: The intensity difference of sadness, surprise and fear in different time periods was statistically significant (P<0.05). The intensity of the left medial eyebrow lift action unit was found significantly different before and after the emotional arousal (P<0.05). The intensity of anger was positively correlated with the Modified Overt Aggression Scale score throughout the experiment (P<0.05). CONCLUSIONS: Eye action units such as eyebrow lifting, eyelid tightening and upper eyelid lifting can be used as effective action units to identify sadness, anger and other negative emotions associated with violent behaviors. Facial expression analysis technology can be used as an auxiliary tool to assess the potential risk of violence in individuals with mental disorders in supervised settings.

Forensic interviewers' difficulty with the birthday narrative.

BACKGROUND: Narrative practice increases children's productivity in forensic interviews, and one recommended topic is the child's last birthday, though interviewers have raised concerns about its productivity. STUDY 1 OBJECTIVE: Study 1 surveyed forensic interviewers' use of and attitudes about the birthday narrative. PARTICIPANTS AND SETTING: Participants included 170 forensic interviewers who subscribed to a webinar promoting use of the birthday narrative (Mage = 43 years, SD = 10.2, 94 % female). RESULTS: Over half (55 %) of interviewers reported that they rarely/never asked about children's birthdays, and non-users were especially likely to view the birthday narrative as never/rarely productive. Although interviewers viewed memory difficulties as more likely to occur with the birthday narrative than other practice topics (the child's likes, the child's day), non-users did not view memory difficulties, reluctance, generic reports, or religious objections as especially problematic. Open-ended responses identified negative experiences with the birthday as an additional concern, and interviewers' recommended wording of the prompts suggested suboptimal questioning strategies. STUDY 2 OBJECTIVE: Study 2 assessed the use of the birthday narrative in forensic interviews. PARTICIPANTS AND SETTING: The sample included 350 forensic interviews with 4- to 12-year-old children (Mage = 8.85, SD = 2.59). RESULTS: Only 4 % of children failed to recall substantive information if interviewers persisted, though another 11 % failed when interviewers stopped persisting. Invitations were more effective than other question types, especially among older children. 21 % of children mentioned a negative detail during their narrative. CONCLUSIONS: Interviewers' skepticism about the birthday narrative may be due to suboptimal questioning and sensitivity to occasional failures and negative information.

Elusive cases in forensic psychiatry? Exploring subgroups of schizophrenia spectrum disorder patients in Germany.

BACKGROUND: The relationship between schizophrenia spectrum disorders (SSD) and criminal behaviour is a central issue in forensic psychiatry. People with mental illness face some of the same types of criminogenic factors as people without mental illness, albeit more frequently. The research question of this study is the extent to which a framework of early and late offender typology can be empirically reconstructed in a forensic psychiatric population, and whether there are any practical implications. METHOD: For N = 733 patients in six different forensic hospitals in Germany, the age at first psychiatric admission and the age at first registered offence were documented, as well as a number of other patient-related characteristics. Two clustering procedures were used to investigate whether forensic psychiatric patients could be classified according to these characteristics. RESULTS: A k-means cluster analysis using age at first psychiatric admission, age at first recorded offence, sociodemographic, clinical and criminological characteristics supported a 4-cluster solution. MANOVA analyses revealed further differences between the identified types. CONCLUSION: This study empirically confirms some of the sub-groups of the early and late starter typology described in the literature. In particular, the "early starters", "late starters" and "first presenters" were identified, but cluster four comprises individuals not previously described in the scientific literature. Each of these classes has group-specific characteristics that may have implications for forensic treatment, post-release aftercare, and the legal system.

Experts' decision-making processes in Swedish forensic psychiatric investigations: A case vignette study.

It has previously been demonstrated that decisions made by forensic experts can suffer from issues with both bias and poor reliability. The outcome of Swedish forensic psychiatric investigations can have a major impact on the courts' choice of sanction for a mentally disordered offender. These investigations are performed by multi-professional teams of experts, where each expert is obliged to state their opinion on whether the client has a severe mental disorder (SMD) or not. In the present study, a case vignette design was used to simulate the decision-making process of forensic psychiatric investigations. Of the 73 Swedish experts working with forensic psychiatric investigations, a total of 27 (37%) participated in the study. The results showed that the Swedish experts formulated multiple diagnostic hypotheses about cases throughout the process and revised these hypotheses when presented with new information. There was substantial variation between the experts in which hypotheses were seen as most relevant. While the experts grew more certain of their opinions on SMD during the simulated investigation, there was considerable variation in their opinions both throughout and at the end of the process. Although low statistical power and the sample not being randomized limit generalizations, the results indicate no idiosyncratic patterns in the decision-making processes of Swedish experts or signs of confirmation bias. If used properly, the variation in both process and outcome could be used to safeguard and possibly increase the reliability and validity of the final decision of Swedish forensic psychiatric investigations.

The predictive validity and temporal characteristics of the HCR-20v3 for inpatient violence in forensic inpatient settings. An international study.

Aggression and violence are common day to day problems in psychiatric settings. However, the optimal means of assessing that risk remains unclear. In the context of that uncertainty many tools have evolved, among which the HCR-20 is one of the most globally accepted, though many questions remain about its performance, how and when it should be deployed and how it can be most effectively used. In this 12 month follow up study of 210 forensic psychiatric inpatients with a diagnosis of a schizophrenia spectrum disorder we explored these issues. We found that the performance of the HCR-20v3, especially its Total score, performed well up to 6 months after it was rated but its performance deteriorated after that. Repeating the HCR-20v3 at 6 months stabilised the risk assessment and led to improved performance in the second months over and above the first rating. The HCR-20v3 was good at identifying those subjects at low risk of violence over 6 months of follow up in a forensic inpatient setting. The real-world implications of this study are that the HCR-20v3 is an effective means of identifying patient at low risk of violence, but it should be reassessed every 6 months.

Criminología, proceso de determinación de salud y control penal del enfermo mental inimputable / Criminology, health determination process and criminal control of the mentally ill person not subject to criminal liability

Resumen La Psiquiatría Forense tienen dentro de sus retos la disposición de evaluar a aquellas personas que de manera pre o post delictiva presenten signos o síntomas que puedan ser susceptibles de una enfermedad psiquiátrica que puede transitar desde un debut o una persona con antecedentes de ser portador de una patología crónica en fase aguda, en este ámbito lo más importante es precisar si en el momento de la comisión del delito el autor tiene o no las capacidades de discernimiento y puede dirigir su conducta entre otras, luego la administración de justicia tiene la obligación de dictar sentencia dependiendo de los resultados del peritaje psiquiátrico. En este trabajo se realiza un análisis desde diferentes ángulos del problema centrados en las personas que son inimputables de responsabilidad penal, y de la visión de diferentes legisladores y criterios de especialistas incluyendo de manera general el beneficio social, médico terapéutico del enfermo mental que se convierte en una diana luego de ser interés jurídico penal.

Abstract The Forensic Psychiatry has within its challenges the provision to evaluate those people who, pre or post crime, present signs or symptoms that may be susceptible to a psychiatric disease that can transit from a debut or a person with a history of being a carrier of a chronic pathology in acute phase, in this area the most important thing is to specify whether or not at the time of the commission of the crime the author has the ability to discern and can direct their behavior among others, then the administration of justice has the obligation to pass sentence depending on the results of the psychiatric expertise. In this work we make an analysis from different angles of the problem centered in the people who are unimputable of criminal responsibility, and of the vision of different legislators and criteria of specialists including in a general way the social, therapeutic medical benefit of the mental patient that becomes a target after being a criminal legal interest.

La intención es lo que cuenta. Una revisión sobre la detección del engaño en intenciones / It's the intention that counts. A review on deception detection focused on intentions

Durante años la investigación sobre detección del engaño ha estado guiada por las teorías clásicas que sustentaban la idea de que el mentiroso emitía indicadores conductuales que lo delataban. Dentro de las nuevas líneas de investigación, ha surgido la detección del engaño focalizado en intenciones. Haremos un repaso de los estudios sobre la detección del engaño focalizados en intenciones futuras. Explicaremos brevemente el pensamiento episódico futuro (EFT), a continuación las primeras aproximaciones en este campo a través de la comparativa entre el engaño sobre hechos pasados vs futuros. Veremos además aquellos estudios que utilizan las preguntas inesperadas en un dominio no anticipado (fase de planificación de un viaje, calidad de esa planificación y sobre el pensamiento episódico futuro), y finalizaremos por los que manejan la evidencia de manera estratégica

For years the research on deception detection has been guided by classical theories that support the idea that the liar gives out behavioral indicators which betray him/her. Within the new lines of research, deception detection focused on intentions has emerged. In this paper we review the studies on deception detection focused on intentions. We briefly explain episodic future thought (EFT) and the first approaches in this field through the comparison of deception detection in past and future events. Additionally, we take a look at the studies that use unexpected questions in a non-anticipated domain (trip planning phase, quality of the planning, and EFT), and we finish by discussing the ones that use evidence strategically

A meta-analytic review of the MMPI validity scales and indexes to detect defensiveness in custody evaluations / Revisión meta-analítica de las escalas e índices de validez del MMPI para detectar disimulación en la evaluación de custodias

Background/Objective: In child custody disputes, one of the remit of the forensic psychologist is to evaluate parental attributes while suspecting defensiveness. The instrument of choice for undertaking this double task is the MMPI. Method: As to establish the state of the art on this, a meta-analysis was undertaken with a total of 32 primary studies from which 256 effect sizes were assessed. A meta-analysis was undertaken, effect sizes were corrected for sampling error and criterion unreliability. Results: The results revealed a positive, significant, large and generalizable mean true effect size for the L, K, S and MP scales, and the L+K and L+K-F indexes. The Wsd was positive, significant and large, but not generalizable. A negative and significant, but not generalizable mean true effect size was found for the F and generalizable for F-K index. The effect sizes for the L, K, S and MP scales, and the L+K and L+K-F indexes were equal. Both the gender of parents (father vs. mother) and the context of evaluation (parent child custody disputes vs. parenting capacity) were assessed as moderators. Conclusions: The results are discussed in relation to forensic practice (AU)

Antecedentes/Objetivo: En los casos de disputa por la custodia, el psicólogo forense tiene entre sus cometidos la evaluación de las competencias parentales, así como sospechar disimulación. Para esta doble tarea, el instrumento de referencia es el MMPI. Método: Para establecer el estado de la cuestión se llevó a cabo un meta-análisis encontrando 32 estudios primarios de los que se obtuvieron 256 tamaños del efecto. Los tamaños del efecto fueron corregidos por error de muestreo y falta de fiabilidad del criterio. Resultados: Los resultados mostraron un tamaño del efecto medio verdadero positivo, significativo, grande y generalizable para las escalas L, K, S y MP, y los índices L+K y L+K-F. Para Wsd, también resultó positivo, significativo y grande, pero no generalizable. Para F y el índice F-K fue negativo y significativo, pero no generalizable para F y generalizable para F-K. Los tamaños del efecto de las escalas L, K, S y MP, y los índices L+K-F y L+K resultaron ser iguales. Se estudiaron como moderadores el género del progenitor (padre vs. madre) y el contexto de evaluación (progenitores en disputa por la custodia de los hijos vs. evaluación de la capacidad parental). Conclusiones: Se discute la utilidad para la práctica forense de estos resultados (AU)

Boundaries between psychological intimate partner violence and dysfunctional relationships: psychological and forensic implications / Límites entre la violencia psicológica y la relación de pareja meramente disfuncional: implicaciones psicológicas y forenses

The main purpose of this paper is to point out the differences between psychological intimate partner violence (IPV) as usual strategy and relational process and a dysfunctional relationship in which partners do not know how to deal with everyday problems or how to negotiate the break-up process and manage the negative emotional states. In this paper behavior patterns of the psychologically violent intimate relationship are outlined and psychological consequences for victims are described. Both of them are useful for distinguishing a psychological IPV from a dysfunctional relationship without systematic violent behaviors. This differentiation is very relevant in order to deal with the problem in an adequate way. Some couples can misinterpret a dysfunctional relationship as intimate partner violence. Implications for forensic practice are very different in each case. Suggestions for good practice in this field are commented on

El objetivo principal de este artículo es establecer las diferencias entre la violencia psicológica en la pareja como estrategia habitual de relación y las relaciones de pareja meramente disfuncionales, en las que sus miembros no saben cómo afrontar los problemas cotidianos o cómo negociar el proceso de ruptura y abordar adecuadamente los problemas emocionales surgidos. En este artículo se describen las pautas de conducta características de una relación violenta y se analizan las consecuencias psicológicas sufridas por la víctima. Estos dos aspectos son fundamentales para distinguir una relación de pareja con violencia psicológica de una pareja meramente disfuncional sin conductas violentas sistemáticas. Esta diferenciación es fundamental para abordar el problema de una forma adecuada. Algunas parejas pueden malinterpretar una relación disfuncional como una relación de pareja violenta. Las implicaciones para la práctica forense son muy distintas en ambos casos. Se sugieren algunas vías de actuación derivadas de la buena práctica en este ámbito

Impacto sobre la vulnerabilidad psicótica del abordaje terapéutico en el Hospital Psiquiátrico Penitenciario de Sevilla / Impact on the psychotic vulnerability of the therapeutic approach in the Prison Psychiatric Hospital in Seville (Spain)

Objetivos: analizar los cambios en la vulnerabilidad psicótica tras la aplicación de un programa de tratamiento psiquiátrico penitenciario, la reincidencia delictiva tras realizar un seguimiento posterior a la excarcelación y variables de interés criminológico. Material y método: revisión de una muestra de 50 pacientes diagnosticados de esquizofrenia ingresados en el Hospital Psiquiátrico Penitenciario de Sevilla. Resultados: Se aprecia una reducción estadísticamente significativa de la vulnerabilidad psicótica, evaluada mediante el Inventario Psicopatológico de Frankfurt (FBF-3), tras realizar un abordaje integral psiquiátrico, psicológico, social y rehabilitador en el ámbito penitenciario. También se reducen significativamente los síntomas básicos en percepción compleja y lenguaje. La disminución es particularmente apreciable en el número de pacientes categorizados como de gravedad media-alta y alta. La reincidencia delictiva en el seguimiento posterior a la excarcelación de los pacientes de la muestra en estudio es baja (6%) y en ningún caso por delito grave o que haya supuesto un daño físico. La reincidencia delictiva, cuando se produce, no es inmediata. Aunque existe cierta versatilidad delictiva, es limitada. Las víctimas más frecuentes con relación previa con el paciente son los padres. La mayoría de los pacientes de la muestra, y la totalidad de los reincidentes, tienen consumo comórbido de sustancias (patología dual). Discusión: Son necesarios estudios más amplios para poder establecer relaciones de causalidad entre la reducción de la vulnerabilidad psicótica y el abordaje integral psiquiátrico, psicológico, social y rehabilitador en el ámbito penitenciario; o para atribuir el escaso índice de reincidencia delictiva a esa disminución de la vulnerabilidad psicótica (AU)

Objectives: to analyze changes in psychotic vulnerability following the implementation of a program of prison psychiatric treatment, recidivism after the release and various descriptive variables of criminological interest. Materials and methods: review of a sample consisting of 50 patients diagnosed with schizophrenia admitted to the Prison Psychiatric Hospital of Seville. Results: there was a statistically significant reduction of psychotic vulnerability according to an assessment using the Frankfurt psychopathological inventory (FBF-3), after conducting a complete psychiatric, psychological, social and rehabilitation approach in the prison environment. The core symptoms relating to complex perception and language also decreased significantly. The reduction is particularly noticeable in the number of patients categorized as medium-high and high severity. Recidivism in the follow-up of release of patients in the study sample is low (6%) and there were no cases of serious felony or grievous bodily harm. Recidivism, when it occurs, is not immediate. Although there is some criminal versatility, it is limited. The most frequent victims are parents with a previous relationship with the patient. Most of the patients in the sample, and all recidivists, have comorbid substance abuse (dual diagnosis). Discussion: we need more comprehensive studies to establish causal relationships between the decrease in psychotic vulnerability and an integrated psychiatric, psychological, social and rehabilitation approach in prisons; or to attribute the low rate of recidivism to the decline of psychotic vulnerability (AU)

Criteria-Based Content Analysis (CBCA) reality criteria in adults: A meta-analytic review / Criterios de realidad del Criteria-Based Content Analysis (CBCA) en adultos: una revisión meta-analítica

Background/Objective: Criteria-Based Content Analysis (CBCA) is the tool most extensively used worldwide for evaluating the veracity of a testimony. CBCA, initially designed for evaluating the testimonies of victims of child sexual abuse, has been empirically validated. Moreover, CBCA has been generalized to adult populations and other contexts though this generalization has not been endorsed by the scientific literature. Method: Thus, a meta-analysis was performed to assess the Undeutsch Hypothesis and the CBCA checklist of criteria in discerning in adults between memories of self-experienced real-life events and fabricated or fictitious memories. Results: Though the results corroborated the Undeutsch Hypothesis, and CBCA as a valid technique, the results were not generalizable, and the self-deprecation and pardoning the perpetrator criteria failed to discriminate between both memories. The technique can be complemented with additional reality criteria. The study of moderators revealed discriminating efficacy was significantly higher in filed studies on sexual offences and intimate partner violence. Conclusions: The findings are discussed in terms of their implications as well as the limitations and conditions for applying these results to forensic settings (AU)

Antecedentes/Objetivo: El Criteria-Based Content Analysis (CBCA) constituye la herramienta mundialmente más utilizada para la evaluación de la credibilidad del testimonio. Originalmente fue creado para testimonios de menores víctimas de abuso sexual, gozando de amparo científico. Sin embargo, se ha generalizado su práctica a poblaciones de adultos y otros contextos sin un aval de la literatura para tal generalización. Método: Por ello, nos planteamos una revisión meta-analítica con el objetivo de contrastar la Hipótesis Undeutsch y los criterios de realidad del CBCA para conocer su potencial capacidad discriminativa entre memorias de eventos auto-experimentados y fabricados en adultos. Resultados: Los resultados confirman la hipótesis Undeutsch y validan el CBCA como técnica. No obstante, los resultados no son generalizables y los criterios auto-desaprobación y perdón al autor del delito no discriminan entre ambas memorias. Además, se encontró que la técnica puede ser complementada con criterios adicionales de realidad. El estudio de moderadores mostró que la eficacia discriminativa era significativamente superior en estudios de campo en casos de violencia sexual y de género. Conclusiones: Se discute la utilidad, así como las limitaciones y condiciones para la transferencia de estos resultados a la práctica forense (AU)

Trastornos psiquiátricos en los casos de suicidio consumado en un área hospitalaria entre 2007-2010 / Psychiatric disorders in cases of completed suicide in a hospital area in Spain between 2007 and 2010

Introducción: El suicidio es un importante problema de salud pública. Uno de los principales factores de riesgo conocidos para el suicidio es el padecimiento de patología psiquiátrica que se identifica en un 90-95% de suicidios consumados, incrementándose el riesgo si existe comorbilidad. Los resultados internacionales sobre la patología psiquiátrica más frecuente son dicotómicos, divididos entre los trastornos del humor y los trastornos psicóticos, si bien los datos en nuestro entorno sobre casos de suicidio consumado son muy escasos. Metodología: El presente estudio describe las características psiquiátricas y forenses de los casos de suicidio consumado (n=79) acontecidos en la región asistencial de un hospital psiquiátrico entre 2007 y 2010. Los datos forenses fueron obtenidos en el Instituto de Medicina Legal de Catalunya y los datos clínicos a partir de la revisión de las historias clínicas. Resultados: La mayoría de los sujetos fallecidos por suicidio consumado en la muestra de referencia fueron varones (78,5%) (IC 68,4%-87,3%). El 45,5% (IC 33,8%-57,1%) (35 de 77) de los fallecidos disponía de historia en el circuito de salud mental y/o toxicomanías de la zona, desconociéndose los antecedentes de dos de los fallecidos por tratarse de menores de edad. De los 35 individuos con historia en el circuito de salud mental, el 54,3% (IC 37,1%-71,4%) presentaba un trastorno afectivo; (37,1%, IC 22,9%-51,4%) trastorno depresivo; 14,3% (IC 2,9%-25,7%) trastorno bipolar y el 17,1% (IC 5,7%-31,4%) un trastorno del espectro psicótico. Además, el 48,6% presentaba comorbilidad psiquiátrica no relacionada con tóxicos y el 42,9% (IC 25,7%-60,0%) comorbilidad con trastornos relacionados con sustancias. Conclusiones: Las características psiquiátricas y forenses del fenómeno del suicidio consumado en nuestro entorno confirman los datos internacionales sobre una tasa elevada de patología psiquiátrica y un patrón característico en cuanto a metodología suicida (AU)

Introduction: Suicide is an important Public Health problem. One of the most relevant known risk factors for suicide is suffering from a mental health disorder, identified in up to 90-95% of completed suicides, with this risk being increased if comorbidity is present. Findings from international research on the most common psychiatric disorders are dichotomous, divided into mood disorders and psychotic disorders. In Spain, data of this kind are scarce. Methods: This study describes the psychiatric and forensic characteristics of completed suicide cases (n=79) ocurred in a psychiatric hospital healthcare area (in Spain), between 2007 and 2010. The forensic data were obtained from the Institute of Legal Medicine of Catalonia and the clinical data by reviewing the clinical records. Results: Most of the subjects in this sample were males (78.5%, 95% CI; 68.4%-87.3%). Almost half of the sample (45.4%, 95% CI; 33.8%-57.1%, 35/77) had records in the Mental Health Services Network (including substance misuse services). Two of the 79 were under 18, so we were not able to access the records. More than half (54.3%, 95% CI; 37.1%-71.4%) of those with psychiatric history suffered from a mood disorder; 37.1% (95% CI; 22.9%-51.4% from a depressive disorder; 14.3% (95% CI; 2.9%-25.7%) from a bipolar disorder, and 17.1% (95% CI; 5.7%-31.4%) suffered from a psychotic disorder. With regard to substance misuse, 42.9% (95% CI; 25.7%-60.0%) presented substance misuse, and 48.6% did not. Conclusions: Psychiatric and forensic characteristics of completed suicide in this Spanish sample confirm previous findings from international studies: there is a high rate of psychiatric disorders in those who complete suicide, and there is a specific pattern as regards the method used to complete it (AU)

Tests personológicos y clínicos en español para evaluar adolescentes infractores / Personality and clinical tests in Spanish for assessing juvenile offenders

La evaluación psicológica de los adolescentes infractores es imprescindible en su recorrido por los servicios de justicia juvenil. Gracias a esta evaluación se garantiza la exigencia legal y la eficiencia de las medidas judiciales y educativas que se prescriben en estos servicios. En el presente artículo, el primero de una serie de dos, se revisan las principales pruebas de evaluación psicológica en español disponibles para profesionales de la psicología que trabajan con adolescentes infractores de los países hispanohablantes. Clasificaremos estas herramientas en tres grupos: a) Personológicas adecuadas para cualquier contexto profesional de la Psicología, b) Clínicas, cuya utilidad inicial se circunscribe al trabajo con adolescentes que presentan necesidades de salud mental y c) Forenses, aquellas desarrolladas especialmente para su uso en adolescentes atendidos en los servicios penales. Los instrumentos forenses se describen en la segunda parte de este artículo (Wenger & Andres-Pueyo, 2016 b) (en este mismo número de la revista). Para cada apartado se presentan y revisan los instrumentos más importantes y de utilidad contrastada

The psychological assessment of offenders is the core of professional activity throughout the juvenile justice system. It ensures the adequacy of the legal and educational measures to be applied in the process. This paper reviews the main tests for psychological assessment available in Spanish, suitable for use by psychology professionals who work with young offenders in the juvenile justice services in Spanish-speaking countries. We classify these tools into three groups: a) Personological, i.e. generic tests, suitable for any professional context in psychology, b) Clinical, i.e. tests whose initial use has been limited to working with adolescents with mental health needs, and c) Forensic, tools that have been specially developed for use in the juvenile justice population. This last group is described in the second part of this article (Wenger & Andres-Pueyo, 2016 b) (which appears in this same issue). The most important instruments of proven utility are presented and reviewed for each group