Autism spectrum disorder, extremism and risk assessment.

BACKGROUND: To date, there is no evidence supporting the existence of an association between Autism Spectrum Disorder (ASD) and extremism in the general population. However, there is increasing recognition that several features of ASD may provide the context of vulnerability to engage in extremist behaviour. AIMS: This paper sets out the case for a dedicated clinical approach to better integrate clinical risk appraisal processes with an assessment of ASD individuals' vulnerabilities within the Criminal Justice System. METHODS AND RESULTS: In this paper the Framework for the Assessment of Risk & Protection in Offenders on the Autistic Spectrum (FARAS): A Guide for Risk Assessors Working with Offenders on the Autistic Spectrum is explored. In developing the FARAS, Al-Attar proposed seven facets of ASD that 'may have different functional links with push and pull factors to terrorism' (p. 928), which include circumscribed interests; rich vivid fantasy and impaired social imagination; need for order, rules, rituals, routine and predictability; obsessionality, repetition and collecting; social interaction and communication difficulties; cognitive styles and Sensory processing. DISCUSSION AND CONCLUSION: We describe the FARAS within the context of the most widely used clinical risk appraisal 'aide memoire' instruments integral to the Structured Professional Judgement of risk process, namely the HCR20v3.

Chronic neuropsychiatric sequelae of SARS-CoV-2: Protocol and methods from the Alzheimer's Association Global Consortium.

Introduction: Coronavirus disease 2019 (COVID-19) has caused >3.5 million deaths worldwide and affected >160 million people. At least twice as many have been infected but remained asymptomatic or minimally symptomatic. COVID-19 includes central nervous system manifestations mediated by inflammation and cerebrovascular, anoxic, and/or viral neurotoxicity mechanisms. More than one third of patients with COVID-19 develop neurologic problems during the acute phase of the illness, including loss of sense of smell or taste, seizures, and stroke. Damage or functional changes to the brain may result in chronic sequelae. The risk of incident cognitive and neuropsychiatric complications appears independent from the severity of the original pulmonary illness. It behooves the scientific and medical community to attempt to understand the molecular and/or systemic factors linking COVID-19 to neurologic illness, both short and long term. Methods: This article describes what is known so far in terms of links among COVID-19, the brain, neurological symptoms, and Alzheimer's disease (AD) and related dementias. We focus on risk factors and possible molecular, inflammatory, and viral mechanisms underlying neurological injury. We also provide a comprehensive description of the Alzheimer's Association Consortium on Chronic Neuropsychiatric Sequelae of SARS-CoV-2 infection (CNS SC2) harmonized methodology to address these questions using a worldwide network of researchers and institutions. Results: Successful harmonization of designs and methods was achieved through a consensus process initially fragmented by specific interest groups (epidemiology, clinical assessments, cognitive evaluation, biomarkers, and neuroimaging). Conclusions from subcommittees were presented to the whole group and discussed extensively. Presently data collection is ongoing at 19 sites in 12 countries representing Asia, Africa, the Americas, and Europe. Discussion: The Alzheimer's Association Global Consortium harmonized methodology is proposed as a model to study long-term neurocognitive sequelae of SARS-CoV-2 infection. Key Points: The following review describes what is known so far in terms of molecular and epidemiological links among COVID-19, the brain, neurological symptoms, and AD and related dementias (ADRD)The primary objective of this large-scale collaboration is to clarify the pathogenesis of ADRD and to advance our understanding of the impact of a neurotropic virus on the long-term risk of cognitive decline and other CNS sequelae. No available evidence supports the notion that cognitive impairment after SARS-CoV-2 infection is a form of dementia (ADRD or otherwise). The longitudinal methodologies espoused by the consortium are intended to provide data to answer this question as clearly as possible controlling for possible confounders. Our specific hypothesis is that SARS-CoV-2 triggers ADRD-like pathology following the extended olfactory cortical network (EOCN) in older individuals with specific genetic susceptibility.The proposed harmonization strategies and flexible study designs offer the possibility to include large samples of under-represented racial and ethnic groups, creating a rich set of harmonized cohorts for future studies of the pathophysiology, determinants, long-term consequences, and trends in cognitive aging, ADRD, and vascular disease.We provide a framework for current and future studies to be carried out within the Consortium. and offers a "green paper" to the research community with a very broad, global base of support, on tools suitable for low- and middle-income countries aimed to compare and combine future longitudinal data on the topic.The Consortium proposes a combination of design and statistical methods as a means of approaching causal inference of the COVID-19 neuropsychiatric sequelae. We expect that deep phenotyping of neuropsychiatric sequelae may provide a series of candidate syndromes with phenomenological and biological characterization that can be further explored. By generating high-quality harmonized data across sites we aim to capture both descriptive and, where possible, causal associations.

The face validity of an initial sub-typology of people with autism spectrum disorders detained in psychiatric hospitals.

LAY ABSTRACT: Autistic adults who have a history of committing crimes pose challenges for the criminal justice system in terms of disposal and treatment. For this reason, we investigated the validity of a proposed sub-typology of autistic adults detained in secure psychiatric hospitals. Initially, we ran a focus group with psychiatrists, clinical psychologists, healthcare workers, family members and autistic adults who had been detained in hospital to consider a sub-typology of autistic adults who may come into contact with secure psychiatric hospitals. We asked 15 psychiatrists and clinical psychologists to rate 10 clinical vignettes based on our sub-typology with three rounds; revisions to the vignettes to improve clarity were made following each round. The findings indicated that these subtypes possess face validity and raters were able to classify all 10 clinical case vignettes into the sub-typology and percentage of agreement ranged from 96% to 100% for overall subtype classification. The findings suggested that the further validity of the sub-typology should be investigated within a larger study using a clinical sample. These subtypes may help inform treatment and care pathways within hospital.

The endocrine management of intractable masturbation after epilepsy surgery: a case report and literature review.

Intractable masturbation has been reported after epilepsy surgery and can be difficult to control, we present a case treated with cyproterone acetate and haloperidol to achieve an endocrine based resolution of symptoms.

An exploratory study of primary care pharmacist-led epilepsy consultations.

OBJECTIVE: Most epilepsies are managed with anti-epileptic drugs (AEDs), but medication non-adherence has been frequently reported. Satisfying patient information needs has demonstrated improved adherence. Multi-professional working has been encouraged to provide cost-effective health services by using the most appropriate healthcare professional. Research has demonstrated that pharmacist-led consultations are acceptable to patients with other medical conditions and therefore may be appropriate for patients with epilepsy. We aimed to determine the feasibility and acceptability of a pharmacist-led epilepsy consultation (PLEC) study. This encompassed estimating the eligibility and consent rate for a PLEC study, plus the acceptability of potential intervention outcome measures and likely effects. METHODS: Eligible patients with a diagnosis of epilepsy and prescribed AEDs were invited by telephone to attend a PLEC. Baseline adherence, general mental well-being, epilepsy-related quality of life and satisfaction with information received about epilepsy medication were recorded. The intervention was a 30 min consultation to provide participants with an opportunity to ask questions related to their epilepsy therapy. Baseline data collection was repeated after 2 months. RESULTS: Of 106 (97.2%) consenting patients, 82 (77.4%) attended the PLEC. The 2 month follow-up questionnaire was fully completed by 50 (67.6%) participants. The number (percentage ± 95% confidence interval) of participants reporting adherent behaviour pre-PLEC was 22 (44.0 ± 13.7%) which increased to 30 (60 ± 13.6%) post-PLEC (P < 0.03, McNemar test). DISCUSSION: Accepting the limitations of a before-and-after study and small sample size, the findings suggest that a PLEC may improve adherence. A definitive trial is necessary to confirm the effect of a PLEC and establish the longevity and cost-effectiveness of the outcomes. Attrition of potential participants not contactable by telephone suggests the need for additional postal contact in subsequent trials. A reduction in loss to follow-up is also desirable and potentially achievable using telephone reminders.