An evaluation of case formulation training and consultation with probation officers.

BACKGROUND: Formulation is a core competency of mental health professionals, drawing on a variety of sources of information. In England and Wales, the current strategy for offenders with personality disorder places formulation-led management, generally by probation staff, at its core, but reliability and validity of the process remain unclear. AIMS: The first aim was to evaluate a checklist previously designed to establish quality of formulation, and the second to measure the impact of training and consultation on the ability of probation officers to formulate cases. METHODS: The inter-rater reliability, test-re-test reliability and internal consistency of the McMurran formulation checklist were calculated from the scores derived from randomised formulations completed by probation officers from fictitious case vignettes. The impact of training was measured by comparing pre- and post-training formulations of these vignettes. Practice cases formulated by probation officers at psychologist-facilitated consultation meetings over a 6-month period were used to measure the impact of consultation. All formulations were scored blind by independent experts. RESULTS: Inter-rater reliability, test-re-test reliability and internal consistency of the scale were all acceptable. Training and practice did not significantly improve the probation officers' formulations. CONCLUSIONS: The purpose and utility of formulation may vary according to the context in which it is applied. Progress in developing formulation skills may depend on the nature and length of the previous experience of this skill. Future research should take account of such variance, with this scale as a potentially useful aid in monitoring progress. IMPLICATIONS: The capacity for teaching formulation to probation officers could be investigated further by comparing the process with formulation development by mental health experts with previously extensive formulation experience. Formulation will probably need to be adapted to meet the needs of the context in which it is developed. The relationship between formulation and management outcome was not investigated here and would be a further important step.

A dose of ruthlessness: interpersonal moral judgment is hardened by the anti-anxiety drug lorazepam.

Neuroimaging data suggest that emotional brain systems are more strongly engaged by moral dilemmas in which innocent people are directly harmed than by dilemmas in which harm is remotely inflicted. In order to test the possibility that this emotional engagement involves anxiety, we investigated the effects of 1 mg and 2 mg of the anti-anxiety drug lorazepam on the response choices of 40 healthy volunteers (20 male) in moral-personal, moral-impersonal, and nonmoral dilemmas. We found that lorazepam caused a dose-dependent increase in participants' willingness to endorse responses that directly harm other humans in moral-personal dilemmas but did not significantly affect response choices in moral-impersonal dilemmas or nonmoral dilemmas. Within the set of moral-personal dilemmas that we administered, lorazepam increased the willingness to harm others in dilemmas where harm was inflicted for selfish reasons (dubbed low-conflict dilemmas) as well as responses to dilemmas where others were harmed for utilitarian reasons (i.e., for the greater good, dubbed high-conflict dilemmas). This suggests that anxiety exerts a general inhibitory effect on harmful acts toward other humans regardless of whether the motivation for those harmful acts is selfish or utilitarian. Lorazepam is also a sedative drug, but we found that lorazepam slowed decision times equally in all 3 dilemma types. This finding implies that its specific capacity to increase ruthlessness in moral-personal dilemmas was not a confound caused by sedation.