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.

Effectiveness of a Self Help Cognitive Behavioural Treatment Program for Problem Gamblers: A Randomised Controlled Trial.

The study aimed to strengthen the scarce literature on self-help treatments for Problem Gambling (PG) by comparing the effectiveness of a Self-Help Cognitive Behavioral Treatment (SHCBT) program (n = 23) with a 6-week Waitlist condition (n = 32) in problem gamblers. Participants were community volunteers with gambling problems and were randomly allocated to the Waitlist and treatment conditions. Results showed significant improvements at post-treatment in gambling behaviors including frequency of gambling, average amount gambled per day and PG symptoms as well as a number of gambling correlates including psychological states (e.g., depression, anxiety and stress), gambling cognitions, gambling urges, gambling related self-efficacy, satisfaction with life, and quality of life among those who completed the SHCBT program, when compared with the waitlist condition. The effect size (partial η 2) ranged from .25 to .57 for all assessed outcomes that showed significant improvement from pre- to post-treatment. It was concluded that a self-help CBT program can be beneficial for treating community problem gamblers.

Positive effects of Individual Cognitive Behavior Therapy for patients with unipolar mood disorders with suicidal ideation in Malaysia: A randomised controlled trial.

The aim of this study was to investigate the effectiveness of Individual Cognitive Behavior Therapy (ICBT) in treating patients with mood disorders with suicidal ideation. A total of 69 patients (48 females, 21 males) with the diagnoses above were randomly allocated to either the group of Treatment As Usual (TAU)+ICBT (n=33) or the TAU group (n=36). All participants completed the Beck Depression Inventory (BDI), Beck Scale for Suicide Ideation (BSS), Positive and Negative Suicide Ideation Inventory (PANSI), Beck Hopelessness Scale (BHS), and Depression Anxiety Stress Scale-21 (DASS-21). These questionnaires were administered at pre-treatment, midway through treatment (week 4), post-treatment (week 8), and at follow-ups after three months (week 20) and six months (week 32). Factorial ANOVA results showed that the TAU+ICBT patients improved significantly and at faster rate as compared to the TAU group, which showed improvement only from pre to mid treatment on DASS-D and BHS-T measures. The effect size (Cohen's d), for the TAU+ICBT group showed large effect (1.47) for depressive symptoms and suicidal ideation (1.00). These findings suggest that ICBT used in addition to the TAU, was effective in enhancing treatment outcome of patients with unipolar mood disorders as well as, reducing risk for suicide behavior.

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.

Suicide ideation and intent in Malaysia: a review of the literature.

The aim of this paper was to review the literature on suicide ideation and intent in Malaysia. PsyINFO, PubMed, Medline databases from 1845 to 2012 and detailed manual search of local official reports from Ministry of Health, Malaysian Psychiatric Association and unpublished dissertations from 3 local universities providing postgraduate psychiatric training, were included in the current review. A total of 13 studies on suicide ideation and intent in Malaysia were found and reviewed. The review showed that research on suicide ideation and intent in Malaysia was fragmented and limited, at best. Approximately 50% of existing research on suicide ideation and intent simply focused on sociodemographic data. Fifty-four percent of the data were obtained from hospitals. No study has been conducted on treatment and interventions for suicide ideation and intent. None of the studies used validated suicide scales. The impact of culture was rarely considered. It was clear from the review that for researchers, clinicians and public health policy makers to gain a better understanding of suicide behavior especially suicide ideation and intent in Malaysia, more systematic and empirically stringent methodologies and research frameworks need to be used.

Psychometric properties and validation of the Reasons for Living Inventory in an outpatient clinical population in Malaysia.

The Reasons For Living Inventory has been shown to have good psychometric properties in Western populations for the past three decades. The present study examined the psychometric properties and factor structure of English and Malay version of the Reasons For Living (RFL) Inventory in a sample of clinical outpatients in Malaysia. The RFL is designed to assess an individual's various reasons for not committing suicide. A total of 483 participants (283 with psychiatric illnesses and 200 with non-psychiatric medical illnesses) completed the RFL and other self-report instruments. Results of the EFA (exploratory factor analysis) and CFA (confirmatory factor analysis) supported the fit for the six-factor oblique model as the best-fitting model. The internal consistency of the RFL was α=.94 and it was found to be high with good concurrent, criterion and discriminative validities. Thus, the RFL is a reliable and valid instrument to measure the various reasons for not committing suicide among psychiatry and medical outpatients in Malaysia.

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.

Health belief model predicts adherence to CPAP before experience with CPAP.

Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is often poor. Biomedical indices explain little of the variance in CPAP use. The present study tested a health belief model of adherence in order to determine the contribution of psychological constructs as compared to biomedical indices in the prediction of CPAP adherence. Consecutive patients (n = 77) newly diagnosed with OSA and naïve to CPAP treatment (had never tried CPAP before) completed questionnaires at baseline (prior to CPAP treatment). The questionnaires assessed: outcome expectancy with treatment, self-efficacy, functional outcomes of sleepiness, and perceived risk of negative health outcomes. Physiological data were obtained from a standard clinical diagnostic sleep study. CPAP adherence was assessed at 4-month follow-up. Health belief model constructs alone explained 21.8% of the variance in CPAP adherence, whereas health belief model constructs and biomedical indices together explained 31.8% of the variance in CPAP adherence. The greatest proportion of CPAP adherence was explained by higher outcome expectancies with treatment, greater functional limitations as a result of sleepiness and lower risk perception. The results suggest that patients have developed beliefs and expectations about obstructive sleep apnoea and continuous positive airway pressure even before they try continuous positive airway pressure treatment. These beliefs and expectations predict the patients' adherence to effective therapy.

Binge drinking in university students: A test of the cognitive model.

The aim of this study was to test the cognitive model [Addict. Behav. 29 (2004) 159] of binge drinking in university students. In Study 1, 202 participants completed the Drinking Expectancy Questionnaire (DEQ), the Drinking Refusal Self-Efficacy Questionnaire (DRSEQ), and the Khavari Alcohol Test (KAT). The results showed that both alcohol expectancies (AEs) and drinking refusal self-efficacy (DRSE) are needed to discriminate between binge, social, and heavy drinkers. In general, binge drinkers tend to have higher AEs than social drinkers, and have slightly lower DRSE. However, young social and binge drinkers can only be discriminated on the basis of their AEs. One hundred and fourteen students were recruited for the second study, to predict which individuals would engage in binge drinking during a 4-week self-monitoring period. Over 80% of predicted binge drinkers binged at least once during the monitoring period. These two studies confirmed the cognitive model of binge drinking, and thus, hold implications for the prevention of binge drinking among adolescents and young adults.

Stenosis detection in forearm hemodialysis arteriovenous fistulae by multiphase contrast-enhanced magnetic resonance angiography: preliminary experience.

PURPOSE: To assess the feasibility and accuracy of multiphase contrast-enhanced magnetic resonance angiography (CE-MRA) in patients with dysfunctioning hemodialysis arteriovenous fistulae (AVF), using digital subtraction angiography (DSA) as the standard of reference. MATERIALS AND METHODS: Fifteen patients with dysfunctioning AVF (eight radiocephalic and seven graft AVF) underwent CE-MRA. Dysfunction was defined as a flow decline of more than 25% in 1 month measured by dilutional flow measurements. CE-MRA was performed during injection of 35 mL of gadolinium-DTPA. The CE-MRA sequence consisted of a time-resolved series of 10 scans, each lasting approximately 10 seconds. The technical parameters were TR/TE/FA/voxel = 5.4/1.6/40/3.1 mm(3), and a rectangular surface reception coil was used. All patients were scheduled to undergo DSA at which an intervention was carried out when a stenosis >or=50% was seen. Two observers, unaware of each other's findings and the findings at DSA, quantified the number and degree of stenosis in the failing AVF. Image quality for CE-MRA and DSA was scored on a 3-point scale. The diagnostic performance of CE-MRA was analyzed with receiver-operator characteristic (ROC) analysis. RESULTS: CE-MRA and DSA examinations were performed without side effects in all 15 patients. Image quality was scored significantly better on CE-MRA (observer 1: CE-MRA, 2.0; DSA, 1.3; P =.001; observer 2: CE-MRA, 2.0; DSA, 1.4; P =.002). Interobserver agreement for detection of >or=50% stenosis was 0.81 (95% confidence interval (CI) = 0.71-0.92) for CE-MRA and 0.69 (95% CI = 0.55-0.84) for DSA. ROC analysis revealed a mean area under the curve of 0.78. On the patient level, at the >or=50% threshold, mean sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100% (95% CI = 69%-100%), 10% (95% CI = 0%-78%), 70% (95% CI = 38%-92%), and 100% (95% CI = 50%-100%), respectively. At the >or=75% threshold, mean sensitivity, specificity, PPV, and NPV were 75% (95% CI = 20%-99%), 78% (95% CI = 39%-98%), 55% (95% CI = 12%-96%), and 89% (95% CI = 52%-100%), respectively. CONCLUSION: CE-MRA is a useful diagnostic tool for detecting stenoses in flow-declined hemodialysis AVF prior to interventional DSA.

Confirmatory factor analysis of the COPE questionnaire on community drinkers and an alcohol-dependent sample.

OBJECTIVE: The COPE questionnaire has often been used as an efficient method of assessing a range of coping dimensions in many areas, including alcohol research. To date, however, this questionnaire has not been validated for use in community drinkers or alcohol-dependent samples. This study aimed to rectify this shortcoming in the literature. METHOD: Confirmatory factor analyses (CFA) were performed for 600 Australians (315 men, 285 women; 300 community drinkers and 300 individuals dependent on alcohol), in an attempt to confirm the 14 primary factors and the higher-order factor structure of the COPE. RESULTS: The results of the CFA showed that, whereas a 14-factor primary structure and the popular 3-factor higher-order structure were confirmed in the sample of community drinkers, the 4-factor model (COPE) was not confirmed. No support for any factor solution was found in the alcohol-dependent sample. CONCLUSIONS: It was concluded that the COPE has good psychometric properties when assessing community drinkers, but it is not an adequate tool for assessing dimensions of coping in an alcohol-dependent sample and should be used with extreme caution.

Cognitive and biochemical processes in depressed adult outpatients: a test of the circular process model.

The circular process model is a psychobiological model of depression, in which it is postulated that catecholamines and negative cognitions interact to influence depression. Since its publication, there have been no empirical tests to support or refute the model. This study tested the model in 92 depressed adult outpatients with non-bipolar non-psychotic depression. There were no significant bivariate correlations among the biochemical and cognitive measures. However, the interactive model was supported by results of two out of three hierarchical regression analyses, in which the biochemical-by-cognitive interactive terms significantly predicted depression after the main effects of each variable were accounted for. These findings show sufficient evidence in support of the Circular Process Model to warrant further testing over the treatment period.

Alcohol expectancy and drinking refusal self-efficacy: a test of specificity theory.

Although alcohol expectancy (expectations about the effects of drinking alcohol on one's behavior and mood) and drinking refusal self-efficacy (one's perceived ability to resist drinking in high-risk situations) have consistently been demonstrated to be useful to our understanding of alcohol use and abuse, the specificity of these constructs to alcohol consumption has not been previously demonstrated. Using 161 first-year psychology students and multiple regression analyses this study indicated that alcohol expectancies and drinking refusal self-efficacy were specifically related to quantity of alcohol consumption, but not to caffeine or nicotine intake. These results provide empirical evidence to confirm the theoretical and practical utility of these two cognitive constructs to alcohol research and serve to strengthen the theoretical foundations of alcohol expectancy theory.

Preoperative assessment of local tumor extent in advanced rectal cancer: CT or high-resolution MRI?

BACKGROUND: We compared high-resolution magnetic resonance imaging (MRI) with computed tomography (CT) in the assessment of tumor infiltration in surrounding structures for locally advanced primary and recurrent rectal cancer. METHODS: Twenty-six patients with operable, locally advanced rectal cancer (15 recurrent and 11 primary) were evaluated with conventional pelvic CT and 1.5-T high-resolution MRI with a quadrature phased-array coil. The images were scored for invasion of nine neighboring pelvic structures, and the results were compared with surgical and histologic findings. RESULTS: A total of 234 structures in 26 patients was evaluated for tumor invasion. For MRI the, sensitivity was 97% and the specificity 98%; for CT, the sensitivity was 70% and the specificity was 85%. The difference in performance was statistically significant (p<0.001). The failure most frequently made on CT was the false-positive prediction of pelvic floor and piriform muscle invasion (14), whereas MRI showed only four false-positive predictions. MRI correctly predicted all four cases of sacral bone invasion, three of which were missed by CT. MRI was accurate in 20 patients (80%) and CT in only five patients (19%). CONCLUSION: High-resolution MRI using a quadrature phased-array coil is highly accurate and superior to CT in predicting tumor infiltration in surrounding structures for locally advanced primary or recurrent rectal cancer and is recommended in the preoperative work-up of these tumors.