Deconstructing "Sexual Deviance": Identifying and Empirically Examining Assumptions about "Deviant" Sexual Fantasy in the DSM.

We identify and examine three assumptions underpinning "sexual deviance" in the Diagnostic and Statistical Manual (DSM) of Mental Disorders: (1) the "sexual deviant" - often, "the male sex offender" - prefers "deviant," and has limited (if any) "non-deviant," sexual fantasies; (2) this differentiates them from the non-sexual-/non-offending "norm"; (3) preferred fantasies are "deviant" or "non-deviant." Adult volunteers (N = 279; equal numbers of sexual offending [SO], non-sexual offending [NSO] and non-offending [NO] men) provided anonymous descriptions of their favorite sexual thought and responses to a revised Wilson Sex Fantasy Questionnaire during a wider computerized survey of 6,289 men from prison and the community. Latent class analysis identified five types of favorite sexual thought; vaginal/oral sex with 1+ woman was commonest for SO men and the WSFQ findings supported this - challenging the first assumption. Both SO and NO men were over-represented for thought types considered "deviant" by the DSM - tempering the second assumption - although SO men were over-represented for thoughts involving children specifically. All thought types were multidimensional; none included solely elements considered "deviant" by the DSM - contesting the third assumption. Notions of the "sexual deviant" as "different"/"other" may underpin these assumptions, potentially negatively impacting research, therapy and understanding sexual crime.

The effect of a peer-led problem-support mentor intervention on self-harm and violence in prison: An interrupted time series analysis using routinely collected prison data.

BACKGROUND: Levels of mental disorder, self-harm and violent behaviour are higher in prisons than in the community. The purpose of this study was to determine whether a brief peer-led problem-support mentor intervention could reduce the incidence of self-harm and violence in an English prison. METHODS: An existing intervention was adapted using a theory of change model and eligible prisoners were trained to become problem-support mentors. Delivery of the intervention took two forms: (i) promotion of the intervention to fellow prisoners, offering support and raising awareness of the intervention but not delivering the skills and (ii) delivery of the problem-solving therapy skills to selected individual prisoners. Training and intervention adherence was measured using mentor log books. We used an Interrupted Time Series (ITS) design utilizing prison data over a 31 month period. Three ITS models and sensitivity analyses were used to address the impact across the whole prison and in the two groups by intervention delivery. Outcomes included self-harm and violent behaviour. Routine data were collected at monthly intervals 16 months pre-, 10 months during and six months post-intervention. Qualitative data measured the acceptability, feasibility, impact and sustainability of the intervention. A matched case-control study followed people after release to assess the feasibility of formal evaluation of the impact on re-offending up to 16 months. FINDINGS: Our causal map identified that mental health and wellbeing in the prison were associated with environmental and social factors. We found a significant reduction in the incidence of self-harm for those receiving the full problem-solving therapy skills. No significant reduction was found for incidence of violent behaviour. INTERPRETATION: Universal prison-wide strategies should consider a series of multi-level interventions to address mental health and well-being in prisons. FUNDING: Research Champions Fund and the Economic and Social Research Council Impact Acceleration Account Fund, University of York, UK.

Self-harm among in-school and street-connected adolescents in Ghana: a cross-sectional survey in the Greater Accra region.

OBJECTIVES: To identify the prevalence, methods, associations and reported reasons for self-harm among in-school and street-connected adolescents in Ghana. DESIGN: A cross-sectional survey. We applied multi-level regression models and model-based cluster analysis to the data. SETTING: Three contexts in the Greater Accra region were used: second cycle schools, facilities of charity organisations and street census enumeration areas (sleeping places of street-connected adolescents, street corners, quiet spots of restaurants, markets, train and bus stations, and lorry and car parks). PARTICIPANTS: A regionally representative sample of 2107 (1723 in-school and 384 street-connected) adolescents aged 13-21 years. OUTCOME MEASURES: Participants responded to a structured self-report anonymous questionnaire describing their experience of self-harm and eliciting demographic information and social and personal adversities. RESULTS: The lifetime prevalence of self-harm was 20.2% (95% CI 19.0% to 22.0%), 12-month prevalence was 16.6% (95% CI 15.0% to 18.0%) and 1-month prevalence was 3.1% (95% CI 2.0% to 4.0%). Self-injury alone accounted for 54.5% episodes and self-poisoning alone for 16.2% episodes, with more than one method used in 26% of episodes. Self-cutting (38.7%) was the most common form of self-injury, whereas alcohol (39.2%) and medications (27.7%) were the most commonly reported means of self-poisoning. The factors associated with self-harm were interpersonal: conflict with parents (adjusted OR (aOR)=1.87, 95% CI 1.24 to 2.81), physical abuse victimisation (aOR=1.69, 95% CI 1.16 to 2.47), difficulty in making and keeping friends (aOR=1.24, 95% CI 0.85 to 1.80), sexual abuse victimisation (aOR=1.21, 95% CI 0.78 to 1.87) and conflict between parents (aOR=1.07, 95% CI 0.73 to 1.56). CONCLUSIONS: Self-harm is a significant public health problem among in-school and street-connected adolescents in the Greater Accra region of Ghana. Its origins are very largely in social and familial adversity, and therefore prevention and treatment measures need to be focused in these areas.

Adolescents at risk of self-harm in Ghana: a qualitative interview study exploring the views and experiences of key adult informants.

BACKGROUND: In Ghana, rates of self-harm in young people are as high as they are in high income countries. Self-reported interpersonal, familial and societal stressors form the most important background, and self-harm is seen by young people as a way of responding to that stress. In the present study, we obtained the views of key adult informants about self-harm among adolescents in Ghana - what they thought as possible reasons for self-harm in young people and what actions might be needed at an individual or population level to respond to the problem. METHODS: We interviewed face-to-face 11 adults, using a semi-structured interview guide. We used an experiential thematic analysis technique to analyse the transcribed interviews. RESULTS: The analysis identified five themes: "underestimating the prevalence of self-harm in adolescents", "life on the streets makes self-harm less likely", "self-harm in adolescents is socially and psychologically understandable", "ambivalence about responding to adolescent self-harm", and "few immediate opportunities for self-harm prevention in Ghana". Adolescent self-harm was acknowledged but its scale was underestimated. The participants offered explanations for adolescent self-harm in social and psychological terms that are recognisable from accounts in high income countries. Low rates among street-connected young people were explained by their overarching orientation for survival. Participants agreed that identification was important, but they expressed a sense of inadequacy in identifying and supporting adolescents at risk of self-harm. Again, the participants agreed that self-harm in adolescents should be prevented, but they recognised that relevant policies were not in place or if there were policies they were not implemented - mental health and self-harm were not high on public or political priorities. CONCLUSIONS: The adults we interviewed about young people who self-harm see themselves as having a role in identifying adolescents at risk of self-harm and see the organisations in which they work as having a role in responding to individual young people in need. These are encouraging findings that point to at least one strand of a policy in Ghana for addressing the problem of self-harm in young people.

Adolescent self-harm in Ghana: a qualitative interview-based study of first-hand accounts.

BACKGROUND: Recent prevalence studies suggest that self-harm among adolescents in sub-Saharan Africa is as common as it is in high income countries. However, very few qualitative studies exploring first-person accounts of adolescent self-harm are available from sub-Saharan Africa. We sought to explore the experiences and first-person perspectives of Ghanaian adolescents reporting self-harm - for deeper reflections on the interpretive repertoires available in their cultural context for making sense of self-harm in adolescents. METHODS: Guided by a semi-structured interview protocol, we interviewed one-to-one 36 adolescents (24 in-school adolescents and 12 street-connected adolescents) on their experiences of self-harm. We applied experiential thematic analysis to the data. RESULTS: Adolescents' description of the background to their self-harm identified powerlessness in the family context and unwanted adultification in the family as key factors leading up to self-harm among both in-school and street-connected adolescents. Adolescents' explanatory accounts identified the contradictory role of adultification as a protective factor against self-harm among street-connected adolescents. Self-harm among in-school adolescents was identified as a means of "enactment of tabooed emotions and contestations", as a "selfish act and social injury", as "religious transgression", while it was also seen as improving social relations. CONCLUSIONS: The first-person accounts of adolescents in this study implicate familial relational problems and interpersonal difficulties as proximally leading to self-harm in adolescents. Self-harm in adolescents is interpreted as an understandable response, and as a strong communicative signal in response to powerlessness and family relationship difficulties. These findings need to be taken into consideration in the planning of services in Ghana and are likely to be generalisable to many other countries in sub-Saharan Africa.

Prevalence of self-harm among lesbian, gay, bisexual, and transgender adolescents: a comparison of personal and social adversity with a heterosexual sample in Ghana.

OBJECTIVES: We sought to estimate the prevalence of self-reported self-harm among adolescents identifying as lesbian, gay, bisexual, and transgender (LGBT) in Ghana, and compare self-reported personal and social adversities related to self-harm in this group to those in a random sample of heterosexual adolescents from the same locality. RESULTS: A total of 444 adolescents aged 13-21 years, comprising 74 LGBT adolescents and 370 heterosexual adolescents, provided data. The lifetime prevalence estimate of self-harm was higher in the LGBT group (47%) than the heterosexual group (23%). The LGBT group reported a higher rate of self-harm during the previous 12 months (45%), compared to the heterosexual group (18%). LGBT adolescents reported more alcohol and substance use and more personal social adversities, including various forms of victimisation, than heterosexual adolescents. They were no more likely to report difficulty in making and keeping friends or schoolwork problems than were heterosexual adolescents.

Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review.

BACKGROUND: Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10-25 years) in sub-Saharan Africa. METHOD: We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence. RESULTS: Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% - 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% - 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% - 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5-14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% - 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm. CONCLUSION: Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.

Implementation of a problem-solving training initiative to reduce self-harm in prisons: a qualitative perspective of prison staff, field researchers and prisoners at risk of self-harm.

BACKGROUND: Social problem-solving is one technique used to help reduce incidence of self-harm. Our study evaluated the feasibility and acceptability of the adaptation and implementation of a brief Problem-Solving Training (PST) intervention to reduce self-harm in prisons. METHODS: The process involved i) adaptation of the training materials using focus groups with prison staff and prisoners, ii) training frontline prison staff to use the skills, and iii) implementation of the skills with prisoners at risk of self-harm. Qualitative interviews were conducted with prison staff, prisoners and field researchers and were analysed using a thematic framework to produce a model of the barriers and facilitators to the process. RESULTS: We conducted 43 interviews across three prison sites. The interviews included 19 prison staff, 18 prisoners and six field researcher meetings. The adaptation to the training and intervention materials were well received. The findings identified the need to support training using a collaborative and flexible approach. Prisoner engagement was affected by their own personal circumstances and by a range of contextual issues relating to the prison environment. Implementation of the skills by prison staff were hindered by resource constraints, the prison environment and staff attitudes. CONCLUSIONS: We found that it was feasible to adapt an existing intervention and contextualise it within the prison environment. Although we could train large numbers of staff it was deemed unfeasible for staff to implement the problem-solving skills to prisoners at risk of self-harm. Prisoners who engaged with the intervention reported a range of benefits. Alternative implementation mechanisms to tackle the contextual barriers proposed by staff and prisoners included delivery of the intervention using an educational setting and/or use of a prisoner peer-led scheme.

Assessing evidence quality in research reporting neurocognitive outcomes following paediatric temporal lobe surgery for epilepsy.

PURPOSE: RCTs are the gold standard in determining intervention efficacy with journal impact factor assumed to index research quality. Flint et al's (2017) systematic review examined neurocognitive outcomes following paediatric temporal lobe epilepsy surgery. Retrieved evidence was restricted to non-RCTs, which pose greater risk of bias and thus diminish research quality. The current study evaluated risk of bias in sources retrieved by Flint et al. and explored whether impact factor related to research quality within this selected field. METHODS: Methodological and reporting bias was evaluated using categories of bias specified by Cochrane. The relationship between the identified number of biases and journal impact factors of retrieved sources was examined. RESULTS: All studies carried substantial risk for bias. Methodology bias included low sample size (76.71%; 56/73), risk of confounding cognitive outcomes due to failure to report pre-surgery neurocognitive data (21.92%; 16/73) and to determine whether patients were prescribed antiepileptic drugs at follow-up (53.42%; 39/73). Reporting bias included overstating claims based on findings (53.42%; 39/73), failure to report individual patient characteristics (66%; 33/50) and omitting the nature of surgical interventions (15.07%; 11/73). The number of sources of common bias within studies was not associated significantly with journal impact factor (p = .878). CONCLUSION: This evaluation highlights risk of bias when sources are predominantly uncontrolled non-RCTs and provides evidence that journal impact factor is not a reliable indicator of quality within this field. Authors should limit bias in their methods and reporting of results, to ensure the highest quality evidence possible is used to inform treatment decisions and prognosis.

Neuropsychological outcomes following paediatric temporal lobe surgery for epilepsies: Evidence from a systematic review.

OBJECTIVE: The systematic review aimed to assess the neuropsychological outcomes of temporal lobe resections for epilepsy in children. Additional objectives included determining whether earlier age at surgery leads to better neuropsychological outcomes; the relationships between and predictors of these outcomes. METHODS: Using advanced search terms, a systematic review of electronic databases was conducted, comprising MEDLINE, Embase, PsycINFO, Global Health, Web of Science and CINAHL. Included studies reported on outcome following neurosurgical treatment for epilepsy. Specifically, studies were included if they reported neuropsychological outcomes and were concerned only with temporal lobe resection. RESULTS: 73 studies met inclusion criteria. For reported neuropsychological outcomes, the majority of participants remained stable after surgery; some declined and some improved. There was some evidence for increased material-specific memory deficits after temporal lobe surgery based on resection side, and more positive cognitive outcome for those with lower pre-surgical ability level. SIGNIFICANCE: Retrieved evidence highlights the need for improvements to quality of methodology and reporting. Appropriately designed prospective multicentre trials should be conducted with adequate follow-up for long-term outcomes to be measured. Core outcome measures should be agreed between centres. This would permit higher quality evidence so that clinicians, young people and their families may make better informed decisions about whether or not to proceed with surgery and likely post-operative profile.

Men Presenting With Sexual Thoughts of Children or Coercion: Flights of Fancy or Plans for Crime?

INTRODUCTION: There is limited evaluation of clinical and theoretical claims that sexual thoughts of children and coercing others facilitate sexual offending. The nature of these thoughts (what they contain) also is unknown. AIM: To examine the relation between child or coercive sexual thoughts and sexual offending and to determine the nature of these thoughts and any differences among sexual offending (SO), non-sexual offending (NSO), and non-offending (NO) men. METHODS: In a cross-sectional computerized survey, anonymous qualitative and quantitative self-reported sexual thought and experience data were collected from 279 adult volunteers composing equal numbers of SO, NSO, and NO men recruited from a medium-security UK prison and a community sample of 6,081 men. MAIN OUTCOME MEASURES: Computerized Interview for Sexual Thoughts and Computerized Inventory of Sexual Experiences. RESULTS: Three analytical approaches found child sexual thoughts were related to sexual offending; sexual thoughts with coercive themes were not. Latent class analyses identified three types of child sexual thought (primarily differentiated by interpersonal context: the reporting of own emotions, emotions of others, or both) and four types of sexual thoughts of coercing others (chiefly discriminated by the other person's response: no emotional states reported, consent, non-consent, or mixed). Type of child sexual thought and participant group were not significantly related. Type of coercive sexual thought and group were marginally related; the consensual type was more common for the NO group and the non-consensual type was more common for the SO group than expected statistically. CONCLUSION: Child sexual thoughts are a risk factor for sexual offending and should be assessed by clinicians. In general, sexual thoughts with coercive themes are not a risk factor, although thought type could be important (ie, thoughts in which the other person expresses an enduring lack of consent). Exploring the dynamic risk factors associated with each type of child and coercive thought could lead to more targeted treatment.

Associations between nonauditory hallucinations, dissociation, and childhood adversity in first-episode psychosis.

Although repeated associations have been found between adversity exposure (particularly exposure to childhood sexual abuse), dissociation, and auditory hallucinations in the context of psychosis, there is little comparable research examining hallucinations in other modalities. This study aimed to determine whether cumulative adversity exposure influences the likelihood of experiencing visual, tactile, olfactory, and gustatory hallucinations among psychosis patients and whether measures of dissociation are significantly associated with nonauditory hallucinations when exposure to childhood adversity and psychological distress are adjusted for. Self-report measures and a retrospective case-control design were applied to assess nonauditory hallucinations, dissociation, psychological distress, and childhood adversity exposure in a sample of first-episode psychosis patients reporting nonauditory hallucinations (n = 36) and controls from the same clinical population without nonauditory hallucinations (n = 31). Case participants reported higher levels of dissociation, psychological distress, and exposure to childhood rape than the control group. Dissociation remained significantly associated with nonauditory hallucinations when we adjusted for childhood sexual abuse, other types of childhood adversity, and a combined measure of emotional distress. Indication of a dose-response relationship was detected, in that total number of adversities was significantly associated with reporting more than one modality of nonauditory hallucination. Observed associations between auditory hallucinations and dissociation in psychosis may extend to other hallucination modalities. It is suggested that more research attention be paid to the etiology and impact of nonauditory hallucinations in psychosis samples.

The co-occurrence of aggression and self-harm: systematic literature review.

BACKGROUND: Epidemiological research supports an association between aggression and self-harm through data on the frequency with which individuals exhibit both behaviours. Unbiased evidence, however, is needed to draw conclusions about the nature and extent of co-occurrence. METHOD: Systematic review of published studies was undertaken to evaluate whether or not the frequency with which aggression and self-harm co-occur is beyond that which would be expected by chance. Outcome measures included: (a) between-group differences on a standardised aggression/self-harm measure - the groups defined by scores on a measure of the other behaviour; (b) correlations between the two behaviours; (c) co-occurrence rates in populations defined by the presence of either behaviour; (d) co-occurrence rates in populations not defined by either behaviour. Odds ratios were calculated for studies presenting complete frequency data. RESULTS: 123 studies, some yielding more than one type of result, met the inclusion criteria. Most case-control studies found elevated levels of aggression in self-harming populations (or self-harm in aggressive populations) compared to controls. The majority of correlational, co-occurrence rate, and odds ratio data found aggression and self-harm to be associated. LIMITATIONS: Results were subject to descriptive synthesis only and thus, unable to report an overall effect size. CONCLUSIONS: Evidence suggests that aggression and self-harm frequently co-occur. Such evidence necessitates more theoretical discussion and associated research on the source and nature of co-occurrence. Nonetheless, individuals who present with one behaviour may be considered an 'at-risk' group in terms of exhibiting the other. Such evidence holds implications for practice (e.g. risk assessment).

Semantics, syntax or neither? A case for resolution in the interpretation of N500 and P600 responses to harmonic incongruities.

The processing of notes and chords which are harmonically incongruous with their context has been shown to elicit two distinct late ERP effects. These effects strongly resemble two effects associated with the processing of linguistic incongruities: a P600, resembling a typical response to syntactic incongruities in language, and an N500, evocative of the N400, which is typically elicited in response to semantic incongruities in language. Despite the robustness of these two patterns in the musical incongruity literature, no consensus has yet been reached as to the reasons for the existence of two distinct responses to harmonic incongruities. This study was the first to use behavioural and ERP data to test two possible explanations for the existence of these two patterns: the musicianship of listeners, and the resolved or unresolved nature of the harmonic incongruities. Results showed that harmonically incongruous notes and chords elicited a late positivity similar to the P600 when they were embedded within sequences which started and ended in the same key (harmonically resolved). The notes and chords which indicated that there would be no return to the original key (leaving the piece harmonically unresolved) were associated with a further P600 in musicians, but with a negativity resembling the N500 in non-musicians. We suggest that the late positivity reflects the conscious perception of a specific element as being incongruous with its context and the efforts of musicians to integrate the harmonic incongruity into its local context as a result of their analytic listening style, while the late negativity reflects the detection of the absence of resolution in non-musicians as a result of their holistic listening style.

Norming the odd: creation, norming, and validation of a stimulus set for the study of incongruities across music and language.

Research into similarities between music and language processing is currently experiencing a strong renewed interest. Recent methodological advances have led to neuroimaging studies presenting striking similarities between neural patterns associated with the processing of music and language--notably, in the study of participants' responses to elements that are incongruous with their musical or linguistic context. Responding to a call for greater systematicity by leading researchers in the field of music and language psychology, this article describes the creation, selection, and validation of a set of auditory stimuli in which both congruence and resolution were manipulated in equivalent ways across harmony, rhythm, semantics, and syntax. Three conditions were created by changing the contexts preceding and following musical and linguistic incongruities originally used for effect by authors and composers: Stimuli in the incongruous-resolved condition reproduced the original incongruity and resolution into the same context; stimuli in the incongruous-unresolved condition reproduced the incongruity but continued postincongruity with a new context dictated by the incongruity; and stimuli in the congruous condition presented the same element of interest, but the entire context was adapted to match it so that it was no longer incongruous. The manipulations described in this article rendered unrecognizable the original incongruities from which the stimuli were adapted, while maintaining ecological validity. The norming procedure and validation study resulted in a significant increase in perceived oddity from congruous to incongruous-resolved and from incongruous-resolved to incongruous-unresolved in all four components of music and language, making this set of stimuli a theoretically grounded and empirically validated resource for this growing area of research.

Dissociation, trauma, and the role of lived experience: toward a new conceptualization of voice hearing.

Voice hearing (VH) is often regarded as pathognomic for schizophrenia. The purpose of this article is to review and integrate historical, clinical, epidemiological, and phenomenological evidence in order to suggest that VH may be more appropriately understood as a dissociative rather than a psychotic phenomenon. First, we discuss the lifetime prevalence of VH in the general population, which is estimated to range between 1% and 16% for adult nonclinical populations and 2% and 41% in healthy adolescent samples. Second, we demonstrate how the ubiquity of VH phenomenology, including variables like voice location, content, and frequency, limits its diagnostic and prognostic utility for differentiating psychotic from trauma-spectrum and nonclinical populations. Finally, we report on the empirical associations between VH, measures of dissociation, and trauma particularly (though not exclusively) childhood sexual abuse. There are 2 main conclusions from this review. First, we argue that available evidence suggests that VH experiences, including those in the context of psychotic disorders, can be most appropriately understood as dissociated or disowned components of the self (or self-other relationships) that result from trauma, loss, or other interpersonal stressors. Second, we provide a rationale for clinicians to use psychotherapeutic methods for integrating life events as precipitating and/or maintaining factors for distressing voices. Potential mechanisms for the relationship between trauma, dissociation, VH, and clinical diagnosis are described, including the relevance of literature from the field of attachment in providing a diathesis for dissociation. Suggestions for future research are also discussed.

Reliability and component structure of the modified Daily Symptom Report (DSR-20).

OBJECTIVES: The purpose of the present study was to modify Freeman et al.'s (1996) Daily Symptom Report (DSR) for premenstrual syndrome (PMS) by adding items depicting aggressive and impulsive symptoms, to explore the component structure of this revised measure (DSR-20) in a sample of PMS sufferers, and to compare their scores with those from controls during the follicular and luteal cycle phases. METHODS: The DSR-20 was administered to 140 PMS sufferers who were seeking treatment for PMS and 54 controls who considered themselves to be free from premenstrual complaints daily for three menstrual cycles. RESULTS: Cronbach's α was 0.95 for the luteal DSR-20 scores of the PMS sufferers, indicating very high internal consistency of the 20 items. Exploratory Principal Components Analysis (PCA) of the luteal ratings of the PMS sufferers identified two components with high internal consistency (>0.90), describing psychological and physical premenstrual symptoms. PMS sufferers scored significantly higher than the controls on each of these components during the luteal, but not follicular, phase. CONCLUSIONS: The DSR-20 total scale score is an internally consistent global measure of the intensity of PMS. The division of PMS symptoms into psychological and physical components, both of which significantly differentiated PMS sufferers from controls during the luteal phase, sheds further light on the description of PMS and provides a clinically relevant and practical means by which to summarise and interpret daily symptom ratings, necessary for the identification and investigation of the syndrome.

The efficacy of Hypericum perforatum (St John's wort) for the treatment of premenstrual syndrome: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Premenstrual syndrome (PMS) is a common condition. Some of the most widely prescribed medications are selective serotonin reuptake inhibitors (SSRIs), based on the hypothesized role of serotonin in the production of PMS symptoms. PMS sufferers, especially those experiencing mild to moderate symptoms, are often reluctant to take this form of medication and instead buy over-the-counter preparations to treat their symptoms, for which the evidence base with regard to efficacy is limited. Hypericum perforatum (St John's wort) influences the serotonergic system. As such, this widely available herbal remedy deserves attention as a PMS treatment. OBJECTIVE: To investigate the effectiveness of Hypericum perforatum on symptoms of PMS. STUDY DESIGN: This randomized, double-blind, placebo-controlled, crossover study was conducted between November 2005 and June 2007. SETTING: Institute of Psychological Sciences, University of Leeds, Leeds, UK. PARTICIPATION: 36 women aged 18-45 years with regular menstrual cycles (25-35 days), who were prospectively diagnosed with mild PMS. INTERVENTION: Women who remained eligible after three screening cycles (n = 36) underwent a two-cycle placebo run-in phase. They were then randomly assigned to receive Hypericum perforatum tablets 900 mg/day (standardized to 0.18% hypericin; 3.38% hyperforin) or identical placebo tablets for two menstrual cycles. After a placebo-treated washout cycle, the women crossed over to receive placebo or Hypericum perforatum for two additional cycles. MAIN OUTCOME MEASURES: Symptoms were rated daily throughout the trial using the Daily Symptom Report. Secondary outcome measures were the State Anxiety Inventory, Beck Depression Inventory, Aggression Questionnaire and Barratt Impulsiveness Scale. Plasma hormone (follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol, progesterone, prolactin and testosterone) and cytokine (interleukin [IL]-1beta, IL-6, IL-8, interferon [IFN]-gamma and tumour necrosis factor [TNF]-alpha) levels were measured in the follicular and luteal phases during Hypericum perforatum and placebo treatment. RESULTS: Hypericum perforatum was statistically superior to placebo in improving physical and behavioural symptoms of PMS (p < 0.05). There were no significant effects of Hypericum perforatum compared with placebo treatment for mood- and pain-related PMS symptoms (p > 0.05). Plasma hormone (FSH, LH, estradiol, progesterone, prolactin and testosterone) and cytokine (IL-1beta, IL-6, IL-8, IFNgamma and TNFalpha) levels, and weekly reports of anxiety, depression, aggression and impulsivity, also did not differ significantly during the Hypericum perforatum and placebo cycles (p > 0.05). CONCLUSION: Daily treatment with Hypericum perforatum was more effective than placebo treatment for the most common physical and behavioural symptoms associated with PMS. As proinflammatory cytokine levels did not differ significantly between Hypericum perforatum and placebo treatment, these beneficial effects are unlikely to be produced through this mechanism of action alone. Further work is needed to determine whether pain- and mood-related PMS symptoms benefit from longer treatment duration. Trial registration number (International Standard Randomised Controlled Trial Number Register) ISRCTN31487459.

Driving aggression in forensic and non-forensic populations: relationships to self-reported levels of aggression, anger and impulsivity.

A series of four questionnaires - the Buss-Perry Aggression Questionnaire (AQ), the Barratt Impulsivity Scale (BIS-11), the Driving Anger Scale (DAS) and a Driving Violence Inventory (DVI) - were administered to a sample of 473 British drivers consisting of undergraduates (N=185), members of the public (N=106) and offenders (N=182) serving sentences in closed prisons in England (violent=82, non-violent=100). Offenders consistently rated acts of driving aggression as less severe compared with other drivers. Offender attributions of driving violence differed to other drivers in that they were equally likely to perceive obscene gesturing as high or low intensity responses; they also viewed assault as a high intensity response whereas members of the public rated it more severely. Trait levels of anger and aggression were the predictors of driving violence in all groups but previous aggressive behaviour was only a predictor for the offenders. Gender and age were found to be predictors of aggressive driving in non-offenders. Even with the effects of age controlled, offenders (and violent offenders in particular) scored higher on measures of driving anger and aggression. These data suggest that offenders differ in their perceptions of aggressive behaviours experienced in everyday driving and as a consequence are more likely to commit acts that other drivers perceive as violent. As offenders are known to display similar perceptual biases in other domains, identified as precursors to their aggressive behaviour, it seems likely that experience effects (as reflected in the trait measures) underpin differences in driving aggression between offenders and non-offenders.

Processing bias for sexual material: the emotional stroop and sexual offenders.

As part of an ongoing research project we examined information-processing biases in forensic and nonforensic participants (n = 10 sex offenders, n = 10 violent offenders, n = 10 nonviolent offenders, and n = 13 undergraduates). A computerised version of the Stroop task demonstrated that offenders convicted of both sexual and violent offences were significantly slower than undergraduates to color-name words relating to sexual offending (with sex offenders demonstrating the greatest interference bias). Furthermore, processing bias was also evident for aggression words in violent offenders and violent sexual offenders but not in non-violent sexual offenders. Specifically, paedophiles convicted of indecent assault presented different response profiles compared to heterosexual rapists. These findings suggest that tests that assess information processing bias for salient material may also prove useful as an assessment tool within forensic populations.