Students' Perceptions on the Effectiveness of a Computer-Delivered Alcohol Intervention.

Objective: Social adjustment, including alcohol use, directly affects the success of college students. Due to an increased reliance on computer-delivered alcohol interventions (CDIs) a need has emerged to further investigate alcohol use and web-based interventions. Methods: In-depth focus group interviews were conducted with 51 undergraduate students to elicit information from students on the shared experience of participating in a CDI. Results: Participants identified the influence of gender, culture, parents, and family on alcohol use behavior. A difference in personal factors, previous exposure, and experiences can affect the attitudes, behaviors, and outcomes of a CDI. Conclusion: Multiple approaches geared towards a wide variety of students from different backgrounds and environments are needed to be truly successful in preventing alcohol misuse.

The all-Wales forensic adolescent consultation and treatment service (FACTS): A 5-year referral cohort study.

BACKGROUND: FACTS is a Wales-wide mental health service for 10-17-year-olds with needs beyond the remit of mainstream child and adolescent mental health services (CAMHS). As a purely consultation-liaison service, it differs from other UK services in the field. AIMS: To describe a complete cohort of referrals to FACTS 2013-2017 with service exit by June 2018. METHODS: Clinical, social and offending data were extracted from FACTS records. RESULTS: 80 young people completed a FACTS episode, averaging nearly a year (309 days; range 13-859 days). Mostly boys (65, 81%) of mean age 15.4 years (range 9-18), two-thirds (n = 53) had three or more referral reasons, one invariably being threatened/actual harm to others; only half were criminal-justice involved. Half (41, 51%) were committing sexually harmful acts. Half were self-harming (41, 51%). All but seven had had at least one adverse childhood experience (ACE), nearly half (35, 44%) four or more. Nevertheless, post-traumatic stress disorder (PTSD) was rarely diagnosed (7, 9%); just over one-quarter (23, 29%) had no diagnosis at all. Correspondence analyses endorsed two distinct Attention deficit hyperactivity disorder groups, distinguished by presence/absence of evidenced brain damage or dysfunction. Suicide-related behaviours clustered with the other diagnoses, flashbacks and psychotic symptoms with no diagnosis. Change in home circumstances during a FACTS episode was slight. CONCLUSIONS: The complexity of presenting problems and service involvement evidences need for FACTS. The extent of persistently harmful sexual behaviours is a novel finding, suggesting need for more expert input for this at other service levels. Rarity of PTSD diagnoses was surprising given the extent of ACEs. This raises concerns that services focus on disorder signs rather than the child's inner life. Given the extent of problems, minimal change may be a positive outcome - especially when remaining in the community. Further development of this service should include explicit case-by-case goals and indicative outcome markers.

Sentencing offenders with mental disorders, developmental disorders or neurological impairments: what does the new Sentencing Council Guideline mean for psychiatrists?

The new Sentencing Council Guideline on sentencing offenders with mental disorders, effective from 1 October 2020, is essential reading for all psychiatrists who give evidence in the criminal courts, revealing something of required judicial thinking, our common ground on public safety concerns but differences in focus on culpability and punishment.

Benefits and risks of conjugal visits in prison: A systematic literature review.

BACKGROUND: Imprisonment impacts on lives beyond the prisoner's. In particular, family and intimate relationships are affected. Only some countries permit private conjugal visits in prison between a prisoner and community living partner. AIMS: Our aim was to find evidence from published international literature on the safety, benefits or harms of such visits. METHODS: A systematic literature review was conducted using broad search terms, including words like 'private' and 'family', to maximise search sensitivity but strict criteria for inclusion - of visits unobserved by prison staff and away from other prisoners. All included papers were quality assessed. Two of us independently extracted data from included papers, according to a prepared checklist. Meta-analysis was considered. RESULTS: Seventeen papers were identified from 12 independent studies, all but three of them from North America. The only study of health benefits found a positive association with maintaining sexual relationships. The three before-and-after study of partnership qualities suggested benefit, but conjugal visiting was within a wider family-support programme. Studies with in-prison behaviour as a possible outcome suggest small, if any, association, although one US-wide study found significantly fewer in-prison sexual assaults in states allowing conjugal visiting than those not. Other studies were of prisoner, staff or partner attitudes. There is little evidence of adverse effects, although two qualitative studies raise concerns about the visiting partner's sense of institutionalisation or coercion. CONCLUSIONS: The balance of evidence about conjugal visiting is positive, but there is little of it. As stable family relationships have, elsewhere, been associated with desistance from crime, the contribution of conjugal visiting to these should be better researched.

Change in the Relationship Between Drinking Alcohol and Risk of Violence Among Adolescents and Young Adults: A Nationally Representative Longitudinal Study.

AIMS: To quantify the relationship between alcohol and violence with increasing age. METHODS: Data were from The National Longitudinal Study of Adolescent to Adult Health (ADD Health) of 20,386 people representative of the US population. Mean age at the first wave of interviews was 16.2 years, with subsequent interviews mean of 1, 6.3 and 12.9 years later. We used random-effects models and predictive marginal effects of the association between varying quantities of alcohol consumption and violence while controlling for possible confounders. RESULTS: Violence was reported by 19.1% of participants at wave I but just 2.1% at wave IV. The random-effects model showed that consuming 1-4 drinks on each occasion was associated with a modest increase in risk of violence in both males (odds ratio (OR) 1.36, 95% CI 1.13-1.63) and females (OR 1.33, 95% CI 1.03-1.72). For consumption of five or more drinks on each occasion, the risk remained similar for females (OR 1.40 (0.99-1.97)) but increased considerably for males (OR 2.41 (1.96-2.95)). Predictive marginal effects models confirmed that violence rates decreased with age. CONCLUSIONS: Alcohol is most strongly linked to violence among adolescents, so programmes for primary prevention of alcohol-related violence are best targeted towards this age group, particularly males who engage in heavy episodic drinking.

Awe or horror: differentiating two emotional responses to schema incongruence.

Experiences that contradict one's core concepts (e.g. of the world, people, the self) elicit intense emotions. Such schema incongruence can elicit awe, wherein experiences that are too vast to understand with existing cognitive schemata cause one to feel that schemata should be updated [i.e. a "need for cognitive accommodation" (NFA); Keltner & Haidt, 2003. Approaching awe, a moral, spiritual, and aesthetic emotion. Cognition and Emotion, 17(3), 297-314]. However, other emotional responses to schema incongruence, such as horror, have not been investigated. The current studies compared awe and horror to investigate if they are distinct emotional responses to schema incongruence. Study 1 observed significant differences between awe and horror in cognitive appraisals (e.g. certainty, legitimacy), indicating several areas of dissimilarity. Study 2 found evidence that awe and horror are both responses to schema incongruence, as schema incongruence and NFA were salient in awe and horror, but not a contrast emotion. However, awe and horror were elicited by different types of schema incongruence: awe by spiritual vastness, horror by extremity. Awe-eliciting experiences also appeared to be easier to assimilate than horrifying experiences, as NFA and uncertainty were significantly lower in awe than in horror. Differences in the functions of horror and awe are also discussed.

Remorse in psychotic violent offenders: An overvalued idea?

Expressing remorse - or not - appears to influence criminal justice outcomes, but preliminary exploration of both judicial and psychological concepts suggests they lack clarity. We asked the following questions: does psychosis impair capacity for, or expression of, remorse for a homicide or other serious harm to others? Is failure to express remorse for an offence associated with recidivism? We conducted systematic reviews of empirical literature on remorse for serious violence while psychotic, and on relationships between remorse and reoffending regardless of mental state. No articles on remorse for homicide or other serious violence while psychotic were identified. There is weak evidence that lack of remorse is associated with reoffending generally, but nothing specific to psychosis. The literature is strong enough to support a case for research into valid measurement of remorse for offending, associations of such measures with recidivism, and whether a change in remorse can be effected - or matters. It is not strong enough to support reliance on perceptions of the presence or absence of remorse as a basis for judicial decisions.

Serving a community sentence with a mental health treatment requirement: Offenders' perspectives.

BACKGROUND: Safe alternatives to custody for offenders with mental disorder are vital, not least as self-harm, and violence rates are rising among them in prisons. In England and Wales, the Criminal Justice Act 2003 allows a mental health treatment requirement (MHTR) to supplement a community or suspended prison sentence, but this combination is poorly understood and rarely sought. AIM: To explore offenders' perspectives on the MHTR. METHODS: We interviewed all 25 consenting offenders under an MHTR in two probation areas. Verbatim transcripts of their audio-taped narratives were analysed using grounded theory methods. RESULTS: Their core concern was "instability," characterised by many health and social difficulties and resolved by achieving stability, which included not reoffending as well as becoming healthy, substance free, and "having a life." Most considered that the MHTR helped their motivation and service provision, but some cited poor supervisor accessibility, supervisor role confusion, and sense of stigma under the order as stressful and threatening good outcomes. CONCLUSIONS: This first account of offenders' perspectives on the MHTR suggests a model in which, under it, offenders see themselves making progress as courts require. They understand the risk of return to court and imprisonment if in breach. This model of understanding how MHTRs work could provide for professional guidance and evaluation of their effectiveness.

A period prevalence study of being a parent in a secure psychiatric hospital and a description of the parents, the children and the impact of admission on parent-child contact.

BACKGROUND: Most secure psychiatric hospital patients are of childbearing age, but their parental status is minimally researched. AIM: The aim of the study is to describe the parent patients in one regional secure hospital and explore post-admission child-parent contact. METHODS: A 9-year records survey of a complete secure hospital admissions cohort was conducted. RESULTS: Nearly half of the cohort of 165 patients (46%) were parents. Parent patients were less likely than childless patients to have diagnostic co-morbidity or to have received childhood mental health care but were more likely to have committed a homicide/life-threatening index offence with family or friend victims. Men, whether fathers or not, and childless women were unlikely ever to have harmed a child, but it was more likely than not that mother patients had. Records indicated minimal discussion about childlessness. Ninety-four (60%) of the 157 children involved were under 18 years on parental admission. Adult children who had been living with the parent patient before the parent's admission invariably maintained contact with them afterwards, but nearly half (48%) of such under 18-year-olds lost all contact. The only characteristic related to such loss was the index offence victim having been a nuclear family member. CONCLUSIONS: As the discrepancy in whether or not parent patients and their children continued contact with each other after the parent's admission seemed to depend mainly on the child's age and his or her resultant freedom to choose, acquisition of accurate data about affected children's perspective on visiting seems essential. Given that parent patients had experienced relative stability in interpersonal relationships and had rarely had childhood disorders, parenting support in conjunction with treatment seems appropriate. Copyright © 2017 John Wiley & Sons, Ltd.

Forensic psychiatry in Europe: The perspective of the Ghent Group.

OBJECTIVE: The Ghent Group was established in 2004 as a forum for forensic psychiatrists from different countries in Europe in order to bridge the gaps in knowledge, experience, practice and care which exist between them due to their different legal traditions and constitutions in dealing with people having mental disorders who come into conflict with the law. METHODS: The Ghent Group considers itself as a loosely organised think tank to which all interested and invited professionals can contribute without statutory restraints. Its aim is to facilitate communication with mentally disordered offenders appearing in court, to understand the procedures of our neighbouring countries and to find common ground between clinicians. RESULTS: The major focus of the Ghent Group is on teaching and training both at a national level, where one can learn about the methods of training from each other, and at a European level. The group of trainees from different countries experiment in seminars in solving medico-legal cases considering European Human Rights issues and their respective national procedures and institutions. CONCLUSIONS: This helps not only to understand the differences between the national medico-legal procedures but also to deepen the understanding of the principles and practice in one's own country.

Disentangling Alcohol-Related Needs Among Pre-trial Prisoners: A Longitudinal Study.

AIMS: To disentangle the alcohol-related needs of short stay, revolving door, male prisoners, and offer a theoretically driven but practical approach for allocation of scarce service resources. METHODS: A prospective longitudinal interview, questionnaire and records study of pre-trial men newly imprisoned in Wales and SW England. RESULTS: Two hundred and forty-one pre-trial men completed an interview and questionnaires within a week of a new reception into prison; 170 completed follow-up 3 weeks later. Questions about problems with alcohol or illicit drugs revealed that problem drinkers were less likely than problem drug users to recognize their difficulty or seek or get help for this during their first month of imprisonment. Co-morbidity was common, but a third of the men had alcohol problems alone. Use of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire identified 80% (195/241) men likely to require some intervention, twice the number identified by direct questions relying on prisoners' judgment about problem use. Furthermore it allowed categorization according to likely risk (dependency), need (problem recognition) and responsivity (wish for help). CONCLUSION: Alcohol misuse is recognized, worldwide, as fuelling crime and more common among prisoners than the general population. In England and Wales, it is a particular factor in brief but recurrent periods of imprisonment. There have been calls to pay more attention to its use in this context, albeit without any increase in resources. Adding two questions to standard screening enables application of the risk-need-responsivity model to problem drinkers and may identify those most likely to benefit from treatment.

Lower anterior cingulate volume in seriously violent men with antisocial personality disorder or schizophrenia and a history of childhood abuse.

OBJECTIVE: Antisocial personality disorder (ASPD) and schizophrenia, as well as childhood abuse, are associated with violent behaviour and show marked volumetric reduction in the anterior cingulate (AC), a brain region implicated in regulation of violence through its involvement in decision making, empathy, impulse control, and emotion regulation. The present study examined, for the first time to the authors' knowledge, the grey matter volume of the AC in relation to seriously violent behaviour and childhood psychosocial deprivation (including physical and sexual abuse) in the context of a mental disorder (schizophrenia or ASPD). METHODS: Fifty-seven men [14 with ASPD and a history of serious violence; 13 with schizophrenia and a history of serious violence (VSZ); 15 with schizophrenia without a violence history (SZ); 15 nonviolent healthy participants] underwent whole-brain magnetic resonance imaging and were rated on the presence of physical abuse, sexual abuse, neglect, extreme poverty, foster home placement, criminal parent, severe family conflict, and broken home (collectively 'psychosocial deprivation'). Stereological volumetric ratings of the AC were examined for group differences and their association with childhood psychosocial deprivation. RESULTS: A higher proportion of ASPD and VSZ patients had suffered psychosocial deprivation as children, in particular severe physical abuse, relative to SZ patients and healthy participants. ASPD and VSZ, but not SZ, patients had significantly lower AC volume relative to healthy participants. AC volumes correlated negatively with (total) psychosocial deprivation as well as physical and sexual abuse ratings. Group differences in AC volume became nonsignificant when psychosocial deprivation ratings were covaried for. CONCLUSIONS: Violent mentally disordered individuals with ASPD or schizophrenia suffer from a significant AC volume loss and this deficit, at least in part, is explained by their histories of stressful childhood experiences. Current and future therapies aiming to reduce violence in such populations would benefit by attending to biological (and other) correlates of childhood abuse.

Exploring the Effectiveness of Telehealth Simulation in a Standardized Patient Scenario.

BACKGROUND: This study evaluated transitioning face-to-face standardized patient (SP) competencies for nurse practitioner (NP) students to telehealth SP (TSP) competencies. Given the effects of coronavirus disease 2019 on clinical nursing education, faculty need evidence-based strategies that offer flexibility and high-quality learning experiences for students. METHOD: SP grade rubrics for NP students (n = 53) who completed either face-to-face or TSP examinations were compared to determine whether there were any differences in overall mean score, history taking, physical examination, final diagnosis, and documentation between the two groups. RESULTS: A two-tailed independent sample t test examined whether the mean scores for the variables differed between face-to-face SP and TSP competencies. CONCLUSION: Overall results indicated the SP competencies were similar between the two groups. This confirms that both options of SP competencies for family NP students are acceptable. [J Nurs Educ. 2023;62(3):162-166.].