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.

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.

[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.

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.

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.

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.

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.

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.

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.

Frequency of hypomagnesemia in hospitalized patients receiving digitalis.

We examined the frequency of hypokalemia and hypomagnesemia in patients receiving digitalis. Serum sodium, magnesium, and potassium levels were determined in 136 serum samples sent to the laboratory for digoxin assay. Hyponatremia (less than or equal to 130 mEq/L) occurred most frequently (21%), followed by hypomagnesemia (less than or equal to 1.25 mEq/L) in 19%, hypokalemia (less than or equal to 3.5 mEq/L) in 9%, and hypermagnesemia (greater than or equal to 2.25 mEq/L) in 7%. The twofold frequency of hypomagnesemia (19%) contrasted with hypokalemia (9%) indicates that clinicians are more attuned to avoiding hypokalemia than hypomagnesemia in patients receiving digitalis. Because hypokalemia and/or hypomagnesemia may contribute to the toxic effects of digitalis, our observation suggests that hypomagnesemia may be a more frequent contributor than hypokalemia to induction of toxic reactions to digitalis. Routine serum magnesium determination in patients receiving digitalis, who often are also receiving potent diuretics, may assist in identifying additional patients at risk for the toxic effects of digitalis.

Relationship between arterial and venous bicarbonate values.

We determined the clinical efficacy of using the venous CO2 value, as obtained with routine "electrolytes", in acid-base management. Venipuncture samples for venous CO2 content and chloride concentrations were obtained in 336 patients with arterial blood pH, PaO2, PaCO2, and oxygen saturation determinations. The linear correlation between actual calculated arterial HCO3- and the measured venous CO2 was significant (P less than .001). Using venous CO2, chloride, and arterial pH values, we present various prediction equations for estimating arterial HCO3-. We determined the effects of time delay, exposure to air, and acute changes in arterial blood pH and PaCO2 on venous CO2 levels. Venous CO2 determinations should not be substituted for the arterial HCO3 value in the Henderson-Hasselbalch equation to calculate arterial blood pH or PaCO2. Clinically, the venous CO2 value has little direct use, but when venous CO2 content is abnormal, it should alert the clinician to the need for obtaining arterial blood gas and pH values.

Predictors of clinical hypomagnesemia. Hypokalemia, hypophosphatemia, hyponatremia, and hypocalcemia.

Four studies were conducted, each determining the frequency of hypomagnesemia in patients already found to have one abnormal electrolyte determination. Hypomagnesemia occurred in 42% of patients with hypokalemia, 29% of patients with hypophosphatemia, 27% of patients with hyponatremia, and 22% of patients with hypocalcemia. These observations suggest that detection of either hypokalemia, hypophosphatemia, hyponatremia, or hypocalcemia, all of which are routinely available determinations, should alert the clinician to order serum magnesium determinations because of the frequent association of hypomagnesemia with these electrolyte perturbations. Optimally, levels of serum Mg should be determined on a routine basis because of the frequency of the occurrence of hypomagnesemia in hospitalized patients.

Catecholamines and aversive learning: a review.

Experimental evidence is reviewed for the implication in aversive learning of the catecholamines, in particular noradrenaline and dopamine and the pituitary-adrenocortical system, in particular adrenocorticotrophic hormone and corticosterone. Depending on task difficulty peripheral neural noradrenaline may be an important factor in aversive learning whereas brain catecholamines are important regardless of task difficulty. The adrenocortical system, as indexed by plasma levels of corticosterone, is also implicated in complex aversive tasks. To date, no convincing empirical evidence exists for a link mechanism between the brain catecholamine system and the adrenocortical system following aversive learning. Earlier behavior theories of aversive learning are reformulated in the light of more recent findings on neuroregulation.

Schedule-induced self-injection of drugs.

Studies of acquisition and maintenance patterns of drug intake, including dependence, necessitate voluntary intake of drugs. Voluntary intake in animal studies is difficult to achieve because of aversive taste factors associated with most drugs, and involuntary or forced choice methods obscure the behavior which is the object of study. The schedule-induced polydipsia paradigm has been used to induce oral ingestion of large volumes of alcohol, barbiturate and other drug solutions. We have developed a method of schedule-induced self-injection which allows the study of acquisition and maintenance of drug intake behavior with changing environments free from the interference of taste factors or imbalances due to excessive water intake. In this paper we review our findings on the acquisition and maintenance patterns of amphetamine, methadone, heroin, alcohol, nicotine, cocaine, delta 9-THC and haloperidol. For all drugs except amphetamine, the combination of schedule and nutritional deprivation leads to the highest rates of drug intake as compared to controls. The schedule does not appear to be a potent factor at 90% and free feeding weight, and drug intake is the result of interaction of environmental factors and pharmacological properties of the drugs, rather than the effects of drug or environmental factors separately. The maintenance patterns of nicotine, cocaine, heroin and alcohol are also discussed and the advantages of schedule-induced self-injection over schedule-induced polydipsia methods are presented.

Kinetics of carbamazepine and carbamazepine-epoxide, determined by use of plasma and saliva.

The concentration-time curves of carbamazepine (CBZ) and its metabolite (carbamazepine-10,11-epoxide; CBZ-epoxide) were determined in patients undergoing long-term antiepileptic drug treatment with the use of plasma and saliva data. Plasma and saliva samples were assayed concurrently for each patient by liquid chromatography. There was excellent linear correlation between CBZ levels in saliva and plasma (r = 0.991, p less than 0.001) over a large concentration range. The saliva/plasma ratio for CBZ concentration was 0.26 +/- 0.01 (SD). Since CBZ binding to plasma proteins is in the order of 76%, saliva CBZ concentration seems to reflect the unbound fraction of the drug in plasma. CBZ-epoxide has not been detected in saliva. The pharmacokinetic parameters of CBZ-epoxide were determined in 6 patients. The pharmacokinetic parameters of CBZ obtained from saliva concentrations were in excellent agreement with those obtained from plasma concentrations. Thus, CBZ determination in saliva is convenient for controlling blood levels in patients as well as for studying pharmacokinetics. The half-life, the relative body clearance of CBZ, and the metabolite concentration during steady-state, expressed as percent the parent compound, appear to be significantly different in patients on single and combined drug therapy.

The latent structure of anxiety symptoms in anxiety disorders.

OBJECTIVE: Research in the psychopathology of panic and anxiety disorders, particularly agoraphobia, suggests that fear of fear may be the basis of these conditions. However, there is little empirical research on the definition and validity of the concept of fear of fear in a clinical study group. The authors' aims are 1) to determine empirically if particular associations between symptoms and beliefs exist in a group of patients with anxiety disorders and what underlying dimensions of perceived threat they represent and 2) to assess the relative importance of these associations in agoraphobia with panic attacks, panic disorder, social phobia, and generalized anxiety disorder. METHOD: In an anxiety disorders treatment unit, 390 outpatients with anxiety disorders diagnosed according to DSM-III criteria completed the Anxiety Symptoms and Beliefs Scale. RESULTS: A principal components analysis of the patients' ratings on the Anxiety Symptoms and Beliefs Scale produced a four-factor solution in which specific sets of anxiety symptoms loaded with specific beliefs. These four factors were interpreted as respiratory symptoms, vestibular symptoms, autonomic arousal, and psychological threat. Respiratory and vestibular symptoms were more associated with panic disorder diagnoses than with social phobia and generalized anxiety disorder diagnoses. CONCLUSIONS: These findings support a conception of fear of fear in anxiety disorders as fearful beliefs concerning the experience of anxiety symptoms. Associations between symptoms and fear of fear are present across anxiety disorders but are most pronounced in agoraphobia with panic attacks.