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Introduction: Recent clinical and empirical works are based on Cleckley's clinical observations in which psychopathy is viewed as a personality disorder, characterised by a lack of emotions, callousness, unreliability and superficiality. Hare operationalised Cleckley's concept of psychopathy by developing the Psychopathy Checklist-Revised composed of 20 items that load on two factors in majority: factor 1 (personality aspects of psychopathy) and factor 2 (behavioural manifestations), close to the antisocial personality disorder (DSM-IV criteria). Comorbidity is strong with antisocial personality disorder but also with histrionic, narcissistic and borderline disorders., Objectives: As results of categorical studies relative to comorbidity suggest a strong comorbidity between psychopathy and other personality disorders, and particularly cluster B disorders (axis II, DSM-IV), this study assesses the relationships between psychopathy (dimensional approach) and personality disorders (categorical approach) and particularly with the borderline personality disorder. The aim of this study is also to underline the complementarity of categorical (SCID-II) and dimensional approaches (PCL-R), and the utility of the standardised clinical examination., Design of the Study: We hypothesised positive associations between psychopathy and other personality disorders, mainly with the cluster B axis II (narcissistic, antisocial, histrionic, and borderline). Among those disorders, a particular link exists with the borderline personality disorder, considering that their association may attenuate the pathological level of the psychopathy. The sample included 80 male inmates from French prisons (age: M=31.48; SD=11.06). Each participant was evaluated with the PCL-R to assess the level of psychopathy and the SCID-II to assess the possible presence of personality disorders. The MINI and the WAIS-III were used to exclude respectively those who presented an axis I comorbidity (mood disorders and psychotic disorders established at the moment of the testing), or a backwardness (IQ<70). Correlations and multiple linear regressions analysis (with the Stepwise procedure) were used to analyse the data., Results: As expected, the results suggested positive correlations between narcissistic, antisocial personalities and scores of psychopathy (from 0.36 to 0.63); paranoid personality was less expected (from 0.32 to 0.47). Borderline personality was associated with both the total score of psychopathy (0.24) and the score of factor 2 (0.30). Linear regression analysis revealed that the antisocial and paranoid personalities predicted the total score (R(2)=38%) and the factor 2 (R(2)=45%) of the PCL-R. Antisocial and narcissistic personalities predicted factor 1 (R(2)=22%). However, in the different models, contrary as predicted, the borderline personality was not a significant predictor., Conclusion: First, these results underline the importance of impulsivity above all for the cluster B personality disorders and secondly, the importance of considering impulsivity with antisocial (factor 2), narcissistic and paranoid characteristics. Moreover, because of the transversality of impulsivity, the literature outlined the cross-over between cluster B disorders and psychopathy. These different studies could have important clinical consequences (risk of violence, therapeutic indications and forecast). These results also emphasize the necessity of standardised examinations. Implications for treatment are outlined: the treatment may be adapted according to the comorbidities having an effect on psychopathy that is antisocial with paranoid personalities, and antisocial with narcissistic personalities., (Copyright (c) 2009 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Aim of Study: This study assesses the impact of major mental and personality disorders on the quality of life perceived by a Belgian adult male population in a forensic hospital. METHOD.-, Population: Population included 72 male patients (mean age=41.00; S.D.=9.73) from a security hospital in Belgium. The evaluations were collected between March 2002 and June 2004., Instruments: We used the World Health Organization Quality Of Life-brief (WHOQOL-brief, 22). The WHOQOL-brief was developed from the larger WHOQOL-100 data sets, forwarded from fifteen international field WHOQOL centers coordinated by the Geneva centre. The WHOQOL-brief is a generic and multidimensional self-report containing 26 items. It includes one item from each of the 24 facets of the WHOQOL-100, and two more items from the overall quality of life and general health facet. Like the WHOQOL-100, all items in the WHOQOL-brief are rated on a five-point scale. Four types of scales assess the: intensity (not at all-extremely), capacity (not at all-completely), frequency (never-always) and evaluation (very dissatisfied/very bad-very satisfied/very good). While the initial conceptual framework for the WHOQOL-100 offered six domains, WHOQOL-brief is composed of four factors: (a) physical health; (b) psychological health; (c) social relations and; (d) environment. Saloppé and Pham [Saloppé X., Pham Th. Validation du WHOQOL-bref en hôpital psychiatrique sécuritaire. A paraître dans Forensic] showed that the WHOQOL-brief fulfils the psychometric qualities to be used in the evaluation of patients interned in a forensic hospital. We used the diagnostic interview schedule screening interview (DISSI, 44) to evaluate major mental disorders and the structured clinical interview for DSM-IV axis II disorders (SCID II, 19) to evaluate personality disorders., Procedure: The aim of this research was to evaluate the quality of life perceived by the forensic patients. It is essential that the instructions clearly indicate this direction so as to avoid patients evoking their quality of life in another environmental context. It is thus specified that the patient must answer the questionnaire referring to the institution's unit in which he was hospitalized at the time of the evaluation., Data Analysis: Initially, a descriptive analysis starting from the transformed scores is presented. In order to evaluate the impact of the mental disorders and the effect of the comorbidity on the quality of life perceived by the patients, in the second phase, we performed average comparisons using Mann Whitney's U-test. The data were analysed using the statistical package for social sciences (SPSS, 52), version 11.0., Results: The forensic inpatients revealed a mean total score of 59.76 (S.D.=13.60) out of 120 on the WHOQOL-brief. The comparisons between the WHOQOL-brief factors suggested that the participants claimed to have better physical than psychological health (W=5.76, P<0.0001), environment (W=6.68, P<0.0001) and social relations (W=6.85, P<0.0001). Major mental disorders did not influence the perceived quality of life of the patients. However, the perception of their quality of life varied significantly in the case of personality disorders. Indeed, the patients with a narcissistic personality claimed to have better global quality of life than the other patients (U=120.00, P=0.005). They claimed to have better physical health, social relations and environment than those without this disorder (U=113.50, P=0.004 and U=136, P=0.011; U=159, P=0.034). Patients with an antisocial personality presented significantly higher scores on the WHOQOL-brief than those without this disorder in the social relations and physical health domains (U=445.50, P=0.020 and U=468.50, P=0.043). The diagnostic comorbidity had no impact on the quality of life of the patients. The lack of sufficient patients in the disorders groups may have contributed to this absence of result., Conclusion: The results of this study encourage us to further consider personality disorders associated or not with major mental disorders. This study reinforces the idea that to apprehend the quality of life of the forensic population is a fundamental element of their treatment.

The population was composed of 76 male patients (mean age=36.14). All of them having committed a violent offence indexed in their institutional file: (1) sexual offences on children; (2) rapes of adult women; (3) homicide offence; and (4) assaults and batteries. TPS was defined by the following 8 diagnostic criteria as described in DSM III-R: 1) has used physical cruelty or violence for the purpose of establishing dominance in a relationship; 2) humiliates or demeans people in the presence of others; 3) has treated or disciplined someone under his or her control unusually harshly; 4) is amused by, or takes pleasure in, the psychological or physical suffering of others; 5) has lied for the purpose of harming or inflicting pain on others 6) gets other people to do what he or she wants by frightening them 7) restricts the autonomy of people with whom he or she has a close relationship; 8) is fascinated by violence, weapons, martial arts, injury, or torture. These criteria were assessed from (a) clinical and institutional files and (b) clinical collateral informations. TPS assessment was conducted by two -trainees in clinical psychology (kappa=0.87; n=20). The assessment of psychopathy was conducted according to the guidelines of the Hare psychopathy checklist manual (PCL-R, 1991, 2003): coding of clinical and institutional files and semi-structural clinical interviews. The PCL-R is mainly composed by 2 factors: factor 1 "Emotional detachment" describing the core psychological component of psychopathy, and factor 2 "Chronically antisocial factor" reflecting behavioral instability and antisocial life style. The total cut-off score for the inclusion of the diagnosis was 25. The prevalence of TPS in the population was 25% (n=19) and is congruent with the large range described in the literature (0.5 to 33%). The most frequent criteria were 6 (gets other people to do what he or she wants by frightening them), 1 (has used using physical cruelty or violence for the purpose of establishing dominance in a relationship) and 3 (has treated or disciplined someone under his or her control unusually harshly). The most sensible criteria were: 7 (restricts the autonomy of people with whom he or she has a close relationship), 8 (major interest for violence) and 4 (pleasure in the psychological or physical suffering of others). The most specific criteria were: 3 (has treated or disciplined someone under his or her control unusually harshly), 6 (gets other people to do what her or she wants by frightening them), 4 (takes pleasure in the psychological or physical suffering of others) and 1 (has used physical -cruelty or violence for the purpose of establishing dominance in a relationship). As concerns psychopathy, the mean of factor 1, factor 2 and the PCL-R total scores were 7.40, 9.08 and 18.67. Thus, 38% of patients were considered as "low psychopaths", 36% were considered as "moderate psychopaths" and 26% were considered as "high psychopaths". In spite of few significant positive correlations between some TPS and PCL-R criteria, TPS diagnosis was not significantly correlated with factors 1, factor 2, nor with total score of the PCL-R. The mean psychopathy total score did not differ between sadistic and non-sadistic patients. Moreover, a two ways ANOVA comparing PCL-R factors 1 and 2 did not reveal any differences between sadism and non-sadism. Again, these comparisons did not support hypothesis of a strong association between TPS and psychopathy.

Violence risk assessment constitutes a major concern in forensic psychiatry, psychology and related fields. Numerous instruments like the Hare Psychopathy Checklist (PCL-R, Hare, 1991) and the Violence Risk Appraisal Guide (VRAG) have been developed in the aim of improving precision in the prediction of violence. This study assesses the reliability index of the HCR-20 Violence Risk Assessment Scheme and evaluates its relationship with the PCL-R the Buss and Perry's self-report Aggression Questionnaire (AQ) and the type of offenses officially registered. All participants (n=86) are male adult offenders detained in a Belgian high-security forensic hospital. The mean IQ and age were respectively, 81,03 and 36,71. Items common to these instruments were omitted in order to avoid a circular effect. Results showed that the HCR-20 was significantly related to the PCL-R: the historical factor was strongly correlated to the PCL-R factor 2 while the clinical factor was strongly correlated to the PCL-R factor 1. The HCR-20 was significantly related to the AQ: the historical factor was strongly correlated to the AQ Physical Aggression factor and to the Anger factor. As regards to the HCR-20 relations with offenses, its Historical factor was related to both violent (assault and battery, robbery) and non-violent offenses (drug offenses, theft). Finally, the HCR-20 was also positively related to "instrumental" and rather premeditated homicide but negatively related to psychotic homicide. The overall findings are congruent with -published data on the convergent validity of the HCR-20.

It has been theorized that psychopaths have a fundamental deficit with respect to emotions (Cleckley, 1941). This study compares psychopaths with control subjects (Hare, 1991) in terms of their physiological and subjective responses to video clips depicting different emotions: joy, fear, anger, sadness, and disgust. Physiological measures assessed cardiovascular, respiratory, electrodermal, electromyographic responding, as well as skin temperature. Subjective measures assessed bodily sensations and subjective emotional appraisal. The principal physiological difference was a lower blood pressure among psychopaths before and during emotional stimulation. Thus, while psychopaths's autonomic base-line may be generally hyporeactive, they do not seem to have any emotion-specific physiological deficit. Globally, the results suggested no specific psychophysiological deficits among psychopaths in a context using daily emotions. Subjective measures also revealed that, compared to control subjects, psychopaths reported less intense bodily sensations during emotional stimulation. There was no difference between the two groups in terms of emotional appraisal.

The PCL-R (Hare, 1991) presents high reliability and validity characteristics. The instrument is the measure of choice for the assessment of psychopathic personality. The PCL-R has never been submitted to psychometric analysis in french speaking european samples. The study examines the psychometric characteristics of the PCL-R on an Belgian prison sample. The study assessed the inter-raters reliability parameters, the Alpha Cronbach coefficient and the PCL-R mean scores. The two correlated factors extracted were compared with those of others European and Nord American samples. The study also described the concomitant validity of the instrument by computing the correlations between the PCL-R scores and the type of offence.