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This paper introduces a special issue of the Journal of Forensic Psychiatry and Psychology dedicated to violent extremism and mental health. We address three challenges faced by mental health pract...

Introduction Quality improvement and implementation science practitioners identify relational issues as important obstacles to success. Relational interventions may be important for successful performance improvement and fostering Learning Health Systems. Methods This case report describes the experience and lessons learned from implementing a relational approach to organizational change, informed by Relational Coordination Theory, in a health system. Structured interviews were used to obtain qualitative participant feedback. Relational Coordination was measured serially using a validated seven‐item survey. Results An initial, relational intervention on one unit promoted increased participant engagement, self‐efficacy, and motivation that led to the spontaneous, emergent dissemination of relational change, and learning into other parts of the health system. Staff involved in the intervention reported increased systems thinking, enhanced focus on communication and relationships as key drivers for improvement and learning, and greater awareness of organizational change as something co‐created by staff and executives. Conclusions This experience supports the hypothesis that relational interventions are important for fostering the development of Learning Health Systems.

PurposeThe task of assessing and managing risk of violence has evolved considerably in the last 25 years, and the field of violent extremism has the potential to stand on the shoulders of the giants of this time. Therefore, the objective of this study was to identify good practice in the risk field and to apply that to the specific area of risk in relation to violent extremism – in order that developments here accord to highest standards of practice achieved so far elsewhere.Method and ResultsWe begin by addressing the essential requirement to define the task of assessing and managing the risk of violent extremism – What is its purpose and parameters, who are its practitioners, in what contexts is this activity delivered, and how might any such context both facilitate and hinder the objectives of the task? Next, we map the terrain – What guidance is already available to assist practitioners in their work of understanding and managing the risk of violent extremism, and by what standards may we judge the quality of this and future guidance in the contexts in which is it applied? Finally, we explore options for the development of the field in terms of the empirical basis upon which the risks presented by individuals and the organizations to which they may affiliate are assessed, understood, and managed.ConclusionsRecommendations are proposed in relation to each of these three areas of concern with a view to supporting the rapid and credible advancement of this growing and vital area of endeavour.

The behavioral effects of methamphetamine (METH) are mediated by the striatum, which is divided into the patch compartment, which mediates limbic and reward functions, and the matrix compartment, which mediates sensorimotor tasks. METH treatment results in repetitive behavior that is related to enhanced relative activation of the patch versus the matrix compartment. The patch, but not the matrix compartment contains a high density of µ opioid receptors, and localized blockade of patch-based µ opioid receptors attenuates METH-induced patch-enhanced activity and repetitive behaviors. Numerous studies have examined patch-enhanced activity and the contribution of patch-associated µ opioid receptors to METH-induced repetitive behavior, but it is not known whether patch-enhanced activity occurs during METH-mediated reward, nor is it known if patch-based µ opioid receptors contribute to METH reward. The goals of this study were to determine if blockade of patch-based µ opioid receptors alters METH-induced conditioned place preference (CPP), as well activation of the patch and matrix compartments following METH-mediated CPP. A biased conditioning paradigm was used to assess CPP, and conditioning occurred over an 8-day period. Animals were bilaterally infused in the striatum with the µ-specific antagonist CTAP or vehicle prior to conditioning. Animals were tested for preference 24h after the last day of conditioning, sacrificed and the brains processed for immunohistochemistry. Blockade of patch-based µ opioid receptors reduced METH-induced CPP, and reduced patch-enhanced c-Fos expression in the striatum following METH-mediated CPP. These data indicate that patch-enhanced activity is associated with METH-mediated reward and patch-based µ opioid receptors contribute to this phenomenon.

Welcome to this special edition of The Journal of Forensic Psychiatry & Psychology. We are delighted that researchers and practitioners from the fields of forensic and clinical psychology, psychiat...

Decisions about when to start or switch a therapy often depend on the frequency with which individuals are monitored or tested. For example, the optimal time to switch antiretroviral therapy depends on the frequency with which HIV-positive individuals have HIV RNA measured. This paper describes an approach to use observational data for the comparison of joint monitoring and treatment strategies and applies the method to a clinically relevant question in HIV research: when can monitoring frequency be decreased and when should individuals switch from a first-line treatment regimen to a new regimen? We outline the target trial that would compare the dynamic strategies of interest and then describe how to emulate it using data from HIV-positive individuals included in the HIV-CAUSAL Collaboration and the Centers for AIDS Research Network of Integrated Clinical Systems. When, as in our example, few individuals follow the dynamic strategies of interest over long periods of follow-up, we describe how to leverage an additional assumption: no direct effect of monitoring on the outcome of interest. We compare our results with and without the “no direct effect” assumption. We found little differences on survival and AIDS-free survival between strategies where monitoring frequency was decreased at a CD4 threshold of 350 cells/mu l compared with 500 cells/mu l and where treatment was switched at an HIV-RNA threshold of 1000 copies/ml compared with 200 copies/ml. The “no direct effect” assumption resulted in efficiency improvements for the risk difference estimates ranging from an 7- to 53-fold increase in the effective sample size.

The aim of the present study was to investigate the inter-correlation between three different instruments for the assessment of psychopathic personality disorder. Eighty male inmates at Bergen prison (Norway) participated in the study. All the participants were assessed for psychopathy using the Psychopathy Checklist Revised (PCL-R; Hare, 1991), the Comprehensive Assessment of Psychopathic Personality – Institutional Rating Scale (CAPP-IRS; Cooke, Hart, & Logan, 2004), and the questionnaire Self-Report of Psychopathy Scale–III (SRP-III; Paulhus, Neumann, & Hare, in press). The correlational analysis revealed significant correlations between all the instruments, but substantial diverges were also found. CAPP-IRS and PCL-R showed high inter-correlations and, hence, seem to tap into the same underlying construct. The CAPP-IRS seems, however to have a higher affect focus in all its domains. Our finding of lower correlation between the SRP-III and the other two clinical tools may suggest a limitation in the in...

Stereotypy can be characterized as inflexible, repetitive behaviors that occur following repeated exposure to psychostimulants, such as cocaine (COC). Stereotypy may be related to preferential activation of the patch (striosome) compartment of striatum, as enhanced relative activation of the patch compartment has been shown to positively correlate with the emergence of stereotypy following repeated psychostimulant treatment. However, the specific contribution of the patch compartment to COC-induced stereotypy following repeated exposure is unknown. To elucidate the involvement of the patch compartment to the development of stereotypy following repeated COC exposure, we determined if destruction of this sub-region altered COC-induced behaviors. The neurons of the patch compartment were ablated by bilateral infusion of the neurotoxin dermorphin-saporin (DERM-SAP; 17 ng/μl) into the striatum. Animals were allowed to recover for eight days following the infusion, and then were given daily injections of COC (25 mg/kg) or saline for one week, followed by a weeklong drug-free period. Animals were then given a challenge dose of saline or COC, observed for 2 h in activity chambers and sacrificed. The number of mu-labeled patches in the striatum were reduced by DERM-SAP pretreatment. In COC-treated animals DERM-SAP pretreatment significantly reduced the immobilization and intensity of stereotypy but increased locomotor activity. DERM-SAP pretreatment attenuated COC-induced c-Fos expression in the patch compartment, while enhancing COC-induced c-Fos expression in the matrix compartment. These data indicate that the patch compartment contributes to repetitive behavior and suggests that alterations in activity in the patch vs matrix compartments may underlie to this phenomenon.