Search

Contains fulltext : 219007.pdf (Publisher’s version ) (Closed access) For patients in long-term forensic psychiatric care (LFPC), a continuous search for treatment possibilities remains important. An alternative viewpoint to these patients as being untreatable is considering them having low treatment readiness. Treatment readiness incorporates internal client-specific factors as well as factors in the therapeutic situation. In the therapeutic situation both social climate and therapeutic alliance are of positive influence on treatment outcome. In this explorative study of 38 male patients in Dutch LFPC, we found correlations with strong (Bayesian) evidence between internal factors of treatment readiness, treatment alliance, and "Therapeutic Hold," which is a subscale of social climate. In a Bayesian linear regression analysis, however, therapeutic hold seemed to be the only strong predictor of internal treatment readiness. These results give way to further research into the factors specifically contributing to the found correlations, in order to create opportunities to enlarge treatment readiness for patients in forensic care. 14 p.

Item does not contain fulltext Objective: Parental rejection in childhood is associated with the increased risk of aggression in adulthood and is thought to contribute to the development of inaccurate beliefs regarding own or others' behavior (i.e., cognitive distortion) as well. Different forms of aggression are thought to be linked to different types of cognitive distortions. This, however, is unclear in adults. Additionally, it is unknown if parental rejection predicts the presence of aggression and cognitive distortions in adults displaying severe aggression. Method: One hundred twenty-three adult forensic psychiatric outpatients with aggression regulation problems were recruited. Least absolute shrinkage and selection operator (Lasso) regression analysis and path analyses were conducted to investigate distinct patterns of cognitive distortions, as measured by use of the How I Think Questionnaire, and the role of perceived parental rejection, as measured by use of the Parental Rejection and Acceptance Questionnaire. Results: Cognitive distortions related to opposition-defiance (e.g. disrespecting rules) and to physical aggression were most strongly associated with the disposition to act aggressively. Furthermore, a direct association was found between parental rejection and this current disposition. This association was partially mediated by cognitive distortions related to opposition-defiance. Conclusion: The current study supports the notion that parental rejection has profound consequences on adult behavior. Acknowledgement of the impact of cognitive distortions on current aggression might be of importance for treatment. A stronger focus on altering distinct cognitive distortions may be more successful in reducing aggression. 10 p.

Contains fulltext : 177865.pdf (Publisher’s version ) (Open Access) Create an overview of characteristics of patients in long-term forensic psychiatric care (LFPC) with a higher length of stay (LOS) care compared to patients in regular forensic psychiatric care (RFPC) with a shorter LOS. Data were collected from 139 patient records. This study examined whether patients in LFPC differ from patients in RFPC on sociodemographic data, legal data and clinical data and whether those characteristics are able to predict LOS. Patients in LFPC were more often born in a Dutch Caribbean country, less often had a substance abuse disorder, were more often emotionally neglected during childhood, had a higher HCR-20 risk item score, a higher security needs score, a higher (less successful) recovery score, were more often recidivist and had absconded more often than RFPC patients. Certain characteristics were able to distinguish the longer LOS group which might be useful to establish sequel services and enhance treatment efficiency. 19 p.

Item does not contain fulltext Purpose: Aim of this study was to develop a brief version of the Forensic inpatient Quality of Life questionnaire (FQL). Methods: Data from a longitudinal study of quality of life (QoL) among long-term forensic psychiatric care (LFPC) patients (N = 130) were used. Per domain, the FQL item that correlated most highly with the mean domain score and Overall QoL was selected. Internal consistency was investigated by calculating Cronbach's alpha. Construct validity was examined by investigating the relationship with the WHOQOL-Bref and EssenCES. Results: The original division into 15 QoL domains was retained, while the number of items per domain was reduced to one or two. The amount of subjective items was shortened from 114 items to 19 items. Reliability analysis demonstrated good internal consistency (Cronbach's alfa = .79). Content validity was assured because the FQL-SV is based on the items of the original FQL that was derived from LFPC patient's and staff's opinions. Construct validity was demonstrated. Conclusions: This study has shown that the FQL-SV is a psychometrically valid abbreviation of the FQL and can therefore be used to monitor or assess QoL in forensic psychiatric care. However, when certain domains should be targeted in treatment, the FQL (full version) can assist both the patient and the clinician to get a more complete view of the individualized targets they should be aiming at in order to improve QoL. 9 p.

Item does not contain fulltext Effective interactions between patients and staff have been associated with positive ward climate and therapeutic effects, but also pose a challenge in high secure forensic psychiatric settings. The goal of this study was to gain more insight into i) the characteristics that play a role in how staff members perceive the interpersonal style of patients, and ii) whether these perceptions are related to patients' evaluation of ward climate and satisfaction with daily staff. Staff members (n=69), rated the interpersonal style of 102 male patients. Satisfaction with daily staff and ward climate were rated by 45 patients. Results show that patient characteristics (primary diagnosis, patient age, disruptive behavior, recent problems with symptoms of major mental disorder and recent problems with treatment or supervision response) were related to how staff perceived the interpersonal style (i.e., affiliation and control) of patients. Furthermore, the level of affiliation was positively related to patients’ satisfaction with daily staff. Patients that were seen as more controlling by staff were less satisfied with the safety on their ward (as a factor of ward climate). The results indicate that perception of patients' interpersonal style entails patient related information and can be relevant for staff to use in their work. 8 p.

Item does not contain fulltext Psychopathy is a personality disorder characterized by interpersonal manipulation and callousness, and reckless and impulsive antisocial behavior. It is often seen as a disorder in which profound emotional disturbances lead to antisocial behavior. A lack of fear in particular has been proposed as an etiologically salient factor. In this review, we employ a conceptual model in which fear is parsed into separate subcomponents. Important historical conceptualizations of psychopathy, the neuroscientific and empirical evidence for fear deficits in psychopathy are compared against this model. The empirical evidence is also subjected to a meta-analysis. We conclude that most studies have used the term “fear” generically, amassing different methods and levels of measurement under the umbrella term “fear.” Unlike earlier claims that psychopathy is related to general fearlessness, we show there is evidence that psychopathic individuals have deficits in threat detection and responsivity, but that the evidence for reduced subjective experience of fear in psychopathy is far less compelling. 28 p.

Contains fulltext : 191432.pdf (Publisher’s version ) (Open Access) The use of relevant reinforcers during treatment is essential for successful interventions. This especially applies to forensic psychiatric populations, which are known to be resistant to treatment. However, it is not clear which rewards are of importance for different types of forensic patients. The aim of the present study was to investigate reward preferences in two forensic patient populations. Applying the concept mapping methodology, 34 male incarcerated violent offenders under imposed psychiatric treatment and 41 male forensic outpatients generated, prioritized and categorized 98 and 115 rewards, respectively. Multidimensional scaling and hierarchical cluster analyses resulted in two concept maps with eight (inpatients) and five (outpatients) reward categories. In both maps, one dimension represented the effort required to achieve the rewards. The other dimension represented either the rewards' independency of the clinical environment (inpatients) or the level of arousal associated with the rewards (outpatients). Both inpatients and outpatients tended to rate high-effort rewards as the most valuable, especially when the rewards involved the clinical environment of the patient or when rewards were associated with lower levels of arousal. The results highlight the importance of considering individual differences in reward preferences in the development of therapeutic interventions. 13 p.

Item does not contain fulltext This study tested the predictive value of attentional bias, emotion recognition, automatic associations, and response inhibition, in the assessment of in-clinic violent incidents. Sixty-nine male forensic patients participated and completed an Emotional Stroop to measure attentional bias for threat and aggression, a Single Target - Implicit Association Task to assess automatic associations, a Graded Emotional Recognition Task to measure emotion recognition, and an Affective Go/NoGo to measure response inhibition. Violent incidents were derived from patient files and scored on severity level. The predictive value of level of psychopathy was tested with the Psychopathy Checklist - Revised (PCL-R). Generalized linear mixed model analyses showed that increased attention towards threat and aggression, difficulty recognizing sad faces and factor 2 of the PCL-R predicted the sum of violent incidents. Specifically, verbal aggression was predicted by increased attention towards threat and aggression, difficulty to recognize sad and happy faces, and PCL-R factor 2; physical aggression by decreased response inhibition, higher PCL-R factor 2 and lower PCL-R factor 1 scores; and aggression against property by difficulty recognizing angry faces. Findings indicate that cognitive tasks could be valuable in predicting aggression, thereby extending current knowledge on dynamic factors predicting aggressive behavior in forensic patients. 9 p.

Item does not contain fulltext Within this study the relationship between patient characteristics (age, length of stay, risk, psychopathy) and individual perceived ward climate (n=83), and differences between staff's and patient perceptions of climate (n=185) was investigated within a high secure forensic hospital. Results show that therapeutic hold was rated higher among staff compared to patients, while patients held a more favorable view on patient cohesion and experienced safety. Furthermore, patient characteristics (age, risk and psychopathy) were found to be related with individual ratings of ward climate. The findings underline the importance of assessing ward climate among both patients and staff in clinical practice. 8 p.

Item does not contain fulltext Huiselijk geweld is de meestvoorkomende vorm van geweld in Nederland. In dit artikel wordt de praktijk van de behandeling van cliënten met middelenmisbuik en/of afhankelijkheid beschreven, als er daarnaast ook sprake is van huiselijk geweld. Huiselijk geweld en, meer specifiek, partnergeweld is in de verslavingszorg een veelvoorkomende bijkomstige problematiek. Door de invoering van de meldcode huiselijk geweld en het instellen van aandachtsfunctionarissen binnen (onder andere) de verslavingszorg, is een belangrijke stap gezet. De behandeling van het problematisch middelengebruik is een belangrijk onderdeel van de aanpak van huiselijke geweld. Er bestaat enige evidentie dat, als het problematisch middelengebruik adequaat wordt behandeld, ook het partnergeweld afneemt. Om de effectiviteit van allerlei specifieke interventies voor huiselijk geweld te bepalen, is verder onderzoek noodzakelijk. Nodig is in ieder geval een cliëntgerichte en multidisciplinaire aanpak die alle betrokkenen, ook plegers, zo snel mogelijk naar de juiste plekken in de hulpverlening leidt. Daarvoor is samenwerken tussen instellingen noodzakelijk. In de praktijk blijkt dat deze samenwerking niet zonder slag of stoot van de grond komt. Heading to an integral approach of substance abuse disorder and domestic violence? Domestic violence is the most common form of violence in the Netherlands. This article describes the treatment in everyday practice of clients with substance abuse disorder/dependence and domestic violence. Domestic violence and, more specific, intimate partner violence appears to be a common and important secondary problem in the treatment of clients with substance abuse disorder/dependence. A lot has been gained in attention for domestic violence with the introduction of the reporting code ‛domestic violence’ and the introduction of attention officers within the institutions for (among other) treatment of addiction. The treatment of problematic substance abuse is an important aspect of the treatment of domestic violence. There is evidence that proper treatment of the substance abuse problem also diminishes the intimate partner violence. Further research is due to determine the effect of the specific interventions for the treatment of domestic violence. Necessary is at least a client-centered multidisciplinary approach that leads all stakeholders, also perpetrators, as fast as possible to the right institutions. To achieve this it is necessary to work together between institutions. It is shown in this article that this is not as self-evident and as common as it seems. 16 p.

Objective To compare quality of life (QoL) ratings of long term forensic psychiatric care patients with the ratings of psychiatric nurses, in which the nurses indicate how they think the patient would answer. Methods Agreement on QoL-scores according to the Forensic inpatient Quality of Life Questionnaire (FQL) was investigated for seventy- seven pairs of patients and psychiatric nurses from two forensic psychiatric long-care facilities where QoL is seen as an important treatment goal. This study also examined whether the amount of agreement was related to specific patient characteristics and characteristics of the patient- psychiatric nurse relationship. Results On group level, only small and mostly non-significant differences were found between patients’ and psychiatric nurses’ mean QoL scores. However, pairwise comparisons revealed poor agreement between patients’ and nurses’ QoL scores for half of the domains and moderate agreement on the other half of the domains, except for Leave, which was the only domain on which patients and their nurses had similar scores. Patient characteristics such as type of offence and type of psychopathology were negligibly related to the level of agreement. However, characteristics of the patient-nurse relationship such as age of the nurse and length of the patient-nurse relationship did influence the amount of consensus between patients’ and proxies’ QoL-scores significantly. Conclusions Nurses were not sufficiently able to accurately estimate their patients’ QoL experience and could probably benefit from a training aimed at assessing QoL of their patients and how to support their patients in optimizing their QoL themselves.

Item does not contain fulltext Optimal behavior depends on the ability to assess the predictive value of events and to adjust behavior accordingly. Outcome processing can be studied by using its electrophysiological signatures-that is, the feedback-related negativity (FRN) and the P300. A prominent reinforcement-learning model predicts an FRN on negative prediction errors, as well as implying a role for the FRN in learning and the adaptation of behavior. However, these predictions have recently been challenged. Notably, studies so far have used tasks in which the outcomes have been contingent on the response. In these paradigms, the need to adapt behavioral responses is present only for negative, not for positive feedback. The goal of the present study was to investigate the effects of positive as well as negative violations of expectancy on FRN amplitudes, without the usual confound of behavioral adjustments. A reversal-learning task was employed in which outcome value and outcome expectancy were orthogonalized; that is, both positive and negative outcomes were equally unexpected. The results revealed a double dissociation, with effects of valence but not expectancy on the FRN and, conversely, effects of expectancy but not valence on the P300. While FRN amplitudes were largest for negative-outcome trials, irrespective of outcome expectancy, P300 amplitudes were largest for unexpected-outcome trials, irrespective of outcome valence. These FRN effects were interpreted to reflect an evaluation along a good-bad dimension, rather than reflecting a negative prediction error or a role in behavioral adaptation. By contrast, the P300 reflects the updating of information relevant for behavior in a changing context. 10 p.

Contains fulltext : 117595.pdf (Publisher’s version ) (Open Access) BACKGROUND: Psychopathy is a severe personality disorder that has been linked to impaired behavioural adaptation during reinforcement learning. Recent electrophysiological studies have suggested that psychopathy is related to impairments in intentionally using information relevant for adapting behaviour, whereas these impairments remain absent for behaviour relying on automatic use of information. We sought to investigate whether previously found impairments in response reversal in individuals with psychopathy also follow this dichotomy. We expected response reversal to be intact when the automatic use of information was facilitated. In contrast, we expected impaired response reversal when intentional use of information was required. METHODS: We included offenders with psychopathy and matched healthy controls in 2 experiments with a probabilistic cued go/no-go reaction time task. The task implicated the learning and reversal of 2 predictive contingencies. In experiment 1, participants were not informed about the inclusion of a learning component, thus making cue-dependent learning automatic/incidental. In experiment 2, the instructions required participants to actively monitor and learn predictive relationships, giving learning a controlled/intentional nature. RESULTS: While there were no significant group differences in acquisition learning in either experiment, the results revealed impaired response reversal in offenders with psychopathy when controlled learning was facilitated. Interestingly, this impairment was absent when automatic learning was predominant. LIMITATIONS: Possible limitations are the use of a nonforensic control group and of self-report measures for drug use. CONCLUSION: Response reversal deficits in individuals with psychopathy are modulated by the context provided by the instructions, according to the distinction between automatic and controlled processing in these individuals. 8 p.

Contains fulltext : 167111.pdf (Publisher’s version ) (Open Access) Psychopathic individuals are notorious for their controlled goal-directed aggressive behavior. Yet, during social challenges, they often show uncontrolled emotional behavior. Healthy individuals can control their social emotional behavior through anterior prefrontal cortex (aPFC) downregulation of neural activity in the amygdala, with testosterone modulating aPFC-amygdala coupling. This study tests whether individual differences in this neuroendocrine system relate to the paradoxical lack of emotional control observed in human psychopathic offenders. Emotional control was operationalized with an fMRI-adapted approach-avoidance task requiring rule-driven control over rapid emotional responses. Fifteen psychopathic offenders and 19 matched healthy control subjects made approaching and avoiding movements in response to emotional faces. Control of social emotional behavior was required during affect-incongruent trials, when participants had to override affect-congruent, automatic action tendencies and select the opposite response. Psychopathic offenders showed less control-related aPFC activity and aPFC-amygdala coupling during trials requiring control of emotional actions, when compared with healthy control subjects. This pattern was particularly pronounced in psychopathic individuals with high endogenous testosterone levels. These findings suggest that reduced prefrontal coordination underlies reduced behavioral control in psychopathic offenders during emotionally provoking situations. Even though the modest sample size warrants replication, the modulatory role of endogenous testosterone on the aPFC-amygdala circuit suggests a neurobiological substrate of individual differences that is relevant for the advancement of treatment and the reduction of recidivism. 12 p.

Full text aanvragen via link What makes a juvenile delinquent develop into an adult criminal? What defines-cognitively, developmentally, legally-the transition from juvenile to adult and what determines whether patterns of criminal behavior persist? In most US states and Western nations, legal adulthood begins at age 18. This volume focuses on the period surrounding that abrupt transition (roughly ages 15-29) and addresses what happens to offending careers during it. Edited by two leading authorities in the fields of psychology and criminology, Transitions from Juvenile Delinquency to Adult Crime examines why the period of transition is important and how it can be better understood and addressed both inside and outside of the justice system.

Contains fulltext : 102824.pdf (Publisher’s version ) (Open Access) Psychopathy (PP) is associated with marked abnormalities in social emotional behaviour, such as high instrumental aggression (IA). A crucial but largely ignored question is whether automatic social approach-avoidance tendencies may underlie this condition. We tested whether offenders with PP show lack of automatic avoidance tendencies, usually activated when (healthy) individuals are confronted with social threat stimuli (angry faces). We applied a computerized approach-avoidance task (AAT), where participants pushed or pulled pictures of emotional faces using a joystick, upon which the faces decreased or increased in size, respectively. Furthermore, participants completed an emotion recognition task which was used to control for differences in recognition of facial emotions. In contrast to healthy controls (HC), PP patients showed total absence of avoidance tendencies towards angry faces. Interestingly, those responses were related to levels of instrumental aggression and the (in)ability to experience personal distress (PD). These findings suggest that social performance in psychopaths is disturbed on a basic level of automatic action tendencies. The lack of implicit threat avoidance tendencies may underlie their aggressive behaviour. 6 p.

Contains fulltext : 99871.pdf (Publisher’s version ) (Open Access) Background: Psychopathy is a severe personality disorder often leading to violent and disruptive antisocial behavior. Efficient and proper social behavior crucially relies on monitoring of one's own as well as others' actions, but the link between antisocial behavior in psychopathy and action monitoring in a social context has never been investigated. Methods: Event-related potentials were used to disentangle monitoring of one's own and others' correct and incorrect actions in psychopathic subjects (n = 18) and matched healthy control subjects (n = 18). The error-related negativity (ERN) was investigated following own and other's responses in a social flanker task. Results: Although both groups showed similar event-related potentials in response to own actions, amplitudes after the observation of others' action-outcome were greatly reduced in psychopathy. More specifically, the latter was not unique to observed errors, because the psychopathic group also showed reduced brain potentials after the observation of correct responses. In contrast, earlier processing of observed actions in the motor system, as indicated by the lateralized readiness potential, was unimpaired. Conclusions: Monitoring of own behavior is not affected in psychopathy, whereas processing of the outcome of others' actions is disturbed. Specifically, although psychopathic individuals do not have a problem with initial processing of the actions of others, they have problems with deeper analyses of the consequences of the observed action, possibility related to the reward value of the action. These results suggest that aspects of action monitoring in psychopathy are disturbed in social contexts and possibly play a central role in the acquisition of abnormal social behavior. 7 p.

BackgroundPsychopathy (PP) is associated with a performance deficit in a variety of stimulus–response and stimulus–reinforcement learning paradigms. We tested the hypothesis that failures in error monitoring underlie these learning deficits.MethodWe measured electrophysiological correlates of error monitoring [error-related negativity (ERN)] during a probabilistic learning task in individuals with PP (n=13) and healthy matched control subjects (n=18). The task consisted of three graded learning conditions in which the amount of learning was manipulated by varying the degree to which the response was predictive of the value of the feedback (50, 80 and 100%).ResultsBehaviourally, we found impaired learning and diminished accuracy in the group of individuals with PP. Amplitudes of the response ERN (rERN) were reduced. No differences in the feedback ERN (fERN) were found.ConclusionsThe results are interpreted in terms of a deficit in initial rule learning and subsequent generalization of these rules to new stimuli. Negative feedback is adequately processed at a neural level but this information is not used to improve behaviour on subsequent trials. As learning is degraded, the process of error detection at the moment of the actual response is diminished. Therefore, the current study demonstrates that disturbed error-monitoring processes play a central role in the often reported learning deficits in individuals with PP.

Contains fulltext : 76957.pdf (Publisher’s version ) (Closed access) Contains fulltext : 76958.pdf (Publisher’s version ) (Closed access) Background - One of the most recognizable features of psychopathy is the reduced ability to successfully learn and adapt overt behavior. This might be due to deficient processing of error information indicating the need to adapt controlled behavior. Methods - Event-related potentials (ERPs) and behavioral components of error-monitoring processes were investigated in 16 individuals with psychopathy and in 18 healthy subjects. A letter version of the Eriksen flanker task was used in two conditions. The first condition (normal condition) required participants to press one of two buttons depending on the identity of the target stimulus. The second condition (signaling condition) required them to signal each time they had committed an error by making a second press on a signaling button. Early stages of error monitoring were investigated by using the error-related negativity (ERN/Ne) and post-error slowing as indexes. Later stages were explored by examining the error positivity (Pe) and signaling rates. Results - Both groups showed similar ERN amplitudes and amounts of post-error slowing. The psychopathic group exhibited both reduced Pe amplitudes and diminished error-signaling rates compared with the control group. Conclusions - Individuals with psychopathy show intact early error processing and automatic behavioral adaptation but have deficits in later stages of error processing and controlled behavioral adaptation. This is an indication that individuals with psychopathy are unable to effectively use error information to change their behavior adequately. Key Words: Automatic processing; behavioral adaptation; error positivity; error-related negativity; error signaling; psychopathy 7 p.

Contains fulltext : 102438.pdf (Publisher’s version ) (Open Access) Recent studies have shown that while psychopathy and non-psychopathic antisociality overlap, they differ in the extent to which cognitive impairments are present. Specifically, psychopathy has been related to abnormal allocation of attention, a function that is traditionally believed to be indexed by event-related potentials (ERPs) of the P3-family. Previous research examining psychophysiological correlates of attention in psychopathic individuals has mainly focused on the parietally distributed P3b component to rare targets. In contrast, very little is known about the frontocentral P3a to infrequent novel events in psychopathy. Thus, findings on the P3 components in psychopathy are inconclusive, while results in non-psychopathic antisocial populations are clearer and point toward an inverse relationship between antisociality and P3 amplitudes. The present study adds to extant literature on the P3a and P3b in psychopathy by investigating component amplitudes in psychopathic offenders (N = 20), matched non-psychopathic offenders (N = 23) and healthy controls (N = 16). Also, it was assessed how well each offender group was able to differentially process rare novel and target events. The offender groups showed general amplitude reductions compared to healthy controls, but did not differ mutually on overall P3a/P3b amplitudes. However, the psychopathic group still exhibited normal neurophysiological differentiation when allocating attention to rare novel and target events, unlike the non-psychopathic sample. The results highlight differences between psychopathic and non-psychopathic offenders regarding the integrity of the neurocognitive processes driving attentional allocation, as well as the usefulness of alternative psychophysiological measures in differentiating psychopathy from general antisociality. 8 p.