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Transcranial Direct Current Stimulation (tDCS) has been used to modulate empathy, but no studies have meta-analyzed the evidence base for its efficacy. This study aimed to determine the efficacy of tDCS at modulating empathy. We conducted a systematic review and meta-analysis of randomized controlled trials involving anodal or cathodal versus sham tDCS to modulate empathy in healthy adults and clinical populations. Random-effects modelling was applied to pooling overall efficacy estimates using standardized mean differences (Hedge's g) and 95% confidence intervals. Outcome measures for tasks designed to measure empathy were reaction time and accuracy. Anodal tDCS appears to improve lab-based computerized measures of cognitive empathy in healthy adult volunteers. While the evidence provided by this review may be of relevance to individuals with impaired empathic capabilities, the generalizability of our findings is geared towards nonclinical populations given the preponderance of healthy volunteers in our review. Hence, it is not clear if moderate improvements in speed and accuracy on lab-based computerized empathy measures would lead to meaningful clinical improvements. Future studies should consider the use of tDCS to modulate empathy in clinical populations.

Attempts to define terrorist typologies often emphasise the importance of socio-political and psychological factors and the distinction between lone and group actors. However, these attempts are pr...

Impulsivity is a multi-faceted construct that underpins various mental health disorders. Impulsive behavior exacts a substantial health and economic burden, hence the importance of developing specific interventions to target impulsivity. Two forms of non-invasive brain stimulation, namely transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), have been used to modulate impulsivity. To date, no reviews have systematically examined their effects on modulating impulsivity in people with mental health disorders. We conducted a systematic review and meta-analysis of the literature from AMED, Embase, Medline and PsycINFO databases on the use of rTMS and tDCS to modulate impulsivity in people with mental health disorders. Results from 11 tDCS and 18 rTMS studies indicate that tDCS has a significant, albeit small, effect on modulating impulsivity (g = 0.29; 95% CI, 0.09 to 0.48; p = .004) whereas rTMS has no significant effect on impulsivity (g = -0.08; 95% Cl, -0.35 to 0.19; p = .550). Subgroup analyses identified the key parameters required to enhance the effects of tDCS and rTMS on impulsivity. Gender and stimulation intensity acted as significant moderators for effects of rTMS on impulsivity. There is insufficient evidence to support the use of tDCS or rTMS in clinical practice to reduce impulsivity in people with mental health disorders. The use of standardized non-invasive brain stimulation protocols and outcome measures in patients with the same diagnosis is advised to minimize methodological heterogeneity.

Introduction We aimed to identify the barriers and facilitators to the implementation of a high fidelity individual placement and support service in a community forensic mental health setting. Method In-depth interviews were conducted with clinical staff ( n = 11), patients ( n = 3), and employers ( n = 5) to examine barriers and facilitators to implementation of a high fidelity individual placement and support service. Data was analysed using thematic analysis, and themes were mapped onto individual placement and support fidelity criteria. Results Barriers cited included competing interests between employment support and psychological therapies, perceptions of patients’ readiness for work, and concerns about the impact of returning to work on welfare benefits. Facilitators of implementation included clear communication of the benefits of individual placement and support, inter-disciplinary collaboration, and positive attitudes towards the support offered by the individual placement and support programme among stakeholders. Offences, rather than mental health history, were seen as a key issue from employers’ perspectives. Employers regarded disclosure of offending or mental health history as important to developing trust and to gauging their own capacity to offer support. Conclusions Implementation of individual placement and support in a community mental health forensic setting is complex and requires robust planning. Future studies should address the barriers identified, and adaptations to the individual placement and support model are needed to address difficulties encountered in forensic settings.

Foetal alcohol spectrum disorder (FASD) is highly prevalent in criminal justice settings. Despite increased awareness of the neurocognitive deficits among justice-involved individuals with FASD, no systematic evaluation of the literature in the field has been conducted to date. We aimed to conduct a systematic review of the literature on the neurocognitive profiles of justice-involved individuals with FASD, by searching five key electronic databases, dissertations database, and Google scholar, up to January 2021. The findings indicate that when contrasted with comparison groups, justice-involved individuals with FASD display significant impairment in a greater number of neurocognitive domains including intellectual capacity, executive function, language, academic achievements, motor skills, and adaptive living skills. The relatively small number of the studies included in the review, along with the confounding effects of comorbidities among study participants, precludes drawing firm conclusions about the true extent and implications of neurocognitive deficits in this population. To advance the field further, there is an urgent need to conduct robust studies involving larger samples of justice-involved individuals with FASD and suitable comparison groups. Advancing knowledge in the field can have important implications for understanding of the antecedents of offending behaviour in this population, and informing strategies for early identification and intervention.

Background Challenging behaviours, in particular aggressive behaviours, are prevalent among people with intellectual developmental disabilities. Predictors of challenging behaviours are numerous, including past history of aggression, poor coping skills and impulsivity. Factors like motor or Rapid Response Impulsivity (RRI), have neurobiological underpinnings that may be amenable to change via neuromodulation using non-invasive brain stimulation techniques like transcranial Direct Current Stimulation (tDCS). Methods This study aims to determine the efficacy of anodal tDCS in reducing RRI and incidents of aggression in people with intellectual developmental disabilities (IDD) in residential or hospital settings. Using a single blind, randomized, sham-controlled trial design, adults with IDD, with a history of impulsivity leading to aggression, will be randomised to receive either repetitive anodal or sham tDCS applied to the left dorsolateral prefrontal cortex. Outcome measures assessing impulsivity and aggression, will be collected for up to one month following the last tDCS session. Discussion The results of this study may pave the way for developing targeted interventions for impulsivity and aggressive behaviours in people with IDD.

Background: The literature surrounding patient feedback is limited, despite government policy integrating patient feedback into how the care quality of the National Health Service (NHS) is assessed...

The tomato crop is Lycopersico esculentum L. of the Solanaceae family. The considered world's first among the vegetable crops in terms of cultivated area annually. It is the third most important agricultural products after wheat and barley and the second most important vegetable crops after potatoes in Libya. The study aimed to isolate and identify the cause of tomato wilt disease its under greenhouse conditions. Four Fusarium oxysporum isolates were obtained from tomato roots and surrounding area growing under protected agricultural conditions at Janzour and Ein Zara in Tripoli- libay. The fungus were more frequent at Ein Zara area (37%), compared with Janzour (22%).

Five isolates of Sclerotinia sclerotiorum were isolated from different plant families: Sca, Scu, Egg, Sep, Sle. The study showed a clear difference between these isolates when studying Their agricultural characteristics, such as the growth and growth rate of mecellium and the production and size of stone bodies between these isolates. All isolates showed growth of transparent mecillium and then evolved and became white cotton on different Nutritious medium. The stone bodies formed in different shapes and sizes depending on themedium and the difference in the number of days of composition. The medium of potatoes, dextrose (PDA) and carrots (CaA) showed the highest growth rate and number of stone bodies of all isolates compared to other.

Pisum sativum. L is one of the most important legumes and vegetables. It is an essential source of energy and highly rich in protein. Peas are affected by many plant diseases, Sclerotinia sclerotiorum, which affects many vegetable and field crops plants causing significant losses in agricultural production. S. sclerotiorum was isolated from infected pea pods on Potato Dextrose Agar (PDA) media. the percentage of seed germination was investigated for both local and Italian varities, also the effect of fungus on seeds and bodes was evaluated. Results of this study showed that the percentage of seed germination in the local varity was 98%, while in the Italian varity 90%. The ability of pathogenicity was high on seeds and bods of the local variety. and also the effect of S. sclerotiorum suspension when using perlite showed that the fungus hed a high effecte on the plant growth and seed germination comparied with sclerotia treatment on local variety only, while the effect of fungal suspension decreased seed and plant germination on petmous comparied with sclerotia treatment.

Graduates are a very important part of universities and colleges where graduates' participation can be considered common among universities and colleges these days. The idea of implementing a mobile application for alumni association is to associate all the alumni together with Middle East College and make the association more active and interactive through a high involvement. We are aware of the importance of graduate students where they can be considered as the key function for any university and any college. Furthermore, it is very important to utilize the power of the graduates. In this paper we propose a framework on how to building a mobile application for alumni association can enhance mentoring between alumni and students of Middle East College using data mining. It is not easy to apply data mining to enhance mentoring between alumni and current students. In the mobile application simple data mining algorithms are performed for more interactive between the alumni and current students.

Terrorism represents a major threat to global security; however, psychosocial risk factors for terrorism are insufficiently explored in the literature. Using a cross-sectional design, we examined g...

Decision-making has many different definitions and is measured in varied ways using neuropsychological tasks. Offenders with mental disorder habitually make disadvantageous decisions, but no study has systematically appraised the literature. This review aimed to clarify the field by bringing together different neuropsychological measures of decision-making, and using meta-analysis and systematic review to explore the performance of offenders with mental disorders on neuropsychological tasks of decision-making. A structured search of PubMed, Embase, PsycINFO, Medline, Cinahl was conducted with additional hand searching and grey literature consulted. Controlled studies of decision-making in offenders with evidence of any mental disorder, including a validated measure of decision-making were included. Total score on each relevant decision-making task was collated. Twenty-three studies met inclusion criteria (n = 1820), and 10 studies (with 15 experiments) were entered into the meta-analysis (n = 841). All studies included in the meta-analysis used the Iowa Gambling Task (IGT) to measure decision-making. Systematic review findings from individual studies showed violent offenders made poorer decisions than matched offender groups or controls. An omnibus meta-analysis was computed to examine performance on IGT in offenders with mental disorder compared with controls. Additionally, two sub-group meta-analyses were computed for studies involving offenders with personality disorder and psychopathy, and recidivists who were convicted of Driving While Intoxicated (DWI). Individual studies not included in the meta-analysis partially supported the view that offenders make poorer decisions. However, the meta-analyses showed no significant differences in performance on IGT between the offender groups and controls. Further research is required to ascertain whether offenders with mental disorder have difficulty in making advantageous decisions. An analysis of cause and effect and various directions for future work are recommended to help understand the underpinning of these findings. Trial Registration: CRD42018088402. Electronic supplementary material The online version of this article (10.1007/s11065-018-09397-x) contains supplementary material, which is available to authorized users.

Several of the disorders categorised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are marked by impulsivity, including borderline and antisocial personality disorders, attention deficit hy­peractivity disorder, conduct disorder and substance use disorders, just to name a few. The behavioural manifestations of impulsivity are numerous (e.g., su­icidality, reckless spending, criminality, acting out on positive or negative emotions), often with undesirable consequences for the individuals involved and others. The knowledge base in respect of the neurobiological underpinnings of impulsivity has expanded signifi­cantly over the past few decades, providing the im­petus to develop specific interventions to target im­pulsivity. Noninvasive brain stimulation techniques, such as Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS), have been used to modulate impulsivity with promising results. This article aims to provide a brief overview of the literature in the field before addressing the implications for future research and clinical practice.

Summary Telemedicine has become increasingly used by prison mental health services throughout the COVID-19 pandemic. In this editorial, we explore the benefits and risks of the remote provision of forensic mental healthcare, with consideration of the clinical, financial, ethical and legal consequences.

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The unique challenges of the correctional healthcare environment are well-documented. Access to community-equivalent care, voluntary informed consent of offenders with mental disorder, violence risk, suicide risk, medication misuse, and clinical seclusion, confinement and segregation are just a few of the challenges faced by correctional psychiatric services. This paper shares experiences for dealing with the ongoing challenges for psychiatrists working in the field. It provides an overview of the current state of mental healthcare in the federal correctional system in Canada, the legislative framework and initiatives aimed at addressing the healthcare needs of federal inmates.

Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted of sexual offences, the evaluation of those with suspected paraphilias not subject to the criminal justice system, risk assessment and measurement of response to sex offender treatment. In some jurisdictions, phallometry is incorporated into legal decisions about release from custody or discharge from secure hospitals. This paper provides a brief overview of the international development of phallometry, considers challenges to its broader adoption and discusses future directions for research and clinical practice.

Background: Impulsivity is a multi-faceted concept. It is a crucial feature of many neuropsychiatric disorders. Three subtypes of impulsivity have been identified: motor, temporal, and cognitive impulsivity. Existing evidence suggests that the right inferior frontal gyrus (rIFG) plays a crucial role in impulsivity, and such a role has been elucidated using inhibitory repetitive transcranial magnetic stimulation (rTMS). There is a dearth of studies using excitatory rTMS at the rIFG, an important gap in the literature this study aimed to address. Methods: Twenty healthy male adults completed a single-blind sham-controlled randomised crossover study aimed at assessing the efficacy of rTMS in the neuromodulation of impulsivity. This involved delivering 10-Hz excitatory rTMS to the rIFG at the intensity of 100% motor threshold with 900 pulses per session. Trait impulsivity was measured at baseline using the Barrett Impulsiveness Scale and UPPS-P Impulsiveness Scale. The Stop Signal Task (SST) and Information Sampling Task (IST), administered before andafter rTMS sessions, were used as behavioural measures of impulsivity. Results: No significant changes on any measures from either SST or IST after active rTMS at the rIFG compared to the sham-controlled condition were found. Conclusions: Excitatory rTMS applied to the rIFG did not have a statistically significant effect on response inhibition and reflective/cognitive impulsivity. Further research is required before drawing firm conclusions. This may involve a larger sample of highly impulsive individuals, a different stimulation site or a different TMS modality such as theta burst stimulation.

Background: Impulsivity is a multi-dimensional construct that is regarded as a symptom of many psychiatric disorders. Harm resulting from impulsive behaviour can be substantial for the individuals concerned, people around them and the society they live in. Therefore, the importance of developing therapeutic interventions to target impulsivity is paramount.\ud Aims and methods: We conducted a systematic review and meta-analysis of the literature from AMED, Embase, Medline, and PsycINFO databases on the use of repetitive transcranial magnetic stimulation (rTMS) in healthy adults to modulate different subdomains (motor, temporal and reflection) of impulsivity. \ud Results: The results indicated that rTMS has distinct effects on different impulsivity subdomains. It has a significant, albeit small, effect on modulating motor impulsivity (g = 0.30, 95% CI, 0.17 to 0.43, p < .001) and a moderate effect on temporal impulsivity (g = 0.59, 95% CI, 0.32 to 0.86, p < .001). Subgroup analyses (e.g., excitatory vs. inhibitory rTMS, conventional rTMS vs. theta burst stimulation, analyses by stimulation sites, and type of outcome measure used) identified key parameters associated with the effects of rTMS on motor and temporal impulsivity. Age, sex, stimulation intensity and the number of pulses were not significant moderators for effects of rTMS on motor impulsivity. Due to lack of sufficient data to inform a meta-analysis, it has not been possible to assess the effects of rTMS on reflection impulsivity.\ud Conclusions: The present findings provide preliminary evidence that rTMS can be used to modulate motor and temporal impulsivity in healthy individuals. Further studies are required to extend the use of rTMS to modulate impulsivity in those at most risk of engaging in harmful behaviour as a result of impulsivity, such as patients with offending histories and those with a history of self-harming behaviour.

Introduction Assessment of the effectiveness of individual placement and support in forensic mental health settings is a relatively new field of research despite evidence demonstrating its effectiveness in generic mental health settings. Method IPS was implemented into a community forensic mental health setting within a large National Health Service trust in the United Kingdom over 6 months. Using the Consolidated Framework for Implementation Research this paper describes the lessons learned from implementing individual placement and support into such settings. Results Our findings suggest that implementation of individual placement and support in forensic mental health settings is complex and requires robust planning and collaboration with internal and external agencies. Barriers to implementation included staff attitudes, difficulty engaging employers and lack of employment related performance indicators, and facilitators included the support of service managers and outside groups. Adaptations to the IPS model were made to address challenges encountered, including difficulty starting rapid job searches, concerns about stigma, lack of confidence, uncertainty around employment opportunities, offence restrictions and lack of interest from potential employers. Conclusion This paper adds to the limited literature in the field. Findings are relevant to practitioners and service providers who wish to implement individual placement and support services for people with mental disorder and offending histories.

Background: Health services are increasingly required to measure outcomes after treatment, which can be reported to the funding body and may be scrutinised by the public. Extensive high quality measurements are time consuming. Routinely collected clinical data might, if anonymised, provide good enough evidence of useful change consequent on service received. Research question: Do the Health of the Nation Scale (HoNOS) and the 20 item Historical, Clinical, Risk (HCR-20) structured professional judgement tool scores provide evidence of clinical and risk change among low security hospital patients at 6 and 12 months after admission? Methods: One hundred and eight men were either resident on the unit on1st January 2011 or new admissions to the census date of 31st May 2013. Their routinely collected data were added to an outcome register following each patient’s Care Programme Approach clinical review meeting and analysed using repeated measures t-tests with Bonferroni corrections. Results: Most of the men, mean age 34.3 years, were single (93%), White British (71%) and with a primary diagnosis of schizophrenia (62%). There were significant reductions in the 11-item HoNOS (excluding the community living condition scale) scores between baseline and 6 months, and between 6 months and 12 months, but no change on its additional 7-item secure subscale. Individual effect sizes indicated that 39% of the men had better social function, although 18% had deteriorated at six months. There was little overall change in the HCR-20; individual effect sizes indicated that 11 men (15%) were rated as being at lower risk level and 10 (14%) at higher after six months in the study. Conclusions/implications for clinical practice: Standard clinical measures are promising as indicators of change in low security hospital patients. Risk ratings may be conservative, but, at this stage of a secure hospital admission, higher scores may be as likely to indicate progress in identifying and quantifying risks as apparent increase in risk.

In the last decade, telepsychiatry – the use of telecommunications technologies to deliver psychiatric services from a distance – has been increasingly utilised in many areas of mental health care. Since the review by Khalifa and colleagues in 2007 the body of literature relevant to the forensic applications of telepsychiatry has grown substantially, albeit not by much in the United Kingdom. In the current review, we aim to provide an update summary of the literature published since 2007 to determine the effectiveness and feasibility of increasing telepsychiatry utilisation in forensic practice. The literature reviewed provides some encouraging evidence that telepsychiatry is a reliable, effective and highly acceptable method for delivering mental health care in forensic settings. There are also a number of papers that indicate the use of telepsychiatry may be cost effective for health providers in the longer term. Further research is required to consider the potential legal and ethical implications of using telepsychiatry in forensic settings.

Staff from one National Health Service (NHS) Trust in England completed an online survey (N = 590) about their experience of intrusive behaviours from patients. These experiences were categorised into either stalking or harassment and compared in terms of staff and patient characteristics, types of intrusions, and aftermath. Overall, 150 were classified as being stalked (25.4%) and 172 harassed (29.2%). There were no differences in staff characteristics between the two groups. Staff from forensic services and nursing staff were particularly susceptible to these intrusions which took many forms. Respondents perceived a range of causes for the stalking and harassment, the most common being to gain power and control/to scare. It was rare for legal sanctions to be brought against the patient. Our findings reinforce the need for service providers to have policies supported with preventative measures, education and a robust process for addressing stalking so that these measures are embedded in practice in a way that supports staff working with patients. Furthermore, service providers should be challenged on what steps they have taken to prevent, and monitor, such behaviour.

Recent literature has focused on severity of personality disorder (PD) and a trait-based assessment of PDs in preference to assessment by specific sets of diagnostic criteria. Evidence suggests that emotional impulsiveness, also known as Urgency (Whiteside, & Lynam (2001). The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences (30, 669–689), might contribute to a broad spectrum of PDs and to overall PD severity. In a sample of 100 forensic psychiatric patients, all men with confirmed PD and a history of serious offending, two hypotheses were tested: first that high Urgency scores would be associated with a broad spectrum of PDs, and with PD severity; and second, that in regression analysis Urgency would uniquely predict measures of PD severity. Results confirmed these hypotheses and are consistent with the idea that emotional impulsiveness/Urgency contributes importantly to overall severity of PD, and in so doing may explain, at least in part, the well-documented link between PD and violence.

This chapter reviews the evidence base for a range of biological factors in antisocial personality disorder (APD) and psychopathy in adults (there is a substantial evidence base for children and adolescents with antisocial behavior as well, though the inclusion of these studies is outside our scope), including genetic factors, neurophysiological and neuropsychological findings, structural and functional brain changes, and transmitter and hormone aberrations. In order to summarize the evidence, this chapter systematically reviews others’ reviews and meta-analyses in the field but also refers to individual studies of particular relevance. The chapter focuses more on psychopathy than on APD because it provides a more narrow and less controversial concept, at least in relation to its use in research.

Aims and methodAs part of a larger clinical trial concerning the use of transcranial magnetic stimulation (TMS) for treatment-resistant depression, the current study aimed to examine referral emails to describe the clinical characteristics of people who self-refer and explore the reasons for self-referral for TMS treatment. We used content analysis to explore these characteristics and thematic analysis to explore the reasons for self-referral.ResultsOf the 98 referrals, 57 (58%) were for women. Depressive disorder was the most commonly cited diagnosis, followed by bipolar affective disorder. Six themes emerged from the thematic analysis: treatment resistance, side-effects of other treatments, desperation for relief, proactively seeking information, long-term illness and illness getting worse.Clinical implicationsTMS has recently been recommended in the UK for routine use in clinical practice. Therefore, the number of people who self-refer for TMS treatment is likely to increase as its availability increases.Declaration of interestNone.

Impulsivity and empathy are clinically relevant multi-dimensional concepts. Existing evidence suggests the left dorsolateral prefrontal cortex (LDLPFC) plays a crucial role in impulsivity and empathy. However, the neuromodulation effect of excitatory repetitive transcranial magnetic stimulation at the LDLPFC is insufficiently explored in the current literature. To address this important gap in the literature, we aimed to examine the effects of intermittent theta burst stimulation (iTBS) at the LDLPFC on impulsivity and empathy. A single-blind sham-controlled randomised crossover trial involving twenty-three healthy male adults was conducted. The iTBS protocol delivered 1800 pulses to the LDLPFC at 80% of the motor threshold in each condition. Trait impulsivity and empathy were measured at baseline using the Barrett Impulsiveness Scale and UPPS-P Impulsiveness Scale. The Reading the Mind in the Eyes Test, Information Sampling Task, and Adjusting Amount Task serving as behavioural measures of empathy, cognitive and temporal impulsivity respectively were administered before and after iTBS sessions. No significant changes were found on any of the measures after iTBS at the LDLPFC compared to the sham stimulation. Neuromodulation at the LDLPFC using iTBS may not alter cognitive empathy and temporal and cognitive impulsivity. Further research is required using amended protocols in a large-scaled sample.

Background: Academic literature and government initiatives have emphasised the importance of work as a means of improving health and reducing reoffending among offenders with mental disorders. Whilst a number of work skills programmes have shown promise for offenders more generally, evaluation of evidence for their effectiveness for those with a mental disorder is lacking, particularly in relation to improving employment outcomes. Aims: To assess the evidence on the effectiveness of work skills programmes for mentally disordered offenders. Method: A systematic review of the literature was conducted by searching the following databases: PsycINFO, CINAHL, Cochrane Library (Trials Register), Embase and Medline, using search terms which included Work Skills Programme*, Offend* and Mental*. Any empirical comparison study of work skills programmes was included in this review. The primary outcome was employment. Secondary outcomes included employment outcomes, reoffending, education, mental state, substance misuse, global functioning, quality of life, acceptability, leaving the study early and cost effectiveness or other economic outcomes. Results: Six articles met the inclusion criteria. Collectively they provided limited evidence that work skills programmes increase the likelihood of people with mental disorder who are offenders obtaining employment in the short term, but there are insufficient studies to determine the long-term impact of work skills programmes. Conclusions: There is modest evidence to support inclusion of specific work skills programmes in the treatment of offenders with mental disorder. Future studies should be of theoretically driven programmes, such as Individual Placement Support (IPS), use a standard set of relevant outcome measures and long enough follow-up for testing the effectiveness of any programme on engagement in competitive, paid employment as, even if skilled, offenders with mental disorder must constitute a hard to place group.

The extent to which assessment of personality disorders (PDs), and trans-diagnostic measures of PD severity, can capture the variance in psychopathy measured by the Psychopathy Checklist-Revised (PCL-R) was examined in 100 forensic patients with a history of violent offending. Correlational and linear regression analyses were carried out to establish whether (i) combinations of PDs would predict PCL-R scores for each of its two factors, interpersonal–affective (F1) and antisocial deviance (F2); (ii) ‘acting out’, a putative measure of externalising maladjustment that transcends PD categories, would predict PCL-R scores. Results showed that narcissistic and avoidant PDs contributed significantly to the prediction of F1, but only antisocial PD contributed to the prediction of F2. ‘Acting out’ predicted both F1 and F2, suggesting that core features of PCL-R psychopathy are embedded within and across different PD diagnoses. Results are discussed in relation to different sub-types of psychopathy described in t...

Evidence suggests that consideration of personality disorder (PD) severity, incorporating both externalising and internalising features of PD, might help to clarify the PD – violence relationship; moreover, that separate developmental pathways might link externalising and internalising personality pathology with criminal violence. This study of 96 forensic patients with confirmed PD and a history of violent offending addressed the question of whether delusional ideation, measured by the Peters Delusions Inventory, might play a significant role in the link between severe PD and criminal violence. Severe PD, defined by summing scores across DSM-IV PD criteria, was significantly associated with delusional thinking, with violence, and with high levels of both externalising and internalising personality features. Delusional thinking was associated with violence via internalising but not externalising PD features, suggesting that the link between severe PD and violence may be partly mediated by delusional thinking.

Empathy is a multi-dimensional concept with affective and cognitive components, the latter often referred to as Theory of Mind (ToM). Impaired empathy is prevalent in people with neuropsychiatric disorders, such as personality disorder, psychopathy, and schizophrenia, highlighting the need to develop therapeutic interventions to address this. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive therapeutic technique that has been effective in treating various neuropsychiatric conditions, can be potentially used to modulate empathy. To our knowledge, no systematic reviews or meta-analyses in this field have been conducted. The aim of the current study was to review the literature on the use of rTMS to modulate empathy in adults. Seven electronic databases (AMED, Cochrane library, EMBASE, Medline, Pubmed, PsycInfo, and Web of Science) were searched using appropriate search terms. Twenty-two studies were identified, all bar one study involved interventions in healthy rather than clinical populations, and 18 of them, providing results for 24 trials, were included in the meta-analyses. Results showed an overall small, but statistically significant, effect in favour of active rTMS in healthy individuals. Differential effects across cognitive and affective ToM were evident. Subgroup analyses for cognitive ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Subgroup analyses for affective ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Meta-regression revealed no significant sources of heterogeneity. In conclusion, rTMS may have discernible effects on different components of empathy. Further research is required to examine the effects of rTMS on empathy in clinical and non-clinical populations, using appropriate empathy tasks and rTMS protocols.

Background: Evidence suggests the relationship between personality disorder (PD) and violence in offenders might be clarified by considering sub-groups of PD offenders defined by patterns of PD comorbidity. Aim: to identify patterns of PD comorbidity associated with severe violence, defined by its severity, quantity and age of onset (Violence Index: VI) in a forensic sample of 100 PD offenders. Methods: Correlations were first computed between VI and a range of personality and criminological variables; next, patients with antisocial/borderline comorbidity were compared with other PD patients; finally, regression analysis was conducted to identify unique predictors of VI. Results: The antisocial deviance factor of psychopathy and antisocial/borderline comorbidity were each significantly and independently associated with severe violence. Patients showing both a high psychopathy score and antisocial/borderline comorbidity had a significantly greater VI than those without these characteristics. Conclusion: PD...

Purpose – The purpose of this paper is to present the arguments for sustaining a clinical database, assess its feasibility in a low-secure service, examine the data that can be captured and discuss what this means for practice implications and service development. The paper aims to demonstrate how a clinical database can provide information on three key areas: what patients are like before admission, what is done with them whilst they are in hospital and what happens to them when they are discharged. The paper also aims to examine the practical, legal and ethical implications of building such a database. Design/methodology/approach – This is conducted in the form of a feasibility study charting the development and implementation of an inpatient clinical database for a low-secure inpatient service. Findings – The feasibility of creating and maintaining a clinical database in a low-secure service has been assessed and the paper has found that they are an invaluable source of data that all mental health services should strive to develop. They will enable services to track their own outcome measures and tailor their service and interventions according to the needs of service users. However, ethical and legal issues surrounding building clinical databases are complex and require careful consideration. Research limitations/implications – This is a small-scale study that captured the experience of one service. Ideally this research should be expanded with nationwide clinical database development. Practical implications – This paper includes implications for the implementation of a clinical database, the resources needed for the running of this and the development of standardised outcome measures for mental health services. Originality/value – This is potentially an innovative way of developing a clinical database for a low-secure unit and some of the first research into the feasibility of a database for this population. Its practical application is relatively new and potentially innovative in how it is applied.

The study was aimed to examine beliefs among 320 attendees of a large University Hospital in Dhaka about Jinn, black magic and evil eye among Muslims in Bangladesh, using a self-completed questionnaire. The majority believed in the existence of Jinn (72%) and in Jinn possession (61%). In contrast, a relatively smaller proportion believed in the existence of black magic and evil eye (50% and 44%, respectively). Women were more likely than men to believe in the existence of Jinn and to cite religious figures as the treating authority for diseases attributed to affliction by black magic. Participants with a higher educational attainment were less likely than those with lower attainment to believe in jinn possession; or to believe that Jinn, black magic, or evil eye could cause mental health problems. Mental health care practitioners need to be mindful of these beliefs to achieve the best outcome for their patients.

Introduction People with involvement in forensic psychiatric services face many obstacles to employment, arising from their offending, as well as their mental health problems. This study aims to assess the feasibility of conducting a randomised controlled trial (RCT) to evaluate the effectiveness of individual placement and support (IPS), in improving employment rates and associated psychosocial outcomes in forensic psychiatric populations. IPS has been found consistently to achieve employment rates above 50% in psychiatric patients without a history of involvement in criminal justice services.Methods/design This is a single-centre feasibility cluster RCT. Clusters will be defined according to clinical services in the community forensic services of Nottinghamshire Healthcare NHS Foundation Trust (NHCT). IPS will be implemented into 2 of the randomly assigned intervention clusters in the community forensic services of NHCT. A feasibility cluster RCT will estimate the parameters required to design a full RCT. The primary outcome is the proportion of people in open employment at 12-month follow-up. Secondary outcome measures will include employment, educational activities, psychosocial and economic outcomes, as well as reoffending rates. Outcome measures will be recorded at baseline, 6 months and 12 months. In accordance with the UK Medical Research Council guidelines on the evaluation of complex interventions, a process evaluation will be carried out; qualitative interviews with patients and staff will explore general views of IPS as well as barriers and facilitators to implementation. Fidelity reviews will assess the extent to which the services follow the principles of IPS prior, during and at the end of the trial.Ethics and dissemination Ethical approval was obtained from the East Midlands Research Ethics Committee-Nottingham 1 (REC reference number 15/EM/0253). Final and interim reports will be prepared for project funders, the study sponsor and clinical research network. Findings will be disseminated through peer-reviewed journals, conferences and event presentations.Trial registration number NCT02442193; Pre-results.

Health services are increasingly required to measure outcomes after treatment, which can be reported to the funding body and may be scrutinised by the public. Extensive high-quality measurements are time consuming. Routinely collected clinical data might, if anonymised, provide good enough evidence of useful change consequent on service received.Do the Health of the Nation Scale and the 20-item Historical, Clinical, Risk structured professional judgement tool scores provide evidence of clinical and risk change among low security hospital patients at 6 and 12 months after admission?One hundred and eight men were either resident on the unit on 1 January 2011 or new admissions to the census date of 31 May 2013. Their routinely collected data were added to an outcome register following each patient's Care Programme Approach clinical review meeting and analysed using repeated measures t-tests with Bonferroni corrections.Most of the men, mean age 34.3 years, were single (93%), White British (71%) and with a primary diagnosis of schizophrenia (62%). There were significant reductions in the 11-item Health of the Nation Scale (excluding the community living condition scale) scores between baseline and 6 months and between 6 and 12 months, but no change on its additional 7-item secure subscale. Individual effect sizes indicated that 39% of the men had better social function, although 18% had deteriorated at 6 months. There was little overall change in the 20-item Historical, Clinical, Risk; individual effect sizes indicated that 11 men (15%) were rated as being at lower risk level and 10 (14%) at higher after 6 months in the study.Standard clinical measures are promising as indicators of change in low security hospital patients. Risk ratings may be conservative, but at this stage of a secure hospital admission, higher scores may be as likely to indicate progress in identifying and quantifying risks as apparent increase in risk. Copyright © 2017 John WileySons, Ltd.

Early-onset alcohol abuse (EOAA) was previously found to both mediate and moderate the effect of childhood conduct disorder (CD) on adult antisocial behavior (ASB) in an American community sample of young adults (Howard, R., Finn, P. R., Gallagher, J., & Jose, P. (2011). Adolescent-onset alcohol abuse exacerbates the influence of childhood conduct disorder on late adolescent and early adult antisocial behavior. Journal of Forensic Psychiatry and Psychology. Advance online publication. doi:10.1080/14789949.2011.641996). This study tested whether this result would generalize to a British forensic sample comprising 100 male forensic patients with confirmed personality disorder. Results confirmed that those in whom EOAA co-occurred with CD showed the highest level of personality pathology, particularly Cluster B traits and antisocial/borderline comorbidity. Those with co-occurring CD with EOAA, compared with those showing only CD, showed more violence in their criminal history and greater recreational drug use. Regression analysis showed that both EOAA and CD predicted adult ASB when covariates were controlled. Further analysis showed that EOAA significantly mediated but did not moderate the effect of CD on ASB. The failure to demonstrate an exacerbating effect of EOAA on the relationship between CD and ASB likely reflects the high prevalence of CD in this forensic sample. Some implications of these findings are discussed.

BACKGROUND: In 1999, the UK government initiated a programme for the assessment and treatment of individuals deemed to have 'dangerous and severe personality disorder' (DSPD). After over 10 years of specialist service development, it is not clear whether DSPD patients represent a distinct group. AIMS: The aim of this study was to establish whether people admitted to DSPD hospital units could be distinguished in presentation or personality traits from people with personality disorder admitted to standard secure hospital services. METHODS: Thirty-eight men detained in high-security hospital DSPD units were compared with 62 men detained in conventional medium or high security hospital units, using the Psychopathy Checklist-Revised (PCL-R) and other standard personality disorder, clinical and offending measures. RESULTS: Compared with their counterparts in standard services, the DSPD group had higher scores on PCL-R psychopathy, significantly more convictions before age 18 years, greater severity of institutional violence and more prior crimes of sexual violence. Regression analysis confirmed that only PCL-R Factor 1, reflecting core interpersonal and affective features of psychopathy, predicted group membership. CONCLUSION: The DSPD group emerged as having higher psychopathy scores, but as there is currently no evidence that the core personality features of psychopathy are amenable to treatment, there is little justification for treating high-psychopathy forensic patients differently from those with other disorders of personality. Copyright © 2011 John Wiley & Sons, Ltd. Language: en

Mental health services in the UK have been repeatedly criticised for being insensitive to patients' religious and cultural needs. Muslims form Britain's largest ethnic minority group – nearly 3% of the UK population – yet, their health beliefs and practices remain relatively unexplored. We examined Muslims’ beliefs about Jinn, black magic and the evil eye and whether believed affliction by these supernatural entities could cause physical or mental health problems and also whether doctors, religious leaders, or both should treat this. A self-report questionnaire was given to a convenience sample of Muslims aged 18 years and over (n=111). The majority of the sample believed in the existence of Jinn, black magic and the evil eye and approximately half of them stated that these could cause physical and mental health problems and that these problems should be treated by both doctors and religious figures. Our results highlight an important area that demands attention from providers of health care.