Search

IntroductionDomestic violence and abuse (DVA) are prevalent among persons with severe mental illness (SMI), being involved as victim, perpetrator, or both.AimsTo assess rates of DVA victimization and perpetration in patients with SMI. We also aimed to assess whether DVA victimization was associated with DVA perpetration, and whether this was mediated by dispositional anger in patients with SMI. Lastly, we aimed to examine whether gender moderated the associations between DVA victimization and perpetration.MethodsWe conducted a nation-wide survey on victimization in patients with SMI. In 942 patients DVA perpetration of physical assault and victimization of physical assault, sexual coercion or psychological aggression over the past year were assessed using the revised Conflict Tactics Scale. Anger was assessed using the dispositional anger reactions scale. Correlation and mediation analyses were conducted, followed by a moderated mediation to assess whether effects of anger differed between men and women.ResultsThe prevalence rate of perpetration of physical assault was 22%, for victimization 27% and 52% for both. We found a strong positive correlation between perpetrated physical assault and victimization of mild physical assault and between both the perpetration and victimization of severe physical assault. Anger mediated the link between being a victim of psychological aggression and being a perpetrator of DVA. Women were more likely to perpetrate violence if they were victims of mild physical assault compared to men. Other moderation effects by gender were not observed.Conclusion and implicationsThis study reveals persistent high DVA rates among patients with SMI. Overall, anger had no mediating effect on the association between victimization and perpetration of violence, except for psychological aggression and perpetration of DVA. This study emphasizes the importance of routine violence discussions in SMI care while taking context into account. However, further research on underlying mechanisms and interventions to improve discussions and care for victims and/or perpetrators of DVA is necessary.

IntroductionForensic psychiatric patients receive treatment to address their violent and aggressive behavior with the aim of facilitating their safe reintegration into society. On average, these treatments are effective, but the magnitude of effect sizes tends to be small, even when considering more recent advancements in digital mental health innovations. Recent research indicates that wearable technology has positive effects on the physical and mental health of the general population, and may thus also be of use in forensic psychiatry, both for patients and staff members. Several applications and use cases of wearable technology hold promise, particularly for patients with mild intellectual disability or borderline intellectual functioning, as these devices are thought to be user-friendly and provide continuous daily feedback.MethodIn the current randomized crossover trial, we addressed several limitations from previous research and compared the (continuous) usability and acceptance of four selected wearable devices. Each device was worn for one week by staff members and patients, amounting to a total of four weeks. Two of the devices were general purpose fitness trackers, while the other two devices used custom made applications designed for bio-cueing and for providing insights into physiological reactivity to daily stressors and events.ResultsOur findings indicated significant differences in usability, acceptance and continuous use between devices. The highest usability scores were obtained for the two fitness trackers (Fitbit and Garmin) compared to the two devices employing custom made applications (Sense-IT and E4 dashboard). The results showed similar outcomes for patients and staff members.DiscussionNone of the devices obtained usability scores that would justify recommendation for future use considering international standards; a finding that raises concerns about the adaptation and uptake of wearable technology in the context of forensic psychiatry. We suggest that improvements in gamification and motivational aspects of wearable technology might be helpful to tackle several challenges related to wearable technology.

Transgressive incidents directed at staff by forensic patients occur frequently, leading to detrimental psychological and physical harm, underscoring urgency of preventive measures. These incidents, emerging within therapeutic relationships, involve complex interactions between patient and staff behavior. This study aims to identify clusters of transgressive incidents based on incident characteristics such as impact, severity, (presumed) cause, type of aggression, and consequences, using latent class analysis (LCA). Additionally, variations in incident clusters based on staff, patient, and context characteristics were investigated. A total of 1,184 transgressive incidents, reported by staff and targeted at staff by patients between 2018-2022, were extracted from a digital incident reporting system at Fivoor, a Dutch forensic psychiatric healthcare organisation. Latent Class Analysis revealed six incident classes: 1) verbal aggression with low impact; 2) verbal aggression with medium impact; 3) physical aggression with medium impact; 4) verbal menacing/aggression with medium impact; 5) physical aggression with high impact; and 6) verbal and physical menacing/aggression with high impact. Significant differences in age and gender of both staff and patients, staff function, and patient diagnoses were observed among these classes. Incidents with higher impact were more prevalent in high security clinics, while lower-impact incidents were more common in clinics for patients with intellectual disabilities. Despite limitations like missing information, tailored prevention approaches are needed due to varying types of transgressive incidents across patients, staff, and units.

Abstract Background Because of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future – Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical item-level per patient class. Method A cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure. Results Four classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge. Discussion Different risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention.

IntroductionAdverse childhood experiences (ACEs) and self-reported aggression have often been associated, however, the mediating and moderating mechanisms underlying this association are not fully understood. In addition, less is known about potential factors that could serve as protection against the development of aggressive behavior. In this study, we investigated a moderated mediation model of sports participation and five impulsivity traits including positive and negative urgency, sensation seeking, and lack of premeditation and perseverance, in the association between ACEs and two forms of aggression.Methods and resultsThe sample comprised 651 (68.5% females) individuals from a Dutch community ranging in age from 18 to 82 years (M = 34.08). Contrary to our expectations, sports participation did not affect the associations of ACEs, the five impulsivity traits, and reactive and proactive aggression, except the association between ACEs and lack of premeditation. Specifically, the detrimental effect of ACEs on the propensity to act without thinking, increases among individuals with lower levels of sports participation. In addition, it was also found that sports participation directly contributed to higher levels of sensation seeking. Finally, after controlling for sociodemographic variables, the positive association between ACEs and reactive aggression was significantly mediated by negative urgency, lack of perseverance, and lack of premeditation, while the positive association between ACEs and proactive aggression was significantly mediated by lack of premeditation and positive urgency.ConclusionThe findings of this study add to the body of knowledge about the role of sports participation and impulsivity traits in the development of both forms of aggression, however, replication studies among multiple populations are needed before firm conclusions can be drawn.

IntroductionChildren’s development into healthy well-functioning adults can be negatively affected by adversity. Adverse childhood experiences (ACEs) have been shown to lead to a variety of poor life outcomes, ranging from mental health problems (e.g., anxiety or suicidality) through problematic health behaviors to serious physical diseases and even early death. ACEs can also make people more prone to aggressive behavior, criminality, and recidivism. In this study, we investigated the association between ACEs, specifically childhood maltreatment (CM), and forensically relevant factors; aggression, criminal risk factors, and treatment trajectories, as little is known about these associations in forensic psychiatric patients.MethodsThe study includes data derived from two studies in The Netherlands, of which the first study enrolled 128 patients residing in a Forensic Psychiatric Center (FPC) and the second study included 468 patients who were released unconditionally from FPCs between 2009 and 2013. We expected that more CM would be correlated with higher levels of aggression, higher clinical risk factor scores, and less decrease in clinical risk factor scores over time. To investigate this, we applied correlational analyses and linear growth curve modeling on risk assessment scores and self-report as well as staff report questionnaires on CM and aggression.ResultsConsistent with our first hypothesis, patients with higher CM scores also had higher aggression and risk assessment scores. The effect sizes were small to medium (0.12 to 0.34). Unexpectedly, CM did not influence the course of these treatment trajectories, however, we found that patients with histories of CM had a significantly longer length of stay in a forensic facility than patients without CM (respectively, 10.8 years and 9.3 years on average).DiscussionThis study underlines the importance of carefully examining the history of ACEs and CM in forensic psychiatric patients and considering this in forensic risk assessment and risk guided treatment. More research is needed to draw conclusions about whether and how histories of ACEs should be considered and targeted during treatment trajectories.

This study investigated the effect of the poly-victimization pattern of traumatic childhood experiences on aggression via the impulsivity traits positive urgency, negative urgency, lack of perseverance, lack of premeditation, and sensation-seeking in 102 poly-victims of childhood trauma (71.57% were females; Mage = 35.76; SDage = 15.91). Analyses with poly-victimization as an independent variable, impulsivity traits as parallel mediators, (1) reactive aggression or (2) proactive aggression as dependent variables, and gender as a covariate revealed that the poly-victimization did not have a direct or indirect effect on reactive or proactive aggression, nor did it have an effect on any of the impulsivity traits. Moreover, lack of premeditation had a positive direct effect on reactive aggression, while gender was a significant covariate in both models, with males reporting more aggression than females. Findings suggest that the poly-victimization does not influence impulsivity traits and aggression in adulthood. However, in males, the poly-victimization had a positive and moderate correlation with reactive aggression and negative urgency, while these correlations were absent in females. This finding implies that males are more vulnerable to the adverse effects of childhood poly-victimization than females.

Background: Radicalization, violent extremism, and terrorism are risks to societal security. Although research on terrorism-related behaviors is increasing, thorough empirical studies are rare. Methods: This study investigates radicalization processes and transitions in a matched sample of female and male terrorist suspects and convicts (N = 26) residing in Dutch penitentiary terrorism wings. Results: Results show that both men and women often experienced discrimination. A subgroup of women grew up in a stressful family environment and lacked emotional support from their family, whereas the other women did not experience such circumstances. The majority of the study sample was susceptible to connecting with radicalized friends or family members. Interestingly, factors that initially led to radicalization (e.g., a utopian image of the Islamic State) could later turn out to be factors associated with abandoning extremism. Conclusions: In this study, differences in radicalization processes and transitional phases between women and men emerged. Men more often had police contact prior to a terrorism-related offense. Making an effort to right old mistakes seemed important in the radicalization processes of men, whereas women had a stronger desire for emotional support and were more driven by experienced trauma and feelings of loneliness. This study provides input for gender-specific prevention and disengagement interventions.

In this exploratory, correlational study, several psychophysiological measures were assessed and the relation between these measures and an experimental self-report questionnaire to measure the seven implicit beliefs of sexual offenders (the Questionnaire for Implicit Theories of Sexual Offenders (QITSO)) was established in a sample of Dutch participants recruited from the healthy population (N = 28) using correlational analyses. After analyzing task performance, electroencephalogram (EEG) data and electrocardiogram (ECG) data, the psychophysiological variables were correlated with the experimental QITSO subscales. The subscale “children as sexual beings” correlated positively with the P300 amplitude at electrode Pz. The subscale “women are unknowable” correlated positively with resting-state beta activity during eyes closed and eyes open, and with alpha activity during eyes open. Additionally, the subscale “entitlement’ correlated positively with low frequency heart rate variability power during eyes closed and eyes open, and with high frequency power during eyes closed. This study is a first exploratory step towards establishing a psychophysiological profile underlying the self-report questionnaire QITSO.

IntroductionWhy are women (not) romantically attracted to dark personalities or villains, which might be a risk factor for intimate partner violence (IPV) victimization? In the current study, it is opted to investigate how adult attachment, maladaptive personality traits, and acceptance of couple violence in women predict romantic attraction to heroic/villainous characters using structural equation modeling (SEM).MethodFirst, a pilot study was conducted in 122 heterosexual women (aged 16–25) to select male TV characters. This resulted in the selection of six villains and 10 heroes for the main study, in which 194 other heterosexual women (aged 16–25) were asked to rate the pictures of TV characters through an online questionnaire. This was combined with self-report measures of maladaptive personality traits, acceptance of couple violence, and adult attachment. These variables were entered into a SEM model to assess model fit.ResultsOverall, women rated heroes higher on physical appearance (pilot study) and romantic attraction (main study) compared to villains. We found different direct effects of avoidant (negative) and anxious (positive) attachment styles on romantic attraction to heroes. Moreover, maladaptive personality traits fully mediated the positive effect of avoidant attachment style on romantic attraction to villains.DiscussionDespite the limitations of the study design (e.g., low N, low notoriety of the TV characters), this study emphasizes that women are generally more romantically attracted to heroes (vs. villains). Besides, there are different predictors of romantic attraction to heroes and villains, which requires further investigation, especially in the context of IPV.

The long-term changes of dynamic risk and protective factors have rarely been studied in forensic psychiatric patients. We utilized a latent growth curve analysis to investigate trajectories of risk and protective factors over time in all 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from any of 12 Dutch forensic psychiatric centers (FPCs). The study covered the period from juridical observation until unconditional release. Moreover, we investigated whether these trajectories differ between patients depending on their psychiatric diagnosis namely substance use disorders (SUD), psychotic disorders, and cluster B personality disorders (PDs). In addition, we also investigated whether SUD may influence changes in risk and protective factors in a group of psychotic and cluster B PDs patients, respectively. Overall, findings suggest that all changes in dynamic risk and protective factors could be depicted by two phases of patients' stay in the FPCs. Specifically, most changes on dynamic risk and protective factors occurred at the beginning of treatment, that is, from the time of juridical assessment up to the time of unguided leave. Moreover, the moment of unguided leave could be considered the ‘turning point’ in the treatment of offenders. We also found that SUD and psychotic patients changed the most in the first phase of their stay, while cluster B PDs patients changed the most in the second phase. However, SUD did not modify changes in risk and protective factors in psychotic and cluster B PDs patients. These findings may help improve offender treatment and crime prevention strategies.

Forensic psychiatric patients form a very heterogeneous population regarding psychopathology, criminal history, and risk factors for reoffending. Therefore, the present study aimed to investigate whether there are more homogeneous classes of forensic patients based on DSM-IV-TR Axis I and II diagnoses and previously committed offenses, by means of explorative latent class analysis (LCA). It was also investigated which risk and protective factors are significantly more prevalent in one class compared to other classes. The study sample contained 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from high-security forensic clinics. Data were retrospectively derived from electronic patient files. Five distinctive patient classes emerged: class with only Axis II diagnosis, class with multiple problems, antisocial class, psychotic class, and intellectually disabled class. These classes differed significantly in risk and protective factors. This study contributes to the understanding of patient classes and provides directions for future, class-tailored interventions.

Forensic healthcare workers deal with patients with severe psychiatric and behavioral problems that put them at an increased risk of developing work-related stress and burnout. Working with this target group of patients during the Coronavirus disease 2019 (Covid-19) pandemic with far-reaching restrictive measures can negatively affect the psychological well-being of forensic workers. Research suggests that resilience can buffer workplace stress and contribute positively to psychological well-being. However, research on resilience, psychological well-being and work-related stress among forensic healthcare workers is still lacking. Therefore, in this study, we investigated the interrelations between psychological well-being and resilience on the one hand and work-related stress and Covid-19 fear-related symptoms on the other hand. Self-report data were obtained from 318 healthcare workers (73.9% women) working in three Forensic Psychiatric Centers (M age = 44.20, SD = 14.31) and are in direct contact with forensic patients. The data were analyzed using network analysis. Consistent with previous research, the results showed that workplace stress and fear associated with the Covid-19 pandemic can be detrimental to workers' psychological well-being, while resilience can serve as a protective factor against being personally attacked or threatened by patients at the workplace. Last but not least, we identified highly central symptoms, namely tremors due to the fear of the coronavirus and anxiety when other people coughing, which would be the best candidates for future treatment targets. This knowledge can help clinicians optimize interventions to reduce workplace stress and fear due to the pandemic. Future studies should aim to replicate our findings in a larger and more representative sample of forensic healthcare workers.

Background Sheltered housing is associated with quality-of-life improvements for individuals with serious mental illness (SMI). However, there are equivocal findings around safety outcomes related to this type of living condition. Aims We aimed to investigate raw differences in prevalence and incidence of crime victimisation in sheltered housing compared with living alone or with family; and to identify groups at high risk for victimisation, using demographic and clinical factors. We do so by reporting estimated victimisation incidents for each risk group. Method A large, community-based, cross-sectional survey of 956 people with SMI completed the Dutch Crime and Victimisation Survey. Data was collected on victimisation prevalence and number of incidents in the past year. Results Victimisation prevalence was highest among residents in sheltered housing (50.8%) compared with persons living alone (43%) or with family (37.8%). We found that sheltered housing was associated with increased raw victimisation incidence (incidence rate ratio: 2.80, 95% CI 2.36–3.34 compared with living with family; 1.87, 95% CI 1.59–2.20 compared with living alone). Incidence was especially high for some high-risk groups, including men, people with comorbid post-traumatic stress disorder and those with high levels of education. However, women reported less victimisation in sheltered housing than living alone or with family, if they also reported drug or alcohol use. Conclusions The high prevalence and incidence of victimisation among residents in sheltered housing highlights the need for more awareness and surveillance of victimisation in this population group, to better facilitate a recovery-enabling environment for residents with SMI.

Rationale: Despite interventions to improve detection rates, domestic violence, and abuse (DVA) remains largely undetected by healthcare services. We therefore aimed to examine the acceptability, feasibility, and sustainability of an intervention aiming to improve DVA detection rates, which included a clear referral pathway (i.e., the BRAVE intervention) and to explore the acceptability and feasibility of DVA management and referrals in general, in the context of low detection rates.Methods: Qualitative study design with four focus groups of 16 community mental health (CMH) clinicians from both control and intervention arms. The focus groups discussed managing DVA in clinical practice and staff experiences with the BRAVE intervention in particular. Focus groups continued until saturation of the subject was reached. Interviews were analyzed using a thematic analysis approach.Results: DVA was seen to be highly relevant to mental healthcare but is also a very sensitive subject. Barriers in CMH professionals, institutions, and society meant CMH professionals often refrained from asking about DVA in patients. Barriers included communication difficulties between CMH professionals and DVA professionals, a fear of disrupting the therapeutic alliance with the patient, and a lack of appropriate services to help victims of DVA.Conclusion: The BRAVE intervention was acceptable but not feasible or sustainable. Personal, institutional, and public barriers make it not feasible for CMH professionals to detect DVA in mental healthcare. To increase the detection of DVA, professional standards should be combined with training, feedback sessions with peers and DVA counselors, and routine enquiry about DVA.Clinical Trial Registration: ISRCTN, trial registration number: ISRCTN14115257.

Background Pregnancy is characterised by many biological and psychosocial changes. Adequate maternal thyroid function is important for the developing fetus throughout gestation. Latent class analyses recently showed three different patterns of change in thyroid function throughout pregnancy with different associations with obstetric outcome. Maternal distress during the pregnancy (anxiety and depression) negatively affects obstetric outcome. Pregnancy distress in turn may be affected by personality traits and attachment styles. Moreover, during the pregnancy, substantial social changes occur in the partner relationship and work experience. The aim of the Brabant study is to investigate the association between thyroid function trajectories and obstetric outcomes. Moreover, within the Brabant study, we will investigate how different trajectories of pregnancy distress are related to obstetric outcome, and the role of personality in this association. We will evaluate the possible role of maternal distress and attachment style on maternal–fetal bonding. Finally, we will study social changes in the perinatal period regarding partner relationship and well-being and performance at work.Methods and analysis The Brabant study is a longitudinal, prospective cohort study of an anticipated 4000 pregnant women. Women will be recruited at 8–10 weeks gestation among community midwife practices in South-East Brabant in the Netherlands. Thyroid function parameters (TSH and fT4), thyroid peroxidase antibody and human chorionic gonadotrophin will be assessed at 12, 20 and 28 weeks gestation. Moreover, at these three time points women will fill out questionnaires assessing demographic and obstetric features, life style habits and psychological and social variables, such as depressive symptoms, personality, partner relationship quality and burnout. Data from the obstetric records will also be collected.Ethics and dissemination The study has been approved by the Medical Ethical Committee of the Máxima Medical Center Veldhoven. Results will be submitted to peer-reviewed journals in the relevant fields and presented on national and international conferences.

Abstract Background Many patients residing in forensic psychiatric centers have difficulties regulating their aggression in an adequate manner. Therefore, they are frequently involved in conflicts. Evidenced-based aggression therapies in forensic psychiatry are scarce, and due to the highly secured environment, it is hard to practice real-life provocations. We have developed a Virtual Reality aggression prevention training (VRAPT), providing safe virtual environments, in which patients can practice controlling their aggressive behaviors in an adequate way. The main objective of this study is to examine whether VRAPT is effective in reducing aggression among forensic psychiatric inpatients. Methods Four forensic psychiatric centers in the Netherlands are participating in this study. Participants will be randomly assigned to either VRAPT or a waiting list. The two groups will be compared at several different time points: baseline (12 weeks before intervention), pre-intervention, post-intervention and at 12 weeks follow-up. After follow-up measurements are completed, participants from the waiting list will also receive VRAPT. The primary outcome is level of aggressive behavior, consisting of staff-reported and self-reported measures. Secondary outcomes are self-report questionnaires on e.g., anger, impulsivity and aggression. Discussion To the best of our knowledge this is the first study to examine the effectiveness of a VR aggression prevention training in forensic psychiatric centers. Further details on the methodological issues are discussed in this paper. Trial registration Dutch Trial Register (NTR, TC = 6340). Retrospectively registered 14–04-2017.

High sensitivity is often considered a characteristic of giftedness, but scientific evidence for this is limited. Therefore, this study aimed to investigate whether gifted children rate themselves higher in sensory processing sensitivity (SPS) than their peers. A total of 882 children from Grades 4, 5, and 6 of primary school participated. They all completed a cognitive ability test (COVAT-3) and two self-report questionnaires to assess SPS (HSC scale and ChiSSEQ). The results revealed that the 10% best-performing children on the cognitive ability test did not differ significantly from their peers in SPS. There was one exception: Only on the HSC scale did children with high cognitive abilities score higher than those with low abilities (not higher than those with average and above-average abilities). However, this difference disappeared when applying stricter cut-offs to define high cognitive abilities.

Abstract Background Domestic Violence and Abuse (DVA) is associated with a range of psychosocial and mental health problems. Having a psychiatric illness increases likelihood of being a victim of DVA. Despite the evidence of a high risk for DVA and the serious effects of violent victimization in psychiatric patients, detection rates are low and responses are inadequate. The aim of the BRAVE (Better Reduction trough Assessment of Violence and Evaluation) study is to improve detection of and response to DVA in psychiatric patients. In this article, we present the protocol of the BRAVE study which follows the SPIRIT guidelines. Methods The BRAVE study is a cluster randomized controlled trial. We will include 24 community mental health teams from Rotterdam and The Hague. Twelve teams will provide care as usual and 12 teams will receive the intervention. The intervention consists of 1) a knowledge and skills training for mental health professionals about DVA, 2) a knowledge and skills training of DVA professionals about mental illness, 3) provision and implementation of a referral pathway between community mental health and DVA services. The follow up period is 12 months. Our primary outcome is the rate of detected cases of recent or any history of DVA in patients per team in 12 months. Detection rates are obtained through a systematic search in electronic patient files. Our secondary aims are to obtain information about the gain and sustainability of knowledge on DVA in mental health professionals, and to obtain insight into the feasibility, sustainability and acceptability of the intervention. Data on our secondary aims will be obtained through structured in depth interviews and a questionnaire on knowledge and attitudes on DVA. Discussion This study is the first cluster randomized controlled trial to target both male and female psychiatric patients that experience DVA, using an intervention that involves training of professionals. We expect the rate of detected cases of DVA to increase in the intervention teams. With early detection of victimization of DVA in psychiatric patients we hope to improve the mental health of psychiatric patients in the short and long term. Trial registration ISRCTN:14115257 . Date of registration: 15th January 2015.

BackgroundDespite the high prevalence of domestic violence and abuse (DVA) among patients with psychiatric conditions, detection rates are low. Limited knowledge and skills on DVA in mental healthcare (MHC) professionals might contribute to poor identification.AimsTo assess the level of, and factors associated with, DVA knowledge and skills among MHC professionals.MethodA total of 278 professionals in Dutch MHC institutions completed a survey assessing factual knowledge, perceived knowledge, perceived skills and attitudes about DVA.ResultsOn average, low scores were reported for perceived skills and knowledge. MHC professionals in primary care scored higher than those working with individuals with severe mental illness (P

[This corrects the article DOI: 10.1371/journal.pone.0160787.].

BackgroundEffective treatment interventions for criminal offenders are necessary to reduce risk of criminal recidivism. Evidence about deviant electroencephalographic (EEG)-frequencies underlying disorders found in criminal offenders is accumulating. Yet, treatment modalities, such as neurofeedback, are rarely applied in the forensic psychiatric domain. Since offenders usually have multiple disorders, difficulties adhering to long-term treatment modalities, and are highly vulnerable for psychiatric decompensation, more information about neurofeedback training protocols, number of sessions, and expected symptom reduction is necessary before it can be successfully used in offender populations.MethodStudies were analyzed that used neurofeedback in adult criminal offenders, and in disorders these patients present with. Specifically aggression, violence, recidivism, offending, psychopathy, schizophrenia, attention-deficit hyperactivity disorder (ADHD), substance-use disorder (SUD), and cluster B personality disorders were included. Only studies that reported changes in EEG-frequencies posttreatment (increase/decrease/no change in EEG amplitude/power) were included.ResultsDatabases Psychinfo and Pubmed were searched in the period 1990–2017 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, resulting in a total of 10 studies. Studies in which neurofeedback was applied in ADHD (N = 3), SUD (N = 3), schizophrenia (N = 3), and psychopathy (N = 1) could be identified. No studies could be identified for neurofeedback applied in cluster B personality disorders, aggression, violence, or recidivism in criminal offenders. For all treatment populations and neurofeedback protocols, number of sessions varied greatly. Changes in behavioral levels ranged from no improvements to significant symptom reduction after neurofeedback training. The results are also mixed concerning posttreatment changes in targeted EEG-frequency bands. Only three studies established criteria for EEG-learning.ConclusionImplications of the results for the applicability of neurofeedback training in criminal offender populations are discussed. More research focusing on neurofeedback and learning of cortical activity regulation is needed in populations with externalizing behaviors associated with violence and criminal behavior, as well as multiple comorbidities. At this point, it is unclear whether standard neurofeedback training protocols can be applied in offender populations, or whether QEEG-guided neurofeedback is a better choice. Given the special context in which the studies are executed, clinical trials, as well as single-case experimental designs, might be more feasible than large double-blind randomized controls.

BACKGROUND:Rehabilitation in forensic psychiatry is achieved gradually with different leave modules, in line with the Risk Need Responsivity model. A forensic routine outcome monitoring tool should measure treatment progress based on the rehabilitation theory, and it should be predictive of important treatment outcomes in order to be usable in decision-making. Therefore, this study assesses the predictive validity for both positive (i.e., leave) and negative (i.e., inpatient incidents) treatment outcomes with the Instrument for Forensic Treatment Evaluation (IFTE). METHODS:Two-hundred and twenty-four patients were included in this study. ROC analyses were conducted with the IFTE factors and items for three leave modules: guided, unguided and transmural leave for the whole group of patients. Predictive validity of the IFTE for aggression in general, physical aggression specifically, and urine drug screening (UDS) violations was assessed for patients with the main diagnoses in Dutch forensic psychiatry, patients with personality disorders and the most frequently occurring co-morbid disorders: those with combined personality and substance use disorders. RESULTS AND CONCLUSIONS:Results tentatively imply that the IFTE has a reasonable to good predictive validity for inpatient aggression and a marginal to reasonable predictive value for leave approvals and UDS violations. The IFTE can be used for information purposes in treatment decision-making, but reports should be interpreted with care and acknowledge patients' personal risk factors, strengths and other information sources.

Professional burnout among professionals in human services has usually been studied by making use of the Maslach Burnout Inventory (MBI). Using confirmatory factor analysis, the present study evaluates the factorial validity of the three versions of this scale that are available for Dutch-speaking regions (the full version with 22 items, a version with 20 items and a version with 16 items). The sample consisted of 995 Flemish special educators. The version of the MBI with 16 items proved to be slightly better than the others, but the fit of the model was still unsatisfactory. Implications for further research are discussed.

BackgroundAlthough crime victimisation is as prevalent in psychiatric patients as crime perpetration (and possibly more so), few European figures for it are available. We therefore assessed its one-year prevalence and incident rates in Dutch severely mentally ill outpatients, and compared the results with victimisation rates in the general population.MethodThis multisite epidemiological survey included a random sample of 956 adult severely mentally ill outpatients. Data on victimisation were obtained using the victimisation scale of the Dutch Crime and Victimisation Survey, which assesses crime victimisation over the preceding 12 months. Comparison data were derived from the nationwide survey on safety and victimisation in the Netherlands. Prevalence and incident rates were weighted for sex, age, ethnicity and socioeconomic status, and compared with a general population sample matched by region (N = 38,227).ResultsIn the past year, almost half of the severely mentally ill outpatients (47%) had been victim of a crime. After control for demographic differences, prevalence rates of overall and specific victimisation measures were significantly higher in severely mentally ill outpatients than in the general population. The relative rates were especially high for personal crimes such as violent threats (RR = 2.12, 95% CI: 1.72-2.61), physical assaults (RR = 4.85, 95% CI: 3.69-6.39) and sexual harassment and assaults (RR = 3.94, 95% CI: 3.05-5.09). In concordance, severely mentally ill outpatients reported almost 14 times more personal crime incidents than persons from the general population (IRR = 13.68, 95% CI: 12.85-14.56).ConclusionCrime victimisation is a serious problem in Dutch severely mentally ill outpatients. Mental-healthcare institutions and clinicians should become aware of their patients' victimisation risk, and should implement structural measures to detect and prevent (re-)victimisation.