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PubMed2006

Risk and the preventive detention of sex offenders in Australia and the United States.

The development of recent statutory schemes, in both the United States and Australia, aim to keep the most dangerous sex offenders detained beyond the expiration of their prison sentence. In Kansas v. Hendricks (1997), the United States Supreme Court found constitutional Sexually Violent Predator (SVP) legislation that allows for the post-sentence, indefinite civil commitment of a subclass of dangerous offenders. More recently, the Australian High Court in Attorney-General (Qld) v. Fardon (2004) similarly upheld the constitutionality of Queensland's Dangerous Prisoners (Sexual Offenders) Act (2003), which allows for the post-sentence preventive detention of sex offenders deemed to be at high risk of serious sexual recidivism. Because an evaluation of a sex offender's likelihood of re-offending is fundamental to these schemes, this article provides an overview of recent advances in the risk assessment literature, discussing base rates of sexual recidivism, the identification of empirically validated risk factors, and the utility of structured risk assessment tools. Although it is recommended that risk assessment measures be utilized to assist the courts in making sound decisions about commitment, the limits of current research knowledge and areas of future research need are discussed.

Australia↗
PubMed2006

Strengths and limitations of actuarial prediction of criminal reoffence in a German prison sample: a comparative study of LSI-R, HCR-20 and PCL-R.

Unlike many other countries, for many years, Germany disregarded structured instruments for assessing the risk of criminal reoffence. However, this negative attitude now seems to be gradually changing. An increasing number of contributions regarding structured instruments have been published in the German literature in the last years, and some instruments have already found their way into practice. However, studies that systematically examine the applicability of the mostly Anglo-American instruments to German criminals are still lacking. Therefore, the major objective of the current study was to test some internationally established procedures in a larger unselected sample from the German penal system. The following were included in the study: the Level of Service Inventory - Revised (LSI-R), the HCR-20 Scheme, and the Psychopathy Checklist - Revised (PCL-R). On the whole, the instruments proved to be applicable to German criminals with only a few adaptations to the German situation, and they achieved a predictive accuracy comparable to the values reported internationally. However, there were only minor differences in the predictive performance between the measures. Moreover, some basic limitations became apparent. Firstly, we found quite high percentages of criminals with medium scores and a correspondingly ambiguous prognosis. Furthermore, the predictive accuracy seemed to be dependent on demographic, criminological and psychopathological characteristics of the offenders. Finally, the instruments appeared to only partially utilize the empirical store of knowledge available regarding factors influencing the recidivism of criminals, since even a simple predictive model that only added a few further aspects besides the tested instruments (e. g. treatment yes or no) achieved systematically better predictions than the instruments alone. Altogether, the tested measures turned out to be useful instruments for risk assessments and may be conducive for a more systemized practice. However, due to the limitations inherent, they should be seen as a complement to a careful and clinically informed appraisal and not a substitute.

Actuarial Analysis↗
PubMed2006

Identifying risk factors in stalking: a review of current research.

Stalking is a behaviour which can cause substantial damage to its victims, whether the perpetrator is violent or not. Victims face a range of risks including not only assault, but persistent or recurrent stalking and varying degrees of psychological and social damage. The responsibility for assessing and managing these risks often falls to the mental health professional, yet the emerging stalking risk assessment literature is at too early a stage to provide clinicians with empirically derived evidence upon which to base their clinical practice. This paper reviews existing research to identify those factors currently believed to be associated with increased risk of physical and sexual assault; with persistent and/or recurrent stalking; and, with psychological and social damage.

Crime↗
PubMed2006

What can we learn from the first community-based epidemiological study on stalking in Germany?

There is a lack of community-based studies on prevalence rates of stalking and the impact of stalking on victims in continental European countries. The authors published the first community-based epidemiological study on stalking in Germany. The purpose of this paper is to discuss possible implications of these epidemiological data for the mental health system, forensic psychiatry and legal regulations in Germany. For these reasons some data of our epidemiological study are outlined and reanalyzed. To examine lifetime and point prevalence rates of stalking, behavioural and psychological consequences for victims and the impact of stalking on current psychological well-being in a German community sample, a postal survey was conducted with 2000 inhabitants randomly selected from Mannheim (response rate 34.2%, n=679). The survey included a stalking questionnaire and the WHO-5 well-being scale. Almost 12% of the respondents reported having been stalked. This study identified a high lifetime prevalence of stalking in the community. Effects on victims' psychological health were significant and there was a high rate of physical (31%) and sexual (19%) violence in the context of stalking. Our data suggest that the phenomenon deserves more attention in future forensic psychiatric research and practice. Implications for forensic psychiatric assessment and treatment of stalkers as well as for management of stalking victims are discussed.

Adolescent↗
PubMed2006

Loathing the sinner, medicalizing the sin: why sexually violent predator statutes are unjust.

In seventeen states, persons convicted of one or more sexually violent offenses may be involuntarily civilly committed at the end of their criminal terms if they suffer from a mental disorder that renders them likely to reoffend sexually. These statutes place the burden on states to show that the sex offender meets the United States Constitutional standard of dangerousness. The key to proving dangerousness is proof of a mental disorder. However, the United States Supreme Court recently found that the offender need not be mentally ill. He need only "suffer" from "mental abnormality" or "personality disorder" that affects his cognitive, emotional or volitional capacities such that he is highly likely to sexually reoffend. These statutes are expressions of disgust: a fear of contamination by persons who engage in sexual conduct that forces us to confront our dark impulses. We do not merely hate the sin; we hate the sinner, and we want the sinner to be removed from our presence. Moreover, the emotions these statutes express are the source of widespread moral panic not warranted by data about recidivism risk. Laws that express disgust are likely to result in the unjust treatment of sex offenders.

Commitment of Persons with Psychiatric Disorders↗
PubMed2006

Manipulating perceptions of spider characteristics and predicted spider fear: evidence for the cognitive vulnerability model of the etiology of fear.

The present study reports on an attempt to experimentally manipulate perceptions of uncontrollability, unpredictability and dangerousness related to an imaginal encounter with a spider in order to determine whether there is an effect on self-rated predicted spider fear. Experimental manipulations involved differing information in relation to both the spider and the imaginal task. The control, predictability and dangerousness manipulations all had significant main effects on task-related spider fear (TRSF). Measures of the perception of the spiders as uncontrollable, unpredictable and dangerous were also significantly associated with TRSF and accounted for 42% of the variance in predicted fear beyond that accounted for by the experimental manipulations. Results are discussed in terms of their implications for better understanding the etiology and maintenance of fear. The overall findings are consistent with the cognitive vulnerability model, with cognitive perceptions of an object or situation seen as causal determinants of the fear associated with the stimulus.

Adolescent↗
PubMed2006

What factors are associated with the maintenance of PTSD after a motor vehicle accident? The role of sex differences in a help-seeking population.

To investigate potential sex differences in factors that are associated with chronic PTSD, data from 223 participants were examined using logistic regression analyses. Each participant had been involved in a serious motor vehicle accident (MVA), which had occurred at least 6 months earlier (range 6mos-37 years). Although men and women did not differ in the rate of diagnosed PTSD, four variables were found to interact significantly with sex in the prediction of chronic PTSD: peritraumatic experiences of helplessness, danger, and the certainty that one would die during the MVA and lack of employment. Follow up analyses indicated that although the peritraumatic experience variables were statistically significant, no notable differences emerged in the odds ratios of men and of women. In contrast, men who were unemployed were 9.94 times more likely to be diagnosed with PTSD, relative to men who were employed, while unemployed women were 2.85 times more likely to be diagnosed with PTSD, relative to women who were employed. Results are discussed in light of the role of functional limitations and their impact on the maintenance of PTSD in men and women.

Accidents, Traffic↗
PubMed2004

A case of suicide-by-cop.

A young man was shot dead on the street by police officers. The results of the investigation indicated that the use of firearms had been provoked with suicidal intent by the victim. A 25 year old man intruded with his car into a row of six police vehicles that was in the midst of an operation. Upon stopping at a traffic light he left his vehicle and pulled out a weapon which was later determined to have been a blank cartridge pistol. He took aim at the officers in the following vehicle from a distance of not more than 2 m. Despite repeated orders to put down the weapon, the man did not comply. Thus, as a result of the presumed threatening situation in which four officers were involved, several shots fell that were fatal for the individual. In the postmortem examination the cause of death was determined to be haemorrhagic shock due to penetration of the aorta by a projectile. On the basis of the results of the investigation a particular form of suicide was presumed since a depressive disorder in some form had been present. The man had expressed suicidal thoughts several times and had taken conspicuous leave of his wife on the day of the incident.

Adult↗
PubMed2006

How is personality disorder linked to dangerousness? A putative role for early-onset alcohol abuse.

This paper questions the assumption that personality disorder and dangerousness are causally linked, and suggests that insofar as a relationship between them exists, it is mediated by early-onset alcohol abuse. The latter, by impairing the function of prefrontal cortex during adolescence, a critical period of its development, putatively leads to deficits in goal-directed behaviour and emotional self-regulation that place the individual at high risk of becoming chronically antisocial in adulthood. Evidence is adduced in support of the hypothesis from the literature on: (i) the comorbidity of personality disorder and alcohol abuse; (ii) frontal lobe deficits in psychopaths; and (iii) life-course persistent offenders. Some testable predictions from the hypothesis are presented, together with its implications; most importantly, that measures to prevent serious antisocial behaviour in adulthood should target at-risk individuals prior to their commencing heavy drinking during adolescence.

Adolescent↗
PubMed2006

Co-sleeping, an ancient practice: issues of the past and present, and possibilities for the future.

Co-sleeping-infants sharing the mother's sleep space-has prevailed throughout human evolution, and continued over the centuries of western civilization despite controversy and blame of co-sleeping mothers for the deaths of their infants. By the past century, "crib death" was recognized, later identified as Sudden Infant Death Syndrome (SIDS), and generally found to occur more frequently during bed sharing. Pediatricians warned parents of the dangers of SIDS and other risks of bed sharing, and the frequency of bed sharing decreased markedly over the years. However, during recent decades, bed sharing began to increase, though major issues were raised, including: whether bed sharing actually exacerbates or is protective against the occurrence of SIDS, whether the practice facilitates breast feeding, whether bed sharing is beneficial for an infant's development, and other concerns. Dissention may soon be diminished by use of a crib which opens at the mother's bed-side and is becoming a popular approach to mother-and-infant closeness through the night.

Adult↗
PubMed2002

Self-reports of aberrant behaviour on the roads: errors and violations in a sample of Greek drivers.

Recent studies have shown that unsafe driver acts can be classified into two distinct categories (i.e.. errors and violations) entailing different measures for reducing road traffic accidents. A survey of over 1,400 drivers in Greece is reported in which a variety of aberrant driving behaviours have been identified. The present study has confirmed the results of earlier studies in the driving populations of Britain. Australia and Sweden that errors and violations are the major determinants in the factor structure of aberrant behaviours. Three types of violations were identified including, highway code-, aggressive- and parking-violations (or situational violations). Mistakes and lapses were two major forms of errors. The factor analysis identified another two classes of behaviour that could not be accounted for very well by the error-violation distinction. One class of behaviours referred to a state of low preparedness and negligence while the other class referred to communication errors and 'social disregard' for the other road users. Each class of behaviour was found to have different demographic correlates. Finally, accident liability was predicted by self-reported tendency to commit highway-code violations, but not by tendency to make errors due to failures of judgement (i.e.. mistakes) or lapses. Aggressive violations were significantly related to involvement in speeding convictions and law-breaking whilst highway-code violations were related to speeding convictions only.

Accidents, Traffic↗
PubMed1998

Factors related to miles driven between drinking and arrest locations among convicted drunk drivers.

The objectives of the study were to estimate the distance driven between drinking and arrest locations among 3,107 offenders convicted of driving while impaired and to determined whether the drinking location, the driver's appearance (factors such as race, age, gender), or age of the vehicle account for any differences in the estimated distance driven. Statistical models were used to determine odds ratios for being arrested in the immediate vicinity of the drinking location, and for miles driven impaired. The independent sociodemographic and arrest variables included: age, gender, ethnicity/race, vehicle age, drinking location, whether the arrest followed a crash, time of arrest, blood alcohol concentration, and drinking in areas with varying levels of arrest intensity. The variables associated with arrest in the immediate vicinity of the drinking location (less than one half mile) were drinking in high or medium-high arrest intensity areas, Hispanic/Mexican ethnicity/nationality, Native American race, and drinking at home. Among those who were not arrested in the immediate vicinity, the number of miles driven ranged from 0.5 to 18.2, with a mean of 3.4 miles (median = 2.6). Analysis of covariance demonstrated that among those arrested outside the immediate vicinity of their drinking locations, persons who drank in a high or medium-high arrest intensity area, those with blood alcohol concentrations of > or = 200 mg/l, and those drinking at bars, restaurants, or private parties, drove fewer miles compared to other offenders. Our findings are mixed regarding ethnicity/race. Traits such as age, gender, and vehicle age are unrelated to how far drunk drivers travel before their arrests.

Adolescent↗
PubMedDate not supplied

Constant observation in a medical-surgical setting. The role of consultation-liaison psychiatry.

Constant observation (CO) is commonly used in general hospital settings to protect patients who are at risk for harming themselves or others. The role of consultation-liaison psychiatry in the implementation of this procedure is often assumed, but has not been well studied. The authors report the findings of a 6-month study of the use of CO in a general hospital and discuss its implications for quality of care and, possibly, cost-effectiveness.

Adult↗
PubMed1986

Incident reporting: evaluation of New York's pilot incident logging system.

A revised incident reporting system that combined an abbreviated logging procedure for documenting minor incidents and a more comprehensive and detailed procedure for documenting major incidents was pilot tested in three New York State adult psychiatric centers. The pilot test had two major goals: to reduce the volume of work associated with current reporting procedures, and to facilitate even more thorough investigation of incidents warranting prompt and comprehensive review. Evaluation of pilot study data showed that a logging procedure is viable for the management of minor incidents.

Aggression↗