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PubMed1985

Assessment of families in psychiatric emergencies.

Families of patients coming to a psychiatric emergency service pose severe professional and emotional challenges. Interviewing the patient and family together has advantages for patient, family, and interviewer. The traditional emergency assessment is greatly enhanced by attention to the family perspective and to the broader social context. Such information effectively facilitates problem-solving and negotiation of disposition. The importance of the interviewer's mature, flexible functioning is emphasized.

Crisis Intervention↗
PubMed1989

Some ethical considerations in defensive psychiatry: a case study.

Involuntary admission of a patient deemed dangerous may be motivated by a wish to protect the patient and others from potential violence-or by a practitioner's wish to limit personal liability. Evidence is offered to suggest that the practice of defensive psychiatry is not uncommon, and a case demonstrating the role of professional self-protection in an involuntary commitment decision is presented. Procedural modifications in the commitment process are proposed as a means of protecting patients' civil liberties.

Aged↗
PubMed2005

The Behavioural Status Index: testing a social risk assessment model in a high security forensic setting.

The Behavioural Status Index model suggests that 'social risk' tends to vary inversely with an individual's insight and capacity to perform key communication and social skills. The aim of this study was to describe emergent trends in data related to the risk, insight, and communication and social skills subscales used in the model. Data were collected from 503 patients in two high security mental health hospitals. Although a distinct factorial structure emerged suggesting groupings of behaviours, results provide little support for the overall model proposed.

Dangerous Behavior↗
PubMed2006

Dangerous severe personality disorder in the United Kingdom.

For years, the UK government has struggled to find the best way to manage people with severe personality disorder. The debate continues and includes concerns by the forensic psychiatric nurses who work with these patients.

Antisocial Personality Disorder↗
PubMed1989

Evaluation of suicide risk among youths in community settings.

Identifying youths in imminent danger of suicide and in need of emergency psychiatric services is a difficult task. Although clinicians have often described the psychiatric profile of youths at risk for suicide, there is little empirical evidence of successful strategies for identifying suicidal risk. Researchers are faced with a number of problems when attempting to validate risk evaluation procedures: Suicide risk profiles vary with age and developmental stage; there appear to be several patterns or subtypes of suicidal patterns; suicidality depends on one's current emotional state; evaluators are likely to be biased in the direction of over-estimating risk and are not likely to have extensive clinical training; imminent danger for suicide is time-limited; and a youth's risk will depend on surrounding environmental stressors and supports. These considerations force researchers to assume a strategic approach in defining levels of suicide risk and imminent danger of suicide. An example of a potential strategy for identifying risk among youths is outlined in this chapter. Although this strategic approach appears useful, researchers continue to be faced with major problems in validating such procedures. Determining the predictive validity of potential suicide screening procedures requires researchers to evaluate and to follow longitudinally a large sample of youths, while deliberately refraining from intervening to help those youths who appear to be in crisis.

Adolescent↗
PubMed1977

The HDHQ results of long-term prisoners: relationships with criminal and institutional behaviour.

The HDHQ (Foulds, Caine & Creasy, 1960) was administered to 100 long-term prisoners as part of routine psychological assessment prior to their allocation to training prisons. The questionnaire results were analyzed in terms of the prisoners' past and present criminal and institutional behaviour. Additionally they were used to test Megargee's (1966) hypothesis that extremely assaultive individuals are generally overcontrolled and will thus express less hostility than moderately assaultive individuals. The results showed that the sample of long-term prisoners had a significantly higher total hostility score than normals but did not differ significantly in the direction of their hostility. Violent offenders were significantly more extrapunitive than non-violent offenders, and prisoners who had attempted suicide were more extrapunitive than those with no history of attempted suicide. Apart from these findings no significant relations were found between the HDHQ results and criminal and institutional behaviour, whether violent or non-violent. Megargee's (1966) over- and under-controlled hypothesis failed to receive support. The results suggest that the HDHQ would be of little value in making predictions about future violent or criminal behaviour.

Adult↗
PubMed1985

Psychopathy and dangerousness: comparison, integration and extension of two psychopathic typologies.

Previous research has failed to relate psychopathy to an increased risk for violence, but several proposed psychopathic typologies have suggested the possibility of isolating more dangerous subtypes. One typology, based upon psychopathy and intelligence, has identified the low IQ psychopath as excessively violent judged by his history of violent crime. A second typology involving psychopathy and social withdrawal predicts greater dangerousness for both the outgoing and the withdrawn psychopath depending upon circumstance. The present study confirmed the dangerousness of the low IQ and withdrawn psychopaths in their prison behaviour and the low IQ psychopath on parole. The attempt to develop a more homogeneous type of dangerous psychopath by increasing the number of defining attributes was successful. The highest prison and parole dangerousness scores in the prisoner sample were obtained by those who shared four attributes. They were (1) psychopaths, who (2) had low IQs, (3) were socially withdrawn, and (4) had a history of prior violent crime.

Adult↗
PubMed1994

Women who stab: a personal construct analysis of sexual victimization and offending behaviour.

The personalities and perceptions of two women with a history of very significant sexual abuse who had committed serious violent offences against 'boy friends' are investigated using role construct repertory grid (Kelly) and hypotheses developed for treatment, in particular to prevent any reoffending. The most significant dimension that emerged was in general terms that of 'abuser-victim'. It was clear that there was significant confusion about their self-perceptions with regard to these roles. They perceived themselves as abusers despite their histories of victimization. There was a high level of guilt associated with the victim role in each woman and in previous therapy simply dealing with their victim role gave rise to very disturbed self-destructive behaviour and even more guilt. The grid results enabled the abuser self-perception to be identified and treatment programmes to be developed using Ryle's cognitive-analytic therapy. Following treatment further grids and clinical evidence suggested that there were significant changes in self-perception and in behaviour. The findings were discussed and the need for further investigations suggested.

Adolescent↗
PubMed1992

Association of perinatal events, epilepsy, and central nervous system trauma with juvenile delinquency.

The association of perinatal events, childhood epilepsy, and central nervous system trauma with juvenile delinquency was studied prospectively in a geographically defined population of 5966 males in northern Finland. Those who had obtained a criminal record up to the age of 22 years, totalling 355, or 6.0%, were defined as delinquents. The incidence of delinquency was not increased in males with a birth weight less than 2500 g or greater than 4000 g, preterm births < 37 weeks' gestation, or those with perinatal brain damage or having epileptic seizures before 14 years of age. The incidence was increased by 6.8% in the group of males with birth weights less than 3500 g, but not significantly increased after standardisation for a number of social and demographic background variables. The incidence was increased by 10.3% among the males who had had a central nervous system trauma by the age of 14 years, however, and this factor remained significant when social and demographic factors were standardised by regression analysis, with an odds ratio of 1.9 for all males with a criminal record and an odds ratio of 3.15 for those who had committed a violent crime. Previous central nervous system trauma may be a cause of delinquency, or another possibility is that the type of behaviour pursued by males who are likely to commit a violent crime will expose them more often to accidents which can result in central nervous system trauma.

Adolescent↗
PubMed1981

Four years' experience of an interim secure unit.

An interim secure unit of 14 beds (Rainford Ward) at Rainhill Hospital has been functioning for four years. During that period 78 patients were referred and 39 were admitted from various sources. Of those admitted, 40% were women, all had committed dangerous acts, and the most common diagnosis was schizophrenia. Only seven patients have stayed for one year or more, and only one seems set to stay indefinitely. Patients discharged are followed up in roughly equal numbers by their catchment area psychiatric teams and by the regional forensic psychiatric service. The number of patients in the ward has settled to about 12 for a population of one million. The unit now functions unobtrusively in a large psychiatric hospital, has a high morale, has had few recruiting problems, and has suffered extremely few disturbing incidents.

Adolescent↗