Neuropsychological and diagnostic differences between recidivistically violent not criminally responsible and mentally ill prisoners

Criminal responsibility: Meta-analysis and study space

While some correlates of criminal responsibility (CR) outcomes are consistent, others are not. Study-level characteristics, such as sample selection, variability in the operational definition of insanity, or other unknown influences may explain discrepant findings. It is critical to systematically consolidate and assess the literature in order to guide future work. We conducted the first meta-analysis and study space analysis (see Malpass et al., ) in this area. 15 studies met inclusion criteria for the meta-analysis, which encompassed 19,500 cases. Summary effects for psycholegal cases indicated that older age, female sex, educational attainment, and unemployment were associated with insanity. Those classified insane more often had psychiatric histories and psychotic disorders. Finally, individuals opined or found insane were less likely to have criminal histories but more likely to have been opined incompetent to stand trial in the past. Importantly, virtually all summary effects were impacted by study design. Study space analyses (N = 7) revealed a dearth of literature that thoroughly addressed theoretically important variables. Taken together, the project provides a comprehensive, empirical analysis of CR correlates and a systematic call for future research.

Accuracy of the Historical, Clinical and Risk Management Scales (HCR-20) in predicting violence and other offenses in forensic psychiatric patients in Brazil

BACKGROUND

Assessing the risk of violence is a complex task. In Latin America it is often based on clinical criteria that are not very objective or structured. HCR-20 has been used to increase the accuracy of this exam.

AIMS

The aim of this study was to examine the predictive validity of the Historical, Clinical and Risk Management Scales (HCR-20) violence risk assessment scale on a sample of Brazilian male forensic psychiatric inpatients.

METHOD

A concurrent prospective cohort design was used. The cohort was selected among the population of inpatients in Unit D (N=68) at Instituto Psiquiátrico Forense Mauricio Cardoso (IPF), Brazil. For the baseline assessment the following instruments: HCR-20-Assessing Risk for Violence, Version 2, and Hare Psychopathy Checklist, Revised (PCL-R) were used. During the one-year follow up, episodes of violent and/or anti-social behavior were assessed, and recorded on the Yudofsky's Overt Aggression Scale (OAS) and Tengström et al.'s Follow-Up Questionnaire. The accuracy of HCR-20 and PCL-R to predict violent and/or anti-social behavior was assessed.

RESULTS AND CONCLUSIONS

For the whole cohort, the mean total score of PCL-R was 13.54 and of HCR-20 it was 23.32. The rate of recidivism in the twelve month follow up was 73.5%. Outstanding among the risk factors explored for their predictive efficacy are scale HCR-20 and subscale H for any event, and scale HCR-20 for a violent event. The predictive efficacy of scales HCR-20 and PCL-R was greater for any antisocial event than for a violent event. By taking into account the possibility of recidivism and the probability of recidivism accumulated over time, instruments HCR-20 and PCL-R behaved as expected. In all these explorations, the instruments significantly differentiated the group of the sample that recidivated earlier.

Incidência de conduta violenta e antissocial em população psiquiátrica forense

INTRODUÇÃO: As consequências de comportamentos violentos e antissociais de internos em hospitais psiquiátricos são graves e podem determinar prejuízo ao tratamento do agressor. A falta de conhecimento sobre a incidência desse fenômeno e suas características favorece sua perpetuação. OBJETIVOS: Apresentar uma revisão bibliográfica atualizada do tema, informar a incidência de conduta violenta e antissocial em uma população manicomial e descrever a implementação de um método de registro sistematizado desse fenômeno. MÉTODO: A coorte foi selecionada dentro da população de pacientes do Instituto Psiquiátrico Forense Maurício Cardoso (IPFMC). Foi utilizada a Escala de Agressividade Declarada de Yudofsky (Overt Aggression Scale, OAS) e o Questionário de Seguimento de Tengström et al. Durante o período de seguimento de 1 ano, foram avaliados diariamente episódios de conduta violenta e antissocial, registrando-se os mesmos na escala e no questionário. A amostra em estudo foi composta de 68 pacientes homens selecionados de forma aleatória entre a população em cumprimento de medida de segurança no IPFMC. RESULTADOS: A incidência de comportamento violento/antissocial no período estudado foi de 200 episódios, envolvendo 50 pacientes. Houve predomínio de agressões e conduta antissocial durante o dia. As intervenções mais utilizadas foram manejo verbal, isolamento do paciente e aplicação de medicação intramuscular. CONCLUSÃO: Foi possível, pela primeira vez, medir a ocorrência de conduta violenta e antissocial em uma população psiquiátrica forense.

Neurological function and HIV risk behaviors of female prison inmates

The purpose of this study was to explain relationships between neurological dysfunction, HIV serological status, and HIV risk behaviors that have not been well understood. A secondary analysis was conducted on data from 117 female prison inmates. Another 18 female inmates from the same prison were further evaluated with more specific neurological, neuropsychological, and HIV risk behavior Risk Assessment Battery (RAB) measures. Neurological function, defined by valid, reliable quantitative measures of cognition, behavior/mood, cranial nerves, motor, reflexes, and sensation, was significantly correlated with HIV RAB scores (.743, p = .006), and RAB scale scores (.824, p = .001) in HIV-negative, but not HIV-positive, inmates. Specifically, the reflex deficits subscale correlated with RAB scores (.779, p = .003) and RAB scale scores (.682, p = .015) in the HIV-negative group. These findings combined with subjects' histories suggest cerebral dysfunction possibly contributes to HIV risk behaviors in certain high-risk female inmates predating HIV infection. These findings further suggest that HIV risk reduction should target neurologically impaired females as a high-risk group. Larger studies are needed to validate these findings.

Personality and executive functioning as risk factors in recidivists

The classification of an inmate population at a maximum security jail in Canada was undertaken to study factors correlated with recidivism. A total of 12 recidivists and 12 nonrecidivists were classified according to their index offenses, and a Criminal Record search was completed to verify their statements. A total of 15 non-offenders who had also undergone a criminal record check were included as controls. All participants were administered the Minnesota Multiphasic Personality Inventory-168, Violence Risk Scale-Experimental Version, Coopersmith Self-esteem Inventory, and the Wisconsin Card Sorting Task. Statistical analysis showed significant differences between the groups on scores for the Hypochondriasis, Psychopathic Deviate, and Hypomania scales of the MMPI-168. Significant differences were noted for the Wisconsin Card Sorting Task and the Violence Risk Scale. Discriminant analysis of the recidivists and nonrecidivists correctly classified at a 91.3% level.