The validity and clinical utility of structured diagnoses of antisocial personality disorder with forensic patients

Which Clinical and Demographic Factors are Related to Incarceration in Male Patients With Antisocial Personality Disorder?

Antisocial Personality Disorder (APD) is a condition largely represented in detention centers where can reach a prevalence of 60% in male prisoners. The objective of this study is to identify the clinical and demographic factors that differentiate subjects with APD and hosted in penitentiary with respect to those are treated in outpatient psychiatric clinics. We recruited 65 male patients affected by APD, whose 26 were followed up in community mental health services and 39 were serving their sentence in a detention center located in Monza. Socio-demographic and clinical data were obtained through a review of the clinical charts, and interviews with patients or their relatives (if available). We performed descriptive analyses on the total sample, then we compared the two groups identified by the type of setting (outpatient clinic vs. penitentiary) by independent sample t tests (quantitative variables) or χ2 tests (qualitative ones). For qualitative variables odds ratios (ORs) were also calculated. Outpatients with APD (with respect to those hosted in the detention center) resulted: to be older (p = .02), to be less likely married (p = .01), to have more pre-onset psychiatric comorbidity (p = .05), to have more pre-onset substance poly-misuse (p = .01), to have more previous psychiatric hospitalizations (p < .01), and to be less likely to have received lifetime psychotherapy (p < .01). Globally, the results of this study show how the presence of psychiatric comorbidity or substance abuse (with the probable access to psychiatric services) before the onset of APD prevents imprisonment. This aspect is even more surprising when we consider that the two groups of patients show no differences in the frequency of crimes. Future research will have to confirm if early mental health care can really limit the access to penitentiary of subjects affected by APD.

A Person-Centered Approach to Prison Behavior Based on Officers' Observations: Relations to Risk, Prison Misconduct, and Recidivism

Incorporating measures of prison behavior into risk assessment and management procedures may assist in treatment planning, risk monitoring, and decision-making. A behavior rating scale was used to assess prison officers' observations on externalizing, internalizing, and adaptive behavior in a sample of 277 sexual and violent offenders in correctional treatment in Berlin, Germany. The present study employed latent profile analysis to identify inmate subtypes with similar behavioral patterns. Results indicated a solution with five latent profiles that showed similarities with previous inmate typologies. The subtypes were termed "Aggressive-Psychopathic," "Asocial," "Situational," "Inconspicuous, and "Inadequate-Dependent." Analyses attested to the construct and predictive validity of the subtypes and involved the examination of differences on criminological characteristics, risk assessment instruments, various types of prison misconduct, and postrelease recidivism. This person-centered study illustrates the importance of attending to broader patterns of inmate behavior. The structured assessment of behavioral observations by prison officers can be a valuable and easy-to-implement approach to benefit from this largely neglected resource.

Predicting Offenders' Institutional Misconduct and Recidivism: The Utility of Behavioral Ratings by Prison Officers

Measures of current behavior are rarely incorporated into risk assessment. Therefore, the current study used a behavior rating scale to assess prison officers' observations of inmates prison behavior and examined the contribution of these ratings for risk assessment. Prison officers rated 272 sexual and violent offenders in three different correctional treatment facilities in Berlin, Germany. Factor analysis revealed three psychologically meaningful factors measuring externalizing, internalizing and adaptive prison behavior. The construct validity of the three factors was established through correlational analyses with standardized risk assessment instruments. Externalizing and internalizing behaviors were significant predictors of violent recidivism after release. In addition, externalizing was a significant predictor of institutional misconduct, whereas adaptive and internalizing behavior predicted whether an inmate was granted privileges (e.g., minimum-security confinement). Logistic regression analyses indicated that externalizing behavior ratings added incrementally to the Level of Service Inventory-Revised for the prediction of institutional misconduct and violent recidivism. The results indicate that prison officers observe important prison behaviors and that behavioral ratings can improve risk assessment.