Beyond theoretical courses - A study of Swedish psychiatric residents' collegial learning through conversations in the workplace

BACKGROUND

Collegial conversations are important for sustainable learning to last beyond a course. Research on collegial conversations and peer learning in the workplace during psychiatric residency courses remains sparse, however. In this study, the aim was to explore residents' opportunities for collegial conversations during and after national courses in psychiatry.

METHODS

Residents in psychiatry completed an online survey including questions on opportunities for collegial conversations in their workplaces. Logistic regression was used for multivariate analysis and thematic content analysis was used for the open-ended answers where a theoretical framework of communities of practice was employed for the interpretation of the findings.

RESULTS

The survey was completed by 112 residents out of 725 (15,4%). The participants reported few structured forums for collegial discussion. The results of multivariate analysis suggest that more women than men feel it is advantageous to attend courses with others from the same workplace or from the same group of residents, described here as a team. The analysis of qualitative data identified how opportunities for collegial conversations differ across contexts and the type of values that are attached to team participation in residency courses.

CONCLUSIONS

This study highlights the importance of collegial conversations as a way to sustain the learning from residency courses into the workplace. By learning about residents' perceptions of collegial conversations during and after courses, teachers and directors may be more able to support residents' lifelong learning and professional development.

Psychopathic Traits in a Swedish Court-Ordered Forensic Sample: Preferential Associations of Boldness, Meanness, and Disinhibition

The construct validity of the triarchic psychopathy model has yet to be evaluated in the Swedish forensic psychiatric context. We examined associations between the three phenotypic constructs of the triarchic model of psychopathy (i.e., boldness, meanness, disinhibition), self-assessed empathy and anxiety, and clinical variables in 91 individuals undergoing pretrial forensic psychiatric evaluation in Sweden. Participants completed the Triarchic Psychopathy Measure (TriPM) and self-report measures of empathy and anxiety. Clinical variables, including psychiatric diagnoses and criminal behavior, were collected from the forensic psychiatric evaluations (FPE). All three subscales of the TriPM displayed significant and predominantly anticipated correlations with empathy and trait anxiety measures. TriPM Disinhibition was the only subscale with significant associations with the clinical variables collected from the FPEs. The results provide evidence for the reliability and construct validity of the Swedish translation of the TriPM in a pretrial forensic setting.

Medical residents' and teachers' perceptions of the digital format of nation-wide didactic courses for psychiatry residents in Sweden: a survey-based observational study

BACKGROUND

This study aimed to explore residents' and teachers' perceptions of the digital format of Metis (a national education network in Sweden) didactic courses for psychiatry residents in Sweden to guide post-pandemic curriculum development.

METHODS

An online attitude survey was developed and sent out to 725 residents in psychiatry and 237 course directors/teachers. Data were examined descriptively and group differences were analysed with independent sample t-tests.

RESULTS

The survey was completed by 112 residents and 72 course directors/teachers. Perceptions of digital formats were quite similar between the two groups with some significant differences i.e., residents agreed more strongly than directors/teachers with the statement that Metis courses in digital format were of the same quality (or better) than the classroom-based format. Residents perceived the positive effects of using interactive tools more than directors/teachers. More than 40% of the responders in both groups preferred a return to classroom-based course meetings. Responders in both groups suggested that different forms of digital elements (e.g., video-based and sound-recorded lectures, digital-group discussions, virtual patients) could be incorporated into different phases in the courses.

CONCLUSIONS

The study represents the current largest survey among residents in psychiatry and a teaching faculty in Sweden, to understand the impact of digitalization on the quality of residents' education during the pandemic. The results point towards applying a mixed format for training and education going forward, incorporating digital aspects into the national curriculum.

Isolation and worry in relation to gambling and onset of gambling among psychiatry patients during the COVID-19 pandemic: A mediation study

When the COVID-19 pandemic started spreading globally, there was a fear that addictive behaviors would increase due to changes in everyday life caused by restrictions due to COVID-19. Studies were carried out to explore if this was true for gambling, typically revealing no overall increase in gambling behavior, although individuals who had previous experience with gambling problems were more likely to increase gambling during the pandemic. However, these studies only included individuals with previous gambling problems. It remains unknown whether other vulnerable groups, such as individuals with common mental disorders increased their gambling. This study aimed to explore the level of gambling problems among individuals with a history of mental disorders, namely, (i) pre-pandemic gamblers and (ii) pandemic-onset gamblers. Furthermore, we explored if worry and isolation mediate gambling and problem gambling. The data were analyzed using descriptive statistics and a structural equation model to investigate mediation. The results showed a high prevalence of at-risk and problem gambling in both groups. The pre-pandemic gamblers had a high level of at-risk and problem gambling. Furthermore, the individuals that started to gamble during the pandemic had an even higher degree of at-risk and problem gambling. The mediation showed that the onset of gambling was linked with the worry of COVID-infection and that worry predicted the level of gambling problems. This study highlights that vulnerability factors, isolation, and worry can be triggers for individuals with common mental disorders to engage in gambling as well as the importance of screening this population for gambling problems.

Trait boldness and emotion regulation: An event-related potential investigation

The present study sought to extend knowledge of the role of boldness, a transdiagnostic bipolar trait dimension involving low sensitivity to threat, in emotional reactivity and regulation using physiological and report-based measures. One prior study found that boldness was associated with reduced late positive potential (LPP) while passively viewing aversive images, but not during emotion regulation; a disconnect between LPP and self-reported reactivity was also observed. Here, participants (N = 63) completed an emotion regulation task in which they either passively viewed or effortfully up- or downregulated their emotional reactivity to pleasant, unpleasant, and neutral pictures while EEG activity was recorded; they later retrospectively rated the success of their regulation efforts. ANOVAs examining the interactive effects of regulation instruction and boldness on LPP amplitude revealed that lower boldness (higher trait fearfulness) was associated with paradoxical increases in LPP to threat photos during instructed downregulation, relative to passive viewing, along with lower reported regulation success on these trials. Unexpectedly, similar LPP effects were observed for affective images overall, and especially nurturance photos. Although subject to certain limitations, these results suggest that individual differences in boldness play a role not only in general reactivity to aversive stimuli, as evidenced by prior work, but in the ability to effortfully downregulate emotional response.

Mental health in individuals with self-reported psychiatric symptoms during the COVID-19 pandemic: Baseline data from a swedish longitudinal cohort study

OBJECTIVE

Individuals with psychiatric disorders may be both vulnerable and sensitive to rapid societal changes that have occurred during the COVID-19 pandemic. To fully understand these impacts, repeated measurements of these individuals are warranted. The current longitudinal study set out to perform monthly assessment of individuals with common psychiatric disorders using established questionnaires with a possibility for them to self- rate their symptoms, over time.

METHODS

Recruitment of individuals who identified themselves as struggling with mental health problems, living in Sweden between July 2020 and June 2021 using an online survey. The individuals answered questions on demographics, psychiatric history, current psychiatric symptoms (e.g., Patient Health Questionnaire, PHQ-9; General Anxiety Disorder, GAD-7), somatic health, health-care contacts and any changes therein during the pandemic. Monthly, longitudinal assessments are still ongoing (consenting participants provide data for 1 year), and here we present descriptive statistics from the baseline measurement. All measurements from baseline (>400 items), and follow-ups are presented in detail.

RESULTS

A total of 6.095 participants (average age 35 years) submitted complete baseline data. Marital status (43% single) and number of years of education (48% highest degree being high school) were evenly distributed in this population. The most common lifetime psychiatric disorder in the sample was depressive disorder (80.5%) and generalized anxiety disorder (45.9%), with a substantial proportion having severe symptoms of depression. (30.5%) and anxiety (37.1%). Lifetime suicidal ideation (75.0%) and non-suicidal self-harm (57.7%) were prevalent in the group and 14.5% reported drug use during the pandemic. Allergies (36.8%) were the most common somatic condition, followed by irritable bowel syndrome (18.7%). For those having experienced a traumatic event, 39% showed symptoms during the pandemic indicating PTSD. Regarding contact with mental health services during the pandemic, 22% had established a new contact, and 20% reported to have increased their psychiatric medication compared to before the pandemic.

CONCLUSION

Baseline data collected during the pandemic from individuals in Sweden with pre-existing psychiatric disorders demonstrate that this sample represents a population suitable for an investigation on the long-term impact of the pandemic, as intended by the longitudinal investigation that is ongoing. Follow-up questionnaires over a 12-month period are being collected and will indicate how the health and well-being of this population was impacted during the changes and uncertainties that have been characteristic of the past 2 years.

Interpersonal trauma and its relation to childhood psychopathic traits: what does ADHD and ODD add to the equation?

BACKGROUND

Childhood trauma has demonstrated associations with callous-unemotional traits (e.g., reflecting lack of remorse and guilt, unconcern about own performance). Less is known about associations between trauma and multiple domains of child psychopathic traits. There has also been limited focus on the role of co-occurring disorders to psychopathy traits among children, namely, attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) and how they interact with childhood trauma.

METHODS

We examined to what degree childhood interpersonal trauma can predict parent-rated psychopathic traits in a large population based Swedish twin sample (N = 5057), using a stringent definition of interpersonal trauma occurring before age 10. Two hundred and fifty-one participants met the interpersonal trauma criteria for analysis. The study explored the additional impact of traits of attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD).

RESULTS

Linear regressions demonstrated statistically significant but clinically negligible effects of interpersonal trauma on total and subscale scores of parent-rated psychopathic traits. When exploring interaction effects of ADHD and ODD into the model, the effect increased. There were interaction effects between ODD and trauma in relation to psychopathic traits, suggesting a moderating role of ODD. Having been exposed to trauma before age 10 was significantly associated with higher parent rated psychopathy traits as measured by The Child Problematic Traits Inventory-Short Version (CPTI-SV), however the explained variance was small (0.3-0.9%).

CONCLUSIONS

The results challenge the notion of association between interpersonal trauma and youth psychopathic traits. They also highlight the need to gain an improved understanding of overlap between psychopathic traits, ADHD and ODD for clinical screening purposes and the underlying developmental mechanisms.

Can the Comprehensive Assessment of Psychopathic Personality Be Used to Measure the Triarchic Model Constructs of Boldness, Meanness, and Disinhibition? A Scale Derivation Study

Can the components of the triarchic model of psychopathy (i.e., boldness, meanness, disinhibition) be operationalized using the item pool comprising the Comprehensive Assessment of Psychopathic Personality (CAPP) model? To address this question, the authors first derived CAPP-based triarchic scales using standard item-selection procedures and then examined the external correlates of these provisional scales in three archival data sets: (a) U.S. jail inmates administered the institutional rating scale version of the CAPP and (b and c) prototypicality ratings of the CAPP traits provided by Swedish forensic mental health professionals and U.S. probation officers. Although most research on triarchic constructs has relied exclusively on self-report inventories, the results suggest that the CAPP model can be reorganized to reflect boldness, meanness, and disinhibition and that its institutional rating scale items can effectively quantify these constructs using interview and file review data. Implications for future research on the measurement and assessment of psychopathic traits are discussed.

Measures of emotion regulation: Convergence and psychometric properties of the difficulties in emotion regulation scale and emotion regulation questionnaire

OBJECTIVE

Investigating unique and shared aspects of measures of emotion regulation (ER) advances our understanding of ER as a multidimensional construct. This study aimed to investigate psychometric properties of three ER-measures: Difficulties in Emotion Regulation Scale (DERS-36), the abbreviated version DERS-16, and Emotion Regulation Questionnaire (ERQ).

METHODS

In a community sample (N = 843; 56% females) we investigated their internal consistency, factor structure, convergence, and association with symptoms of depression, anxiety, stress and substance abuse.

RESULTS

The proposed factor structures of the DERS-16 and the ERQ demonstrated an adequate fit. There were moderate correlations between the two DERS versions (36 and 16) and ERQ subscales Reappraisal and Suppression. Total scores of DERS-36 and DERS-16 demonstrated preferential associations with depression and anxiety. Corresponding associations between ERQ subscales and psychiatric symptoms were weak.

CONCLUSION

The results indicate that DERS-16 could be useful as an alternative, easily administered measure of ER difficulties.

Oxazepam and cognitive reappraisal: A randomised experiment

Background

Cognitive reappraisal is a strategy for emotional regulation, important in the context of anxiety disorders. It is not known whether anxiolytic effects of benzodiazepines affect cognitive reappraisal.

Aims

We aimed to investigate the effect of 25 mg oxazepam on cognitive reappraisal.

Methods

In a preliminary investigation, 33 healthy male volunteers were randomised to oxazepam or placebo, and then underwent an experiment where they were asked to use cognitive reappraisal to upregulate or downregulate their emotional response to images with negative or neutral emotional valence. We recorded unpleasantness ratings, skin conductance, superciliary corrugator muscle activity, and heart rate. Participants completed rating scales measuring empathy (Interpersonal Reactivity Index, IRI), anxiety (State-Trait Anxiety Inventory, STAI), alexithymia (Toronto Alexithymia Scale-20, TAS-20), and psychopathy (Psychopathy Personality Inventory-Revised, PPI-R).

Results

Upregulation to negative-valence images in the cognitive reappraisal task caused increased unpleasantness ratings, corrugator activity, and heart rate compared to downregulation. Upregulation to both negative- and neutral-valence images caused increased skin conductance responses. Oxazepam caused lower unpleasantness ratings to negative-valence stimuli, but did not interact with reappraisal instruction on any outcome. Self-rated trait empathy was associated with stronger responses to negative-valence stimuli, whereas self-rated psychopathic traits were associated with weaker responses to negative-valence stimuli.

Conclusions

While 25 mg oxazepam caused lower unpleasantness ratings in response to negative-valence images, we did not observe an effect of 25 mg oxazepam on cognitive reappraisal.

Early findings from periscope (Pan-European response to the impacts of COVID-19 and future pandemics and epidemics)

Abstract Body

The H2020/PERISCOPE project, including 32 partners from European universities & agencies, began 1st November 2020 and will last 36 months. The overarching objectives of PERISCOPE are to map and analyse the unintended impacts of the COVID-19 outbreak; develop solutions and guidance for policymakers and health authorities on how to mitigate the impact of the outbreak; enhance Europe’s preparedness for future similar events; and reflect on the future multi-level governance in the health as well as other domains affected by the outbreak. During this session we will report about early lessons learnt from the mapping and assessments of the impacts of the COVID-19 outbreak on mental health at national and subnational level in the EU with respect to individuals, communities and societies. Further, we will comment on their comparability. The aim is to explore differences between countries regarding the occurrence of mental ill health, and especially the impact on vulnerable groups, and how this is related to exposure to SARS-CoV-2, differences in policies over time, and effects on the economy. We will reflect on the short- and long-term consequences on mental health and health inequalities, report on the ongoing development of holistic policy guidelines for health authorities & other authorities, and from the analysis of multilevel governance, at local, regional and national level, memberstate – EU-level, and EU - global governance level. PERISCOPE will continue collecting data and updating a common data ”Atlas”, which would lead the consortium to engage in modelling and experiments to provide “continuous nowcasting” of the outbreak.

Disclosure

No significant relationships.

Emotion dysregulation across levels of substance use

Emotion dysregulation has shown to be of importance in the onset and maintenance of psychiatric disorders, including substance use disorders. How difficulties in emotion regulation differ across levels of substance use, and whether these relations are influenced by co-occurring psychiatric disorders, is less clear. This study aimed to identify difficulties in emotion regulation across the spectrum of substance use and evaluate the influence of co-occurring psychiatric symptoms. Self-reported emotion regulation difficulties, substance use, and other psychiatric symptoms were assessed in one community sample (n = 843) and two inpatient clinics, with substance use disorder populations (n = 415). Data were merged and analyzed with regression models and correlations. Emotion dysregulation was distributed across different levels of substance use, and significantly associated with substance use severity and frequency. High substance use severity and frequency was significantly associated with high scores on the emotion dysregulation facet specifically involving difficulties controlling impulsive behaviors. Psychiatric symptoms did not significantly influence the association between substance use and emotion dysregulation. Results indicate an association between emotion dysregulation and the frequency and severity of substance use, and also suggest that difficulties controlling impulsive behaviors may be a potentially useful treatment target for individuals with substance dependence.

Interrelations Among Biologically Relevant Personality Traits, Emotion Regulation Strategies, and Clinical Symptoms

Biologically relevant personality traits of weak inhibitory control (disinhibition) and threat sensitivity confer vulnerability to various clinical problems. Difficulties with emotion regulation have also been studied extensively in relation to risk for and maintenance of psychopathology. However, it remains unclear how emotion regulation strategies interface with dispositional vulnerabilities in affecting clinical symptomatology. The current study provided an initial examination of the roles of disinhibition, threat sensitivity, and use of key emotion regulation strategies (cognitive reappraisal, expressive suppression) in the occurrence of distress-related symptoms (i.e., depressivity, anxiousness, and borderline personality features). Analyses revealed that trait disinhibition and lowered use of cognitive reappraisal were related to each form of distress symptomatology, with the predictive relationship for disinhibition accounting entirely for that of reappraisal. This finding suggests that deficient top-down control capacity (i.e., disinhibition) is integral to failures in the use of an adaptive but cognitively demanding regulation strategy (i.e., reappraisal). By contrast, threat sensitivity was related both to anxiousness and use of expressive suppression, with the latter two variables unrelated to one another. Anxious individuals may avoid emotionally evocative situations, negating the downstream need to engage in the maladaptive strategy of expressive suppression. Despite certain study limitations (a cross-sectional, self-report design; modest sample size), the current study yielded evidence in line with study hypotheses, indicating a pivotal role for dispositional traits in associations between cognitive-behavioral processes and clinical problems.

Trends in childhood and adolescent internalizing symptoms: results from Swedish population based twin cohorts

Background

Previous research has noted trends of increasing internalizing problems (e.g., symptoms of depression and anxiety), particularly amongst adolescent girls. Cross-cohort comparisons using identical assessments of both anxiety and depression in youth are lacking, however.

Methods

In this large twin study, we examined trends in internalizing symptoms in samples of 9 year old children and 15 year old adolescents, gathered from successive birth cohorts from 1998 to 2008 (age 9) and 1994–2001 (age 15). Assessments at age 9 were parent-rated, and at age 15 self- and parent-rated. We examined (i) the relation between birth cohorts and internalizing symptoms using linear regressions, and (ii) whether percentages of participants exceeding scale cut-off scores changed over time, using Cochrane Armitage Trend Tests.

Results

Among 9 year old children, a significantly increasing percentage of participants (both boys and girls) had scores above cut-off on anxiety symptoms, but not on depressive symptoms. At age 15, a significantly increasing percentage of participants (both boys and girls) had scores above cut-off particularly on self-reported internalizing symptoms. On parent-reported internalizing symptoms, only girls demonstrated a corresponding trend.

Conclusion

In line with previous studies, we found small changes over sequential birth cohorts in frequencies of depression and anxiety symptoms in children. Further, these changes were not exclusive to girls.

Symptom shifting and associations with mental illness: A transdiagnostic approach applied to eating disorders

Diagnostic comorbidity is common among psychiatric patients. One approach to obtain an improved understanding of this phenomenon is to explore diagnostic transitions, across time. In the present study, we aim to take this methodology further within the specific context of eating disorders by investigating whether there are individuals who shift not only between different eating disorder symptoms, but also shift to deliberate self-harm and substance use over time, and relations of this to other indicators of mental illness. Retrospective longitudinal registry data from the Swedish Stepwise national quality assurance platform for eating disorders were analyzed, including self-report measurements and clinical assessments. Individuals (N = 3,159 adults) were selected for analysis based on available data at admission and 12 months postadmission, and grouped based on occurrence of a "symptom shift" (defined as a decrease in one symptom and increase in another over time). In this sample of patients, 422 (13%) demonstrated symptom shifting among eating disorder symptoms. As hypothesized, "symptom shifters" were more prone to engage in deliberate self-harm and shifted to both deliberate self-harm and substance use across time. They had higher reported levels of symptoms indicative of mental illness (e.g., anxiety and compulsivity) and more pronounced functional impairment (clinician rated and self-rated), compared to nonshifters. Taken together, this study demonstrates that a subgroup of individuals diagnosed with eating disorder(s) shift between distinct psychiatric symptoms across time, indicating that they may share a common vulnerability to engaging in problem behaviors and a need for a more comprehensive and individualized treatment plan. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

MyCompass in a Swedish context - lessons learned from the transfer of a self-guided intervention targeting mental health problems

BACKGROUND

Depression and anxiety is a major public health problem, in Sweden and internationally. Internet-based interventions are increasingly acknowledged as promising approaches for individuals with varying degrees of mental health problems. We present findings from the implementation of myCompass, a fully automated self-guided intervention of Australian origin, in a Swedish context.

METHODS

We (i) share our experience of the E-health study platform (i.e., regarding security aspects, functionality) to which the myCompass intervention was linked, and (ii) report findings from the empirical evaluation of myCompass (i.e., prerequisites, execution, study outcomes), in a community sample of individuals (N = 837) reporting mild-to-moderate levels of depression, anxiety and stress. Outcomes were calculated with repeated measures ANOVA and linear mixed models.

RESULTS

The E-health study platform proved to be an efficient tool enabling randomization, informed consent and evaluation to be administered in a fully automated manner. The study rendered substantial interest initially with 1207 individuals enrolling, however it failed to maintain engagement of those enrolled with only few participants logging in more than once or twice following registration. A smaller subgroup of "active users" (n = 35) had a markedly higher activity in the program, however their treatment results were not significantly better than those of the control group.

CONCLUSION

Based on the large number of dropouts and also modest use of the intervention overall, only tentative speculations can be made regarding its effectiveness in a Swedish context. The number of individuals remaining active in the intervention is much more limited that the number of individuals initially signing up. Moreover, the transportation of interventions across countries and cultures may need more careful consideration, and pilot-trials before attempting large-scale trials are recommended.

TRIAL REGISTRATION

MyCompass was retrospectively registered at ClinicalTrials.gov . NCT03659630 September 3rd 2018, and was given the protocol ID 2015/1268-31/2 + 2016/88.

Psychometric Properties of the Swedish Version of the Brief Repetitive Thinking Questionnaire (RTQ-10): An Internet-Based Study on Degrees of Affective Symptoms and Levels of Distress

INTRODUCTION

Repetitive negative thinking (RNT) is reported in a wide variety of emotional disorders, although it is most often associated with either depression or anxiety disorders, assessed as symptoms of rumination and worry. Early detection of indicators for RNT across disorders is needed. To this end we explored the psychometric properties of a transdiagnostic measure, i.e., the Swedish version of the brief Repetitive Thinking Questionnaire (RTQ-10), in adults (n = 674, age: 18 years or older).

METHODS

Participants completed an online battery of questionnaires measuring RNT, anxiety, depression and levels of positive and negative affect, satisfaction with life, metacognitive beliefs, and sick leave. Reliability and validity were evaluated with Cronbach's α, item and scale correlations, factor analysis (including multigroup analysis), and multiple linear regression analysis. Principal component analysis and exploratory factor analysis were first carried out to identify the number of latent factors. Confirmatory factor analysis was then used to assess the model fit of a single latent factor.

RESULTS

Analyses supported a single-factor solution. Results showed that the reliability was excellent. The single-factor model was robust, except across levels of distress that did not support scalar invariance. Negative metacognitive beliefs, negative affect, and anxiety were strong covariates demonstrating convergent validity. Negative and weaker correlations with life satisfaction, positive affect, and physical symptoms contributed to the discriminant validity.

CONCLUSION

This study showed that the instrument is robust in a population with various degrees of affective symptoms and distress. These results provide additional psychometric support for the RTQ-10 as a transdiagnostic measure. It can be administered online to assess RNT as a risk factor for emotional disorders.

Self- and informant perceptions of psychopathic traits in relation to the triarchic model

OBJECTIVE

The validity of self-report psychopathy measures may be undermined by characteristics thought to be defining features of the construct, including poor self-awareness, pathological lying, and impression management. The current study examined agreement between self- and informant perceptions of psychopathic traits captured by the triarchic model (Patrick, Fowler, & Krueger, 2009) and the extent to which psychopathic traits are associated with socially desirable responding.

METHOD

Participants were undergraduate roommate dyads (N = 174; M_age  = 18.9 years; 64.4% female; 59.8% Caucasian) who completed self- and informant reports of boldness, meanness, and disinhibition.

RESULTS

Self-reports of psychopathic traits reasonably aligned with the perceptions of informants (rs = .36-.60), and both predicted various types of antisocial behaviors, although some associations were only significant for monomethod correlations. Participants viewed by informants as more globally psychopathic did not engage in greater positive impression management. However, this response style significantly correlated with self- and informant-reported boldness, suppressing associations with antisocial behavior.

CONCLUSIONS

These findings suggest that participants are willing and able to disclose psychopathic personality traits in research settings under conditions of confidentiality. Nonetheless, accounting for response style is potentially useful when using self-report measures to examine the nature and correlates of psychopathic traits.

Examination of the Triarchic Assessment Procedure for Inconsistent Responding in six non-English language samples

The Triarchic Assessment Procedure for Inconsistent Responding (TAPIR; Mowle et al., 2016) was recently developed to identify inattentiveness or comprehension difficulties that may compromise the validity of responses on the Triarchic Psychopathy Measure (TriPM; Patrick, 2010). The TAPIR initially was constructed and cross-validated using exclusively English-speaking participants from the United States; however, research using the TriPM has been increasingly conducted internationally, with numerous foreign language translations of the measure emerging. The present study examined the cross-language utility of the TAPIR in German, Dutch, Swedish, and Italian translations of the TriPM using 6 archival samples of community members, university students, forensic psychiatric inpatients, forensic detainees, and adolescents residing outside the United States (combined N = 5,404). Findings suggest that the TAPIR effectively detects careless responding across these 4 translated versions of the TriPM without the need for language-specific modifications. The TAPIR total score meaningfully discriminated genuine participant responses from both fully and partially randomly generated data in every sample, and demonstrated further utility in detecting fixed "all true" or "all false" response patterns. In addition, TAPIR scores were reliably associated with inconsistent responding scores from another psychopathy inventory. Specificity for a range of tentative cut scores for assessing profile validity was modestly reduced among our samples relative to rates previously obtained with the English version of the TriPM; however, overall the TAPIR appears to demonstrate satisfactory cross-language generalizability. (PsycINFO Database Record

Effects of 25 mg oxazepam on emotional mimicry and empathy for pain: a randomized controlled experiment

Emotional mimicry and empathy are mechanisms underlying social interaction. Benzodiazepines have been proposed to inhibit empathy and promote antisocial behaviour. First, we aimed to investigate the effects of oxazepam on emotional mimicry and empathy for pain, and second, we aimed to investigate the association of personality traits to emotional mimicry and empathy. Participants (n=76) were randomized to 25 mg oxazepam or placebo. Emotional mimicry was examined using video clips with emotional expressions. Empathy was investigated by pain stimulating the participant and a confederate. We recorded self-rated experience, activity in major zygomatic and superciliary corrugator muscles, skin conductance, and heart rate. In the mimicry experiment, oxazepam inhibited corrugator activity. In the empathy experiment, oxazepam caused increased self-rated unpleasantness and skin conductance. However, oxazepam specifically inhibited neither emotional mimicry nor empathy for pain. Responses in both experiments were associated with self-rated empathic, psychopathic and alexithymic traits. The present results do not support a specific effect of 25 mg oxazepam on emotional mimicry or empathy.

Effects of 25 mg oxazepam on emotional mimicry and empathy for pain: a randomized controlled experiment

Emotional mimicry and empathy are mechanisms underlying social interaction. Benzodiazepines have been proposed to inhibit empathy and promote antisocial behaviour. First, we aimed to investigate the effects of oxazepam on emotional mimicry and empathy for pain, and second, we aimed to investigate the association of personality traits to emotional mimicry and empathy. Participants (n=76) were randomized to 25 mg oxazepam or placebo. Emotional mimicry was examined using video clips with emotional expressions. Empathy was investigated by pain stimulating the participant and a confederate. We recorded self-rated experience, activity in major zygomatic and superciliary corrugator muscles, skin conductance, and heart rate. In the mimicry experiment, oxazepam inhibited corrugator activity. In the empathy experiment, oxazepam caused increased self-rated unpleasantness and skin conductance. However, oxazepam specifically inhibited neither emotional mimicry nor empathy for pain. Responses in both experiments were associated with self-rated empathic, psychopathic and alexithymic traits. The present results do not support a specific effect of 25 mg oxazepam on emotional mimicry or empathy.

Effects of Mental Health and Neuroscience Evidence on Juror Perceptions of a Criminal Defendant: the Moderating Role of Political Orientation

Several recent studies have examined the effects of mental health and neuroscientific evidence on attitudes toward criminal defendants, suggesting that these factors may influence juror decision-making in meaningful ways. Few studies to date have manipulated both of these variables while also considering theoretically important individual difference variables (e.g., political orientation). Using a criminal case simulation, this study manipulated the presence of evidence concerning mental disorders (psychopathy and schizophrenia) and increasing levels of neuroscientific detail regarding a defendant's brain injury, and examined verdicts and sentencing recommendations in over 400 persons attending jury duty. Main effects were detected for mental health testimony and political orientation, although interactions were noted as well. More negative reactions to defendants labeled as psychopaths were relatively consistent, whereas participants who identified as liberal generally were less punitive towards a defendant identified as schizophrenic than were more conservative jurors. Consistent with other recent research, juror perceptions of the defendant's level of psychopathic traits (independent of the effects of the experimental manipulations) predicted guilty verdicts and longer sentencing recommendations. Copyright © 2016 John Wiley & Sons, Ltd.

Reliability and Construct Validity of the Psychopathic Personality Inventory-Revised in a Swedish Non-Criminal Sample - A Multimethod Approach including Psychophysiological Correlates of Empathy for Pain

Cross-cultural investigation of psychopathy measures is important for clarifying the nomological network surrounding the psychopathy construct. The Psychopathic Personality Inventory-Revised (PPI-R) is one of the most extensively researched self-report measures of psychopathic traits in adults. To date however, it has been examined primarily in North American criminal or student samples. To address this gap in the literature, we examined PPI-R's reliability, construct validity and factor structure in non-criminal individuals (N = 227) in Sweden, using a multimethod approach including psychophysiological correlates of empathy for pain. PPI-R construct validity was investigated in subgroups of participants by exploring its degree of overlap with (i) the Psychopathy Checklist: Screening Version (PCL:SV), (ii) self-rated empathy and behavioral and physiological responses in an experiment on empathy for pain, and (iii) additional self-report measures of alexithymia and trait anxiety. The PPI-R total score was significantly associated with PCL:SV total and factor scores. The PPI-R Coldheartedness scale demonstrated significant negative associations with all empathy subscales and with rated unpleasantness and skin conductance responses in the empathy experiment. The PPI-R higher order Self-Centered Impulsivity and Fearless Dominance dimensions were associated with trait anxiety in opposite directions (positively and negatively, respectively). Overall, the results demonstrated solid reliability (test-retest and internal consistency) and promising but somewhat mixed construct validity for the Swedish translation of the PPI-R.

Boldness and its relation to psychopathic personality: Prototypicality analyses among forensic mental health, criminal justice, and layperson raters

Research on psychopathic personality has been dominated by a focus on criminality and social deviance, but some theoretical models argue that certain putatively adaptive features are important components of this construct. In 3 samples (forensic mental health practitioners, probation officers and a layperson community sample), we investigated adaptive traits as conceptualized in the Triarchic model of psychopathy (Patrick et al., 2009), specifically the relevance of boldness to construals of psychopathic personality. Participants completed prototypicality ratings of psychopathic traits, including 3 items created to tap components of boldness (Socially bold, Adventurous, Emotionally stable), and they also rated a series of attitudinal statements (e.g., perceived correlates of being psychopathic, moral judgments about psychopaths). The composite Boldness scale was rated as moderately to highly prototypical among forensic mental health practitioners and probation officers and positively associated with other theoretically relevant domains of psychopathy. Across samples, higher composite Boldness ratings predicted greater endorsement of adaptive traits (e.g., social skills) as characteristic of psychopathy. For the individual items, Socially bold was rated as highly prototypical and was associated with theoretically relevant correlates. Adventurous also was seen as prototypical, though to a lesser degree. Only forensic mental health practitioners endorsed Emotionally stable as characteristic of psychopathy. Our results provide partial support for the contention that the boldness concept is viewed as an important component of psychopathy, particularly among professionals who work directly with offender populations. (PsycINFO Database Record

Urban air pollution, poverty, violence and health--Neurological and immunological aspects as mediating factors

Rapid rural-urban migration has created overcrowded areas characterized by concentrated poverty and increases in indoor and outdoor air pollutants. These "hotspots" constitute an increased risk of violence and disease outbreaks. We hypothesize that the effects of poverty and associated air pollution-related stress on impaired cognitive skills are mediated by inflammatory cytokines. A research framework is proposed, encompassing (i) an epidemiological investigation of associations between poverty, high concentrations of air pollutants, violence and health, (ii) a longitudinal follow-up of working memory capacities and inflammatory markers, and (iii) intervention programs aiming to strengthen employability and decreased exposures to toxic air pollutants.

How reliable are Psychopathy Checklist-Revised scores in Canadian criminal trials? A case law review

The Psychopathy Checklist-Revised (PCL-R; Hare, 2003) is a professional rating scale that enjoys widespread use in forensic and correctional settings, primarily as a tool to inform risk assessments in a variety of types of cases (e.g., parole determinations, sexually violent predator [SVP] civil commitment). Although widely described as "reliable and valid" in research reports, several recent field studies have suggested that PCL-R scores provided by examiners in forensic cases are significantly less reliable than the interrater reliability values reported in research studies. Most of these field studies, however, have had small samples and only examined SVP civil commitment cases. This study builds on existing research by examining the reliability of PCL-R scores provided by forensic examiners in a much more extensive sample of Canadian criminal cases. Using the LexisNexis database, we identified 102 cases in which at least 2 scores were reported (of 257 total PCL-R scores). The single-rater intraclass correlation coefficient (ICC(A1)) was .59, indicating that a large percentage of the variance in individual scores was attributable to some form of error. ICC values were somewhat higher for sexual offending cases (.66) than they were for nonsexual offending cases (.46), indicating that poor interrater reliability was not restricted specifically to the assessment of sexual offenders. These and earlier findings concerning field reliability in legal cases suggest that the standard error of measurement for PCL-R scores that are provided to the courts is likely to be much larger than the value of 2.90 reported in the instrument's manual.

Forensic mental health professionals' perceptions of psychopathy: a prototypicality analysis of the Comprehensive Assessment of Psychopathic Personality in Sweden

Assessments of psychopathic traits are used on a routine basis in forensic evaluations across Westernized countries. Despite this, consensus has not yet emerged concerning what exactly are the "core" features of this construct. Moreover, relatively little is known about how practitioners in the field construe this disorder. This study explored perceptions and attitudes regarding psychopathy among individuals working in the forensic mental health system (N = 90) in Sweden. Participants provided prototype ratings of what they considered to be core psychopathy features based on the Comprehensive Assessment of Psychopathic Personality (CAPP), a model that increasingly is the focus of research in North America and Europe. The study protocol also included questions regarding (a) global perceptions and attitudes about a number of aspects of the psychopathy construct (e.g., personal experience, perceived prevalence), and (b) attitudinal scales that assessed perceived correlates of psychopathic traits across a variety of domains (e.g., violence proneness, treatment amenability) and moral judgments and attitudes concerning how psychopathic offenders should be treated within the legal system. The majority of the 33 individual CAPP items and the six CAPP scales were rated as at least moderately prototypical of psychopathy, with Dominance, Self, and Attachment domains obtaining the highest mean ratings. Participants viewed psychopaths as more likely to commit crimes than the average criminal, without being blatantly "evil" people. We believe our results help to advance our understanding of the psychopathy construct by exploring forensic professionals' perceptions of this disorder in general and in relation to the CAPP model specifically.

Field reliability of the Psychopathy Checklist-Revised among life sentenced prisoners in Sweden

Although typically described as reliable and valid, the Psychopathy Checklist-Revised (PCL-R) has come under some criticism by researchers in the last half-decade due to evidence of poor interrater reliability and adversarial allegiance being reported in applied settings in North America. This study examines the field reliability of the PCL-R using a naturalistic test-retest design among a sample of Swedish life sentenced prisoners (N = 27) who had repeatedly been assessed as part of their application to receive a reduced prison term. The prisoners, who were assessed by a team of forensic evaluators retained by an independent government authority, had spent on average 14 years in prison with a mean time from Assessment 1 to Assessment 2 of 2.33 years. The overall reliability of the PCL-R (ICC(A1)) was .70 for the total score and .62 and .76 for Factor 1 and 2 scores, respectively. Facet 1-3 scores ranged from .54 to .60, whereas Facet 4 was much higher (.90). Reliability of individual items was quite variable, ranging from .23 to .80. In terms of potential causes of unreliability, both high and low PCL-R scores at the initial assessment tended to regress toward the mean at the time of the second evaluation. Our results are in line with previous research demonstrating concerns regarding the reliability of the PCL-R within judicial settings, even among independent evaluation teams not retained by a particular side in a case. Collectively, these findings question whether the interpersonal (Facet 1) and affective (Facet 2) features tapped by the PCL-R are reliable enough to justify their use in legal proceedings.