Pathways to PTSD, part II: Sexually abused children. (25/133)

OBJECTIVE: The goal of this research was to develop and test a prospective model of posttraumatic stress symptoms in sexually abused children that includes pretrauma, trauma, and disclosure-related pathways. METHOD: At time 1, several measures were used to assess pretrauma variables, trauma variables, and stress reactions upon disclosure for 156 sexually abused children ages 8 to 13 years. At the time 2 follow-up (7 to 36 months following the initial interview), the children were assessed for posttraumatic stress disorder (PTSD) symptoms. RESULTS: A path analysis involving a series of hierarchically nested ordinary least squares multiple regression analyses indicated three direct paths to PTSD symptoms: avoidant coping, anxiety/arousal, and dissociation, all measured during or immediately after disclosure of sexual abuse. Additionally, age and gender predicted avoidant coping, while life stress and age at abuse onset predicted symptoms of anxiety/arousal. Taken together, these pathways accounted for approximately 57% of the variance in PTSD symptoms. CONCLUSIONS: Symptoms measured at the time of disclosure constitute direct, independent pathways by which sexually abused children are likely to develop later PTSD symptoms. These findings speak to the importance of assessing children during the disclosure of abuse in order to identify those at greatest risk for later PTSD symptoms.  (+info)

The new research ethic: will oversight requirements sink forensic research? (26/133)

The conduct of research with human participants is facing increased scrutiny from government, media, and academic sources. Research oversight is consequently increasing dramatically as education and accreditation movements gain momentum. Institutional review boards themselves are undergoing significant changes in organization and accountability, implementing new tools to monitor investigator compliance. This article describes the causes of recent calls for increased scrutiny, the resultant trends in research oversight, and the general lack of preparation for increased costs in the public sector. These are costs that will be felt acutely in the forensic setting as diminishing state budgets affect hospitals, universities, and correctional institutions.  (+info)

Looking for pyromania: characteristics of a consecutive sample of Finnish male criminals with histories of recidivist fire-setting between 1973 and 1993. (27/133)

BACKGROUND: As pyromania is a rare diagnosis with questionable validity, we aimed to describe a forensic psychiatric population of arson recidivists. METHODS: The medical records as well as the forensic psychiatric examination statements of 90 arson recidivists referred for pretrial psychiatric assessment in Helsinki University Hospital Department of Forensic Psychiatry between 1973 and 1993 were reviewed. RESULTS: The most important diagnostic categories of arson recidivists were personality disorders, psychosis and mental retardation, often with comorbid alcoholism. In all, 68% of arsonists were under alcohol intoxication during the index crime. Psychotic as well as mentally retarded persons with repeated fire-setting behaviour were mostly "pure arsonists"--persons guilty only of arsons during their criminal careers. Arson recidivists with personality disorder, in contrast, often exhibited various types of criminal behaviour and arson appeared to be only one expression of a wide range of criminal activity. Comorbid alcoholism was apparently a more rarely observed phenomenon among pure arsonists than in "nonpure arsonists". We found only three subjects fulfilling the present diagnostic criteria for pyromania. CONCLUSION: Using the criteria of the DSM-IV-TR, pyromania must be regarded as an extremely rare phenomenon. Especially the question of substance intoxication as an exclusion criterion for pyromania should be reconsidered.  (+info)

Psychiatric aspects of homicide in Singapore: a five-year review (1997 - 2001). (28/133)

INTRODUCTION: The association between mental illness and violent offenders is an important issue not just for psychiatrists but for the public as well. Several studies have linked an increased prevalence of psychiatric illness among offenders of violent crimes. This study seeks to update the psychiatric community in Singapore on individuals charged with murder from 1997 to 2001, all of whom received a psychiatric assessment. METHODS: 110 individuals were charged with murder from 1997 to 2001. Socio-demographical data, psychiatric diagnoses, offence and victim profiles and court outcomes were obtained from prison records and psychiatric files. RESULTS: There were 110 individuals charged with murder between January 1, 1997 to December 31, 2001, with a total of 113 victims. In 70 of the cases, one offender killed one victim. Offenders were mostly unmarried males in the 20-39 year age group who received a secondary school level of education or less. 57 of the remandees were found not to suffer from any mental illness. Alcohol abuse and dependence disorders accounted for the largest diagnostic group. Depressive disorders accounted for 9.1 percent of the accused persons and schizophrenia, 6.4 percent. Victim profiles and court outcomes are also described. A comparison is drawn between this study and the last large report on homicides in Singapore, published in 1985. No difference is detected when the rates of schizophrenia and depression are compared between the two eras. CONCLUSION: Perpetrators of murder have been shown to have an increased incidence of psychiatric disorders. Reduction of the rate of homicide in the country may be achievable via the reduction of controllable factors found to be linked to the aetiology of murder. Alcohol and other illicit substance use are frequently found to be associated with homicide. The authorities are encouraged to enhance campaigns to dissuade alcohol abuse.  (+info)

Accuracy and utility of post-conviction polygraph testing of sex offenders. (29/133)

BACKGROUND: Polygraphy is used increasingly in the treatment and supervision of sex offenders, but little research has addressed its accuracy in this setting, or linked accuracy with utility. AIMS: To investigate the utility and accuracy of polygraphy in post-conviction testing of community-based sex offenders. METHOD: A self-report measure examined the experiences of offenders with polygraphy. RESULTS: Based on self-report, the polygraph's accuracy was approximately 85%. False negatives and false positives were not associated with demographic characteristics, personality variables or IQ. The majority of offenders found the polygraph to be helpful in both treatment and supervision. Nine percent of offenders claimed to have made false disclosures; these individuals had higher scores on ratings of neuroticism and lower scores on ratings of conscientiousness. CONCLUSIONS: These results support the view that the polygraph is both accurate and useful in the treatment and supervision of sex offenders.  (+info)

Fusion of mental health and incapacity legislation. (30/133)

The enactment of a single legislative scheme governing nonconsensual treatment of both 'physical' and 'mental' illnesses, based on incapacity principles, has been mooted in recent law reform debates in the UK. We propose a framework for such legislation and consider in more detail the provisions it should contain. The design of legislation that combines the strengths of both incapacity and civil commitment schemes can be readily imagined, based on the criteria for intervention in England and Wales found in the Mental Capacity Act 2005. Such legislation would reduce unjustified legal discrimination against mentally disordered persons and apply consistent ethical principles across medical law.  (+info)

Mental health needs of young offenders in custody and in the community. (31/133)

BACKGROUND: Research has revealed high levels of mental health needs in young offenders but many studies have been small, focusing on specific populations. AIMS: To evaluate the mental health and psychosocial needs of a nationally representative sample of juvenile offenders in England and Wales, including female offenders and those from Black and minority ethnic groups. METHOD: A cross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, was conducted in six geographically representative areas across England and Wales. Each young person was interviewed to obtain demographic information, mental health and social needs, and psychometric data. RESULTS: Young offenders were found to have high levels of needs in a number of different areas including mental health (31%), education/work (36%) and social relationships (48%). Young offenders in the community had significantly more needs than those in secure care and needs were often unmet. One in five young offenders was also identified as having a learning disability (IQ<70). CONCLUSIONS: Needs for young offenders were high but often unmet. This emphasises the importance of structured needs assessment within custody and community settings in conjunction with a care programme approach that improves continuity of care.  (+info)

Mental health provision for young offenders: service use and cost. (32/133)

BACKGROUND: The full costs of accommodating and supporting young people in the criminal justice system are unknown. There is also concern about the level of mental health needs among young offenders and the provision of appropriate mental health services. AIMS: To estimate the full cost of supporting young people in the criminal justice system in England and Wales and to examine the relationship between needs, service use and cost. METHOD: Cross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, conducted in six geographically representative areas of England and Wales. RESULTS: Mental health service use was low despite high levels of need, particularly in the community. Monthly costs were significantly higher among young people interviewed in secure facilities than in the community (pound 4645 v. pound 1863; P<0.001). Younger age and a depressed mood were associated with greater costs. CONCLUSIONS: Young people in the criminal justice system are a significant financial burden not only on that system but also on social services, health and education. The relationship between cost and depressed mood indicates a role for mental health services in supporting young offenders, particularly those in the community.  (+info)