Assessment of caring and its effects in young people: development of the Multidimensional Assessment of Caring Activities Checklist (MACA-YC18) and the Positive and Negative Assessment of Caring Outcomes (PANOC-YC20)
Year: 2009
Month: January
Author(s): Joseph, S, Becker, F, Becker, S and Regel, S
Child: Care Health and Development
Vol 35(4), 510-520
Referrals for expert psychiatric opinion on dangerous offenders: a survey of instructions regarding defendants liable on conviction to a statutory assessment of dangerousness.
Year: 2008
Month: September
Author(s): Bickle, A. and Stankard, P.
Medicine, Science and the Law
Vol 48(3), 211-216.
Audit of Statutory Urgent Treatment at a High Secure Hospital
Year: 2008
Month: May
Author(s): Bickle, A., Abdelrazek, T., Aboaja, A. and Page, K.
Journal of Mental Health Law
p. 66-74
Casenote: The Minister of Justice does have a responsibility to provide Offending Behaviour Programmes in Prison - submissions to the contrary are lacking in realism!
Year: 2008
Month: May
Author(s): Bickle, A.
Journal of Mental Law
p.101-107
Proposed Reforms to Partial Defences and Their Implications for Mentally Disordered Defendants
Year: 2008
Month: May
Author(s): Bickle, A.
Journal of Mental Health Law
p38-52
Careers in academic forensic psychiatry
Year: 2008
Month: January
Author(s): Gibbon, S, Duggan, C, Langley, M & Khalifa, N.
British Medical Journal Career Focus
336, 3-4.
Evaluation of screening in children referred for an ADHD assessment
Year: 2008
Month: January
Child and Adolescent Mental Health
13, 41-46
Tensions around inclusion: reframing the moral horizon
Year: 2008
Month: January
Journal Applied Research in Intellectual Disability
21, 81-94
Levels of anxiety and sources of stress in adults with autism
Year: 2007
Month: December
Journal of Intellectual Disabilities, 11(4), 359-370
Partial Defences to Murder Under Review
Year: 2007
Month: September
Author(s): Bickle, A.
Mental Health Review
12(3), p4-6.
Epidemiology of ADHD in the Community
Year: 2007
Month: July
British Journal of Hospital Medicine
68, 352-355
Measuring motivation for therapy and motivation for change in adult prisoners.
Year: 2007
Month: July
Author(s): McMurran M, Theodosi E, Sellen JL
Altered emotional decision-making in prisoners with borderline personality disorder.
Year: 2007
Month: June
Author(s): Kirkpatrick T, Joyce E, Milton J, Duggan C, Tyrer P, Rogers RD
A preliminary study of a measure of role-play competence in Psychodynamic Interpersonal Therapy
Year: 2007
Month: June
Author(s): Palmieri G, Margison F, Guthrie E, Moorey J, Hardy G, Evans C et al.
Neuroaffective processing in criminal psychopaths: Brain event-related potentials reveal task-specific anomalies.
Year: 2007
Month: June
Author(s): Howard RC, McCullagh P
Predictive validity of the PCL-R for offenders with intellectual disability in a high security hospital: treatment progress
Year: 2007
Month: June
Author(s): Catrin Morrissey, Paul Mooney, Todd Hogue, William Lindsay and John Taylor
Click here for paper [Adobe Acrobat PDF - 100.68 KB]
Prospects for a Cognitive-Developmental Account of Psychotic Experiences.
Year: 2007
Month: June
Author(s): Bentall RP, Fernyhough C, Morrison AP, Lewis S, Corcoran R.
Click here for link to abstract
The nursing gaze: power relations in a study of nurse-resident interactions in learning disability.
Year: 2007
Month: June
Author(s): Lau MH, Callaghan P, Twinn SF, Goodfellow B
The SESAMI evaluation of employment support in the UK: Background and baseline data.
Year: 2007
Month: June
Author(s): Sesami Research Team, Practice Partnership
Year: 2007 Month: May Author(s): Barnett JH, Croudace TJ, Jaycock S, Blackwell C, Hynes F, Sahakian BJ et al. Year: 2008 Month: May Author(s): Louise Braham, David Jones and Clive Hollin. International Journal of Forensic Mental Health Year: 2007 Month: April Author(s): Daffern M, Howells K Year: 2007 Month: April Author(s): Daffern M, Howells K, Ogloff J Year: 2007 Month: March Author(s): Bartlett, Peter 15, Medical Law Journal 86-98. Year: 2007 Month: March Author(s): Howard RC, Menkes D
Improvement and Decline of Cognitive Function in Schizophrenia Over one Year: a Longitudinal Investigation Using Latent Growth Modelling
The Violent Offender Treatment Programme (VOTP): development of a treatment programme for violent patients in a high security psychiatric hospital
Aggressive behaviour in high risk personality disordered inpatients during prison and on admission to hospital.
The interaction between individual characteristics and the function of aggression in forensic psychiatric inpatients.
A Matter of Necessity? Enforced treatment under the Mental Health Act
Keywords: mental health law; Haddock; psychopathic disorder; Mental Health Act 1983 s58; treatment for mental disorder, treatment without consent; psychiatry; Herczegfalvy, Wilkinson hearings,
Changes in brain function during acute cannabis intoxication. Preliminary findings suggest a mechanism for cannabis-induced violence.
Predictive validity of the PCL-R for offenders with intellectual disability in a high security hospital: Institutional aggression.
Year: 2007
Month: March
Author(s): Morrissey C, Mooney P, Hogue TE, Lindsay WR, Taylor JL
Enhanced Relapse Prevention for bipolar disorder - ERP trial. A cluster randomised controlled trial to assess the feasibility of training care coordinators to offer enhanced relapse prevention for bipolar disorder.
Year: 2007
Month: February
Author(s): Lobban F, Gamble C, Kinderman P, Taylor C, Chandler C, Tyler E et al.
Homeless mothers: Is there a relationship between coping strategies, mental health and goal achievement?
Year: 2007
Month: February
Author(s): Tischler V, Vostanis P
Predictive validity of the PCL-R in offenders with intellectual disability in a high secure hospital setting: institutional aggression
Year: 2007
Month: February
Author(s): Catrin Morrissey, Todd Hogue, Paul Mooney, Clare Allen, Susan Johnston, Clive Hollin, William Lindsay and John Taylor
Click here for paper [Adobe Acrobat PDF - 100.68 KB] - Upload
Prenatal alcohol exposure and gender differences in childhood mental health problems: a longitudinal population-based study
Year: 2007
Month: February
Pediatrics, 119, 426-434
QTc-interval abnormalities in a forensic population.
Year: 2007
Month: February
Author(s): Girgis S, Huckstep B, Oakley J, Ferriter M, Nicolau V
A clinical service for those with dangerous and severe personality disorder
Year: 2007
Month: January
Author(s): Hogue TE, Jones L, Talkes K, Tennant A
A comparison of adults with antisocial personality traits with and without conduct disorder.
Year: 2007
Month: January
Author(s): Perdikouri M, Rathbone G, Huband N, Duggan C
Alcohol consumption in pregnancy as a risk factor for later mental health problems
Year: 2007
Month: January
Evidence-Based Mental Health, 10, 98-100
A probabilistic cost effectiveness analysis of psychological therapies including dialetical behaviour therapy for borderline personality disorder.
Year: 2007
Month: January
Author(s): Holmes M, Brazier J, Tumur I, Ferriter M, Parry G, Dent-Brown K et al.
A Slovak adaption of CORE-OM (Clinical Outcomes in Routine Evaluation - Outcome Measure)
Year: 2007
Month: January
Author(s): Gampe K, Biescad M, Balunova L, Timul'ak L, Evans C
Assessment implications of "What Works" research for Dangerous and Severe Personality Disorder (DSPD) service evaluation.
Year: 2007
Month: January
Author(s): Langton C
Assessing the functions of aggression in psychiatric inpatients.
Year: 2007
Month: January
Author(s): Daffern M
A systematic review of the soteria paradigm for the treatment of people diagnosed with schizophrenia.
Year: 2007
Month: January
Author(s): Calton T, Ferriter M, Huband N, Spandler H.
Characteristics of offenders referred to a medium secure NHS personality disorder service: the first five years.
Year: 2007
Month: January
Author(s): Milton J, Duggan C, Costley=White A, Mason L
Computerised cognitive behaviour therapy for obsessive-compulsive disorder: A systematic review.
Year: 2007
Month: January
Author(s): Tumur I, Kaltenthaler E, Ferriter M, Beverley C, Parry G
Concluding comments [to the special issue, High Risk Offenders with Personality Disorders: Conceptual and Scientific Bases]
Year: 2007
Month: January
Author(s): Howells, Kevin
Psychology Crime and Law 13, 123-124
Costs occupational therapy in residential homes and its impact in service use.
Year: 2007
Month: January
Author(s): Schneider J, Duggan S, Cordingley L, Mozley CG, Hart C
Current perspectives on assessment and therapy with survivors of torture: the use of a cognitive behavioural approach
Year: 2007
Month: January
Author(s): Regel, S and Berliner, P
European Journal of Psychotherapy and Counselling
Vol 9(3), 289-299
Diazepam-induced disruption of classically-conditioned fear-potentation of late-latency auditory evoked potentials is prevented by flumazenil given before, but not after, CS-US pairing.
Year: 2007
Month: January
Author(s): Scaife JC, Hou RH, Samuels ER, Baqui F, Langley RW, Bradshaw CM et al.
Emotional and behavioural problems in offenders with intellectual disability: comparative data from three forensic services
Year: 2007
Month: January
Author(s): Hogue, T, Mooney, P, Morrissey, C et al
Journal of Intellectual Disability Research 51, 10, 778-785
Factor structure of personality disorder symptoms in offenders with intellectual disability
Year: 2007
Month: January
Author(s): Lindsay, WR et al
Journal of Intellectual and Developmental Disability 32, 2
Iatrogenic interventions with personality disordered offenders.
Year: 2007
Month: January
Author(s): Jones L
Introductory comments to the special issue [High Risk Offenders with Personality Disorders: Conceptual and Scientific Bases]
Year: 2007
Month: January
Author(s): Howells, K, Hogue, T and Langton, C
Psychology Crime and Law 13, 3-5
Managers' views on supported employment.
Year: 2007
Month: January
Author(s): Wistow R, Schneider J
Health & Social Care In The Community. 2007; 15 (2):128-35
Minor physical anomalies across ethnic groups in a first episode psychosis sample.
Year: 2007
Month: January
Author(s): Dean K, Dazzan P, Lloyd T, Morgan C, Morgan K, Doody GA et al.
Volume 89, Issues 1-3, Article no.9
Post Trauma Support in the Workplace: the current status and practice of critical incident stress management (CISM) and psychological debriefing (PD) within organisations in the United Kingdom
Year: 2007
Month: January
Author(s): Regel, S
Occupational Medicine
Vol 57, 411-416
Protocool for THREAD (THREshold for Antidepressants). Study: A randomised controlled trial to determine the clinical and cost-effectiveness of antidepressants plus supportive care alone, for mild to moderate depression in UK general practice.
Year: 2007
Month: January
Author(s): Chatwin JA, Kendrick TR, Morriss R
Psychological Debriefing in cross cultural contexts: Ten implications for practice
Year: 2007
Month: January
Author(s): Regel, S, Dyregrov, A and Joseph, S
International Journal of Emergency Mental Health
9(1), 37-45
Psychological therapies for borderline personality disorder. 10: S5-S6
Year: 2007
Month: January
Author(s): Brazier J, Tumur I, Holmes M, Ferriter M, Dent-Brown K, Paisley S et al
Click here for link to journal
Readiness for treatment in high risk offenders with personality disorders.
Year: 2007
Month: January
Author(s): Howells K, Day A
Rethinking clinical placements for mental health nursing students.
Year: 2007
Month: January
Author(s): Callaghan P, Cooper L, Gary R
Social problem-solving plus psychoeducation for adults with personality disorder: a pragmatic randomised controlled trial.
Year: 2007
Month: January
Author(s): Huband N, Duggan C, McMurran M, Evans C
The Care Home Activity Project: Does introducing an occupational therapy programme reduce depression in care homes?
Year: 2007
Month: January
Author(s): Mozley CG, Schneider J, Cordingley L, Molineux M, Dugan S, Hart C et al.
The contradictory attitudes of family practicioners towards patients with medically unexplained symptoms: implications for improving practice.
Year: 2007
Month: January
Author(s): Salmon P, Peters S, Rogers A, Gask L, Clifford R, Iredale W et al.
Journal of General Internal Medicine 2007; 22:565-71
The NICE Guidelines for the Management of PTSD in Adults and Children in Primary and Secondary Care - A Review
Year: 2007
Month: January
Author(s): Regel, S and Joseph, S
Counselling and Psychotherapy Research
7(2), 129-130
The predictive validity and practical utility of structured schemes used to assess risk for aggression in psychiatric inpatient settings.
Year: 2007
Month: January
Author(s): Daffern M
Volume 12, Issue 1
Aggression & Violent Behaviour archive
The relationships between personality disorders and social problem solving in adults.
Year: 2007
Month: January
Author(s): McMurran M, Duggan C, Christopher G, Huband N
Personality and Individual Differences 2007; 42 (1):145-55
The role of perspective taking in anger arousal.
Year: 2007
Month: January
Author(s): Mohr P, Howells K, Gerace A, Wharton M, Day A
Personality and Individual Differences 2007; 43:507-17
To move or not to move - that is the question! Some reflections on the transfer of patients in the face of uncertainty.
Year: 2007
Month: January
Author(s): Duggan C
What's the point? Towards a methodology for assessing the function of psychiatric inpatient aggression.
Year: 2007
Month: January
Author(s): Daffern M, Howells K, Ogloff JRP
(Volume 45, Issue 1, no.10)
Working with adults with personality disordered clients in the community: a multi-agency interview study.
Year: 2007
Month: January
Author(s): Huband N, Duggan C
Dissociating Neural Indices of Dynamic Cognitive Control in Advance Task-set Preparation: An ERP Study of Task Switching
Year: 2006
Month: December
Author(s): Astle DE, Jackson GM, Swainson R.
Click here for link to abstract
Beyond body, beyond words: cognitive analytic music therapy in forensic psychiatry - new approaches to the treatment of personality disordered offences.
Year: 2006
Month: December
Author(s): Compton Dickinson, Stella
Moderation of psychosocial risk factors through dysfunction of the hypothalamic-pituitary-adrenal stress axis in the onset of chronic widespread musculoskeletal pain: Findings of a population-based prospective cohort study.
Year: 2006
Month: December
Author(s): McBeth J, Silman AJ, Gupta A, Chiu YH, Ray D, Morriss R et al.
The relationships among insight, social support and depression in psychosis.
Year: 2006
Month: December
Author(s): Kaiser SL, Snyder J, Corcoran R, Drake RJ.
Killing Gay Men 1976-2001
Year: 2006
Month: November
Author(s): Bartlett, Peter
Published online by British Journal of Criminology
Keywords: homosexual panic; murder of gay men; homosexual advances; provocation; diminished responsibility; homosexuality and masculinity; homophobia and murder.
The role of psychological factors in predicting the onset of chronic widespread pain: results from a prospective population-based study.
Year: 2006
Month: November
Author(s): Gupta A, Silman AJ, Ray D, Morriss R, Dickens C, Macfarlane GJ et al.
Computerised cognitive behaviour therapy for depression and anxiety update: a systematic review and economic evaluation.
Year: 2006
Month: October
Author(s): Kaltenthaler E, Brazier J, De N, E., Tumur I Ferriter M, Beverley C et al.
Interventions for helping people recognise early signs of recurrence in bipolar disorder.
Year: 2006
Month: October
Author(s): Morriss R, Faizal M, Jones A, Williamson P, Bolton C, McCarthy J
The meaning of anger for Australian indigenous offenders: The significance of context.
Year: 2006
Month: October
Author(s): Day A, Davey L, Wanganeen R, Howells K, DeSantolo J, Nakata M
Click for abstract http://ijo.sagepub.com/cgi/content/abstract/50/5/520
Brief Psycho-Education for People with Personality Disorder - a Pilot Study.
Year: 2006
Month: September
Author(s): Bannerjee P, Duggan C, Huband N, Watson N.
Pain thresholds and tender points count as predictors of new chronic widespread pain in psychologically distressed subjects.
Year: 2006
Month: September
Author(s): Gupta A, McBeth J, MacFarlane GJ, Morriss R, Dickens C, Ray D et al.
Two studies on the prevalence and validity of personality disorder in three forensic intellectual disability samples.
Year: 2006
Month: September
Author(s): Lindsay WR, Hogue T, Taylor JL, Mooney P, Steptoe L, Johnston S et al.
Reasoning under uncertainty; heuristic judgements in patients with persecutory delusions or depression.
Year: 2006
Month: August
Author(s): Corcoran R, Cummins S, Rowse G, Moore R, Blackwood N, Howard RC et al.
Annotation: pathways to care for children with mental health problems
Year: 2006
Month: July
Journal of Child Psychology and Psychiatry, 47, 649-659
Barriers to the identification of children with Attention Deficit/Hyperactivity Disorder
Year: 2006
Month: July
Journal of Child Psychology and Psychiatry, 47, 744-750
Identification of children with ADHD: a school-based intervention.
Year: 2006
Month: July
Author(s): Sayal K, Hornsey H, Warren S, MacDiarmid F, Taylor E
Sure Start graduates: predictors of attainment on starting school.
Year: 2006
Month: July
Author(s): Schneider J, Ramsay A, Lowerson SA
Turning theory into practice; rationale, feasibility and external validity of an exploratory randomized controlled trial of training family practitioners in reattribution to manage patients with medically unexplained symptoms (MUST).
Year: 2006
Month: July
Author(s): Morriss R, Gask L, Dowrick C, Peters S, Salmon P, Hogg J
Evaluating STORM skills training for managing people at risk of suicide.
Year: 2006
Month: June
Author(s): Gask L, Dixon C, Morriss R, Appleby L, Green G
Impact of a multimedia intervention “Skinsafe” on patients' knowledge and protective behaviour
Year: 2006
Month: June
Author(s): Glazebrook CP, Garrud P, Avery AJ, Coupland CA, Williams HC
Preventive Medicine, Volume 42, Issue 6, Article no. 11
Staff gender ratio and aggression in a forensic psychiatric hospital.
Year: 2006
Month: June
Author(s): Daffern M, Mayer M, Martin T
The alcohol-related questionnaire.
Year: 2006
Month: June
Author(s): McMurran M, Egan V, Cusens B, Van den Bree M, Austin E, Charlesworth P
Comparison of pramipexole and amisulpride on alertness, autonomic and andocrine functions in healthy volunteers.
Year: 2006
Month: May
Author(s): Samuels ER, Hou RH, Langley RW, Szabadi E, Bradshaw CM
Misunderstanding the intentions of others: An exploratory study of the cognitive etiology of persecutory delusions in very late-onset schizophrenia-like psychosis.
Year: 2006
Month: May
Author(s): Moore R, Blackwood N, Corcoran R, Rowse G, Kinderman P, Bentall RP
A randomised controlled trial of an interactive educational computer package for children with asthma.
Year: 2006
Month: April
Author(s): McPherson A, Glazebrook CP, Forster BB, Smyth A
Effects of remorse and shame and criminal justice experience on judgements about a sex offender.
Year: 2006
Month: April
Author(s): Proeve M, Howells K
Evaluation of generic patient information: effects on health outcomes, knowledge and satisfaction.
Year: 2006
Month: April
Author(s): Sheard C, Garrud P
Patient Education and Counselling 2006; 61:43-7
Motivating convicted sex offenders into treatment: A pilot study.
Year: 2006
Month: September
Author(s): Theodosi E, McMurran M
Assessment and immediate management of people at risk of harming themselves.
Year: 2006
Month: August
Author(s): Gask L, Morriss R
Fatigue Intervention by Nurses Trial - the FINE Trial. A randomised controlled trial of nurse led self-help treatment for patients in primary care with chronic fatigue syndrome; study protocool [ISRCTN 74156610]
Year: 2006
Month: April
Author(s): Wearden AJ, Riste L, Dowrick C, Chew-Graham C, Bentall RP, Morriss R et al.
Personality across the ethnic divide in Singapore: Are "Chinese traits" uniquely Chinese?
Year: 2006
Month: April
Author(s): Cheung SF, Cheung, FM, Howard RC, Lim Y-H
(Volume 41, Issue 3)
A comparison of offenders with intellectual disability across three levels of security
Year: 2006
Month: March
Author(s): Hogue T, Steptoe L, Taylor JL, Lindsay WR, Mooney P, Pinkney L et al.
How is personality disorder linked to dangerousness? A putative role for early-onset alcohol abuse.
Year: 2006
Month: March
Author(s): Howard RC
Medical Hypotheses, 2006 Volume 67, Issue 4, 702-8
Psychosis revisited: taking a collaborative look at psychosis
Year: 2006
Month: March
Author(s): Houghton, P, Shaw, R, Hayward, M and West, S
Mental Health Practice, Vol 9(6), 40-43
Bayesian belief network for quality assessment: application to employment officer support.
Year: 2006
Month: February
Author(s): Wooff D, Schneider J
Controlled drinking goals for offenders.
Year: 2006
Month: February
Author(s): McMurran M
Service users and other stakeholders' evaluation of a liaison mental health service in an A&E department and a general hospital setting.
Year: 2006
Month: February
Author(s): Eales S, Callaghn P, Johnson B
Assertive outreach: policy and reality.
Year: 2006
Month: January
Author(s): Schneider J, Brandon T, Wooff D, Carpenter J, Paxton R
Affective determinants of treatment engagement in violent offenders.
Year: 2006
Month: January
Author(s): Howells K, Day A
Cognitive-behavioural therapy for severe and recurrent bipolar disorders. Randomised controlled trial.
Year: 2006
Month: January
Author(s): Scott J, Paykel E, Morriss R, Bentall Rp, Kinderman P, Johnston T et al.
Convergent validity of the CORE Measures with measures of depression for clients in cognitive therapy for depression.
Year: 2006
Month: January
Author(s): Cahill J, Barkham M, Stiles WB, Twigg E, Hardy GE, Rees A et al.
DSM-IV and dangerous and severe personality disorder - an essay
Year: 2006
Month: January
Social Science and Medicine, Vol 63(7), 1960-1971
Evidence that the Effect of 5-HT2 Receptor Stimulation on Temporal Differentiation is Not Mediated by Receptors in the Dorsal Striatum.
Year: 2006
Month: January
Author(s): Body S, Cheung THC, Bezzina G, Asgari K, Bradshaw CM, Glennon JC et al.
Homeless children and parents: short-term mental health outcome.
Year: 2006
Month: January
Author(s): Karim K, Tischler V, Gregory P, Vostanis P
Individual characteristics predisposing patients to aggression in a forensic psychiatric hospital.
Year: 2006
Month: January
Author(s): Daffern M, Howells K, Ogloff J, Lee J
Journal of Forensic Psychiatry and Psychology home page
Involving patients in schizophrenia research: The challenge of patient-centredness.
Year: 2006
Month: January
Author(s): Tischler V, Calton T, Cheetham A, D'Silva K, Goring M
Schizophrenia Research 2006a; Supp 81:285
Involving service-users in schizophrenia research: the challenge of patient-centredness.
Year: 2006
Month: January
Author(s): Tischler V, Calton T, Cheetham A, D'Silva K, Goring M
Acta Psychiatrica Scandinavica 2006b; 114:68
La valutazione routinaria degli esiti della psicoterapia: traduzione e validazione preliminare del sistema CORE (Clinical Outcome for Routine Evaluation)
Year: 2006
Month: January
Author(s): Palmieri G, Evans C, Freni S, Bajoni A, Chicherio M, Ferrari S et al.
nuove tendenze della psicologia 2006; 4 (3):371-86
Maternal self-esteem after successful treatment for fertility.
Year: 2006
Month: January
Author(s): Cox S, Glazebrook CP, Sheard C, Nduwke G, Oates MR
Fertility & Sterility Journal home page
Neural correlates of theory of mind and empathy: an fMRI study in a nonverbal task.
Year: 2006
Month: January
Author(s): Vollm B, Taylor A, Richardson P, Corcoran R, Stirling J, McKie S et al.
Neuroimage. 2006; 29:90-8
Self-management in mental health: questions for service providers and commissioners.
Year: 2006
Month: January
Author(s): Schneider J
Subsyndromal and syndromal symptoms in the longitudinal course of bipolar disorder.
Year: 2006
Month: January
Author(s): Paykel E, Scott J, Morriss R, Hayhurst H, Abbot R
Temporal reliability of psychological assessment for patients in a special hospital with severe personality disorder.
Year: 2006
Month: January
Author(s): Tyrer P, Cooper S, Seivewright H, Duggan C, Rao B, Hogue T
The effectiveness of dementia care mapping in intellectual disability residential services.
Year: 2006
Month: January
Author(s): Jaycock S, Persaud M, Johnson R
The Personal Concerns Inventory (Offender Adaption): Measuring and enhancing motivation to change.
Year: 2006
Month: January
Author(s): Sellen JL, McMurran M, Cox MW, Theodosi E, Klinger E
Tourette's Syndrome
Year: 2006
Month: January
Author(s): Jackson GM
Current Biology. 2006; 16 (12):443-4
Using a school based intervention to challenge stigmatising attitudes
Year: 2006
Month: January
Author(s): Vicky Essler, Anthony Arthur & Theo Stickley (Journal of Mental Health, 15(2), 243-250).
Click here for abstract [Adobe Acrobat PDF - 14.73 KB]
Who comes into therapeutic communities? A description of the characteristics of a sequential sample of client members admitted to 17 therapeutic communties.
Year: 2006
Month: January
Author(s): Lees J, Evans C, Freestone M, Manning N
Therapeutic Communities 2006; 27 (3):411-33
Applicability, Reliability and Validity of the Psychopathy Checklist-Revised in Offenders with Intellectual Disabilities: some initial findings
Year: 2005
Month: December
Author(s): Catrin Morrissey, Todd Hogue, Paul Mooney, William Lindsay, Lesley Steptoe, John Taylor and Susan Johnston
Click here for paper [Adobe Acrobat PDF - 131.52 KB]
Parental concerns about their child's emotions and behaviour and referral to specialist services: general population survey
Year: 2005
Month: December
British Medical Journal, 331, 1435-1436
The role of parental burden in child mental health service use: longitudinal study
Year: 2005
Month: November
Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1328-1333
Identification of children at risk of ADHD: a school-based intervention
Year: 2006
Month: October
Social Psychiatry and Psychiatric Epidemiology, 41, 806-813
The Test of Compulsion in Mental Health Law: capacity, therapeutic benefit and dangerousness as possible critieria
Year: 2005
Month: September
Author(s): Bartlett, Peter
Medical Law Review 326-352
Parent ratings of school behaviour in children at risk of Attention Deficit/Hyperactivity Disorder
Year: 2005
Month: June
Acta Psychiatrica Scandinavica, 111, 460-465
Capacity, Treatment and Human Rights
Year: 2005
Month: February
Author(s): Bartlett, Peter
Journal of Mental Health Law 326-352
Click here for full article [Adobe Acrobat PDF - 164.95 KB]
Keywords: Mental health law; treatment without
A cross-sectional snapshot of therapeutic community client members
Year: 2005
Month: January
Therapeutic Communities
Vol 26(3), pp295-314
A hermeneutic approach to research ethics
Year: 2005
Month: January
British Journal of Learning Disabilities
Applicability, reliability and validity of the Psychopathy Checklist - Revised in offenders with intellectual disabilities: some initial findings
Year: 2005
Month: January
Author(s): Morrissey, C, Hogue, T, Mooney, P, Lindsay, WR, Steptoe, L, Taylor, J & Johnson S
International Journal of Forensic Mental Health 4, 2, 207-220
A prospective evaluation of the Theory of Planned Behaviour (TPB) and the Transtheoretical Model of Change (TTM) on exercise in young people
Year: 2005
Month: January
Psychology and Health, 19, 29-30
Attitude to personality disorder among prison officers working in a dangerous and severe personality disorder among prison officers working in a dangerous and severe personality disorder unit
Year: 2006
Month: January
Author(s): Bowers, L, Carr-Walker, P, Allan, T, Callaghan, P, Nijman, H and Paton, J
International Journal of the Law and Psychiatry, 29: 333-342
Beyond ethical individualism
Year: 2005
Month: January
Journal of Intellectual Disability Research, 44(1), 1-11
Bullying and people with severe learning disabilities
Year: 2005
Month: January
Journal of Intellectual Disability Research, 45, 407-415
Challenging behaviour and insecure attachment
Year: 2005
Month: January
Journal of Intellectual Disability Research, 46(6), 503-506
Changes in attitudes to personality disorder on a DSPD unit
Year: 2005
Month: January
Criminal Behaviour and Mental Health
15(3), 171-183
Comparisons of psychotropic drug prescribing patterns in acute psychiatric wards across Europe
Year: 2005
Month: January
European Journal of Clinical Pharmacology, 60, 1, 29-35
Death, disability and dogma
Year: 2005
Month: January
Philosophy, Psychiatry, Psychology, 10, 67-79
Does the Therapeutic Community work?
Year: 2005
Month: January
Therapeutic Communities, Vol 26(4), pp385-396
English Mental Health Reform: lessons from Ontario?
Year: 2005
Month: January
Author(s): Bartlett, Peter
Journal of Mental Health Law 27-43
Exploring the meaning of trauma with adults with intellectual disabilities
Year: 2006
Month: January
Journal of Applied Research in Intellectual Disability
19, 131-142
Eye Movement Desensitization and Reprocessing (EMDR): An update
Year: 2005
Month: January
Author(s): Coetzee, R and Regel, S
Advances in Psychiatric Treatment
Vol 11, 347-354
Histories of trauma in client members of therapeutic communities.
Year: 2005
Month: January
Author(s): Freestone M, Lees J, Evans C, Manning N
2006; 27(3):387-409
Is Post-Traumatic Stress Disorder a helpful concept with intellectual disability?
Year: 2005
Month: January
Journal of Intellectual Disability Research
49, 552-559
Legal Madness in the Nineteenth Century
Year: 2005
Month: January
Author(s): Bartlett, Peter
Social History of Medicine 107-131
Living with uncertain knowledge and partial information
Year: 2005
Month: January
Philosophy, Psychiatry, Psychology, 10, 100-102
Madness and Asylums in Modern Europe
Year: 2005
Month: January
Author(s): Bartlett, Peter
Scribners Encyclopaedia of European Social History Vol III, 429-443
Mental Incapacity and Mental Health: the development of legal reform and the need for joined-up thinking
Year: 2005
Month: January
Author(s): Bartlett, Peter and McHale, Jean
Professionals' perceptions of interprofessional working in community mental health teams
Year: 2005
Month: January
Journal of Interprofessional Care, 19(4), 338-346
Psychiatric Treatment: in the absence of law?
Year: 2006
Month: January
Author(s): Bartlett, Peter
Medical Law Review 122-131
Link to the journal
Keywords: mental health law; B v Ashworth Hospital; treatment without consent; compulsory treatment; t
Severe learning disability and transition to adulthood
Year: 2005
Month: January
British Journal of Medical Psychology, 74, 151-166
Silence and Sodomy: the creation of homosexual identity in law
Year: 2005
Month: January
Author(s): Bartlett, Peter
Modern Law Review 61(1), 102-114
Click here for link to journal
Structures of Confinement in Nineteenth-Century Asylums, using England and Ontario as a comparative study
Year: 2005
Month: January
Author(s): Bartlett, Peter
International Journal of Law and Psychiatry 23(1), 1-13
Keywords: mental health law; asylums; civil confinement; detention; civil committal; Ontario; England; nineteenth century; poor law.
The origins and essence of US social policy: on taxonomies, time and transfers
Year: 2006
Month: January
Global Social Policy, Vol 6(2), 155-173
The Asylum, The Workhouse and the Voice of the Insane Poor in Nineteenth-Century England
Year: 2005
Month: January
Author(s): Bartlett, Peter
International Journal of Law and Psychiatry 21(3), 1-12
Keywords: mental health law; county asylums; nineteenth century; England; poor law; workhouses; history of psychiatry.
The course of substance use disorders in patients with borderline personality disorder and Axis II comparison subjects: a 10-year follow-up study
Year: 2010
Authors: Zanarini M C.; Frankenbur F R.; Weingeroff J L.; Reich D. B; Fitzmaurice G M.; Weiss, R D.
Addiction, Vol 106 No 2 pages 342-348
The purpose of this study is to detail the course of substance use disorders (SUDs) over 10 years of prospective follow-up among patients with borderline personality disorder (BPD) and Axis II comparison subjects. Design- This study uses data from the McLean Study of Adult Development (MSAD), a multi-faceted study of the longitudinal course of BPD using reliable repeated measures administered every 2 years over a decade of prospective follow-up. Setting- All subjects were initially in-patients at McLean Hospital in Belmont Massachusetts. Participants- A total of 290 patients with BPD and 72 Axis II comparison subjects were assessed at baseline and five waves of follow-up. Measurements- The Structured Clinical Interview for DSM-III-R Axis I Disorders (SCID-I), the Revised Diagnostic Interview for Borderlines (DIB-R) and the Diagnostic Interview for DSM-III-R Personality Disorders (DIPD-R) were administered six times. Generalized estimating equations were used to assess longitudinal prevalence of SUDs. Kaplan-Meier analyses were used to assess time-to-remission, recurrence and new onsets of SUDs. Results- The prevalence of SUDs among borderline patients and Axis II comparison subjects declined significantly over time, while remaining significantly more common among those with BPD. More than 90% of borderline patients meeting criteria for a SUD at baseline experienced a remission by 10-year follow-up. Recurrences and new onsets of SUDs were less common (35-40% and 21-23%). Conclusions- Remissions of alcohol and drug abuse/dependence among borderline patients are both common and relatively stable. Results also suggest that new onsets of these disorders are less common than might be expected.
Criminal thinking patterns, aggression styles, and the psychopathic traits of late high school bullies and bully-victims
Year: 2011
Authors: Ragatz L L, Anderson R J, Fremouw W and Schwartz R
Aggressive Behavior, Vol 37 No 2 pages 145-160
This study explored the current psychological characteristics and criminal behaviour history of individuals who retrospectively reported being bullies, bully-victims, victims, or controls (i.e. neither victims nor bullies) during their last 2 years of high school. College students (n = 960) completed measures of criminal thinking, aggression, psychopathy, and criminal behaviour online. We predicted bullies and bully-victims would demonstrate the highest scores for criminal thinking, proactive aggression, psychopathy, and have the most criminal infractions. Bullies and bully-victims had significantly higher scores on criminal thinking, aggression, psychopathy, and criminal behaviours than victims or controls. Additionally, men were significantly higher in criminal thinking, aggression, psychopathy, and had more criminal acts than women. There were no gender by bully group interactions. Logistic regression analyses differentiated bully-victims from bullies. Bully-victims tended to be male, higher in criminal thinking, and higher in reactive aggression. In addition, bully-victims were distinct from victims, showing higher criminal thinking and higher proactive aggression.
Psychopathic personality traits in relational aggression among young adults
Year: 2011
Authors: Czar K A, Dahlen E R, Bullock E E and Nicholson B C
Aggressive Behavior, Vol 37 No 2 pages 207-214
Psychopathy is a robust predictor of overt physical aggression that may also be relevant to relational aggression (RA). This study was conducted to investigate the utility of psychopathic personality traits in the prediction of RA in a sample of 291 college students. Hierarchical multiple regression analyses indicated that both primary and secondary psychopathic traits explained additional variance in general/peer and romantic RA beyond physical aggressiveness. Consistent with previous research, no gender differences were found on either form of RA, challenging the popular stereotype of RA as a female behavior. Moreover, psychopathic traits were not differentially predictive of RA by gender or level of physical aggressiveness. Implications of these findings for research and clinical practice are discussed.
The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV Axis I and all Axis II disorders.
Year: 2011
Authors: Kendler KS, Aggen SH, Knudsen GP, Røysamb E, Neale MC, Reichborn-Kjennerud T.
American Journal of Psychiatry, Vol 168 No 1 pages 29-39
OBJECTIVE: The authors sought to clarify the structure of the genetic and environmental risk factors for 22 DSM-IV disorders: 12 common axis I disorders and all 10 axis II disorders. METHOD: The authors examined syndromal and subsyndromal axis I diagnoses and five categories reflecting number of endorsed criteria for axis II disorders in 2,111 personally interviewed young adult members of the Norwegian Institute of Public Health Twin Panel. RESULTS: Four correlated genetic factors were identified: axis I internalizing, axis II internalizing, axis I externalizing, and axis II externalizing. Factors 1 and 2 and factors 3 and 4 were moderately correlated, supporting the importance of the internalizing-externalizing distinction. Five disorders had substantial loadings on two factors: borderline personality disorder (factors 3 and 4), somatoform disorder (factors 1 and 2), paranoid and dependent personality disorders (factors 2 and 4), and eating disorders (factors 1 and 4). Three correlated environmental factors were identified: axis II disorders, axis I internalizing disorders, and externalizing disorders versus anxiety disorders. CONCLUSIONS: Common axis I and II psychiatric disorders have a coherent underlying genetic structure that reflects two major dimensions: internalizing versus externalizing, and axis I versus axis II. The underlying structure of environmental influences is quite different. The organization of common psychiatric disorders into coherent groups results largely from genetic, not environmental, factors. These results should be interpreted in the context of unavoidable limitations of current statistical methods applied to this number of diagnostic categories.
Relationships between techniques and outcomes for borderline personality disorder.
Year: 2010
Authors: Goldman, G A; Gregory, R J
American Journal of Psychotherapy, Vol 64 No 4 pages 359-371
Although a number of psychotherapeutic modalities for borderline personality disorder (BPD) have empirical support, it is unclear what aspects of treatment are responsible for improvement. The present study analyzes the relationships between different techniques and outcomes in a randomized controlled trial of dynamic deconstructive psychotherapy (DDP)for comorbid BPD and alcohol-use disorders. Video recordings of psychotherapy sessions at 3-month intervals were rated to measure therapeutic alliance and the relative frequencies of specific treatment interventions. Outcomes included measures of borderline symptoms, depression, dissociation, social support, alcohol misuse, parasuicide, and institutional care. Discrete sets of techniques were associated with reliable changes in specific outcomes, indicating that treatments for BPD should be tailored to the specific constellation of symptoms presenting in a given individual. The study findings suggest that treatments with a specified set of techniques, such as DDP, dialectical behavior therapy, mentalization-based treatment, schema therapy, supportive therapies, and transference-focused psychotherapy, may be helpful for different individuals, depending on their particular set of symptoms.
Body dysmorphic traits and personality disorder patterns in rhinoplasty seekers
Year: 2010
Authors: Barahmand, U; Mozdsetan, N; Narimani, M.
Asian Journal of Psychiatry, Vol 3 No 4 pages 194-199
The purpose of the study was to examine symptoms of body dysmorphic concerns, mental health indices and certain specific personality disorder patterns in seekers of cosmetic rhinoplasty. A sample of 100 consecutive female patients scheduled for esthetic rhinoplasty was recruited for the study. Findings reveal body dysmorphic concerns in 22% of the sample, though individual traits are observed in 5–85% of the sample. Appearance evaluation, but not preoccupation with appearance, correlates with anxiety and depression. Furthermore, dissatisfaction with appearance and body parts decrease, while preoccupation with appearance increases after the surgical intervention. Positive appearance evaluations are associated with histrionic and narcissistic traits, while dissatisfaction with body parts correlates positively with obsessive–compulsive traits. Overall, results imply that body dysmorphic concerns are better conceived of either as an obsessive–compulsive spectrum disorder or as morbid manifestations of inflexible perfectionistic tendencies seen in obsessive–compulsive personality disorders.
In search of the psychopathic sexuality taxon: Indicator size does matter.
Year: 2011
Authors: Walters G D, Marcus D K, Edens J F, Knight R A, Sanford G M.
Behavioral Sciences & the Law, Vol 29 No 1 pages 23-39
Recent research has suggested that a qualitatively distinct subtype of psychopathic sex offender can be identified via taxometric analyses (Harris et al., 2007). In this study we attempted to replicate the hypothesized psychopathic sexuality taxon in a group of 503 male sexual offenders using data from the Psychopathy Checklist-Revised (PCL-R) and five coercive and precocious sexuality items. Ambiguous to dimensional results were obtained when, in a replication of the Harris et al. (2007) study, dichotomized indicators were analyzed with summed input maximum covariance (MAXCOV). Clearly dimensional results, however, were obtained when higher correlating and more valid quasi-continuous indicators were analyzed with traditional (input variables not summed) MAXCOV, and both dichotomous and quasi-continuous indicators were analyzed with mean above minus below a cut (MAMBAC) and latent-mode factor analysis (L-Mode). These results suggest that Harris et al. (2007) may have mistaken the random fluctuations of weakly correlating and poorly differentiating indicators for a taxon. Consistent with the vast majority of earlier research, our results suggest that psychopathy (with or without coercive and precocious sexuality) is a dimensional construct.
Comparison of different strategies to decrease negative affect and increase positive affect in women with borderline personality disorder
Year: 2011
Authors: Jacob G A, Arendt J, Kolley L, Scheel C N, Bader K, Lieb K, Arntz A, Tüscher O
Behaviour Research and Therapy, Vol 49 No 1 pages 68-73
In this study we compared the effect of different emotion regulation strategies on positive and negative emotions in patients with borderline personality disorder. Emotion regulation strategies were a distracting task, individual positive memory imagery, individual soothing imagery, and a neutral comparison condition. During two separate sessions, 17 participants watched either neutral or negative movie segments before using these strategies. All three strategies influenced emotions into a favorable direction as compared to the neutral comparison condition. The positive memory image increased positive emotions significantly stronger than counting colors and distracting. Different strategies seem to have similar effects in decreasing negative emotions. Positive emotions may be affected in particular by positive and soothing imagery techniques
Dealing with feelings: the effectiveness of cognitive behavioural group treatment for women in secure settings.
Year: 2011
Authors: Long C G, Fulton B, Dolley O & Hollin C R
Behavioural and Cognitive Psychotherapy, Vol 39 No 2 pages 243-247
Women in secure psychiatric settings have gender specific treatment needs. The current study examined the feasibility of a Dealing with Feelings Skills Group training for dual diagnosis women admitted to a medium secure setting. A pre-test – post-test design was used to evaluate a group programme adapted from dialectical behaviour therapy skills training. Most patients had a primary diagnosis of personality disorder. Treatment completers (n = 29) were compared with non-completers (n = 15). Clinically significant changes in treatment completers were apparent on coping response measures of positive reappraisal, problem solving and alternative rewards; on measures of anxiety and suicidality; on self-reported ability to engage in activities to reduce negative mood and to recognize mood changes. Self-harming and aggressive behaviours also reduced in the 3 months following group treatment. An adapted coping skills component of DBT benefit many dual diagnosis patients: issues related to treatment drop-out and failure to benefit are discussed.
Attention Deficit Hyperactivity Disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder.
Year: 2010
Month: December
Authors: Ginsberg Y, Hirvikoski T, Lindefors N
BMC Psychiatry, 10(1):112.
ADHD is a common and disabling disorder, with an increased risk for coexisting disorders, substance abuse and delinquency. In the present study, we aimed at exploring ADHD and criminality. We estimated the prevalence of ADHD among longer-term prison inmates, described symptoms and cognitive functioning, and compared findings with ADHD among psychiatric outpatients and healthy controls. At Norrtalje Prison, we approached 315 male inmates for screening of childhood ADHD by the Wender Utah Rating Scale (WURS-25) and for present ADHD by the Adult ADHD Self-Report Screener (ASRS-Screener). The response rate was 62%. Further, we assessed 34 inmates for ADHD and coexisting disorders. Finally, we compared findings with 20 adult males with ADHD, assessed at a psychiatric outpatient clinic and 18 healthy controls. The estimated prevalence of adult ADHD among longer-term inmates was 40%. Only 2 out of 30 prison inmates confirmed with ADHD had received a diagnosis of ADHD during childhood, despite most needed health services and educational support. All subjects reported lifetime substance use disorder (SUD) where amphetamine was the most common drug. Mood and anxiety disorders were present among half of subjects; autism spectrum disorder (ASD) among one fourth and psychopathy among one tenth. Personality disorders were common; almost all inmates presented conduct disorder (CD) before antisocial personality disorder (APD). Prison inmates reported more ADHD symptoms during both childhood and adulthood, compared with ADHD psychiatric outpatients. Further, analysis of executive functions after controlling for IQ showed both ADHD groups performed poorer than controls on working memory tests. Besides, on a continuous performance test, the ADHD prison group displayed poorer results compared with both other groups. This study suggested ADHD to be present among 40% of adult male longer-term prison inmates. Further, ADHD and coexisting disorders, such as SUD, ASD, personality disorders, mood- and anxiety disorders, severely affected prison inmates with ADHD. Besides, inmates showed poorer executive functions also when controlling for estimated IQ compared with ADHD among psychiatric outpatients and controls. Our findings imply the need for considering these severities when designing treatment programmes for prison inmates with ADHD.
Integrative multidisciplinary treatment in the public sector: a pilot study.
Year: 2010
Authors: Barber CR, Weinberg EF.
Bulletin of the Menninger Clinic, Vol 74 No 4 pages 263-82.
Integrative Multidisciplinary Treatment (IMT) emphasizes factors common to evidence-based treatments for borderline personality disorder (BPD) and is suitable for implementation in a public sector setting staffed by clinicians with diverse theoretical backgrounds. Preliminary results suggested decreases in psychiatric disturbance, depression, suicidality, hospitalizations, and emergency room visits, and increases in quality of relationships and quality of life. Results generalized across patients with and without BPD, with two exceptions: hospitalizations and suicidality.
The Problematic Object Representation Scales (PORS): A preliminary study to assess object relations in personality disorder through the AAI protocol
Year: 2010
Authors: Ribeiro L A; Target M; Chiesa M; Bateman A; Stein H and Fonagy P
Bulletin of the Menninger Clinic, Vol 74 No 4 pages 328-352
There has been an increasing interest in assessing object relations in individuals presenting with personality pathology. The present study describes the development of the Problematic Object Representation Scales (PORS), which were devised to assess dimensions of object representations through the Adult Attachment Interview protocol in an effort to integrate psychoanalytic and cognitive approaches. The results of this study have revealed that the PORS are able to distinguish patients with severe personality disorder both from patients with Axis I disorders and from healthy controls. Although the PORS have been shown to be a reliable and promising instrument, further validation of the scales is needed before they can become a valuable research tool for the assessment of object relations in personality pathology.
Screening items for personality disorders in older adults: A multi-center study of psychiatric inpatients and outpatients in the Netherlands.
Year: 2011
Authors: Tummers, J. H. A; Hoijtink, J. H. A; Penders, K. A. P; Derksen, J. L. L; van Alphen, S. P. J
Clinical Gerontologist: The Journal of Aging and Mental Health, Vol 34 No 1 pages 34-44
There is little to no information available regarding the utility of screening items for the identification of personality disorders in older adults. This study sought to identify the best screening items among a group of 33 items that were identified by experts as particularly useful. The items were presented to 309 older adults in a Dutch multi-center study of mental health care patients; 143 patients responded on two occasions. Two of the items proved to be most useful: "I like to be in control" and "I have sometimes said that I would like to put an end to my life." Together, these items correctly identified personality pathology at a rate of 65%: Administration on two occasions produced more than 70% correct prediction. Time-pressured clinicians may want to use these items as a brief screener; together they perform much better than chance at identifying personality pathology in older adults. Additional research is needed to more comprehensively demonstrate the reliability, predictive validity, and generalizability of these items.
The presentation of narcissistic personality disorder in an octogenarian: Converging evidence from multiple sources.
Year: 2011
Authors: Balsis, S; Eaton, N R; Cooper, L D; Oltmanns, T F
Clinical Gerontologist: The Journal of Aging and Mental Health, Vol 34 No 1 pages 71-87
Little is known about personality disorders (PDs) in later life. One reason for this dearth of knowledge is that many investigators believe that PDs soften with age. Recent anecdotal and empirical evidence, however, suggests that PDs are still very relevant in later life and may actually have unique presentations and consequences. The DSM-IV PD criteria seem to overlook these possibilities, perhaps because the personalities of older adults were not sufficiently understood when these criteria were written. But without age-appropriate criteria, clinicians and investigators who work with older adults may be
unable to measure PDs adequately in their clients and research participants. A starting point for better understanding these disorders in older adults is the presentation of rich, empirical, clinical descriptions of symptoms and related behaviors using data from multiple instruments and sources. To this end, we describe in depth a case of narcissistic PD (NPD) in a woman in her mid 80s. This case study reveals that NPD is indeed relevant in the context of later life and impairs functioning in significant ways.
Investigating the relationship between antisocial personality disorder and malingering.
Year: 2011
Authors: Pierson A, Rosenfeld B, Green D, Belfi B.
Criminal Justice and Behavior, Vol 38 No 2 pages 146-156
Forensic patients with antisocial personality disorder (APD) were compared to forensic patients without APD on a validated measure of malingering (Structured Interview of Reported Symptoms [SIRS]). Results indicated that patients with APD were not significantly more likely to exceed accepted cutoff scores on the SIRS (i.e., 17.9% vs. 11.6%, respectively), nor were they more likely to be suspected of malingering by clinicians (17.9% vs. 18.6%). Although there was a high level of disagreement between clinicians’ determination of malingering and classification by the SIRS, this relationship was not significant. Furthermore, patients with APD who were suspected by clinicians to be malingering were not more likely to be classified as responding genuinely using the SIRS. These findings challenge the recommendation issued by the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) that advises clinicians to be highly suspicious of malingering in the presence of APD.
DSM-5 borderline personality disorder: at the border between a dimensional and a categorical view
Year: 2011
Authors: Trull T J, Distel M A and Carpenter R W
Current Psychiatry Reports, Vol 13 No 1 pages 43-49
Recently, the DSM-5 Personality Disorders Workgroup offered its proposed revision for borderline personality disorder (BPD) and other personality disorder types (http://www.dsm5.org). According to the workgroup, this revision reflects an attempt to address excessive comorbidity among personality disorders, place personality pathology on continua, and replace individual behavioral criteria with personality traits. Essentially, the committee proposes a hybrid model of BPD (ie, categorical and dimensional)—one that combines the notion of a borderline “type” with supplemental dimensional ratings of relevant personality traits. In this article, we review recent findings on the dimensionality of BPD from phenotypic, genetic, and endophenotypic perspectives. Finally, we evaluate the current DSM-5 proposal for diagnosing BPD—one that ostensibly combines a categorical and dimensional perspective—in light of these findings.
Attachment and its vicissitudes in borderline personality disorder
Year: 2011
Authors: Levy, K. N. Beeney, J. E. Temes, C. M.
Current Psychiatry Reports, Vol 13 No 1 pages 50-59
This article reviews the recent literature on attachment and attachment-related constructs in borderline personality disorder, with attention given to how recent findings in this area may inform understanding of the mechanisms underlying the etiology, maintenance, and treatment of the disorder. Most findings on this topic have stemmed from three major areas of research, each of which is reviewed in this article: 1) developmental psychopathology studies; 2) experimental psychopathology studies, particularly those using a neuroscience approach; and 3) treatment studies that have examined variables relevant to attachment. Overall, these findings suggest that attachment and related constructs may factor greatly into the underlying psychopathology of borderline personality disorder and may significantly impact the process and outcome of psychotherapy for the disorder. These findings are discussed as they relate to existing theories and ongoing debates in the field, and the implications for future research and clinical practice are highlighted.
Common factors in empirically supported treatments of borderline personality disorder
Year: 2011
Authors: Weinberg I; Ronningstam E; Goldblatt M. J; Schechter M; Maltsberger J. T.
Current Psychiatry Reports, Vol 13 No 1 pages 60-68
In this article, we examine the manuals of empirically supported psychotherapies for borderline personality disorder (BPD) by comparing their common and specific treatment strategies. We compare these treatments using a previously constructed scale of treatment interventions. Individual psychotherapies for BPD have several common strategies: clear treatment framework, attention to affect, focus on treatment relationship, an active therapist, and exploratory and change-oriented interventions. Use of interpretations, supportive interventions, designating treatment targets, attention to patient functioning, multimodal treatment, and support for therapies varied across the psychotherapies. We discuss these findings in the context of clusters of BPD symptoms, reports regarding overlap in treatment interventions used by various psychotherapies, and the effectiveness of specific treatment strategies.
State of the art in the pharmacologic treatment of borderline personality disorder
Year: 2011
Authors: Feurino, L. Silk, K. R.
Current Psychiatry Reports, Vol 13 No 1 pages 69-75
This article reviews the most recent studies of the pharmacologic treatment of borderline personality disorder (BPD). Although research continues using randomized controlled trials with a placebo arm as well as active medication, meta-analyses and systematic reviews have revealed that the use of any specific medication or medication class in BPD remains at best uncertain and inconclusive. Studies indicate that the selective serotonin reuptake inhibitors have fallen out of favor, and researchers have turned their attention to the study of mood stabilizers and atypical antipsychotics. Thus, it is not surprising that trends in prescribing appear to be shifting toward the use of these two classes over the selective serotonin reuptake inhibitors; yet we remain without any medication that has a specific indication for treatment of BPD or an indication for any symptom that is seen as part of the BPD syndrome.
The associations between two facets of narcissism and eating disorder symptoms.
Year: 2010
Authors: Gordon KH, Dombeck JJ.
Eating Behaviors, Vol 11 No 4 pages 288-92.
The current study sought to examine the relationships between two facets of narcissism (vulnerable and grandiose) and eating disorder symptoms. Based upon previous research (Davis, Claridge, & Cerullo, 1997), it was predicted that the vulnerable narcissism facet would be more strongly associated with eating disorder symptoms because of the tendency for vulnerable narcissists to base their self-worth on their appearance (Zeigler-Hill, Clark, & Picard, 2008). The hypotheses were tested cross-sectionally in a sample of 355 male and female undergraduate students. Results generally conformed to prediction, in that vulnerable narcissism tended to be positively correlated with eating disorder symptoms, and this relationship was partially mediated by self-worth that is contingent upon physical appearance. Our findings are consistent with the notion that vulnerable narcissism is a risk factor for eating disorder symptoms because it is associated with a drive to improve self-worth through the enhancement of physical appearance.
Early retirement from work among employees with a diagnosis of personality disorder compared to anxiety and depressive disorders
Year: 2011
Authors: Korkeila J, Oksanen T, Virtanen M, Salo P, Nabi H, Pentti J, Vahtera J, Kivimäki M
European Psychiatry, Vol 26 No 1 pages 18-22
Risk of retirement from work before statutory retirement age among employees with personality disorders is unknown. We used diagnoses of awarded medical rehabilitations and hospitalisations to select two clinical cohorts from a population of 151,618 employees: participants in rehabilitation (total N = 1942, 233 personality disorder, 419 anxiety disorder and 1290 depression cases) and hospitalised patients (N = 1333, 354, 126 and 853, respectively). Early retirement from work was tracked through national registers during a period of 5 years. Cox proportional hazard models were used to examine the association of diagnostic groups with risk of early retirement. In models adjusted for age, sex and socioeconomic position, the relative risk of early retirement for patients with personality disorders was 3.5-fold (95% CI 2.1 to 5.8) in the rehabilitation cohort and 2.3-fold (95% CI 1.6 to 3.5) in the hospital cohort compared with anxiety disorders. The corresponding hazard ratios of early retirement for personality disorders compared with depressive disorders were 1.1 (95% CI 0.8–1.5) and 1.7 (95% CI 1.4–2.1), respectively. Personality disorders increase the risk of early retirement at least to an equal extent as depression and more than twice that of anxiety disorders.
Treatment of severe borderline personality disorder with clozapine.
Year: 2010
Author: Vohra AK
Indian Journal of Psychiatry, Vol 52 No 3 pages 267-9.
Patients with borderline personality disorder (BPD) show significant impairment in the domain of interpersonal and social functioning and may use the resources of health and social services extensively, with little beneficial outcome. At present there are no clear guidelines in literature for the use of pharmacotherapy in the management of BPD. According to the scanty literature available in the form of case reports and small studies, clozapine has been demonstrated to be effective in the management of BPD. The case presented here describes the effectiveness of clozapine in a young female patient with severe BPD (without psychotic features), who had repeated and prolonged periods of hospitalization and was successfully treated with a moderate dose of clozapine, following a failure to improve with other psychotropic medications. More studies are suggested to evaluate the efficacy of clozapine in patients with BPD, both
with and without psychotic features, to find out the optimum dose and to weigh the risk and benefits of clozapine.
Does having a dysfunctional personality hurt your career? Axis II personality disorders and labor market outcomes
Year: 2011
Authors: Ettner S L, Maclean J C and French M T
Industrial Relations, Vol 50 No 1 pages 149-173
Despite recent interest in how psychiatric disorders affect work outcomes, little is known about the role of personality disorders (PDs), which are poorly understood yet prevalent (15%) and impairing. We used nationally representative data for 12,457 men and 16,061 women to examine associations of PDs with any employment, full-time employment, chronic unemployment, being fired or laid off, and having trouble with a boss or co-worker. Antisocial, paranoid, and obsessive-compulsive PDs demonstrated the broadest patterns of associations with adverse outcomes. Findings suggest that PDs may have implications for the productivity of co-workers as well as that of the disordered employees themselves.
Narcissistic characteristics and eating-disordered behaviors.
Year: 2010
Authors: Campbell M, Waller G.
International Journal of Eating Disorders, Vol 43 No 6 pages 560-564
There is evidence that core narcissism and the narcissistic defenses have a role in the emotions and cognitions associated with the eating disorders. However, there is little understanding of its relationship with behaviors seen in this population. This study aimed to examine the relationship between narcissism
and eating-disordered behaviors (e.g., bingeing and purging). The participants, 110 women presenting with an eating disorder, completed measures of narcissism and eating disorder psychopathology. Associations were found between patients who engaged in excessive exercise and levels of narcissism. There were also dimensional associations between eating-disordered behaviors and specific aspects of narcissism. Clinical implications and limitations of the study are discussed, and future directions for research suggested.
Psychopathy, ADHD, and brain dysfunction as predictors of lifetime recidivism among sex offenders
Year: 2011
Authors: Langevin R and Curnoe S
International Journal of Offender Therapy & Comparative Criminology, Vol 55 No 1 pages 5-26
This study examines the best predictor of lifetime recidivism among Hare’s psychopathy scores (PCL-R), attention deficit hyperactivity disorder (ADHD) diagnosis, and brain dysfunction measures in a sample of 1,695 adult male sexual, violent, and nonviolent offenders. Results indicated that most variables were associated with significantly more frequent recidivism. The best predictor of overall recidivism was the PCL-R, but more specifically, it was its items on criminal history that were associated with recidivism. Sexual offense recidivism was predicted by the presence of learning disorders; however, all measures were poor predictors. General recidivism was primarily associated with past criminal history and secondarily with learning disorders and ADHD. Results suggest that ADHD and brain dysfunction with criminal history measures are the best predictors for addressing the problem of criminal recidivism.
Personality disorders predict relapse after remission from an episode of major depressive disorder: A 6-year prospective study
Year: 2010
Authors: Grilo C.M.; Stout R.L.; Markowitz J.C.; Sanislow C.A.; Ansell E.B.; Skodol A.E.;
Bender D.S.; Pinto A.; Shea M.T.; Yen S.; Gunderson J.G.; Morey L.C.; Hopwood C.J.; McGlashan T.H.
Journal of Clinical Psychiatry, Vol 71 No 12 pages 1629-1635
Objective: To examine prospectively the course of major depressive disorder (MDD) and to test for the moderating effects of personality disorder (PD) comorbidity on relapse after remission from an episode of MDD. Method: Participants were 303 patients (196 women and 107 men) with current DSM-IV-diagnosed MDD at baseline enrolment in the Collaborative Longitudinal Personality Disorders Study. Major depressive disorder and Axis I psychiatric disorders were assessed with the Structured Clinical Interview for DSM-IV, and Axis II PDs were assessed with the Diagnostic Interview for DSM-IV Personality Disorders. The course of MDD was assessed with the Longitudinal Interval Followup Evaluation at 6 and 12 months and then yearly through 6 years. Survival analyses were used to analyze time to remission and time to relapse. The study was conducted from July 1996 to June 2005. Results: Of 303 patients, 260 (86%) remitted from MDD; life table survival analyses revealed that patients with MDD who had PDs at baseline had significantly longer time to remission from MDD than patients without PDs. Among the 260 patients whose MDD remitted, 183 (70%) relapsed. Patients with MDD with PDs - specifically those with borderline and obsessive-compulsive PDs - at baseline had significantly shorter time to relapse than patients with MDD without PDs. Cox proportional hazards regression analyses revealed that the presence of PDs at baseline (hazard ratio = 1.5) and recurrent-type MDD (hazard ratio = 2.2), but not sex (hazard ratio = 1.03) or dysthymic disorder (hazard ratio = 0.97), significantly predicted time to relapse. Conclusions: Personality disorders at baseline were robust predictors prospectively of accelerated relapse after remission from an episode of MDD. Personality disorders at baseline significantly moderated eventual time to relapse in MDD among patients who remitted from an episode of MDD, even when controlling for other potential negative prognostic predictors.
An evaluation of a managed clinical network for personality disorder: breaking new ground or top dressing?
Year: 2010
Authors: Hogard, E; Ellis, R
Journal of Evaluation in Clinical Practice, Vol 16 No 6 pages 1147-1156
This article describes an evaluation of an innovative managed clinical network in the UK. The purpose of the network was to establish a better-coordinated service for those with personality disorder. The network was evaluated with regard to the extent it met its stated and implied outcomes; the process whereby it was established and operated; and the views of the various stakeholders involved. Managed clinical networks are briefly reviewed. Methods to gather evaluation data included documentary analysis, the use of specially devised tools to assess partnership, staff development needs and record keeping, and interviews. While the network had achieved its objectives to establish new operational structures and communication networks and staff showed a high level of commitment, it was unclear whether the network had maintained or improved the clinical service. Record keeping for assessment and clinical intervention was at an early stage and there was a need for more systematic use of assessment instruments and data management systems. The creation of a new category of staff – the Network coordinator – raised problems of delivery and staff development. On the basis of this evaluation and at this stage of one network's development it is concluded that the benefits of a managed clinical network remain theoretical rather than proven.
Personality disorders and criminal responsibility in the Spanish Supreme Court
Year: 2011
Authors: Mohíno, S et al
Journal of Forensic Sciences, Vol 56 No 1 pages 150-154
The aim of this study is to determine how personality disorders (PDs) are viewed in relation to criminal responsibility (CR) within the jurisprudence of the Spanish Supreme Court. All sentences with PD from 2000 to 2006 were included. The most frequently occurring PDs are cluster B and nonspecific disorders, alongside another Axis I disorder. The Spanish Supreme Court admitted appeals on 50%, and sentencing criteria were changed in 25% of the cases. The most frequent outcome was in the first instance a minor reduction in CR and second full CR being upheld. The borderline PD and the comorbidity between a PD and an Axis I disorder are the variables associated with the decrease in CR. The assessment of CR in PD should be undertaken using the diagnosis as a base taking into account other elements, such as the type of PD, its seriousness, comorbidity, and relationship with the criminal behaviour on trial.
The role of fantasy in a serial sexual offender: a brief review of the literature and a case report
Year: 2011
Atuthors: Carabellese, F et al
Journal of Forensic Sciences, Vol 56 No 1 pages 256-260
Extensive research has attempted to elucidate the role of fantasy in sexual offending. In this paper, the authors summarize the main results of the literature, especially the contents, themes, dynamics, etiopathogenesis, and potential functions of fantasy in sexual offending. Further, the authors analyze the case of a serial sexual offender who assaulted 39 women. The forensic-psychiatric assessment revealed that his fantasies of forced sex, sexual coercion, and dominance, which were linked to narcissistic personality organization and functioning, were the primary drive mechanism in his crimes, because he imagined himself in the role of the aggressor, identified with the power associated with the role of perpetrator, and was sexually aroused by such images of omnipotent control of the victim. In conclusions, the authors suggest that fantasies of sexual aggression, coercion, and dominance of women may stimulate grandiosity and omnipotence and, in a minority of cases, may lead to sexual offending.
Plasma homovanillic acid correlates inversely with history of childhood trauma in personality disordered and healthy control adults.
Year: 2010
Authors: Lee, R; Coccaro, E F
Journal of Neural Transmission, Vol 117 No 11 pages 1327-1334
Studies of the cerebrospinal fluid (CSF) level of the dopamine metabolite, homovanillic acid (HVA), suggest a relationship between CSF HVA concentration and history of childhood trauma. In this study, the authors test the hypothesis that this relationship is also present using peripheral levels of HVA in healthy volunteers and in personality disordered subjects. 68 personality disordered (PD) and healthy control (HC) subjects were chosen, in whom morning basal plasma HVA (pHVA) concentrations and an assessment of childhood trauma were obtained. History of childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). A significant inverse correlation was found between CTQ Total scores and pHVA concentration across all subjects. In addition, pHVA was lower, and CTQ scores were higher, in PD as compared with HC subjects. Correlations with other personality and behavioral measures were not statistically significant. The data suggest that pHVA concentrations are inversely correlated with history of childhood trauma and that variability in this index of dopamine function may be affected by the history of childhood trauma in healthy and personality disordered subjects.
Unprovoked aggression: effects of psychopathic traits and sadism
Year: 2011
Authors: Reidy D E, Zeichner A and Seibert L A
Journal of Personality, Vol 79 No 1 pages 75-100
Psychopathic individuals engage in the most violent and cold-blooded acts of aggression. In the laboratory, psychopathy traits have been linked to the commission of unprovoked aggression. The purpose of this study was to assess affective motives that may underlie the relationship between psychopathy and unprovoked aggression. One hundred thirty-seven men viewed a series of photographs depicting violent imagery, completed a lexical decision task designed to assess state affect, and competed in a laboratory-based aggression paradigm. Results indicated that participants who responded faster to happiness words after viewing violent imagery (i.e., sadistic) were significantly more likely to engage in unprovoked aggression. Additionally, Factor 1 psychopathy (emotional detachment) predicted increased probability of unprovoked aggression; however, this relationship was not mediated by sadism. Rather, Factor 1 and sadism each independently predicted unprovoked aggression. The implications of the present data suggest that the type of violence evinced may inform the risk for perpetration of future acts. That is, the individual who demonstrates unprovoked violence may be more likely to employ aggressive tactics across situational contexts than the individual who demonstrates only impulsive acts of hostile/reactive aggression.
The Five-Factor Model of personality at the facet level: association with antisocial personality disorder symptoms and prediction of antisocial behavior
Year: 2010
Authors: Corff, Y; Toupin, J
Journal of Psychopathology and Behavioral Assessment, Vol 32 No 4 pages 586-594
The association between the Five-Factor Model of personality (FFM) and antisocial personality disorder (APD) symptoms was investigated in a sample of young males with a history of severe antisocial behaviour. Results were compared against those of an expert-consensus study (Lynam and Widiger Journal of Abnormal Psychology 110:401-412, 2001) and those of a recent meta-analysis (Samuel and Widiger Clinical Psychology Review 28:1326-1342, 2008) based primarily on non-antisocial samples. A high degree of similarity was observed across the three. Multivariate analysis indicated two FFM facets, Compliance and Activity, to be associated with APD symptoms. The contribution of these facets to the prospective prediction of antisocial behaviour over and above that of APD symptoms and past antisocial behaviour was evaluated. Compliance alone explained 8.7% of the unique variance in future antisocial behaviour.
Borderline personality disorder
Year: 2011
Authors: Leichsenring F, Leibing E, Kruse J, New A S, Leweke F
The Lancet, Vol 377 No 9759 pages 74-84
Recent research findings have contributed to an improved understanding and treatment of borderline personality disorder. This disorder is characterised by severe functional impairments, a high risk of suicide, a negative effect on the course of depressive disorders, extensive use of treatment, and high costs to society. The course of this disorder is less stable than expected for personality disorders. The causes are not yet clear, but genetic factors and adverse life events seem to interact to lead to the disorder. Neurobiological research suggests that abnormalities in the frontolimbic networks are associated with many of the symptoms. Data for the effectiveness of pharmacotherapy vary and evidence is not yet robust. Specific forms of psychotherapy seem to be beneficial for at least some of the problems frequently reported in patients with borderline personality disorder. At present, there is no evidence to suggest that one specific form of psychotherapy is more effective than another. Further research is needed on the diagnosis, neurobiology, and treatment of borderline personality disorder.
Sex differences in orbitofrontal gray as a partial explanation for sex differences in antisocial personality
Year: 2011
Authors: Raine A, Yang Y, Narr K L and Toga A W
Molecular Psychiatry, Volume 16 Issue 2 pages 227-236
Attention is increasingly being given to understanding sex difference in psychopathology to better understand the etiology of disorders. This study tests the hypothesis that sex differences in ventral and middle frontal gray volume contribute to sex differences in antisocial personality disorder (APD) and crime. Participants were recruited from temporary employment agencies, consisting of normal controls, substance/alcohol-dependent controls, axis I/II psychiatric controls and individuals with APD. An independent sample of female volunteers was also recruited. Magnetic resonance imaging volumes of superior frontal, middle frontal, inferior frontal, orbital frontal and rectal gyral frontal gray matter, and dimensional scores of APD and criminal behavior were assessed. APD males when compared with male controls showed an 8.7% reduction in orbitofrontal gray volume, a 17.3% reduction in middle frontal gray and a 16.1% reduction in right rectal gray. Reduced middle and orbitofrontal volumes were significantly associated with increased APD symptoms and criminal offending in both males and females. Males as a whole had reduced orbitofrontal and middle frontal gray volume when compared with females, and controlling for these brain differences reduced the gender difference in the antisocial personality/behavior by 77.3%. Findings were not a function of psychiatric comorbidity, psychosocial risk factors, head injury or trauma exposure. Findings implicate structural differences in the ventral and middle frontal gray as both a risk factor for APD and as a partial explanation for sex differences in APD.
The prosocial psychopath: explaining the paradoxes of the creative personality.
Year: 2010
Author: Galang AJ.
Neuroscience & Biobehavioral Reviews, Vol 34 No 8 pages 1241-8.
The literature on the creative personality is curiously equivocal in its characterization of the traits supposedly possessed by eminent creators. While acclaimed as revolutionary and pioneering visionaries, the same category of people can come across as unsocialized and discomfiting even to their close associates and admirers. This paper suggests that these ambiguities can be addressed by appealing to the potential psychobiological mechanisms that can give rise to the expression of both creative ability and "antisocial" traits. Work on latent inhibition, the somatic marker hypothesis, Eysenck's biosocial theory of crime and the dopamine hypothesis of addiction are reviewed and integrated into a model that examines the role of dopamine as a critical agent in the creative personality system. Finally, testable hypotheses stemming from the model are proposed.
A novel balanced chromosomal translocation found in subjects with schizophrenia and schizotypal personality disorder: Altered l-serine level associated with disruption of PSAT1 gene expression
Year: 2011
Authors: Ozeki, Y; Pickard, B. S; Kano, S.-I; Malloy, M. P; Zeledon, M; Sun, D. Q; Fujii, K; Wakui, K; Shirayama, Y; Fukushima, Y; Kunugi, H; Hashimoto, K; Muir, W. J; Blackwood, D. H; Sawa, A.
Neuroscience Research, Vol 69 No 2 pages 154-160
L-Serine is required for the synthesis of glycine and D-serine, both of which are NMDA receptor co-agonists. Although roles for D-serine and glycine have been suggested in schizophrenia, little is known about the role of the L-serine synthesizing cascade in schizophrenia or related psychiatric conditions. Here we report a patient with schizophrenia carrying a balanced chromosomal translocation with the breakpoints localized to 3q13.12 and 9q21.2. We examined this proband and her son with schizotypal personality disorder for chromosomal abnormalities, molecular expression profiles, and serum amino acids. Marked decrease of L-serine and glutamate was observed in the sera of the patient and her son, compared with those in normal controls. Interestingly, expression of PSAT1 gene, which is located next to the breakpoint and encodes one of the enzymes in the L-serine synthesizing cascade, was reduced in both patient and her son. Direct effect of impaired PSAT1 gene expression on decreased serum L-serine level was strongly implicated by rat astrocyte experiments. In summary, we propose an idea that PSAT1 may be implicated in altered serine metabolism and schizophrenia spectrum conditions.
Sex differences in the dark side traits
Year: 2011
Authors: Furnham A, Trickey G
Personality and Individual Differences, Vol 50 No 4 pages 517-522
Over 18,366 British adults completed the Hogan Development Survey, which is a measure derived from the personality disorders framework and designed to identify personality-based performance risks and derailers of interpersonal behaviour. Overall the highest scores were for Obsessive–Compulsive (Diligent/Perfectionist), Histrionic (Vivacious/Dramatic) and Dependent (Dutiful) and lowest for Borderline (Enthusiastic/Excitable), Avoidant (Careful/Cautious) and Schizoid (Independent/Detached). DSM-IV-TR (American Psychiatric Association, 2000) suggests that there would be sex differences in many disorders particularly Narcissistic, Anti-Social, Schizotypal and Obsessive–Compulsive. Results revealed sex differences on most disorders particularly Avoidant, Schizoid and Anti-Social with males scoring higher on the latter two. Females scored higher on Borderline, Avoidant, Passive–Aggressive, Obsessive Compulsive and Dependent. The smallest sex differences were found for Paranoid, Obsessive–Compulsive, Schizotypal, Passive–Aggressive and Histrionic disorders. Implications of the research are considered.
An exploratory analysis of the NEO-FFI and DSM personality disorders using multivariate canonical correlation.
Year: 2011
Authors: Aboaja A, Duggan C, Park B
Personality and Mental Health, Vol 5 No 1 pages 1-11
It has been argued that some of the difficulties in the Diagnostic and Statistical Manual of Mental Disorders (DSM) personality disorders might be overcome by examining their association with measures of general personality such as the Neuroticism, Extroversion and other Five-Factor Inventory (NEO-FFI) model. The study explored associations between the NEO-FFI and DSM personality disorder in 85 male offenders referred to a personality disorder unit. Although simple correlation showed the expected associations, multivariate canonical correlation revealed more complex and novel associations such as the finding that borderline personality disorder has a more robust conceptual relationship than antisocial personality disorder with the NEO-FFI. Overall, the NEO-FFI can be used to conceptualize most DSM personality disorders
Clinicians' use of personality disorder models within a particular treatment setting: A longitudinal comparison of temporal consistency and clinical utility.
Year: 2011
Authors: Samuel D B, Widiger T A
Personality and Mental Health, Vol 5 No 1 pages 12-28
An active line of current investigation is how the five-factor model (FFM) of personality disorder might be applied by clinicians and particularly, how clinically useful this model is in comparison to the existing nomenclature. The current study is the first to investigate the temporal consistency of clinicians' application of the FFM and the DSM-IV-TR to their own patients. Results indicated that FFM ratings were relatively stable over 6 months of treatment, supporting their use by clinicians, but also indexed potentially important clinical changes. Additionally, ratings of utility provided by the clinicians suggested that the FFM was more useful for clinical decision-making than was the DSM-IV-TR model. We understand the clinical utility findings within the context of previous research indicating that the FFM is most useful among patients who are not prototypic for a personality disorder.
Testing the biosocial model of borderline personality disorder: Results of a prospective 5-year longitudinal study.
Year: 2011
Authors: Arens E A, Grabe H-J, Spitzer C, Barnow B
Personality and Mental Health, Vol 5 No 1 pages 29-42
Since its initial formulation, the biosocial theory of borderline personality disorder (BPD) still lacks robust empirical evidence, given there are no prospective longitudinal studies testing the main assumptions of the model. The current study examined longitudinally whether temperamental traits harm avoidance (HA) and novelty seeking (NS), internalizing and externalizing disorders, trauma and perceived invalidating parenting style, as measured during adolescence, contributed to the risk of BPD, diagnosed on the basis of standardized clinical interviews 5 years later. Individuals with BPD (n= 17) from a community sample of 416 young adults were compared to individuals with depressive disorders (n= 17) and psychiatrically healthy subjects (n= 34). Results indicated that adolescent internalizing disorders as well as the interaction of HA and perceived maternal overprotection predicted the risk of BPD 5 years later. NS was not shown to be a predisposing vulnerability. Results are interpreted as confirmation of the biosocial model. Gender-specific etiological differences are discussed.
Non-expert's theories of three major personality disorders.
Year: 2011
Authors: Furnham A, Kirkby V, Mcclelland A
Personality and Mental Health, Vol 5 No 1 pages 43-56
Background The aims of this study were to assess lay people’s ability to recognize personality disorders as
psychological ‘illnesses’ and to establish their beliefs concerning causes and treatment of each disorder.
Methods Two hundred fourteen participants answered a questionnaire, consisting of three case vignettes
describing paranoid, narcissistic and obsessive–compulsive personality disorders, according to DSM-IV-TR,
each followed by 20 attitudinal statements concerning aetiology and treatment.
Results Narcissistic personality disorder was the disorder least recognized as a psychological ‘illness’. Overall, psychological causes and treatments were given more prominence than biological ones. Results suggest that personal experience of mental health problems (whether theoretical or practical) seems to improve ‘illness’ recognition.
Conclusion To the extent that personality disorders were recognized as psychological ‘illnesses’, recognition
was increased if the personality disorder was related to a similar Axis I disorder. Experience of mental health
problems and knowledge of psychology or psychiatry improves ‘illness’ recognition, although not for every
personality disorder. Psychological causes were endorsed more strongly than biological causes for all disorders— but again, the extent to which a disorder was thought to have a psychological rather than biological cause varied as a function of the disorder. A similar pattern was observed for treatment preferences.
The home for histrionism.
Year: 2011
Authors: Gore W L, Tomiatti M, Widiger T A
Personality and Mental Health, Vol 5 No 1 pages 57-72
One of the official proposals for the fifth edition of the American Psychiatric Association's diagnostic manual (DSM-5) is to provide a dimensional model in which 37 traits are included within six broad domains. One of the more important traits within this model is ‘histrionism’ because another proposal for DSM-5 is to delete the histrionic diagnostic category. The only way to recover histrionic traits in DSM-5 will be through the dimensional model. Histrionism, though, is included within the domain of antagonism of this dimensional model, despite the fact that previous research has consistently placed histrionic personality disorder within extraversion. The current study tests empirically whether histrionic personality traits are optimally placed within the domain of extraversion or antagonism through tests involving seven alternative measures of histrionic personality disorder, five scales to assess the DSM-5 components of histrionism, 10 measures of various histrionic personality traits and two alternative measures of extraversion. The results of the study provide support for placing histrionism within antagonism and clarify the inconsistency of the DSM-5 placement with the existing research, but also indicate that a more complete and accurate understanding of histrionism would include extraversion. The implications of the findings for DSM-5 and future research are discussed.
Mentalization-inspired case formulation: Minding the difficult patient.
Year: 2011
Authors: Simonsen S, Nørgaard N L, Larsen K A, Bjørnholm K I
Personality and Mental Health, Vol 5 No 1 pages 73-79
We present a case describing a patient with borderline personality disorder (BPD) and comorbid antisocial personality disorder (ASPD). We want to focus on the question of how to optimize the process and contents of such a case formulation in order to best support mentalizing processes in both patient and therapist. After a brief presentation of Ms X, we will present some of the main points of the case formulation and her immediate responses at the time of presentation. In the Discussion section, we will provide a theoretically
based understanding of the problems encountered and make some suggestions about how therapists may adapt case formulations to complex cases such as Ms X. In the final section, we will sum up the major questions illustrated by the case and hope that the commentators will use these questions as a starting point for sharing their knowledge on the matter.
The commentaries on this article are
Finn Skårderud. Two minds in the text: A commentary to Sebastian Simonsen, Nana Lund Nørgaard, Kirsten Aaskov Larsen and Kraka Ingeborg Bjørnholm Personality and Mental Health, Volume 5, Number 1 (February 2011), pp. 80-84
Anthony W. Bateman. Commentary on ‘Minding the difficult patient’: Mentalizing and the use of formulation in patients with borderline personality disorder comorbid with antisocial personality disorder. Personality and Mental Health, Volume 5, Number 1 (February 2011), pp. 85-90
John Gunderson. Complex case: Mentalization-inspired case formulation: Minding the difficult patient. Personality and Mental Health, Volume 5, Number 1 (February 2011), pp. 91-92
Prototype personality diagnosis in clinical practice: A viable alternative for DSM-5 and ICD-11
Year: 2010
Authors: Westen, D; DeFife, J A; Bradley, B; Hilsenroth, M J
Professional Psychology: Research and Practice, Vol 41 No 6 pages 482-487
Several studies suggest that a prototype-matching approach yields diagnoses of comparable validity to the more complex diagnostic algorithms outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Furthermore, clinicians prefer prototype diagnosis of personality disorders to the current categorical diagnostic system or alternative dimensional methods. An important extension of this work was to investigate the degree to which clinicians are able to make prototype diagnoses reliably. The aim of this study was to assess the interrater reliability of a prototype-matching approach to personality diagnosis in clinical practice. Using prototypes derived empirically in prior research, outpatient clinicians diagnosed patients' personality after an initial evaluation period. External evaluators independently diagnosed the same patients after watching videotapes of the same clinical hours. Interrater reliability for prototype diagnosis was high, with a median r = .72. Cross-correlations between disorders were low, with a median r = .01. Clinicians and clinically trained independent observers can assess complex personality constellations with high reliability using a simple prototype-matching procedure, even with prototypes that are relatively unfamiliar to them. In light of its demonstrated reliability, efficiency, and versatility, prototype diagnosis appears to be a viable system for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the 11th edition of the International Classification of Diseases, with exceptional utility for research and clinical practice.
Clinical utility of a dimensional model of personality disorder.
Year: 2010
Authors: Widiger, T A; Mullins-Sweatt, S N
Professional Psychology: Research and Practice, Vol 41 No 6 pages 488-494
The purpose of this paper is to discuss the clinical utility of a dimensional classification of personality disorder. The paper begins with a brief description of the five-factor model of personality disorder, followed by a discussion of three fundamental components of clinical utility: ease of usage, communication, and treatment decisions. It is suggested that the five-factor model compares well to personality disorder diagnostic categories with respect to all three components of clinical utility.
Nidotherapy in the treatment of substance misuse, psychosis and personality disorder: secondary analysis of a controlled trial
Year: 2011
Authors: Tyrer P, Miloseska K, Whittington C, Ranger M, Khaleel I, Crawford M, North B, and Barrett B
The Psychiatrist, Vol 35 No 1 pages 9-14
Aims and method To examine the clinical outcome and bed usage in patients with comorbid substance misuse and psychosis. The patients were randomised to ordinary assertive outreach team care or to enhanced assertive outreach with nidotherapy. Ratings of clinical symptoms, social function, engagement with services, bed usage (primary outcome after 1 year) and economic costs were assessed at baseline and at 6 and 12 months after randomisation.
Results Patients referred to nidotherapy had similar reduction in symptoms and engagement, with marginal superiority in social function (P = 0.045). There was a 110% reduction in hospital bed use after 1 year compared with control assertive care (P = 0.03). The mean cost savings for each patient allocated to nidotherapy was £14 705 per year, mainly as a consequence of reduced psychiatric bed use. Clinical implications Nidotherapy shows promise in the treatment of substance misuse and psychosis and may reduce hospital bed usage.
Validity, utility and acceptability of borderline personality disorder diagnosis in childhood and adolescence: survey of psychiatrists
Year: 2011
Author: Griffiths M
The Psychiatrist, Vol 35 No 1 pages 19-22
Aims and method To establish the views of child and adolescent psychiatrists (n = 52) regarding the conceptual and empirical validity, clinical utility and acceptability of the diagnosis of borderline personality disorder in child and adolescent populations. A questionnaire survey was carried out.
Results The child and adolescent psychiatrists’ perception of the validity of borderline personality disorder for adult populations was relatively high (82% felt it to be valid). Significantly fewer of those considered borderline personality disorder to be valid for adolescent populations (37%). Strikingly different results were obtained when the questions related to child (<12 years) populations (2%). Clinical implications Given the views expressed by these consultant child and adolescent psychiatrists, it would seem appropriate to approach with caution suggestions that the borderline personality disorder category should have extended use with adolescent and child populations.
Personality disorder: challenges in service development in the light of the new NICE guidelines
Year: 2011
Authors: Garrett C, Lee T, Blackburn S, Priestly L, and Bhui K
The Psychiatrist, Vol 35 No 1 pages 22-26
Aims and method using the National Institute for Health and Clinical Excellence (NICE) guidelines on borderline personality disorder as a framework, we describe the profile of the first 100 individuals referred to a personality disorder service in London, captured through the use of record review and case study.
Results The referral population ethnic profile does not match the wider population of the borough; a third of the borough is Bangladeshi, but only 9% of those referred to the service are. Of those diagnosed with borderline personality disorder and on psychotropic medications, only one person had a clear current indication based on NICE guidelines. Of the 100 individuals who were referred to the service, a quarter were accepted to the programme; a third either did not want to proceed with the assessment or were unprepared for an intensive programme.
Clinical implications The under-representation of Black and minority ethnic individuals in referrals in the personality disorder service needs to be actively addressed. Interventions are required to support psychiatrists in reviewing their prescribing practice regarding individuals with borderline personality disorder. Access to the service needs to be improved.
The need for patient-subjective data in the DSM and the ICD.
Year: 2010
Authors: Flanagan EH, Davidson L, Strauss JS.
Psychiatry: Interpersonal & Biological Processes, Vol 73 No 4 pages 297-307.
One improvement from the second to the third edition of the Diagnostic and Statistical Manual of Mental Disorders was to replace clinicians' subjective interpretations of mental disorders with objective descriptions of signs and symptoms that could be rated reliably across investigators. Along with clinicians' subjective impressions, however, the subjective experiences of the person with the mental disorder were minimized. This information could be valuable, as people's subjective experiences of disorders may indicate major
underlying processes and be different from how characteristics of disorders appear objectively to outside observers. The authors suggest that empirically derived, patient-subjective characteristics of mental disorders be incorporated into future editions of the DSM and the ICD. Not only will these data offer important information that will help to enhance the accuracy of the diagnostic categories of the DSM and ICD, but such data also may serve to enhance clinicians' abilities to conceptualize accurately and empathically treat these disorders in their patients. Examples of patient-subjective criteria and their relationship to current DSM criteria are examined for borderline personality disorder and schizophrenia and suggestions for DSM-V and ICD-11 are offered. Diagnostic criteria that accurately reflect patients' subjective experience could also increase clinicians' ability to empathize with patients, one of the most important variables in treatment alliances.
The clinical profile and service needs of psychiatric inpatients with intellectual disabilities and forensic involvement.
Year: 2011
Authors: Lunsky Y, Gracey C, Koegl C, Bradley E, Durbin J, Raina P.
Psychology, Crime and Law, Vol 17 No 1 pages 9-23
There is increasing recognition around the world that individuals with intellectual disabilities (ID) and mental health issues with forensic involvement are a particularly complex patient group whose needs are not well met. However, few studies have examined how these individuals may differ from other service users within a psychiatric hospital setting. Inpatients with ID and forensic involvement were compared to non-forensic inpatients with ID and to forensic inpatients without ID in terms of psychiatric diagnoses and clinical issues. Inpatients with ID and forensic involvement were younger, more often male, had greater lengths of stay, were more likely to have a personality disorder diagnosis and less likely to have a mood disorder diagnosis than their counterparts with ID. They were also similar to their forensic counterparts without ID with regards to demographics, but were less likely to have a substance abuse or psychotic disorder diagnosis. Furthermore, patients with ID and forensic involvement exhibit more severe symptoms, have fewer resources, and a higher recommended level of care than other forensic patients. Patients with ID and forensic involvement present with unique demographic and clinical profiles. The characteristics that set these individuals apart from other services users should be taken into account in order to better meet the needs of this complex group.
The Relationship between Personality Organization and Psychiatric Classification in Chronic Pain Patients
Year: 2011
Authors: Fischer-Kern, M; Kapusta, N. D; Doering, S; Horz, S; Mikutta, C; Aigner, M
Psychopathology, Vol 44 No 1 pages 21-26
Background: The present study investigated the relationship between psychiatric classification and personality organization (PO) in a secondary/tertiary clinical sample of chronic pain patients (CPPs). Sampling andMethods: Forty-three patients were administered the Structured Clinical Interview for DSM-IV (SCID I+II) and the Structured Interview of Personality Organization (STIPO). The prevalence of axis I and axis II disorders was correlated with the STIPO level of PO. The STIPO dimensional ratings of patients without personality disorder (PD) were compared to those of patients diagnosed with one or more PDs. Results: Axis I comorbidity was high (93%), and 63% of the patients met the criteria for at least one axis II diagnosis. Twenty-five patients (58%) were diagnosed as borderline PO, with high-level impairments in the dimensions ‘coping/rigidity’, ‘primitive defenses’ and ‘identity’. Higher axis I and axis II comorbidity corresponded with greater severity of PO impairment. No difference was found between the dimensional ratings of patients without PD and those of patients with one or more PDs. Conclusions: The assessment of PO is a crucial issue for diagnosis and treatment planning in CPPs, since it represents a measure of structural impairment that is to a considerable extent independent of axis I and II diagnoses. Moreover, the STIPO dimensional rating focuses on the most salient dysfunctions at a given time.
The role of transference work, the therapeutic alliance, and their interaction in reducing interpersonal problems among psychotherapy patients with Cluster C personality disorders.
Year: 2010
Authors: Ryum, T; Stiles, T C.; Svartberg, M; McCullough, L
Psychotherapy: Theory, Research & Practice, Vol 47 No 4 pages 442-453
The aim of the present study was to examine whether transference work, the therapeutic alliance, and their interaction predicted a reduction in interpersonal problems at treatment termination. Forty-nine patients with Cluster C personality disorders from a randomized controlled trial investigating the effectiveness of short-term dynamic psychotherapy and cognitive therapy were included. Transference work was measured with the Inventory of Therapeutic Strategies (Gaston & Ring, 1992), while the therapeutic alliance was measured with the Helping Alliance Questionnaire (Luborsky, Crits-Christoph, Alexander, Margolis & Cohen, 1983). Less emphasis on transference work predicted overall reduced interpersonal problems, whereas the effects of the therapeutic alliance did not reach statistical significance. An interaction effect was also demonstrated, indicating that greater emphasis on transference work performed on patients with lower therapeutic alliance ratings was associated with a smaller reduction in interpersonal problems at termination. However, the results also indicate that a low dose of transference work may be beneficial in reducing interpersonal problems.
Patients with Cluster A personality disorders in psychotherapy: an effectiveness study.
Year: 2011
Authors: Bartak A, Andrea H, Spreeuwenberg MD, Thunnissen M, Ziegler UM, Dekker J, Bouvy F, Hamers EF, Meerman AM, Busschbach JJ, Verheul R, Stijnen T, Emmelkamp PM.
Psychotherapy & Psychosomatics, Vol 80 No 2 pages 88-99.
Background: While psychopharmacological studies are common in patients with cluster A personality disorders, the effects of psychotherapy have received little attention. The aim of this study is to explore whether psychotherapeutic treatment yields health gains for these patients. Methods: The study was
conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 57 patients with a DSM-IV-TR axis II cluster A diagnosis. Patients were assigned to 3 settings of psychotherapeutic treatment (outpatient, day hospital, inpatient), and effectiveness was assessed at 18
months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45) and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. Results: Patients in the day hospital and inpatient group improved substantially in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life. Patients in the outpatient group showed less improvement. Direct comparison of the improvement of psychiatric symptoms showed significant results in favour of day hospital (p = 0.046) and inpatient (p = 0.01) treatment, as compared to outpatient treatment. However, due to substantial baseline differences, this direct comparison should be judged carefully. Conclusions: Cluster A psychopathology is not a contraindication to benefit from psychotherapy. This is especially true for more intensive forms like inpatient and day hospital treatment. Future research should focus more on psychotherapeutic treatment to gain further insight into effective treatment options for this patient group.
Clinical associations of deliberate self-injury and its impact on the outcome of community-based and long-term inpatient treatment for personality disorder.
Year: 2011
Authors: Chiesa M, Sharp R, Fonagy P.
Psychotherapy & Psychosomatics, Vol 80 No 2 pages 100-109.
Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). There are gaps in our knowledge of DSI as an indicator of severity of psychopathology, as moderator of outcome and with regard to its response to different treatment programs and settings. We compare 2 samples of PD with (n = 59) and without (n = 64) DSI in terms of clinical presentation, response to psychosocial treatment and relative outcome when treated with specialist long-term residential and community-based programs. We test the assumption that DSI is an appropriate indicator for long-term inpatient care by contrasting the outcomes (symptom severity and DSI recidivism) of the 2 DSI sub-groups treated in the 2 different approaches. PD with DSI had greater severity of presentation on a number of variables (early maternal separation, sexual abuse, axis-I comorbidities, suicidality and inpatient episodes) than PD without DSI. With regard to treatment response, we found a significant 3-way interaction between DSI, treatment model and outcome at 24-month follow-up. PD with DSI treated in a community-based program have significantly greater chances of improving on symptom severity and recidivism of self-injurious behaviour compared to PD with DSI treated in a long-term residential program. Although limitations in the study design invite caution in interpreting the results, the poor outcome of the inpatient DSI group suggests that explicit protocols for the management of DSI in inpatient settings may be beneficial and that the clinical indications for long-term inpatient treatment for severe and non-severe PD may require updating.
Fledgling psychopathy in the classroom: ADHD subtypes, psychopathy, and reading comprehension in a community sample of adolescents
Year: 2011
Authors: DeLisi M, Vaughn M, Beaver K M, Wexler J, Barth A E & Fletcher J M
Youth Violence and Juvenile Justice, Vol 9 No 1 pages 43-58
The current study explores characteristics that are associated with fledgling psychopathy and educational outcomes relating to reading comprehension performance in a community sample of 432 middle school students. Latent class analysis (LCA) produced a four-class solution. Class 1 was a large (71.5% of sample) ‘‘control’’ group of youths with no attention/hyperactivity deficits and the highest reading comprehension scores. Class 2 was 11.6% of the sample and was consistent with traits associated with attention deficit hyperactivity disorder (ADHD) predominantly inattentive type. Class 3 was 7.4% of the sample and was consistent with traits associated with ADHD predominantly hyperactive—impulsive type. Class 4 was 9.5% of the sample and was consistent with traits associated with ADHD combined type. Classes 2 and 4 were characterized by elevated levels of psychopathic and callous-unemotional (CU) traits and lower educational performance. This study extends the utility of fledgling psychopathy to educational outcomes, which has broad implications for adolescent development, delinquency, and youth violence.
