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Nottingham, United Kingdom

Gibbon S.,Institute of Mental Health
Cochrane database of systematic reviews (Online) | Year: 2010

BACKGROUND: Antisocial personality disorder (AsPD) is associated with a wide range of disturbance including persistent rule-breaking, criminality, substance use, unemployment, homelessness and relationship difficulties. OBJECTIVES: To evaluate the potential beneficial and adverse effects of psychological interventions for people with AsPD. SEARCH STRATEGY: Our search included CENTRAL Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, ASSIA, BIOSIS and COPAC. SELECTION CRITERIA: Prospective, controlled trials in which participants with AsPD were randomly allocated to a psychological intervention and a control condition (either treatment as usual, waiting list or no treatment). DATA COLLECTION AND ANALYSIS: Three authors independently selected studies. Two authors independently extracted data. We calculated mean differences, with odds ratios for dichotomous data. MAIN RESULTS: Eleven studies involving 471 participants with AsPD met the inclusion criteria, although data were available from only five studies involving 276 participants with AsPD. Only two studies focused solely on an AsPD sample. Eleven different psychological interventions were examined. Only two studies reported on reconviction, and only one on aggression. Compared to the control condition, cognitive behaviour therapy (CBT) plus standard maintenance was superior for outpatients with cocaine dependence in one study, but CBT plus treatment as usual was not superior for male outpatients with recent verbal/physical violence in another. Contingency management plus standard maintenance was superior for drug misuse for outpatients with cocaine dependence in one study but not in another, possibly because of differences in the behavioural intervention. However, contingency management was superior in social functioning and counselling session attendance in the latter. A multi-component intervention utilising motivational interviewing principles, the 'Driving Whilst Intoxicated program', plus incarceration was superior to incarceration alone for imprisoned drink-driving offenders. AUTHORS' CONCLUSIONS: Results suggest that there is insufficient trial evidence to justify using any psychological intervention for adults with AsPD. Disappointingly few of the included studies addressed the primary outcomes defined in this review (aggression, reconviction, global functioning, social functioning, adverse effects). Three interventions (contingency management with standard maintenance; CBT with standard maintenance; 'Driving Whilst Intoxicated program' with incarceration) appeared effective, compared to the control condition, in terms of improvement in at least one outcome in at least one study. Each of these interventions had been originally developed for people with substance misuse problems. Significant improvements were mainly confined to outcomes related to substance misuse. No study reported significant change in any specific antisocial behaviour. Further research is urgently needed for this prevalent and costly condition.

Colovic O.,Institute of Mental Health
Journal of Nervous and Mental Disease | Year: 2016

ABSTRACT: Our study was intended to test whether there are any differences in the way defense mechanisms are used by patients suffering from pure anxiety and those with pure depressive disorders. The sample size was as follows: depressive disorders without psychotic symptoms 30, anxiety disorders 30, and the healthy control group 30. The assessment of defense mechanisms was made using the DSQ-40 questionnaire. Our findings show that “pure” anxiety disorders differ from “pure” depressive disorders only in the use of immature defense mechanisms. The group with depressive disorders was significantly more prone to use immature defense mechanisms than the group with anxiety disorders (p = 0.005), primarily projection (p = 0.001) and devaluation (p = 0.003). These defense mechanisms may therefore be used both to differentiate between anxiety and depressive disorders and also to determine which symptoms (anxiety or depressive disorders) are dominant at any given stage of treatment. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Olver M.E.,University of Saskatchewan | Wong S.C.P.,University of Saskatchewan | Wong S.C.P.,Institute of Mental Health
Criminal Justice and Behavior | Year: 2011

The authors investigated the efficacy of static versus dynamic approaches to risk assessment and the validity of the Risk Principle through comparing treatment changes made by high- versus lower-risk offenders. The investigations were carried out using a sample of 321 treated sex offenders followed up for an average 10 years postrelease. Risk was assessed using the Static 99, and treatment change was assessed using the Violence Risk Scale-Sexual Offender version. Actuarially high-risk/ low-change offenders had significantly higher rates of sexual recidivism than similarly high-risk offenders who had demonstrated greater treatment changes. The Static 99 predicted sexual recidivism well among sex offenders with smaller treatment change but demonstrated weaker prediction among offenders with greater treatment change, likely owing, in part, to the static nature of the risk predictors. Implications regarding the dynamic nature of risk and potential utility of incorporating treatment change-related information into sex offender risk assessments are discussed. © 2011 International Association for Correctional and Forensic Psychology.

Sum M.Y.,Institute of Mental Health
Molecular Psychiatry | Year: 2016

Volume deficits of the hippocampus in schizophrenia have been consistently reported. However, the hippocampus is anatomically heterogeneous; it remains unclear whether certain portions of the hippocampus are affected more than others in schizophrenia. In this study, we aimed to determine whether volume deficits in schizophrenia are confined to specific subfields of the hippocampus and to measure the subfield volume trajectories over the course of the illness. Magnetic resonance imaging scans were obtained from Data set 1: 155 patients with schizophrenia (mean duration of illness of 7 years) and 79 healthy controls, and Data set 2: an independent cohort of 46 schizophrenia patients (mean duration of illness of 18 years) and 46 healthy controls. In addition, follow-up scans were collected for a subset of Data set 1. A novel, automated method based on an atlas constructed from ultra-high resolution, post-mortem hippocampal tissue was used to label seven hippocampal subfields. Significant cross-sectional volume deficits in the CA1, but not of the other subfields, were found in the schizophrenia patients of Data set 1. However, diffuse cross-sectional volume deficits across all subfields were found in the more chronic and ill schizophrenia patients of Data set 2. Consistent with this pattern, the longitudinal analysis of Data set 1 revealed progressive illness-related volume loss (~2–6% per year) that extended beyond CA1 to all of the other subfields. This decline in volume correlated with symptomatic worsening. Overall, these findings provide converging evidence for early atrophy of CA1 in schizophrenia, with extension to other hippocampal subfields and accompanying clinical sequelae over time.Molecular Psychiatry advance online publication, 23 February 2016; doi:10.1038/mp.2016.4. © 2016 Macmillan Publishers Limited

Sarkar J.,Institute of Mental Health
Advances in Psychiatric Treatment | Year: 2013

Making potentially critical clinical decisions in complex cases with the real risk of death by suicide is a most challenging job in psychiatry. Sadly, risk assessment and management of harm to self is a largely ignored area compared with risk of harm to others. The legal and ethical challenges are more nuanced, and contemporary training schemes and textbooks on psychiatry have not always done justice to this area, where front-line clinicians require probably most assistance. This article is an attempt to integrate the seemingly disparate threads from legal, ethical and clinical realms to assist decision-making, and it introduces a set of principles for managing these in clinical practice. It refers in particular to legislation in England and Wales, but the clinical and ethical issues discussed are universal.

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