Forensic Inpatient Sample Research Articles

Vitamin D Status and Physical Activity during Wintertime in Forensic Inpatients—A Randomized Clinical Trial

This study aimed to gain deeper knowledge about the relationship between vitamin D and physical activity in a sample of forensic inpatients. Sixty-seven male forensic inpatients participated. Participants were randomly assigned into an Intervention group (vitamin D) or a Control group (placebo). The Physical Activity–Rating (PA-R) questionnaire was used to measure physical activity from January to May. Vitamin D status was measured as 25-hydroxy vitamin D (25-OHD) pre- and post-intervention. The results revealed that vitamin D status at post-test was positively correlated with physical activity, but there was no effect of vitamin D supplementation looking at the two randomized groups. However, controlling for body mass index (BMI), the results showed an effect of BMI and a main effect of groups with a higher level of physical activity in the Intervention group. No interaction effects were found. Participants were also assigned into High and Low vitamin D groups based on the vitamin D status at post-test; i.e., the upper (75.1 nmol/L) and lower quartile (46.7 nmol/L). T-tests revealed that participants with a vitamin D status above 75 nmol/L showed significantly higher levels of physical activity than participants with a vitamin D status below 46.7 nmol/L. Thus, a vitamin D status above 75 nmol/L seems to be an optimal level.

Adverse Childhood Experiences and the Onset of Aggression and Criminality in a Forensic Inpatient Sample

Offenders and persons with serious mental illness experience disproportionate exposure to Adverse Childhood Experiences (ACEs). This study examines prevalence, distribution, and correlates of ACEs in 182 male and female forensic psychiatric inpatients in secure care. Descriptive statistics, chi-squares analysis, ANOVA, and logistic regression were used to describe ACEs by race and gender and to identify associations between ACEs and onset of aggression, arrest, and psychiatric hospitalization. Participants evidenced significant exposure to ACEs, with significant differences by race and gender. ACE score, race, and foster care or investigations of child abuse were significant predictors of outcomes related to aggression and criminality.

Specificity and item endorsement rates of personality assessment inventory over-reporting scales across ethnic, gender, and diagnostic groups in a forensic inpatient sample

The accurate evaluation of response style, particularly with respect to overreporting, is imperative in forensic settings wherein an external incentive to feign exists. Given the high cost of false positive errors in this context, as well as the associated cost of false negative errors, evaluators need to ensure that overreporting methods are effective with the unique patient populations with whom they work. Complicating this issue is that forensic samples often differ in predictable ways from the normative samples upon which typical psychological assessment instruments were normed. The purpose of the present investigation was to evaluate the specificity of the overreporting indices on the Personality Assessment Inventory, one of the most commonly used personality inventories, in a forensic sample with no ostensible incentive to feign. Although item endorsement and configural elevations on the Negative Impression Management (NIM) scale and the Malingering Index (MAL) were associated with genuine psychopathology, results indicated that the overall specificity estimates across groups were generally adequate. Further, and consistent with prior research, Rogers Discriminant Function (RDF) performed poorly in this sample.

C - 65Evaluating MMPI-2-RF Infrequent Somatic Responses (Fs) Item Endorsement Rates Across Ethnic, Gender, and Age Groups with a Forensic Inpatient Sample

C - 65Evaluating MMPI-2-RF Infrequent Somatic Responses (Fs) Item Endorsement Rates Across Ethnic, Gender, and Age Groups with a Forensic Inpatient Sample

The Metacognitive Anger Processing (MAP) Scale - Validation in a Mixed Clinical and a Forensic In-Patient Sample.

The metacognitive approach by Wells and colleagues has gained empirical support with a broad range of symptoms. The Metacognitive Anger Processing (MAP) scale was developed to provide a metacognitive measure on anger (Moeller, 2016). In the preliminary validation, three components were identified (positive beliefs, negative beliefs and rumination) to be positively correlated with the anger. To validate the MAP in a sample of mixed clinical patients (n = 88) and a sample of male forensic patients (n = 54). The MAP was administered together with measures of metacognition, anger, rumination, anxiety and depressive symptoms. The MAP showed acceptable scalability and excellent reliability. Convergent validity was evidenced using the general metacognitive measure (MCQ-30), and concurrent validity was supported using two different anger measures (STAXI-2 and NAS). The MAP has promising potential to assess anger regulation problems by providing a framework on angry rumination as well as the belief structures that proposedly drive the selection of this maladaptive processing strategy as suggested in the metacognitive model. These findings may have implications for clinical interventions. For example, conducting functional analyses on anger rumination could increase the understanding of dysregulated anger processing and lead to new interventions focused on shifting thinking style.

Association between the COMT Val158Met polymorphism and aggression in psychosis: Test of a moderated mediation model in a forensic inpatient sample.

Objective: Aggression in schizophrenia can be explained by at least 2 different pathways. One of these pathways is aggression associated with comorbid antisocial characteristics. This pathway of aggressive behavior is likely to have a distinct underlying etiology, including particular genetic underpinnings. The Val allele of the COMT Val158Met polymorphism is found to be related to some forms of antisocial characteristics. This study aimed to examine the relation between the Val allele of the COMT Val158Met polymorphism and antisocial characteristics in forensic inpatients with a psychotic disorder and without a psychotic disorder. It was hypothesized that the relation between the Val allele and aggression would be mediated by diminished cognitive control (i.e., disinhibition). Method: A final sample of 71 male forensic inpatients were included and genotyped for the val158met SNP of the COMT gene. Self-reported aggression was measured with the Reactive-Proactive Aggression Questionnaire and different constructs of psychopathic traits (i.e., boldness, meanness and disinhibition) were measured using the Triarchic Psychopathy Measure. Results: Results showed that the Val allele was positively related to aggression and disinhibition in a subsample of patients with a psychotic disorder. Moreover, the relation between the Val allele and aggression in this subsample was conditionally mediated by disinhibition. Conclusion: These results indicate that aggression posed by patients with a psychotic disorder can be explained by different neurobiological pathways, 1 of which associated with a dysfunctional working of inhibitory control (i.e., disinhibition). These outcomes highlight the importance of personalized forensic treatment for specific subgroups of offenders with psychosis.

The MacArthur Competence Assessment Tool-Criminal Adjudication: Factor structure, interrater reliability, and association with clinician opinion of competence in a forensic inpatient sample.

Adjudicative competence is the most frequently referred evaluation in the forensic context, and it is because of this that periodic evaluation of competence assessment instruments is imperative. Among those instruments, the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) has demonstrated adequate psychometric properties suggesting its utility in informing the forensic inquiry. The purpose of the current study was to further investigate the psychometric properties and ultimate utility of subscale scores using archival data from a sample of 103 male and female forensic patients who were hospitalized for competence restoration treatment. Results of the present study suggested adequate internal consistency and good model fit for the factor structure. Interrater reliability was evaluated by comparing the absolute agreement of scores derived from 2 independent research assistants for each of the subscales; 2 of the 3 subscales fell within the acceptable range given established interpretative benchmarks for forensic assessment. Of particular interest was that the Appreciation subscale, while heralding the lowest intraclass correlation coefficient, explained the largest proportion of variance in clinician opinion relative to the other 2 subscales. In other words, the most subjective subscale (as evidenced by the lowest intraclass correlation), explained the largest proportion of variance in ultimate opinion. The authors argue that, although these results are an important consideration in these assessments, they are neither surprising nor entirely problematic when considering the case-specific nature of the inquiries on the subscale, as well as the subjectivity of scoring criteria for each of the Appreciation items. (PsycINFO Database Record

Evaluating item endorsement rates for the MMPI-2-RF F-r and Fp-r scales across ethnic, gender, and diagnostic groups with a forensic inpatient sample.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F(p) (Infrequency-Psychopathology) scale was developed to measure overreporting in a manner that was minimally confounded by genuine psychopathology, which was a problem with using the MMPI-2 F (Infrequency) scale among patients with severe mental illness. Although revised versions of both of these scales are included on the MMPI-2-Restructured Form and used in a forensic context, no item-level research has been conducted on their sensitivity to genuine psychopathology among forensic psychiatric inpatients. Therefore, we examined the psychometric properties of the scales in a sample of 438 criminally committed forensic psychiatric inpatients who were adjudicated as not guilty by reason of insanity and had no known incentive to overreport. We found that 20 of the 21 Fp-r items (95.2%) demonstrated endorsement rates ≤ 20%, with 14 of the items (66.7%) endorsed by less than 10% of the sample. Similar findings were observed across genders and across patients with mood and psychotic disorders. The one item endorsed by more than 20% of the sample had a 23.7% overall endorsement rate and significantly different endorsement rates across ethnic groups, with the highest endorsements occurring among Hispanic/Latino (43.3% endorsement rate) patients. Endorsement rates of F-r items were generally higher than for Fp-r items. At the scale level, we also examined correlations with the Restructured Clinical Scales and found that Fp-r demonstrated lower correlations than F-r, indicating that Fp-r is less associated with a broad range of psychopathology. Finally, we found that Fp-r demonstrated slightly higher specificity values than F-r at all T score cutoffs. (PsycINFO Database Record

The Relationship between Feigned Psychiatric Symptoms and Feigned Lack of Legal Knowledge among a Multi-Site Sample of Forensic Inpatients

ABSTRACTThe accurate assessment of feigning is a cornerstone of forensic evaluations. This study examined two feigning strategies defendants may use for the purpose of being found not competent to stand to trial: feigning psychiatric symptoms and feigning lack of legal knowledge. Participants included 203 forensic inpatients undergoing competency to stand trial assessments at two state hospitals. Each participant was administered the Miller Forensic Assessment of Symptoms Test and the Inventory of Legal Knowledge. Results indicated that there was a significant relationship between these two types of feigning (manual cut scores: χ2 (1, 203) = 23.02, p < .001) and the presence of one feigning strategy increased his or her risk for engaging in the other feigning strategy (e.g., using the manual cut scores, participants shown to be feigning psychiatric symptoms were 2.23 times more likely to feign lack of legal knowledge than those not feigning psychiatric symptoms). This article provides evidence of an increased risk of defendants employing a second feigning strategy when it is determined they are already using one strategy. These results encourage forensic evaluators to be cognizant of the nature of feigning and various strategies employed by individuals undergoing evaluations of competency.

Supplemental Material for Evaluating Item Endorsement Rates for the MMPI-2-RF F-r and Fp-r Scales Across Ethnic, Gender, and Diagnostic Groups With a Forensic Inpatient Sample

Supplemental Material for Evaluating Item Endorsement Rates for the MMPI-2-RF F-r and Fp-r Scales Across Ethnic, Gender, and Diagnostic Groups With a Forensic Inpatient Sample

Predictors of Severe and Repeated Aggression in a Maximum-Security Forensic Psychiatric Hospital

Institutional aggression within forensic psychiatric facilities is a common problem that has not been adequately researched. Several studies have shown that a relatively small portion of the at-risk patient population is responsible for the majority of inpatient aggression. The present study compared a sample of forensic inpatients who engaged in repeated and severe aggression towards staff or peers with a sample of non-aggressive inpatients that were matched for age, gender, legal commitment type, and hospital length of stay. The discriminant model correctly predicted 74.2% of those classified as perpetrating severe and repeated aggression and 87.1% of those classified as non-aggressive within the institution. The model accounted for 51% of the variance. The predictors included variables traditionally associated with violence risk, such as the presence of a personality disorder. However, the model also included suicide attempts and psychiatric hospitalization as a juvenile; two predictors that have not been commonly included in community violence measures. These findings identify unique predictors of highly aggressive patients who cause serious injuries to other patients and staff. The early identification and management of individuals with increased risk for severe and repeated aggression is an important consideration for triaging inpatients at risk for this type of aggression.

The four-factor model of the Psychopathy Checklist—Revised: Validation in a Dutch forensic inpatient sample

In The Netherlands, the Ministry of Security and Justice requires the assessment of the Psychopathy Checklist—Revised (PCL-R; Hare, 1991; Hare, 2003) in all forensic psychiatric inpatients. To examine the four-factor structure of the Psychopathy Checklist—Revised, confirmatory factor analysis (CFA) was conducted using a Dutch sample of forensic psychiatric inpatients (N=411) and the results indicated acceptable fit. Also, using multiple group CFA, the four-factor model provided an acceptable fit in both patients with a personality disorder and patients with a psychotic disorder, and there was reasonably good evidence of measurement invariance between these two subgroups. Furthermore, correlations with external measures of aggression and personality traits provided additional support for the validity of the four-factor model in patients with a personality disorder. In patients with a psychotic disorder fewer significant correlations with external measures were found. Taken together, the results support the use of the four-factor structure in Dutch offenders who are detained under hospital order.

A Comparison of Factor Structures of the Barratt Impulsiveness Scale in a Mentally Ill Forensic Inpatient Sample

The present study examined the factor structure of the Barratt Impulsiveness Scale, 11th version (BIS-11, Patton, Stanford & Barratt, 1995) in a sample of 327 mentally ill forensic inpatients. Using confirmatory factor analysis, the fit of five a priori factor structures of the BIS-11 were evaluated and compared. Fit indices supported a two-factor structure (Motor and Nonplanning Impulsiveness). Internal consistency of these scales was strong and their association with one another moderate. Significant associations with psychiatric diagnoses and self-reported continuous measures of psychopathology supported the construct validity of the revised BIS factor structure. Implications of these findings and the usefulness of the revised BIS in clinical and research settings are discussed.

Severe Sexual Sadism—An Underdiagnosed Disorder? Evidence from a Sample of Forensic Inpatients

Severe sexual sadism is a disorder of sexual preference that focuses on humiliation and subjugation of the victim, sometimes causing grievous injury or death. Sexual sadists pose a particular risk. However, the diagnosis as such is unreliable and prevalence estimates vary. In a sample of male high-security forensic inpatients who had committed sexual offenses, we found two-thirds of sexual sadists had not been identified as such prior to commitment. Possible reasons for missing the diagnosis are many fold. Present data support the notion that unrecognized sexual sadists more closely resembled non-sadistic sex offenders than accurately diagnosed sadists. In particular, initially unrecognized sexual sadists had less severe previous convictions, less vocational training, and experienced a less supportive upbringing than their correctly identified sadistic counterparts. The latter, in contrast, more often reached media coverage through their offense(s). We conclude that severe sexual sadism is likely an underdiagnosed, yet forensically highly relevant disorder.

The Violence Risk Scale Second Edition (VRS-2) as a predictor of institutional violence in a British forensic inpatient sample

This study examined the utility of The Violence Risk Scale 2nd Edition (VRS-2) [Wong, S., Gordon, A., 1999. Manual for the Violence Risk Scale. University of Saskatchewan, Saskatchewan, Canada] as an institutional violence risk predictor. The VRS-2 and the Psychopathy Checklist: Screening Version (PCL: SV) were rated independently from pre-admission/admission case records in 147 patients in a medium security facility. Inpatient aggression post-admission was recorded by an independent researcher. Aggressive patients had significantly higher scores on both measures. The VRS-2 and the PCL: SV were only modest predictors of inpatient aggression. The VRS-2 putative “dynamic” items showed the highest predictive accuracy. The results tentatively support the use of the VRS-2 as a predictor of inpatient violence in mentally ill patients in medium security settings, with the dynamic component of this instrument showing most promise. Further studies validating this instrument are required before it is adopted into routine clinical practice.

The validity of the Violence Risk Scale second edition (VRS-2) in a British forensic inpatient sample

The aim of the present investigation was to examine the validity of the Violence Risk Scale second edition (VRS-2) in a sample of 136 male medium secure psychiatric inpatients. Ratings on the VRS-2 were completed within the first month of admission based on preadmission records, court depositions, and criminal records. Construct validity was assessed using the Historical Clinical Risk-20 (HCR-20) assessment scheme in a subsample of 80 cases rated on the same basis. This showed that the VRS-2 and HCR-20 total scale scores correlated very highly, supporting the notion that the VRS-2 is a measure of violence risk. Both the HCR-20 and the VRS-2 could distinguish between violent and non-violent subgroups with reasonable effect sizes. There were highly significant correlations between the scales on the rating of items measuring comparable variables. Both measures were predictive of violence at 12-month follow-up, but the HCR-20 clinical subscore was the most robust contributor in the summary regression analysis. Our results offer preliminary evidence that the VRS-2 is a reasonably valid measure of violence risk and that it could be useful for research in this area.

Reporting of personality disorder symptoms in a forensic inpatient sample: Effects of mode of assessment and response style

Self-report measures of personality disorder are known to over-report personality disorder traits consistently relative to measures based on a clinical interview. This study tests the hypothesis that there is a relationship between a participant's tendency to give socially desirable responses and the discrepancy between their results on self-report and interview-based measures. The relative over-reporting of the self-report measure, the PDQ4, was confirmed, but no association was found between the magnitude of the over-reporting and the tendency to give socially desirable responses.

Detecting Malingered and Defensive Responding on the MMPI-2 in a Forensic Inpatient Sample

The purpose of this study was to examine the effectiveness of the various validity scales and indices on the MMPI-2 to detect malingered (fake-bad), and defensive (fake-good) responding. The entire sample consisted of 165 college students who completed the MMPI-2 under one of three conditions--fake-bad, fake-good, or respond honestly--and 173 forensic inpatients who completed the test as part of a routine evaluation. To detect faking-good and faking-bad, cutting scores for the validity scales and indices were established from the fake-good and fake-bad groups and were compared to the honest and patient groups. Corresponding sensitivity and specificity rates were then determined. Four validity indicators appeared to be moderately effective-at detecting fake-bad profiles: F, F--K, the MMPI-2 version of revised Gough Dissimulation Scale, and Wiener's Obvious-Subtle index, whereas the fake-good indicators were much less effective--only F--K and the Obvious-Subtle index appeared to have moderate utility.