Research In Forensic Psychiatry Research Articles

A Primer for Increasing Competency in Forensic Psychiatry Research.

Empirical research is foundational to the discipline of forensic psychiatry. Candilis and Parker provide a cogent systematic review of the empirical literature on restoration of competence to stand trial using National Institutes of Health quality metrics. Components of the study methodology are highlighted, as they represent current best practices for conducting a systematic review. A discussion of strategies to increase empirical research uptake in forensic psychiatry is pursued alongside concrete examples of how the American Academy of Psychiatry and the Law Research Committee can help facilitate this goal.

Genetic studies on forensic-psychiatric inpatients? : Clinical, ethical and legal considerations

Research on people deprived of liberty raises serious questions, especially concerning behavioral genetic studies. Does including criminally detained patients with mental disorders in genetic studies lead to again of new knowledge and can this be ethically and legally justified? Evaluation of existing literature and interdisciplinary reflection. After areview of research ethics and legal norms, we consider the benefits and risks of behavioral genetic research, taking the unique situation of test persons deprived of their liberty into account. The fundamental right to freedom of research also justifies foundational research in forensic psychiatry and psychotherapy. The possible future benefits of improving treatment plans must be weighed against the risks resulting from potential data leaks and inappropriate public reception of research results. Then we analyze possible threats to voluntary and informed consent to study participation in more detail by the ethical concept of vulnerability. Alongside problems with grasping complex issues, above all dependencies and power dynamics in the correctional system play apivotal role. Recommendations on the ethical and legal inclusion of this study population are given. Including criminally detained study participants can be ethically and legally justified when autonomous consent is supported by specific organizational and legal procedures and measures, for example via aclear professional and organizational separation of correction and research.

La formation des professionnels en psychiatrie légale : résultats d’une enquête en Occitanie

ObjectivesSince the enactment of the French law of 4 March 2002, patients’ rights have been the subject of constant legislative evolution and particular attention from many independent administrative authorities. In psychiatry, these have led to numerous legal reforms over the years. Moreover, psychiatry is a medical specialty with abundant, long-standing and more than ever topical interactions with the judicial system (psychiatric care without consent, isolation and restraint, court-ordered care, psychiatric care in prisons, treatment of perpetrators of sexual violence, judicial expertise or the question of lack of criminal responsibility due to a mental disorder). In response to the many legal questions asked by medical and paramedical teams, and to the growing interest in research in forensic psychiatry, a unit called EPL (Espace de Psychiatrie Légale) was created, composed of a multidisciplinary team, based in the department of Haute-Garonne, France. In order to adjust its scope of intervention, a questionnaire was distributed to mental health professionals to assess their training needs in forensic psychiatry. In this article, we aim to present and discuss the results of this survey. MethodsWe used a self-assessment survey designed by the multidisciplinary team of the EPL and which was filled out online by the respondents. The target population was all the professionals working in mental health facilities, members of the FERREPSY Occitanie research federation. The questionnaire consisted of several sections relating to the respondents, the typology of patients under their care, the professionals’ daily practice, and training in and knowledge of forensic psychiatry. We included some open-ended questions on the situations encountered that may have presented difficulties and on the impact of legislative changes on the daily practice of professionals. All responses were analyzed anonymously. ResultsFrom 05/05/21 to 17/07/21, 155 professionals responded. Most of them were psychiatrists (32.3%), healthcare managers (20.6%) or nurses (18.7%). The majority were women (78.7%) and had been working in Haute-Garonne for more than 5 years (74.2%). 56.1% of the professionals worked in outpatient units, 37.4% in inpatient wards and 74.8% in adult psychiatry. This questionnaire revealed a strong need for training in forensic psychiatry. Indeed, 94.8% of respondents wanted to receive training in forensic psychiatry, which contrasts with the number of people who had already received training in this area (15.5% in initial training, 32.3% in continuing education). The results highlighted that the most common forensic situations encountered in daily clinical practice concerned areas where professionals considered their knowledge to be insufficient. In addition, the self-assessment scales used were able to highlight specific training topics that should be developed. ConclusionsThe results of this survey therefore establish a basis for making adjustments to future educational interventions involving forensic psychiatry, which, although it has only recently emerged in France, embraces issues that have always concerned the management of patients receiving psychiatric care.

On the issue of objective diagnosis of dissociative identity disorder in the practice of forensic psychiatry

The article presents the possibilities of a new method of neurophysiological research in forensic psychiatry — the variance of the amplitude- frequency characteristics of the alpha rhythm of the EEG on the example of a dynamic study of a patient with dissociation of personality identification

On the issue of objective diagnosis of dissociative identity disorder in the practice of forensic psychiatry

The article presents the possibilities of a new method of neurophysiological research in forensic psychiatry – the variance of the amplitude-frequency characteristics of the alpha rhythm of the EEG on the example of a dynamic study of a patient with dissociation of personality identification.

Justice Dept. Threatens Action Against Planned Safe Injection Sites

Justice Dept. Threatens Action Against Planned Safe Injection Sites

Navigating the Libido Dominandi: Intricate Realities of Forensic Psychiatry Research Ethics in Zimbabwe

The purpose of this report is to present the inherent ethical issues experienced in conducting forensic psychiatry research in special institutions Zimbabwe. The inertia of the habitus of forensic psychiatry research ethics has consistently been acknowledged as a rather complex conundrum in literature. Zimbabwe is no exception. In Zimbabwe, the precarious double bind exposure of the objectified and disempowered forensic psychiatric patients creates a hysteretic research ethical terrain or platform for the researcher. The platform is such that the Ethical Review Board in medical research gives the researcher ethical approval to carry out a research study on forensic psychiatric patients. The reality on the field is that these potential participants (patients) are gagged by the environment in which they are being cared for. The environment is such that the researcher can only congregate with a forensic psychiatric patient for interview provided the researcher has violated all the provisions of the Belmont Report of 1979. This labyrinthine ethical excursion is a result of symbolic assertion of power and struggle for legitimating between the prison system, the judiciary and the medical system. This scenario then calls for collaboration as academia, practice, professional organizations and regulatory bodies to untangle this intricate ethical web.

Protecting the prominent? A research journey with Paul Mullen

Recent research from the United Kingdom has called into question entrenched assumptions from the USA about public figure threat assessment, in particular the low importance given to mental illness and to the making of threats. This article reviews some of the evidence, concluding that the high prevalence of psychotic illness in threateners and harassers of public figures and the frequency of warning behaviours determines that these factors should be accorded a central role in the assessment and management of such cases. It is noted that data in US studies do not differ greatly from those in UK studies, but rather their interpretation. The practical benefits of attending to the factors in question are illustrated by reference to the activities of the United Kingdom's Fixated Threat Assessment Centre. The overlap is noted between the fields of public figure threat assessment and stalking, which have hitherto developed separately. The issue of public figure threat assessment is used to illustrate some of the attitudes and personal qualities which have typified the career and achievements of Paul Mullen in forensic psychiatry research.

Psychopathy—an approach to neuroscientific research in forensic psychiatry

"Psychopathy" is a construct that has come into vogue again in science and practice. In line with the growing impact, different diagnostic approaches have been used to investigate forensically relevant social behavior as well as involved brain functions and structures. Research on psychopathy has become of major importance for empirical research in forensic psychiatry. An overview on the development of the concept of psychopathy is given; the heterogeneity of the diagnostic tools is addressed, focusing critically on the characteristics of the included samples. Neurobiological findings on psychopathy are presented, focusing in particular on structural and functional imaging data. Limitations and further requirements of neuroimaging research in psychopathy are discussed. In order to emphasize the limitations of lesion studies, in particular in a forensic context, a case report on pseudoneurasthenia following orbitofrontal brain damage without any change in behavior is presented.

Dutch training and research in forensic psychiatry in a European perspective

Dutch training and research in forensic psychiatry in a European perspective

Psychosis Risk Doesn't Drop in Second-Generation Immigrants

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPsychosis Risk Doesn't Drop in Second-Generation ImmigrantsMark MoranMark MoranSearch for more papers by this authorPublished Online:19 Dec 2008https://doi.org/10.1176/pn.43.24.0012The risk of psychosis among first- and second-generation immigrants to the United Kingdom appears to be similar.That's an important finding because it underscores the well-documented elevated risk for psychosis among immigrants and clarifies that the risk does not diminish depending on how long immigrant groups have been residing in the host country.The finding was from the East London First-Episode Psychosis Study and was reported in the November Archives of General Psychiatry.The study also supports the concept that the elevated risk is likely related to environmental factors.“This suggests that within ethnic groups, the cumulative effect—or load—of factors that serve to increase the risk of psychoses in black and minority ethnic groups is probably similar across generations, although the exact specification of these factors will probably differ,” wrote Jeremy Coid, M.D., and colleagues. “For example, the pressures faced by first-generation black Caribbean immigrants in the 1950s and 1960s were very different from those faced by their second-generation counterparts in the 1990s and beyond. Assuming for a moment that discrimination is a risk factor for psychoses in black and minority ethnic populations, our results support the notion that its cumulative effect is roughly similar across generations, although the form of discrimination has probably changed over generations.”Coid is with the Forensic Psychiatry Research Unit at St Bartholomew's Hospital, London.The study was a population-based epidemiological survey during a two-year period among 484 patients with first-episode psychosis in three inner-city boroughs of East London, England. The area is exclusively inner city, characterized by high levels of socioeconomic deprivation; historically, it has hosted a number of diverse ethnic groups who immigrated to the United Kingdom.All potential cases of psychosis presenting to psychiatric services for the first time (including adult community mental health teams, inpatient units, forensic services, learning disability services, adolescent mental health services, and drug and alcohol units) were screened. Patients were classified as being in one of six ethnic subgroups: white British, white other (predominantly Irish and European groups), black Caribbean (including black other, mixed white, and black Caribbean groups), black African, Asian (Indian, Pakistani, and Bangladeshi groups), and all other ethnic groups (Chinese, other Asian, and other mixed ethnic groups).Rates in each ethnic group were standardized using the 2001 census population of England and Wales stratified by sex and age.The researchers found higher incidence rates of both nonaffective and affective psychoses for all of the black and minority ethnic subgroups compared with white British individuals. The risk of nonaffective psychoses for first- and second-generations varied by ethnicity: only black Caribbean second-generation individuals were at significantly greater risk, compared with their first-generation counterparts.No significant differences between first and second generations were observed in other ethnic groups. Asian women but not men of both generations were at increased risk for psychoses, compared with white British individuals.The researchers postulated that the greater risk for second-generation black Carribean individuals may be due to the fact that the first-generation cohort in that ethnic group tends to be older than in the other groups and to have bypassed the period of 18-24 years of age, when individuals are at greatest risk of psychosis.“For other ethnic groups such as the black African and white other groups, where the modal age group in each generation was closer to the main period of risk of psychoses, the elevated risk of psychoses was comparable between first- and second-generation immigrants,” Coid and colleagues wrote.Ezra Susser, M.D., Dr.P.H., a researcher who has also studied psychosis among immigrant groups and who reviewed the report for Psychiatric News, said it adds to the picture of elevated risk for immigrant ethnic groups that has been reported in a number of studies.“It's further evidence that something in the socioeconomic environment is causing the increased risk,” Susser said. “And whatever it is has to be common across first- and second-generation immigrants.”He is a professor of epidemiology at Columbia University's Mailman School of Public Health and a professor of psychiatry at the New York State Psychiatric Institute.Susser was one of the lead investigators in a study showing that immigrants living in neighborhoods where their own ethnic group represents a very small proportion of the population are at increased risk for psychosis, a finding that points to the influence of social mechanisms—social networks, language fluency, stigma, discrimination and harassment, and other environmental and psychosocial factors—in the etiology of some cases of schizophrenia (Psychiatric News, February 1).An abstract of “Raised Incidence Rates of All Psychoses Among Migrant Groups: Findings From the East London First-Episode Psychosis Study” is posted at< http://archpsyc.ama-assn.org/cgi/content/abstract/65/11/1250>.“ Ethnic Density of Neighborhoods and Incidence of Psychotic Disorders Among Immigrants” is posted at < http://ajp.psychiatryonline.org/cgi/content/full/165/1/66>.▪ ISSUES NewArchived

Research in Forensic Psychiatry - 2ndInternational Conference, July 13 to 15, 2006 in Regensburg

Research in Forensic Psychiatry - 2^ndInternational Conference, July 13 to 15, 2006 in Regensburg

Exploring evidence of the therapeutic relationship in forensic psychiatric nursing.

While the body of nursing research in forensic psychiatry is growing rapidly, the therapeutic nurse-patient relationship in secure hospitals needs to be further examined. This paper reports on a research project that found two representations of the nurse-patient relationship in two male acute secure inpatient units. One representation was formed by the data collected from the unit nurses in semistructured interviews. The nurses valued the relationship and described their practice as therapeutic, however, evidence from the interviews would suggest that the nurses operate from a social frame of reference. Examination of the nurses 'entries in patients' case files formed the other representation. Through their documentation practices, nursing was represented as being oriented to custodial care. While neither representation can capture the clinical reality, these findings are relevant to forensic psychiatric nurses as their entries are a historical record through which their practice will become known to others, and in some cases, judged by others.

Forensic psychiatric studies and research ethical considerations

The author gives a comprehensive view of the multi-dimensioned field of ethics, from general medicine to specific forensic psychiatric research. While the Declaration of Helsinki pointed out the possible risks involved in medical research, the CIOMS/WHO Ethical Guidelines from 1993 points out possible beneficial effects of research. The latter also particularly mentions prisoners and other marginal groups in society, which is especially relevant to research in forensic psychiatry.

Lecture: Epidemiology and forensic psychiatry*

Epidemiology has been oustandingly successful in assisting with the understanding and prevention of disease. This is as true in psychiatry as in general medicine. It is also true in forensic psychiatry, for example in understanding the relationship between homicide and psychosis, the development of antisocial personality disorder and the causation of crime. Philippe Pinel advocated scientific enquiry as part of humanitarian psychiatry. The Institute of Psychiatry in London has used epidemiology for research in forensic psychiatry, for example in determining the prevalence of mental disorders, including epilepsy, in prisons, the relationships between violence and disease and the outcome of patients deemed unfit to plead. Epidemiological findings need careful interpretation, for example Penrose’s Law is an invalid myth that has arisen from a misunderstanding of epidemiological data. Recent surveys of prisoners have confirmed that substance abuse and personality disorder are the most common psychiatric diagnoses among prisoners, only 1‐2% being psychotic. About 4% of prisoners (700 or 800) should be transferred into NHS psychiatric hospitals. These findings could be useful to planners.

Research in Forensic Psychiatry

In November and December 1981 a survey was conducted of the members of the Forensic Psychiatry Section. A questionnaire invited members to report any research they were undertaking. Although the response was incomplete, the replies indicated a wide range of investigation in the specialty. This brief report indicates the main areas of study.

Ethical issues in the practice of forensic psychiatry.

The recent, rapid development of the practice of forensic psychiatry has led to an increasing awareness of and a growing concern about the ethical issues that inhere in this subspecialty. While some such issues are similar to those found in the general practice of psychiatry (confidentiality, informed consent, etc.), there are aspects of these and other ethical issues which are unique to the practice of forensic psychiatry. On October 16 and 17, 1980, at the annual meeting of the American Academy of Psychiatry and Law held in Chicago, Illinois, a panel discussion concerning ethical issues in forensic psychiatry took place. The chairman was Henry C. Weinstein, M.D., Director, Forensic Psychiatry Services, Bellevue Hospital Center, New York. This panel, made up of two forensic psychiatrists and two philosophers (with special interests in medical ethics), discussed the ethical issues in the practice of forensic psychiatry from a variety of perspectives. A general statement in regard to ethics and forensic psychiatry opened the panel, followed by a series of presentations relating to specific ethical issues, including those which face the forensic psychiatrist practicing in a secure forensic unit, those which arise in the practice of forensic psychiatry with children and adolescents, as well as ethical issues relating to research in forensic psychiatry. A special program for the exploration and teaching of ethical issues, in a clinical forensic psychiatric setting, utilizing a philosopher-in-residence, was described and discussed. The panel presentation was concluded by a commentary from the philosophical perspective.

Scientific inquiry in forensic psychiatry

Forensic psychiatry and psychology, with an extensive history of clinical practice, is only recently emerging as a new scientific specialty. It is confronted with both general scientific-methodological issues, as well as unique, empirically-based psycholegal applications. Aimed towards a broader, more flexible paradigm for understanding the basis of our scientific inquiry, the paper examines various research and methodological issues. As a model for connecting and understanding these complicated and interrelated issues, Holton's explicit and useful model of scientific structure is provided. The methodology, logical and statistical analysis, and themata are explored with regards to their potential impact on scientific inquiry in forensic psychiatry. This paper argues for several considerations in furthering research. From a methodological basis, the prospective researcher has to consider (1) whether the methodology is, in part, predetermining the results; (2) whether the results are a prediction of the inclusion criteria rather than an independent finding; (3) what balance between specificity and generalizability is designed within the research study; and (4) what is the impact of various methodological artifacts on the results and conclusions of forensic psychiatric research (e.g., demand characteristics, evaluation apprehension, experimenter bias, systems influence). Further, the forensic psychiatric researcher is asked to consider the basis of the "validity" of his research findings in comparison with "objective reality" from the perspective of logical and statistical analysis. Scientists within forensic psychiatry are asked to consider (1) whether to employ "best fit" or complementarity in understanding their results; (2) how to make explicit the steps in data transformation and redefinition within their study; (3) what are the implications of exclusive use of null hypothesis testing in establishing research results; and (4) what is the comparative utility of non-parametric and multivariate statistical procedures in studying and understanding experimental variables. Finally, in acknowledging the non-linear and sometimes self-justifying aspect of science, researchers are invited to examine their basic assumptions, and the self-perpetuating and constraining nature of unacknowledged themata, as well as their impact on forensic psychiatry. This paper is conceptualized as a movement towards articulating both general methodological issues and their unique application to forensic psychiatry. The brief exposition of Holton's model and review of illustrative research in forensic psychiatry constitutes one attempt to strengthen the scientific rigor of forensic psychiatric research.