Psychopathic Patients Research Articles

Attachment and psychopathy in forensic patients

Effective treatment of patients with severe psychopathy is very difficult to achieve. This conclusion may be drawn from an extensive examination into the usage of the term ‘psychopathy’ in scientific research literature, in theoretical development from various psychological schools of thought, in the practice of therapy and in assessment. The central issue for the authors of this article is the inability of severely psychopathic patients to commit to the patient‐therapist relationship. Attachment theory and mentalisation‐based treatment are used here to define the cause and nature of this inability, which is incurred in very early childhood. These two models can aid in the development of more dynamic definitions of psychopathy, better suited to dynamic therapy formats.The ways in which psychopathy is defined partly account for a number of problems encountered in the practice of therapy. The authors assume that the treatment of psychopathy should be interactional and should match patients' individual levels of psychological development and mentalisation; highly psychopathic patients often perceive others as objects, ie. as part of the context, not as subjects, ie. autonomous personalities.The authors propose to conduct further research in order to verify the validity of their hypothesis. They also put forward a number of suggestions for therapy formats with a view to establishing effective working relationships with psychopathic patients.

Do psychopathic patients use their DLPFC when making decisions in moral dilemmas?

Do psychopathic patients use their DLPFC when making decisions in moral dilemmas?

Qualify of Life of Forensic Psychiatric Inpatients

In this article, the quality of life (QoL) of mentally disordered offenders was investigated. The data of 44 forensic psychiatric inpatients were analyzed using the Lancashire Quality of Life Profile (LQoLP), Rehabilitation Evaluation Hall and Baker (REHAB), and the Psychopathy Checklist-Revised (PCL-R). Outcome on the LQoLP was compared with data of hospitalized male psychiatric patients. Results show that the QoL of forensic psychiatric inpatients was particularly low as to their living conditions and their health. However, compared to general psychiatric patients they encountered fewer problems with envisioning their life as having some meaningful perspective. On six of the ten domains, nonpsychotic forensic psychiatric patients reported a lower, though nonsignificant, QoL as compared to the psychotic forensic psychiatric patients. Between psychopathic and nonpsychopathic forensic psychiatric patients no significant differences were found. A trend was found for the domain finances for which nonpsychopaths reported a lower quality of life. Our hypothesis that patients with a lower level of functioning will report a lower QoL was not confirmed in this study. However, a significant correlation between general behavior and global well-being was found. Future studies should further investigate the relation between quality of life of forensic psychiatric patients and recidivism, to gain more insight in whether (certain aspects of) QoL are associated with lower recidivism risks in the long run.

Executive Functioning and the Two-Factor Model of Psychopathy: No Differential Relation?

There are indications that the interpersonal affective factor and the social deviation factor, both of which are underlying dimensions of psychopathy, have a positive and a negative relationship, respectively, with executive functioning. However, this is seldom taken into consideration in the research on the relationship between executive functioning and psychopathy, which may be an explanation for the many inconsistent results in this area as reported in the literature (e.g., Rogers, 2006). In the present study, executive functioning was studied using the Wisconsin Card Sorting Test (WCST) in 53 inpatients of a Dutch forensic psychiatric clinic who were classified by means of the Psychopathy Checklist-Revised (PCL-R). Special attention was given to the relationship between the two separate factors and executive functioning. Age, educational level, and substance abuse were controlled for in the analysis. No difference was found between psychopathic (N = 17) and nonpsychopathic (N = 36) patients in the WCST scoring categories, nor was there a significant difference in the four diagnostic subgroups defined by the two factors. However, the trends observed do justify further study in this direction.

Categorization and evaluation of emotional faces in psychopathic women

Psychopathic individuals have been shown to respond less strongly than normal controls to emotional stimuli. Data about their ability to judge emotional facial expressions are inconsistent and limited to males. To measure categorical and dimensional evaluations of emotional facial expressions in psychopathic and non-psychopathic women, 13 female psychopathic forensic inpatients, 15 female non-psychopathic forensic inmates and 16 female healthy participants were tested in an emotion-categorizing task. Emotional facial expressions were presented briefly (33 ms) or until buttonpress. Participants were to classify emotional expressions, and to rate their valence and arousal. Group differences in categorization were observed at both presentation times. Psychopathic patients performed worst with briefly presented sad expressions. Moreover, their dimensional evaluation resulted in less positive ratings for happy expressions and less arousal for angry expressions compared with the responses of non-psychopathic and normal subjects. Results shed light on the mechanism possibly underlying the emotional deficits in psychopathic women.

Sensation seeking scales and traits delineating personality disorders in a sample of Chinese students

Scores on the Zuckerman Sensation Seeking Scales (SSS) are consistently elevated in samples of psychopathic patients or prisoners suggesting that sensation seeking is an aspect of antisocial personality disorder. This was investigated in a sample of 171 Chinese university students (102 women and 69 men) who also completed the Dimensional Assessment of Personality Pathology – Basic Questionnaire (DAPP) which assesses four broad domains of personality dysfunction. Factor Analysis clearly identified five-factors, four of which were labeled as “Emotional Dysregulation”, “Dissocial”, “Bored” and “Inhibition”, similar to those detected in the previous studies. Contrary to expectations, except the Boredom Susceptibility was loaded on the factor “Bored” in women, the four SSS subscales were loaded on a fifth factor in both gender samples, suggesting that the SSS does not clearly measure an important feature of personality disorder.

Beauty in the eye of the beholder? How high security hospital psychopathically-disordered patients rate their own interpersonal behaviour

As service user involvement, particularly through ‘expert patient’ schemes, increases for service development and implementation in the UK, we investigated the concordance between how patients with personality disorder view their interpersonal functioning and the views of staff who care for them in a high security mental health setting. We compared self and observer ratings of interpersonal functioning for 55 legally-defined psychopathic disorder patients detained in a high security psychiatric hospital using the CIRCLE, an instrument designed to assess interpersonal functioning. We found that male patients underestimated their worst qualities, such as dominance (p < .0005) or coerciveness (p < .0005), and overestimated their best qualities, such as nurturance (p < .0005), a finding not intuitively surprising but which confirms aspects of previous research. This result raises the questions of how such discordance should be interpreted, whether self or observer ratings should be considered more valid, and whether such findings have a bearing on both future risk assessment and the individual's eventual movement from high secure care.

Die emotionale Informationsverarbeitung bei Patienten mit einer dissozialen Persönlichkeitsstörung vom Subtyp der „Psychopathy” nach Hare

Functional MRI was used to test the effects of the deficient emotional responsiveness of psychopathic patients on cognitive processes. We used a Simon-paradigm, in which ten healthy volunteers and ten patients with a diagnosis of "psychopathy" (defined by Hare Psychopathy Checklist Revised) have to select their spatially defined responses on the basis of a nonspatial stimuli feature. For the emotion induction pictures from the International Affective Picture System (IAPS) were selected. At the beginning and intermediated by the Simon-paradigm blocks of positive, negative or neutral pictures were presented. Patients with "psychopathy" exhibited untypical activation patterns in amygdala and prefrontal regions during interferences between negative or positive stimulations and cognitive tasks. These results demonstrated disturbed regulation of emotion-cognition-interaction in "psychopathy" according to PCL-R.

Spiritual Psychotherapy for Antisocial and Psychopathic Personalities: Some Theoretical Building Blocks

Until now a profound theoretical model for spiritual psychotherapy, which is constructed specifically for nonreligious antisocial and psychopathic patients who have spiritual and philosophical interests, is missing. In this paper some important theoretical issues with respect to spiritual psychotherapy for antisocial and psychopathic patients will be discussed such as the links between spirituality on one hand and authenticity, vanity; emotional, moral, and social capacity; reality testing; creativity; and faith in life on the other. Furthermore, the spiritual psychotherapist's attitude towards his or her patients will be explored.

Psychopathy, treatment involvement, and subsequent violence among civil psychiatric patients.

Individuals with psychopathy typically are viewed as incurable cases that should be diverted from treatment settings to environments where their behavior can be monitored and controlled. The prevailing clinical conviction that psychopaths are untreatable has crucial implications, given the scarcity of mental health care resources, the number of legal contexts that call for assessment of treatability, and the explosion of research on psychopathy and violence risk over recent years. Based on a sample of 871 civil psychiatric patients (including 195 "potentially psychopathic" and 72 "psychopathic" patients), this study explores the relations among psychopathy, receipt of outpatient mental health services in real-world settings, and subsequent violence in the community. The results suggest that psychopathic traits do not moderate the effect of treatment involvement on violence, even after controlling statistically for the treatment assignment process. Psychopathic patients appear as likely as non-psychopathic patients to benefit from adequate doses of treatment, in terms of violence reduction. We interpret these results in light of prior research with offenders and analyze their implications for future research, policy, and practice.

Motiveless malignity: Problems in the psychotherapy of psychopathic patients

Abstract This paper attempts to draw attention to the difference between the states of mind and inner worlds of neurotic, borderline and psychopathic patients, with reference to different types of destructiveness: anger in the neurotic patient; desperate vengeful hatred in the borderline paranoid; and a cold addiction to violence in the psychopath. Discussion focuses on technical issues and the need to meet the psychopathic patient where he really is, in the inner bleak emotional cemetery he may be inhabiting. Although most patients refuse to stay put in the neat schematic categories outlined, they do seem to appreciate and to need the therapist's recognition of the specific quality of these vastly different states of mind.

Violence and self-injury

Abstract This is an empirical study of the relationship between self-injury and violence in female Special Hospital patients. The relationship between self-injury and violence over the course of admission was assessed for 80 patients. The temporal relationship between weekly rates of violence and self-injury for 5 psychopathic disorder patients was assessed. There is an association between the level of self-injury and violent behaviour in Special Hospital patients with a legal category of psychopathic disorder but not for those with a category of mental illness. However, variations in self-injury explain only a small part of the variation in violence. There is a temporal association between the two behaviours, with violent behavier more likely to occur in the same week as self-injury in certain psychopathic disorder patients, but the association is not strong.

Object Relations and Reality Testing in Psychopathic and Antisocial Methadone Patients

The Bell Object Relations and Reality Testing Inventory (BOR-RTI) was used to evaluate differences in object relations and reality testing in a sample of 215 male and 25 female methadone patients based on their degree of psychopathy, measured by the Psychopathy Checklist-Revised (PCL-R), and their degree of antisociality, measured by the Personality Disorder Examination (PDE). As hypothesized, results showed that compared to non psychopaths, psychopaths demonstrated significantly greater impairment in object relations and, also, unexpectedly in reality testing. No significant differences in object relations or reality testing between antisocial and non-antisocial individuals were revealed. Additionally, it was hypothesized that differences in object relations would be found in antisocial subjects who were and were not considered to be psychopathic. No significant differences in object relations were revealed, however, but differences in reality testing were revealed between antisocial individuals based on...

TWELVE OPERATED CASES OF INGESTED FOREIGN BODY IN ADULTS

Ingested foreign body is a relatively common entity and infant cases represented about 60-80% of all cases. Most adult cases occurred in psychopathic patients or those who attempted suicide. These ingested foreign bodies are often evacuated naturally and few cases have been operated on. In this paper 12 operated cases of ingested foreign body in adults are clinically studied. Nine (75%) of 12 patients had psychic disease of were defendants in the detention house. They swallowed incredible foreign bodies for instance an antenna and wire intentionally. In these cases, it is possible that they swallowed some X-ray permeable materials, and it is uncetrain when they swallowed the foreign bodies, because antipsychal drugs should mask their abdominal symptoms. So careful observation is important and we recommend to operate on them aggressively to avoid a possibility causing perforation or intestinal obstruction.

Arsonists in maximum security: Mental state at time of firesetting and relationship between mental disorder and pattern of behaviour

Seventy-nine arsonists were identified in a Special Hospital. Sixty-eight had a clinical interview which included an analysis of symptoms present at the time of the most recent fire. Mentally ill arsonists did not differ from Psychopathic Disorder arsonists in their self-report of symptoms at the time of firesetting, the major difference was in the time course of their behaviour. Mentally ill arsonists lit their first fire on average eight years later than did Psychopathic Disorder patients. Further analysis indicates that PD women have a distinct group of current symptoms and behaviours. Language: en

Motiveless malignity: Problems in the psychotherapy of psychopathic patients

Abstract This paper attempts to draw attention to the difference between the states of mind and inner worlds of neurotic, borderline and psychopathic patients, with reference to different types of destructiveness: anger in the neurotic patient; desperate vengeful hatred in the borderline paranoid; and a cold addiction to violence in the psychopath. Discussion focuses on technical issues and the need to meet the psychopathic patient where he really is, in the inner bleak emotional cemetery he may be inhabiting. Although most patients refuse to stay put in the neat schematic categories outlined, they do seem to appreciate and to need the therapist's recognition of the specific quality of these vastly different states of mind.

Catecholamine overflow within rat striatum: the influence of microstimulation and electroconvulsive stimulation as observed with voltammetry

Differential pulse voltammetry with a carbon fibre microelectrode was used in chloral hydrate-anaesthetized rats for testing the influence of microstimulation and of electroconvulsive stimulation on the changes in concentration of electro-oxidizable materials (catechol derivates) in the extracellular space of the corpus striatum. Microstimulation applied in the striatum (8 V anodal pulses, 0.1 ms, 100 Hz for 40 s) caused a significant increase of the catechol-oxidative current (Ico); 5 s after microstimulation was stopped Ico ranged from 117 to 141% of the control (all values means +/- S.D. unless otherwise stated; 124 +/- 11%, n = 4, P < or = 0.01, Student's t test). This effect ceased in the third minute after microstimulation. A comparable result was observed when microstimulation was repeated at intervals of 10 min. Electroconvulsive stimulation with a sinusoidal current (50 Hz, approximately 150 mA, 0.2 s) caused a large increase in Ico; 20 s after stimulation ceased, Ico was 987 +/- 90% (n = 3) of the control and it returned to the baseline 2 min later. The mechanisms inducing transmitter overflow are considered and the influence of electroconvulsive stimulation on the striatum is discussed in the context of its beneficial effects in psychopathic patients.

Predicting Threatening Psychopathic Patient Behavior in an Inpatient Milieu

This study describes a practical approach to the successful prediction of threatening behavior by psychopathic patients within an inpatient setting. Patient reports to staff concerning unit members' alleged transgressions were employed to monitor and predict the escalation of dangerous behavior by patients within an inpatient population containing both Axis I and Axis II patients. Results demonstrated that only the psychopaths (a subset of Axis II patients) within the patient population participated in the process of making such reports to the staff. Similarly, the subjects of those reports were also only other psychopaths (and staff, collectively). The successful forecasting of the potentially dangerous events led both to minimal overreactions by staff and to effective management and treatment interventions with the patients.

Psychiatric interim regional secure unit: seven years' experience.

The 140 patients admitted during the seven-year period 1977–84 accounted for 225 discharges. Schizophrenia and personality disorder were the two commonest diagnoses and violence and arson the commonest cause for their admission. Patients were accepted from prisons, Special Hospitals and other hospitals, and were discharged to the community principally and into the care of their orginal catchment-area hospitals. Problems which remain unresolved include responding quickly enough to requests from catchment-area hospitals to accept difficult patients, finding appropriate treatment facilities for behaviourally-disturbed subnormal individuals and providing a service for psychopathic patients. The security within the secure unit has not proved a problem. Maintaining staffing levels has proved difficult both locally and nationally. Staff morale can be sustained by good personnel arrangements.

A preliminary study of Hare's “Research Scale for the Assessment of Psychopathy” in mentally-abnormal offenders

The abbreviated (15-item) version of Hare's Research Scale for the Assessment of Psychopathy (RSAP) was investigated in a sample of male admissions to Broadmoor Special Hospital ( N = 50), along with five MMPI measures relevant to psychopathy (Impulsivity, Sociability, Psychopathic Deviate, Anxiety and Sociopathy). Patients were assigned to one of four clinical diagnostic groups: Personality Disorder, Mixed (personality disorder with schizophrenia), Schizophrenia and Affective Disorder. Results indicated that while both psychopathic groups (Mixed and Personality Disorder) showed high scores on almost all RSAP items, the Affective Disorder group showed low scores on almost all items. Results of a discriminant function analysis indicated that Hare's RSAP was superior to the MMPI measures at discriminating between psychopaths and non-psychopaths. Use of the discriminant function to re-allocate patients to criterion groups showed a high hit rate (94%) for psychopathic patients but a hit rate of only 61% for non-psychopathic patients. Half of the schizophrenic patients were mis-allocated to the psychopathic group. The results support the idea of an affective deficit common to psychopaths and schizophrenics, but suggest that psychopaths additionally show a deficit which may be characterized by a lack of goal-directed behaviour.