Psychopathy Checklist Screening Version Research Articles

Psychopathy in a forensic sample - the factor structure of the PCL:SV in a Danish forensic sample.

The research literature reveals an ongoing debate regarding the most appropriate conceptualization of psychopathic personality disorder. Specifically, it is discussed to what degree antisocial behavior is part of the conceptualization of the psychopathy construct and what constitutes the best factor model of the Psychopathy Checklist scales. The aim of the present study is to consider the underlying factor structure of the PCL:SV (Psychopathy Checklist Screening Version) in a Danish sample as well as considering the role of antisocial behavior in the psychopathy construct. Data from a Danish forensic patient sample (N=225) was used and item response theory (IRT), aonfirmatory factor analyses (CFA) and structural equations model (SEM) analyses were carried out. Overall, the findings suggest appropriate item and model fit for the PCL:SV as well as superiority of the three-factor model over the four-factor model. The results are discussed in relation to the broader concept of personality disorder as well as clinical practice in regards to violence risk assessments and treatment of psychopathy.

Understanding motives for aggression in forensic psychiatric patients: a preliminary study

ABSTRACTThe primary aim of this study was to explore motivations underpinning aggression among men detained within conditions of high security. Thirty men residing at a high secure psychiatric hospital completed self-report measures, including the Aggression Motivation Questionnaire, Revised EXPAGG and Barratt Impulsiveness Scale-IIr. The Historical items of the Historical, Clinical and Risk-Management (HCR-20) and the Psychopathy Checklist-Screening Version were rated. A subsample of participants agreed to complete a functional assessment on an aggressive incident that had occurred during their placement (n = 9). Increased psychopathy and impulsivity, and the presence of historical risk items were predicted to associate with higher levels of both aggression motivation and beliefs supportive of aggression. Young age at first violent incident and personality disorder related positively to aggression motivation. Thematic analysis conducted on the functional assessments identified social recognition, emotion regulation, communication and protection as functions underpinning aggression. Results are discussed with regards to their implication for violence treatment and assessment, with a focus on motivation recommended.

Assessing Protective Factors for Violence Risk in U.K. General Mental Health Services Using the Structured Assessment of Protective Factors.

Violence risk assessment and management are key tasks in mental health services and should be guided by validated instruments covering both risk and protective factors. This article is part of an international effort to validate the Structured Assessment of Protective Factors (SAPROF) for violence. The SAPROF, Historical, Clinical, Risk Management-20 (HCR-20) and the Psychopathy Checklist-Screening Version (PCL-SV) were administered in a sample of 261 patients in U.K. forensic, general inpatient, and community mental health settings. There was significant variation between these groups on SAPROF scores with fewer protective factors in the forensic group. The prospective validity of the SAPROF for nonviolence in the general inpatient and community samples was moderate (area under the curve [AUC] = .60). Adoption of the SAPROF or similar instruments as a supplement to risk-focused assessments has the potential to improve awareness of protective factors and enhance therapeutic engagement in a range of mental health services.

Neural Mechanisms Underlying Affective Theory of Mind in Violent Antisocial Personality Disorder and/or Schizophrenia.

Among violent offenders with schizophrenia, there are 2 sub-groups, one with and one without, conduct disorder (CD) and antisocial personality disorder (ASPD), who differ as to treatment response and alterations of brain structure. The present study aimed to determine whether the 2 groups also differ in Theory of Mind and neural activations subsuming this task. Five groups of men were compared: 3 groups of violent offenders-schizophrenia plus CD/ASPD, schizophrenia with no history of antisocial behavior prior to illness onset, and CD/ASPD with no severe mental illness-and 2 groups of non-offenders, one with schizophrenia and one without (H). Participants completed diagnostic interviews, the Psychopathy Checklist Screening Version Interview, the Interpersonal Reactivity Index, authorized access to clinical and criminal files, and underwent functional magnetic resonance imaging while completing an adapted version of the Reading-the-Mind-in-the-Eyes Task (RMET). Relative to H, nonviolent and violent men with schizophrenia and not CD/ASPD performed more poorly on the RMET, while violent offenders with CD/ASPD, both those with and without schizophrenia, performed similarly. The 2 groups of violent offenders with CD/ASPD, both those with and without schizophrenia, relative to the other groups, displayed higher levels of activation in a network of prefrontal and temporal-parietal regions and reduced activation in the amygdala. Relative to men without CD/ASPD, both groups of violent offenders with CD/ASPD displayed a distinct pattern of neural responses during emotional/mental state attribution pointing to distinct and comparatively successful processing of social information.

A predictive model of criminality in civil psychiatric populations

Purpose – The purpose of this paper is to develop a predictive model of criminal risk in civil psychiatric populations, by determining the relative impacts of psychopathy, drug use, impulsivity and intelligence on levels of criminality. Design/methodology/approach – The sample consisted of 871 civil psychiatric patients, selected from the MacArthur Violence Risk Assessment Study, who had been diagnosed with a mental illness or personality disorder, and hospitalised less than 21 days. Each participant was administered the Hare Psychopathy Checklist Screening Version (PCL:SV), Barratt Impulsiveness Scale (BIS-11) and the Wechsler Adult Intelligence Scale (WAIS-R). In addition, information on background demographics, drug use and criminality was obtained via a self-report questionnaire. Findings – Pearson correlations identified significant positive relationships between past arrests, psychopathy, impulsivity and drug use. Intelligence was negatively related to past arrests. Multiple regressions identified a significant main effect for Factor 2 psychopathy on past arrests when controlling for all covariates, but not for Factor 1 psychopathy, intelligence or impulsivity. Drug use and gender had small univariate effects. Research limitations/implications – It is suggested that future research investigates the influence of specific mental disorders on different types of offending. Originality/value – By investigating predictors of criminal behaviour in civil psychiatric patients, the present study makes valuable contributions to the research literature, enhancing our theoretical understanding of the relationships between psychopathy and criminality/recidivism. It also has notable implications in applied practice, for example in the development and refinement of risk assessment methods.

Riesgo de violencia institucional y comunitaria en delincuentes con trastorno mental

High scores on the Historical Clinical Risk Management (HCR-20) and the Psychopathy Checklist-Screening Version (PCL:SV) are traditionally associated to risk of violent behaviour in mentally disordered persons. The present work explores the relation between both instruments and violence inside and outside a forensic psychiatric hospital in a sample of mentally-disordered males (n=29). Results indicate that both instruments are associated with institutional violence, whereas they appear to be independent of community violence.

Prediction of Institutional Misconduct Among Civil Psychiatric Patients

Research has shown that psychiatric patients with criminal histories report attitudes reminiscent of the prison culture that predict therapeutic alliance. This study examined the impact of these “correctional adaptations” on the behavior of a sample of 75 discharged civil psychiatric patients whose medical charts were reviewed for incidents of institutional misconduct including cigarette dealing, drug use, and weapons possession. Patients had been previously administered the Psychopathy Checklist–Screening Version (PCL-SV), Brief Psychiatric Rating Scale (BPRS), and Structured Assessment of Correctional Adaptation (SACA). Of the sample, 53% ( n = 40) committed at least one act of misconduct, with an average of M = 2.8 (range = 0–18, SD = 4.27) incidents. Bivariate analyses revealed a significant relationship between incidents and the total SACA score, r s(74) = .33, p = .004. Ordinal regression analyses showed the SACA to be significantly predictive of misconduct, regardless of arrest history.

The Manifestation of Psychopathic Traits in Women: An Exploration Using Case Examples

The construct of female psychopathy is poorly understood. Progress in this area is hindered by the reliance on male psychopathy conceptualizations and measurement frameworks, and the failure to establish what the construct looks like in females. Case studies are a fundamental step in the development of a clearer female psychopathy conceptualization, yet one that has been neglected in the literature. This article explores the presentation and manifestation of psychopathic traits in two cases of women offenders with high levels of such traits, using two measures of psychopathy: the Comprehensive Assessment of Psychopathic Personality (CAPP) and the Psychopathy Checklist Screening Version (PCL:SV). Findings are discussed in relation to what is known about psychopathy in women, and in men. Potential implications for clinical practice, including the assessment of psychopathy in women, are considered.

Predicting Recidivism in Adolescents With Behavior Problems Using PCL-SV

Studies show that identifying persistent delinquents on the basis of early antisocial conduct yields a significant error rate. However, evaluating childhood or adolescent psychopathic traits is likely to improve matters in this regard. This study seeks to verify the contribution of psychopathic traits in adolescence to antisocial conduct prediction in early adulthood. To this end, a French version of the Psychopathy Checklist -Screening Version (PCL-SV) adapted to adolescents is used to evaluate psychopathic traits in 27 youths aged 15 to 19 years recruited in youth centres and presenting behavioral problems reaching a clinical threshold. The PCL-SV scores contribute significantly above and beyond indices of delinquent behavior to predict self-reported antisocial conduct 2 years later and, specifically, to predict criminal versatility and violent recidivism.

Viewing Psychopathy from the Perspective of the Personality Psychopathology Five Model: Implications for DSM-5

The current study examined the association between domains from the Personality Psychopathology Five (PSY-5; Harkness & McNulty, 1994) model, which is a dimensional model of pathological personality that corresponds closely to the proposed domains of the DSM-5, and psychopathy as indexed by the Psychopathy Checklist-Screening Version (PCL-SV; Hart, Cox, & Hare, 1995). The sample comprised 99 individuals undergoing forensic psychological evaluations. The PSY-5 domain of Aggressiveness was strongly associated with the PCL-SV global measure of psychopathy, as well as both PCL-SV parts and the four facets. The PSY-5 domain Disconstraint was preferentially associated with the behavioral facets of psychopathy, whereas low Negative Emotionality was related to the affective characteristics of the construct. These findings have implications for the Antisocial/Psychopathic prototype proposed for the DSM-5.

The Utility of the HCR-20 and PCL:SV in the Prediction of Diversion Noncompliance and Reincarceration in Diversion Programs

Diversion programs were developed to decrease the number of incarcerated mentally ill individuals. The number of diversion programs and mental health courts is rapidly growing, and an increased number of diversion programs are willing to accept defendants charged with violent felonies, stressing the need for thorough risk assessments as part of diversion eligibility evaluations. This study was designed to examine the utility of the Historical–Clinical–Risk Management–20 (HCR-20) and Psychopathy Checklist Screening Version (PCL:SV) in predicting diversion noncompliance and reincarceration in a sample of 131 defendants participating in different diversion programs in New York. Results provided support for the use of the HCR-20 and PCL:SV in the context of diversion, although the HCR-20 proved to be superior to the PCL:SV in predicting diversion noncompliance and reincarceration.

Disentangling Structural Brain Alterations Associated With Violent Behavior From Those Associated With Substance Use Disorders

Studies aimed at identifying structural brain alterations associated with persistent violent behavior or psychopathy have not adequately accounted for a lifetime history of substance misuse. Thus, alterations in gray matter (GM) volume that have been reported to be correlates of violent behavior and/or psychopathy may instead be related to lifelong substance use disorders (SUDs). To identify alterations in GM volume associated with violent behavior and those associated with lifelong SUDs. Cross-sectional study. Participants were recruited from penitentiaries, forensic hospitals, psychiatric outpatient services, and communities in Germany. Structural magnetic resonance imaging was performed at a university hospital. Four groups of men were compared: 12 men with SUDs who exhibited violent behavior (hereafter referred to as violent offenders), 12 violent offenders without SUDs, 13 men with SUDs who did not exhibit violent behavior (hereafter referred to as nonoffenders), and 14 nonoffenders without SUDs. Voxel-based morphometry was used to analyze high-resolution magnetic resonance imaging scans. Assessments of mental disorders, psychopathy (using the Psychopathy Checklist-Screening Version), aggressive behavior, and impulsivity were conducted by trained clinicians. Compared with nonoffenders, violent offenders presented with a larger GM volume in the amygdala bilaterally, the left nucleus accumbens, and the right caudate head and with less GM volume in the left insula. Men with SUDs exhibited a smaller GM volume in the orbitofrontal cortex, ventromedial prefrontal cortex, and premotor cortex than did men without SUDs. Regression analyses indicated that the alterations in GM volume that distinguished the violent offenders from nonoffenders were associated with psychopathy scores and scores for lifelong aggressive behavior. The GM volumes of the orbitofrontal cortex and prefrontal cortex that distinguished the men with SUDs from the men without SUDs were correlated with scores for response inhibition. These findings suggest that a greater GM volume in the mesolimbic reward system may be associated with violent behavior and that reduced GM volumes in the prefrontal cortex, orbitofrontal cortex, and premotor area characterize men with SUDs.

The development and validation of the guidelines for stalking assessment and management

International research has established that stalking is a prevalent problem with serious and often life-threatening consequences for victims. Stalking is also a unique form of violence due to its nature and diversity, making it difficult for criminal justice and health professionals to establish which perpetrators and victims have the greatest need for services and protection. Risk assessment is one way to address these problems but few tools exist. This article describes the development of the Guidelines for Stalking Assessment and Management (SAM), the first risk assessment instrument designed specifically for the stalking situation. Preliminary data are presented, indicating that the SAM has promise for use by professionals working with stalkers and their victims. Results indicated that interrater reliabilities for the SAM risk factors and total scores range from fair to good, and the structural reliability of the SAM is sound. Moreover, the SAM showed good concurrent validity when compared with two other measures of violence propensity: the Psychopathy Checklist Screening Version (PCL:SV) and the Violence Risk Appraisal Guide (VRAG). Limitations of the study are discussed, especially those related to the difficulties inherent in file-based research, and suggestions for future research are offered.

Factors Predicting Dropout From the Reasoning and Rehabilitation Program With Mentally Disordered Offenders

Studies evaluating the implementation of cognitive skills programs with mentally disordered offenders (MDOs) have reported high dropout rates, but little is known about the factors associated with treatment noncompletion. The authors analyzed data from the first randomized controlled trial of the Reasoning and Rehabilitation (R&R) program with MDOs to determine predictors of treatment dropout. Patients with psychotic disorders were recruited from medium-secure hospitals in the United Kingdom. Fifty percent of the 44 participants allocated to receive R&R prematurely terminated treatment. Program dropout was significantly predicted by scores on the Clinical and Risk Management scales of the Historical, Clinical, Risk Management—20, Factor 2 scores of the Psychopathy Checklist—Screening Version, antisocial personality disorder (ASPD), psychopathy, and recent violence. Psychopathy, ASPD, and recent violence emerged as the strongest predictors of dropout in multivariate analyses. Strategies to improve treatment retention should be targeted at MDOs who display high levels of impulsivity, poor behavioral controls, and antisocial or psychopathic traits.

Psychopathy as a Risk Factor for Violent Recidivism: Investigating the Psychopathy Checklist Screening Version (PCL:SV) and the Comprehensive Assessment of Psychopathic Personality (CAPP) in a Forensic Psychiatric Setting

A robust relationship has been established between psychopathy and violence, and psychopathy is considered essential in the process of violence risk assessment. This study presents data on a patient sample from a forensic psychiatric unit in Denmark. All patients were assessed for psychopathy using the Psychopathy Checklist Screening Version (PCL:SV) and the Comprehensive Assessment of Psychopathic Personality (CAPP). After a follow-up period of 5.7 years, recidivism outcomes were obtained from the Danish National Crime Register. Both psychopathy measures were related to a more severe and versatile criminal career as well as to violent recidivism. Overall, the predictive accuracy of violent recidivism of the two measures was good, and no significant difference was found in terms of predictability. The newly developed CAPP could be a promising clinical risk management tool in terms of its comprehensiveness. Its validity needs to be further explored, but at least its ability to predict violence similar to the PCL:SV is supported by the present study.

Facets on the psychopathy checklist screening version and instrumental violence in forensic psychiatric patients

There is a recognised relationship between psychopathy and instrumental violence, but not all violence by people who meet the criteria for psychopathy is instrumental. Our aims were to compare offence types among forensic psychiatric patients with and without the Psychopathy Checklist: Screening Version (PCL: SV) criteria for psychopathy. Our specific questions were whether factor 1 - the interpersonal affective dimension - was related to instrumentality and on severity of the violent crime. Our hypothesis was that the relationship between psychopathy and instrumental violence would be dependent on the severity of the violent crime. Sixty-five male patients at the forensic psychiatric hospital in Sundsvall, all with a violent criminal history, were assessed for psychopathy through interview and records using the PCL: SV. Severity and the instrumentality of their previous violence were coded using the Cornell coding guide for violent incidents. The interpersonal features of psychopathy (the interpersonal facet), and only the interpersonal features were significantly associated with instrumentality and severity of violence. Instrumentality was also significantly related to the severity of the violence, independent of psychopathy score. The results indicated that, at least among forensic psychiatric patients, planning is more likely than not with respect to serious crimes. The specific link between interpersonal features of psychopathy and instrumental and severe violence suggests potential clinical value in recognising subtypes of psychopathy.

S22-01 - Preventive monitoring of psychiatric patients at risk for compulsory readmission: preliminary results of a multi-center RCT

ObjectivesThis study aims at reducing the risk for compulsory readmission in psychiatric patients by a comprehensive intervention comprising psychoeducation on warning signs, crisis cards and a continuous telephone monitoring of the patients‘ mental health status and health care utilization over a two-year period. Beyond reducing involuntary admissions, further objectives of the intervention are to reduce number and duration of inpatient stays and to result in a more cost-effective service provision.MethodsPsychiatric inpatients suffering from schizophrenia or an affective disorder were randomly allocated to the intervention group or the control group (treatment as usual). Risk for compulsory readmission was defined by a current involuntary treatment episode or involuntary treatment within the previous 24 months. Both groups are assessed at baseline, at 12-month and 24-month follow-up. Interviewer ratings cover psychopathology (Positive and Negative Syndrome Scale, Young Mania Rating Scale, Hamilton Depression Sale, Global Assessment of Functioning), psychopathy (Hare Psychopathy Checklist Screening Version) and risk for violence (HCR 20). Treatment satisfaction, empowerment and quality of life is measured by self-report questionnaires. Health care utilization and prescription of psychotropic medication is recorded continuously in the intervention group and over a 3-month period in the control group.ResultsPreliminary results of this ongoing study will be presented, illustrating sample characteristics and first results of the one year follow-up. Focusing on data of type, number and duration of inpatient stays, the potential of the intervention to reduce the risk for involuntary readmission to psychiatry will be discussed.

Psychopathy and stalking.

We examined the association between psychopathy, assessed using the Hare Psychopathy Checklist-Revised: Screening Version (Hart et al., Manual for the psychopathy checklist screening version (PCL:SV), 1995), and stalking in 61 men convicted of stalking-related offenses. Psychopathic symptoms were rare, but their presence-especially that of affective deficit symptoms-was associated with victimization of casual acquaintances and with several risk factors from the Guidelines for Stalking Assessment and Management (SAM) (Kropp et al., Guidelines for stalking assessment and management, 2008a), including stalking in violation of supervision orders, degree of preoccupation with victims, and targeting of victims with limited access to external resources. The findings suggest that in spite of their rarity, psychopathic traits may be important in the assessment and management of stalking risk.

The distribution of psychopathy among a household population: categorical or dimensional?

The study aimed to examine the distribution of psychopathic traits in a representative household population to identify whether a transition point is reached on a continuum of psychopathy to indicate a 'disease' or categorical entity. Mixture Poisson distribution and epidemiological procedures were used to examine the distribution of the Psychopathy Checklist Screening Version (PCL:SV) score in a sample of 638 adults in households in Great Britain. Analysis aimed to identify a cut-off within the population using the distribution of continuous scores (mean and (1/2) SD) and validate a 'probable' psychopathy category using a scale of social and behavioural problems as an external validator. The distribution of psychopathy within the population was quasicontinuous, represented by a mixture of three-Poisson distributions with differing demography and comorbid Axis I and II psychopathology. Independent calculation indicated a cut-score at 11.8 on the PCL:SV. There was an exponential rise of associated social and behavioural problems at a transition point of 11.3. The prevalence of 'probable' psychopathy was 3.6% (95% CI = 2.3-5.5%) above this level. The findings suggest a transition from a non-clinical to clinical state of psychopathy which can be defined categorically using a cut-off on the PCL:SV. The cut-off approximates to that previously recommended for identification of a case using the instrument. Above this critical level, individuals are at exceptional risk of compulsory care or incarceration due to multiple social and behavioural problems. Psychopathy should be considered for future inclusion in DSM-V and successfully combines both categorical and dimensional approaches to diagnosis.

The Prevalence of Mental Disorders in a German Sample of Male Incarcerated Juvenile Offenders

The current study investigated the prevalence of mental disorders among incarcerated juvenile offenders in Germany and sought to identify clinically relevant subgroups. In sum, 149 newly incarcerated male juvenile delinquents (M age = 19 years) were included. Diagnostic tools included the German version of the Structured Clinical Interview for DSM-IV and the Psychopathy Checklist-Screening Version. The most prevalent diagnoses in the sample included conduct disorders (81%), Cluster B personality disorders (up to 62%), and substance-related disorders (up to 60%). Moreover, psychopathic features were found among 21% of the participants. Cluster analysis distinguished three subgroups among this group of young offenders. The most problematic consisted of juveniles with multiple psychopathology, including antisocial traits, personality pathology, higher scores on the Psychopathy Checklist, as well as multiple substance abuse. Study outcomes are discussed in light of their implications for the development of effective treatment for juvenile offenders.