Swedish penal law does not exculpate on the grounds of diminished accountability; persons judged to suffer from severe mental disorder are sentenced to forensic psychiatric care instead of prison. Re-introduction of accountability as a condition for legal responsibility has been advocated, not least by forensic psychiatric professionals. To investigate how professionals in forensic psychiatry would assess degree of accountability based on psychiatric diagnoses and case vignettes, 30 psychiatrists, 30 psychologists, 45 nurses, and 45 ward attendants from five forensic psychiatric clinics were interviewed. They were asked (i) to judge to which degree (on a dimensional scale from 1 to 5) each of 12 psychiatric diagnoses might affect accountability, (ii) to assess accountability from five case vignettes, and (iii) to list further factors they regarded as relevant for their assessment of accountability. All informants accepted to provide a dimensional assessment of accountability on this basis and consistently found most types of mental disorders to reduce accountability, especially psychotic disorders and dementia. Other factors thought to be relevant were substance abuse, social network, personality traits, social stress, and level of education.
Borderline personality disorder (BPD) is closely related to suicidal behavior, and suicide attempts per se are considered a diagnostic criterion. However, there has been no previous study of completed suicides and BPD. The present study is based on a population of 134 consecutive psychiatric suicides from 1961 to 1980 in a catchment area of 250,000 inhabitants. Clinical records were retrospectively diagnosed according to the Diagnostic Interview for Borderlines and DSM-III. There was a progressive increase in proportion of borderline suicides during the time period. The overall proportion of BPD, however, was only 12%, indicating that borderline patients are not seriously overrepresented among patients committing psychiatric suicides. Demographic variables, earlier psychiatric care, and suicidal behavior in the borderline group are described and analyzed.
Chercheure à l'Institut de recherche pour le développement social des jeunes (IRDS), Institut de recherche du Centre jeunesse de Montréal-Institut universitaire et au département de psychiatrie du Centre universitaire de santé McGill (CUSM).
An exploratory survey of 68 youth protection services' workers in Montréal, who followed 1,030 children reveals that 39 % of these children have at least one parent who suffer from mental health problems. Among these parents, 48 % of mothers and 30 % of fathers have a personality disorder, and for the majority, a borderline personality disorder. This mental health problem is preoccupying for youth protection workers because of its high prevalence, its impact on children and case workers and the difficulties brought forth by having to intervene in a context of authority and within an organization not adapted to the management of this mental health problem. Some intervention's guidelines to work with these parents are presented as well as some challenges and future perspectives.
To test whether the adult self-report scale for ADHD, six-items version (ASRS-6), measures inattentiveness and hyperactivity independently.
The ASRS-6 was completed by 234 university students and 157 outpatients treated for drug dependence. In both samples, the ASRS-6 was subjected to two confirmatory factor analyses, one testing a one-factor model and the other testing a model with two correlated factors indicating inattentiveness and hyperactivity, respectively. Test-retest reliability of the subscales was tested on a subset of the student sample (n = 25).
In both samples, the one-factor solution did not fit the data, but the two-factor solution fit the data better. Subscales differed in their correlates in ways that mirror the correlates of inattentiveness and hyperactivity in the published literature on ADHD. In the student sample, the test-retest reliability was adequate for hyperactivity (r = .70) and inattentiveness (r = .77).
The ASRS-6 measures two correlated constructs, rather than one unitary construct.
This paper presents, as part of a national Swedish research project, a study of associations between staff feelings toward patients and treatment outcome at 23 small psychiatric inpatient units. The outcome was measured with a composite scale based on structured interviews. Staff feelings were reported on a feeling checklist. Few and scattered correlations were found between staff feelings and treatment outcome when the whole group of patients was analyzed together. More meaningful patterns were found when data for psychotic and borderline patients were analyzed separately. For psychotic patients, positive outcome was associated with low levels of negative feelings throughout treatment. For borderline patients, positive outcome was associated with negative feelings at the beginning of treatment, followed by strong positive feelings in the later part. Staff feelings were more strongly associated with outcome for borderline patients than for psychotic patients. Patients with different structural diagnoses need different kinds of staff "feeling milieus."
Avoidant personality disorder (AvPD) and social phobia (SP) are common, closely related conditions. Little is known about the underlying processes related to the social discomfort of subjects with AvPD and SP. Both disorders are associated with interpersonal problems. An attachment perspective may shed light on similarities and differences in close relationships between the disorders. The aim of the study was to compare self-reported attachment styles in patients with AvPD and SP. We expected that patients with AvPD would have more attachment anxiety and avoidance and more often a Fearful attachment style, compared with SP.
This is a cross-sectional multisite study of 90 adult patients with AvPD and SP. Patients with AvPD with and without SP (AvPD group) were compared with patients with SP without AvPD (SP group).
Patients were assessed using structured diagnostic interviews and self-reporting questionnaires, including Experiences in Close Relationships (ECR). The ECR dimensions, Anxiety and Avoidance, and the new described five factors of the ECR were used.
The AvPD group had higher levels of attachment anxiety than the SP group, especially for the sub-factors Anxiety for abandonment and Separation frustration. The diagnostic groups did not differ in levels of avoidance. Anxiety for abandonment was still associated with AvPD after controlling for symptom disorders and the criteria of other personality disorders. A Fearful attachment style was more frequent among patients with AvPD.
The results indicate AvPD is associated with more attachment anxiety than SP. Fear of abandonment may play a significant role in the AvPD pathology.
This is the first study to compare attachment styles in patients with avoidant personality disorder (AvPD) and social phobia (SP). The AvPD group had higher attachment-related anxiety than the SP group, and anxiety was most pronounced for the fear of abandonment. Fear of abandonment may play an important role in the AvPD pathology.
The aim of the study was to explore the associations between the presence of avoidant personality problems (APPs) and 5 areas of impairment: demography, somatic issues, mental health, lifestyle, and social issues.
Avoidant personality problem was defined by confirmation of the 2 avoidant personality disorder items of the Iowa Personality Disorder Screen and and the Social Phobia Inventory (SPIN) short version (MINI-SPIN) screening assessment for generalized social anxiety disorder sum score of 6 or more. The questionnaires were administered in a Norwegian population survey (the Oslo Health Study-HUBRO). Cases consisted of 280 individuals with APP and 5 randomly selected controls without APP (n = 1400).
The APP group more frequently reported living alone, lower level of education, and lower income than controls. Poor self-rated health, presence of somatic disease, muscular pain, frequent use of analgesics, and visits at a general practitioner were significantly more common in the APP group than among controls. The APP group had significantly higher proportion of caseness of mental distress, low general self-efficacy, and insomnia, and this result held up in multivariate analyses. The APP group showed statistically significant higher proportions of physical inactivity, obesity, daily smoking, and alcohol problems compared with controls. As for social impairment, a significantly higher proportion of the APP group reported "not having enough good friends," "high powerlessness," and low community activism, and the 2 former variables held up in multivariate analyses.
In this population-based study, we found that high levels of APP, defined closely to avoidant personality disorder, were significantly associated with demographic, somatic, and mental impairment; low general self-efficacy; and insomnia affecting work ability. In addition, APP showed associations with negative lifestyle, alcohol problems, and social impairment reporting lack of good friends and lack of empowerment. Avoidant personality problem is associated with clinically significant impairment in several areas, which underlines the importance of recognizing these problems in primary health care.
This study analyzed the borderline traits of a sample of community alcoholics drawn from a rural and a metropolitan area of the province of Quebec. The Diagnostic Interview Schedule and other questions from the Diagnostic Interview for Borderlines were administered. About one-third of the sample of alcoholics showed a high number of borderline traits, a proportion similar to that found in institutionalized samples elsewhere. The borderline alcoholics tended to be younger and they all came from the urban area. This result suggests that alcoholics are probably better tolerated in rural areas and are less likely to adopt a pathological behaviour.
The Antisocial Process Screening Device- Self-Report (APSD-SR) is a self-report measure for assessment of psychopathic traits in adolescents. The present study aimed to investigate the factor structure and internal consistency of the APSD-SR in a sample of 4855 Finnish community adolescents. A three-factor structure with factors representing impulsivity (IMP), narcissism (NAR) and callous-unemotional (CU) features was found. Internal consistency indices ranged from moderate to good. The findings provide promising data on applicability of the APSD-SR instrument to Scandinavian youth. Results have implications for researchers and clinicians interested in measuring adolescent psychopathy.
In the three decades since the definitive decisions regarding duty to warn and protect, several cases have shaped psychiatric practice. In this article we present a tragic case that we postulate may have a significant effect on psychiatric practice in Canada. A psychiatric patient murdered a relative some 50 days after the patient left the hospital. On the day before his release, the patient's status was changed from involuntary to voluntary. We argue that this case may result in a reversal of current mental health and social policy, whereby psychiatrists will be less willing to release difficult and potentially dangerous patients. To provide context to the case, we review some concepts of the literature and recent legal cases pertaining to the release of such patients.