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Background: The ARMIDILO-S is advocated as a promising tool for assessing dynamic risk factors in sex offenders with intellectual disabilities (SOIDs). However, research remains scarce. The present study aimed to further validate this instrument in SOIDs. Method: The study prospectively followed 38 SOIDs for up to one year to test the accuracy of the ARMIDILO-S in predicting violent and sexual incidents. Results: Overall predictive accuracy was moderate to high. The ARMIDILO-S further showed excellent prospective qualities in identifying both high-risk and low-risk offenders for violence. Regarding sexual offending, it was only good at prospectively detecting low-risk individuals. Conclusions: This study provided further evidence of the good predictive validity of the ARMIDILO-s in predicting future sexual and violent incidents in SOIDs. More research in preferably larger samples as well as field validity studies are recommended.

AbstractForensic psychiatric patients pose a vulnerable population due to their unbalanced diet, overweight, smoking, adverse effects of medication, and sedentary lifestyle within secure settings. These lifestyle traits have been correlated with a higher incidence of morbidity and a lower life expectancy. Nonetheless, empirical data regarding these topics remains limited. In the current study we examined obesity, metabolic syndrome and smoking patterns in two high-security settings in Flanders. We also examined the influence of psychiatric diagnoses and the usage of antipsychotic medication to these characteristics. Results indicated that obesity, smoking, and metabolic syndrome were highly prevalent across different diagnoses. In contrast to previous findings, there was no association between the presence of metabolic syndrome and the use of (second generation) antipsychotics. Missing information in the electronic files further indicated that there remains room for improvement in the detection and monitoring of physical health. It is recommended that forensic institutions pay more attention to the provision of care programs to manage weight and smoking. [ABSTRACT FROM AUTHOR]

Background: One of the most extensively tested risk assessment instruments in offenders with an intellectual disability (OIDs) is the Violence Risk Appraisal Guide (VRAG). The purpose of this prospective study was to test the ability of this instrument to predict institutional aggression in OIDs. Method: VRAG scores were collected for 52 OIDs, and staff registered aggressive incidents during a period of 6 months. Predictive accuracy was analysed using several performance indicators. Results: The VRAG was not able to significantly predict aggressive behaviour, although a trend towards significance was found for interpersonal physical aggression. Furthermore, the VRAG was only accurate in prospectively identifying low-risk individuals. Conclusion: Compared to other studies, demonstrating good predictive validity for institutional aggression in OIDs, the VRAG performed poorly in this study. The usefulness of this instrument in identifying high- risk offenders is questioned. Until further evidence is available from studies using multiple performance indicators, clinicians have to be very careful in relying on the results of a risk assessment tool.

Empirical studies on the longitudinal change of risk factors during treatment of forensic psychiatric patients are scarce. Therefore, in the current study, changes in risk factors of 341 high-security forensic psychiatric patients in Flanders were investigated using latent growth curve analyses. Annual assessments of the Historical Clinical Future-Revised (HKT-R) at three time points were considered, starting at time of admission. A significant small improvement was found on the future scale and most future factors. However, the clinical scale did not change significantly and only one of the 14 clinical factors (i.e., problem insight) changed significantly over time. Although the forensic treatment seems to be a slow process, the sensitivity of the HKT-R to detect clinically relevant change is questioned, underscoring the importance of determining whether there are instruments capable of detecting small significant changes over time. [ABSTRACT FROM AUTHOR]

Background: A stable assessment of cognition is of paramount importance for forensic psychiatric patients (FPP). The purpose of this study was to compare repeated measures of IQ scores in FPPs with and without intellectual disability. Methods: Repeated measurements of IQ scores in FPPs (n = 176) were collected. Differences between tests were computed, and each IQ score was categorized. Additionally, t-tests and regression analyses were performed. Results: Differences of 10 points or more were found in 66% of the cases comparing WAIS-III with RAVEN scores. Fisher's exact test revealed differences between two WAIS-III scores and the WAIS categories. The WAIS-III did not predict other IQs (WAIS or RAVEN) in participants with intellectual disability. Discussion: This study showed that stability or interchangeability of scores is lacking, especially in individuals with intellectual disability. Caution in interpreting IQ scores is therefore recommended, and the use of the unitary concept of IQ should be discouraged.

Research on risk assessment and risk management in offenders with intellectual disabilities (OIDs), although far behind compared to the mainstream offender literature, is now expanding. The current review provides an overview of the predictive value of risk assessment and treatment outcome monitoring tools developed for both mainstream forensic populations and OIDs. It is suggested that "mainstream" instruments have equal validity in OIDs, although studies in sex offenders show mixed results. In order to tackle specific criminogenic needs, unique characteristics of OIDs and their environment should be taken into account, which are addressed in ID-specific tools. Evidence regarding the added value and validity of these tools is however still preliminary.

The ARMIDILO-S is advocated as a promising tool for assessing dynamic risk factors in sex offenders with intellectual disabilities (SOIDs). However, research remains scarce. The present study aimed to further validate this instrument in SOIDs. The study prospectively followed 38 SOIDs for up to one year to test the accuracy of the ARMIDILO-S in predicting violent and sexual incidents. Overall predictive accuracy was moderate to high. The ARMIDILO-S further showed excellent prospective qualities in identifying both high-risk and low-risk offenders for violence. Regarding sexual offending, it was only good at prospectively detecting low-risk individuals. This study provided further evidence of the good predictive validity of the ARMIDILO-s in predicting future sexual and violent incidents in SOIDs. More research in preferably larger samples as well as field validity studies are recommended. [ABSTRACT FROM AUTHOR]

Identifying pedophilic sexual interest among persons who have sexually offended against children (PSOCs) is important for risk assessment because not all PSOCs are pedophilic. Existing physiological and self-report methods have several limitations. In the present study, sexual interest was assessed indirectly by means of a computer task: the Choice Reaction Time (CRT) task in 49 extrafamilial PSOCs and 25 persons without a history of sexual offences against children (control group). The results showed that PSOCs, the participants with a DSM-IV diagnosis of pedophilia or with a high score on pedophilic interest (measured by the SSPI-2) performed equally fast in the different age category stimuli. In other words, no effect of sexual orientation towards children was found. The control group however, showed longer reaction times for the adult and adolescent stimuli compared to the child stimuli, indicative that they did not have a sexual orientation towards children. The present study found only partial evidence for the validity of the CRT paradigm, as it was effective in discriminating age orientation in the control group but not in the group of PSOCs. [ABSTRACT FROM AUTHOR]

Background: Guidelines suggest treating men with paraphilic disorder with androgen‐deprivation therapy (ADT). However, little evidence is available about the long‐term impact on bone loss and how to manage this adverse event. Objectives: The aim of this study is to assess the impact of ADT on bone mineral density (BMD) in men treated for paraphilic disorder with the androgen receptor blocker cyproterone acetate (CPA) and/or GnRH agonist triptoreline (GnRHa) and to evaluate the effect of treatment with bisphosphonates. Methods: Baseline and follow‐up dual‐energy X‐ray absorptiometry scan (DXA‐scan) data (lumbar and femoral T‐scores) were retrospectively extracted from electronic medical files of paraphilic men who received CPA and/or GnRHa. Results: A total of 53 patients with a mean age of 39.1 years (range 17.5–74.6) were included. Lumbar (−0.39 ± 0.17, Mean ± SEM, p = 0.046), femoral neck (−0.34 ± 0.09, p = 0.002) and total femur (−0.33 ± 0.12, p = 0.014) T‐scores decreased significantly in the CPA‐only group (n = 13) during a mean follow‐up of 6.0 ± 5.3 years. In the GnRHa group (n = 29), T‐scores at all sites decreased significantly over 6.6 ± 4.4 years (lumbar: −0.55 ± 0.12, p < 0.001, femoral neck: −0.53 ± 0.09, total femur: −0.44 ± 0.09, p < 0.001). In the group, who received bisphosphonates (n = 11), no significant T‐score change was observed (lumbar: −0.25 ± 0.14, p = 0.106, femoral neck −0.15 ± 0.17, p = 0.402, total femur −0.25 ± 0.14, p = 0.106) during 5.0 ± 2.8 years of follow‐up. Discussion and conclusion: Following a mean duration of 6 years of ADT, we observed a significant decline in BMD of approximately half a standard deviation in T‐score at lumbar and femoral site. Although the number of patients who received bisphosphonates was limited, this treatment seems to have a positive stabilizing effect on bone density. [ABSTRACT FROM AUTHOR]

Violence is a common phenomenon both in regular and forensic psychiatric settings, and has a profound impact on staff and other patients. Insight into the individual risk factors associated with violence in forensic psychiatric settings is rare and is therefore the subject of this research. A retrospective file study in three medium security units in Flanders was conducted to compare non-violent inpatients with inpatients who engaged in (verbal and physical) violent behavior. Binary logistic regression analyses were used to examine which variables contributed independently to the risk of violence. The results showed that absconding during treatment was independently associated with physical violence. A personality disorder diagnosis and general non-compliance with treatment were associated with verbal violence. Both types of violence predicted early termination of treatment. Contrary to previous research, the results from the risk assessment tools were not associated with inpatient violence. Clinical implications are discussed and include, among others, that clinicians should remain vigilant for early warning signs of non-compliance during treatment. [ABSTRACT FROM AUTHOR]