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A major challenge in offender therapy is to facilitate clients’ emotional engagement especially with clients who over-regulate their affect. It has been suggested that treatments that focus on improving clients’ affect regulation (AR) and deepen of client’s emotional experience during treatment may enhance treatment outcome. In this systematic mixed methods case study the role of Emotion-Focused Therapy (EFT) to change clients’ problems with AR during inpatient treatment for individuals who committed sexual offences against children was investigated. It was observed that clients’ over-regulation of affect was coupled with a lack of connection to a part of the self that was deemed unacceptable. Over the course of treatment, this hidden part of self that had instigated the misbehaviour became more accepted and integrated. Verbatim clinical vignettes are included to illuminate key interventions, hindrances, and possible mechanisms of change. Quantitative analysis showed significant change in AR based on self-report and observation. ispartof: Journal Of Sexual Aggression vol:29 issue:1 pages:1-17 status: Published online

Background: Previous studies of the effect of interaction between psychiatric disorders on suicide have reported mixed results. We investigated the joint effect of depression and various comorbid psychiatric disorders on suicide. Methods: We conducted a population-based case–cohort study with all suicide deaths occurring between 1 January 1995 and 31 December 2015 in Denmark (n = 14,103) and a comparison subcohort comprised of a 5% random sample of the source population at baseline (n = 265,183). We quantified the joint effect of pairwise combinations of depression and major psychiatric disorders (e.g., organic disorders, substance use disorders, schizophrenia, bipolar disorder, neurotic disorders, eating disorders, personality disorders, intellectual disabilities, developmental disorders, and behavioral disorders) on suicide using marginal structural models and calculated the relative excess risk due to interaction. We assessed for the presence of competing antagonism for negative relative excess risk due to interactions. Results: All combinations of depression and comorbid psychiatric disorders were associated with increased suicide risk. For example, the rate of suicide among men with depression and neurotic disorders was 20 times (95% CI = 15, 26) the rate in men with neither disorder. Most disorder combinations were associated with subadditive suicide risk, and there was evidence of competing antagonism in most of these cases. Conclusions: Subadditivity may be explained by competing antagonism. When both depression and a comorbid psychiatric disorder are present, they may compete to cause the outcome such that having 2 disorders may be no worse than having a single disorder with respect to suicide risk.

Objectives: Recovery and empowerment have evolved into key objectives in the treatment and care of people with severe mental illness (SMI), and interest has grown in the role of social relationships in recovery. This study is the first to explore whether attachment styles are related to levels of empowerment, and secondly, whether attachment anxiety and attachment avoidance are associated with lower empowerment levels, independently of quality and frequency of social contact. Design: We used a cross-sectional design. Methods: In a sample of 157 participants with SMI in outpatient care, associations between attachment (Revised Adult Attachment Scale), self-reported social functioning, and empowerment (Netherlands Empowerment List) were assessed. Results: Attachment anxiety and attachment avoidance were both associated with lower levels of empowerment. A stepwise multiple regression analysis showed that the prediction of empowerment was significantly improved by adding attachment anxiety and attachment avoidance to quality and frequency of social contact. Attachment anxiety, attachment avoidance, and quality of social contact were significant predictors; frequency of social contact was not. Conclusions: Although our design does not allow causal conclusions, our results highlight the importance of interpersonal processes and behaviours as routes to improving empowerment for people with SMI. A promising approach might thus consist of securing attachment bonds with significant others so that the self and the other are perceived as reliable resources. Our findings also feature the importance of reciprocity and equality in social relationships. Taken together, our study emphasizes the value of social, contextualized interventions in recovery work for people with SMI. Practitioner points: Working towards attachment safety in interpersonal relations may be important in recovery-oriented treatment and care for people with severe mental illness (SMI). Helping people with SMI to recognize and change how they tend to relate themselves to others may promote engagement and effectiveness of recovery-oriented treatment and care. Reciprocity and equality in social relationships as vital complements to the more one-sided nature of ‘standing alongside’ and offering support may be important requisites for empowerment.

Continued interest in the distinction between grandiose narcissism, vulnerable narcissism and the fluctuation between grandiose and vulnerable states has expanded the repertoire of self-report instruments. The present study examined the psychometric properties of four brief narcissism measures [the Narcissistic Personality Inventory-13 (NPI-13), Hypersensitive Narcissism Scale (HSNS), Super-Brief Pathological Narcissism Inventory (SB-PNI), and the g-FLUX] in a Finnish sample of university students. Confirmatory factor analyses supported the reliability of the NPI-13, g-FLUX, SB-PNI Vulnerability, and two HSNS subfactors (Oversensitivity and Egocentrism). Tests of measurement invariance indicated the NPI-13, SB-PNI Vulnerability, HSNS Oversensitivity, and the g-FLUX perform similarly between males and females and are generally similar between individuals in younger and older age groups. Construct and predictive validity were evaluated by examining relations between narcissism measures and relevant criteria including psychopathology symptoms, self-esteem, well-being, five factor traits, and empathy. Results supported the construct validity of all four measures, while correlational profiles highlighted the convergence between the g-FLUX and measures of both grandiosity and vulnerability. The NPI-13 was most predictive of NPD symptoms, whereas vulnerable narcissism measures were most predictive of psychopathology. Results further establish the psychometric properties of the NPI-13, SB-PNI Vulnerability, HSNS Oversensitivity, Egocentrism, and provide new validation of the g-FLUX.

BackgroundViolent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs.MethodsWe compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms.ResultsPatients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*time: t(1387) = −2.85, p = 0.005).ConclusionsThese findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level'' dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity'' by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach. (C) 2020 Published by Elsevier Masson SAS.

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level'' dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity'' by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach. (C) 2020 Published by Elsevier Masson SAS.

The Levenson Self-Report Psychopathy (LSRP) scale is widely used to assess psychopathic traits in noninstitutionalized samples. Recent studies suggest that a three-factor structure measuring Egocentricity, Callousness, and Antisocial factors outperformed the original two-factor structure of the LSRP. This study replicated and extended these findings by examining the factor structure and construct validity of a Dutch version of the LSRP in a community sample (N = 856, subsamples ranging between 140 and 572 participants). Confirmatory factor analysis results corroborated the superiority of the three-factor model of the LSRP, using 19 of the 26 LSRP items. Limitations included the need to specify correlated residuals for some indicators, although these were largely in line with prior studies. Across three subsamples, we found evidence for construct validity of the LSRP subscales. Egocentricity and Antisocial showed a pattern of differential associations with external correlates in accordance with theoretical expectations. Callousness shared some correlates with Egocentricity, others with Antisocial, and uniquely predicted low morality and high physical aggression. Few exceptions to the hypothesized associations were observed, mostly concerning Callousness. Overall, the LSRP three-factor model received further support in a Dutch sample, and is thus recommended in future research, possibly adding items to improve the performance of the Callousness factor.

Asrat Wolde,1 Yonas Tesfaye,2 Yimenu Yitayih2 1Department of Psychiatry, Colleague of Medicine and Health Sciences, Mizan Tepi University, Mizan Aman, Ethiopia; 2Department of Psychiatry, Faculty of Medical Sciences, Jimma University, Jimma, EthiopiaCorrespondence: Asrat WoldeDepartment of Psychiatry, Colleague of Medicine and Health Sciences, Mizan Tepi University, Mizan Aman, EthiopiaTel +251916389179Email Asratwolde2017@gmail.comBackground: Psychopathy is an emerging health and behavioral problem worldwide. Psychopathy is linked to risk substance use, maltreatment, violence, crime, and reoffending, but little is known about psychopathy in low income countries like Ethiopia. Therefore, we assessed the prevalence and factors associated with psychopathy among newly-admitted prisoners in Bench Sheko and West Omo zone correctional center, Mizan Aman, Ethiopia.Methods: A cross-sectional study was conducted from April 20 to July 19, 2019, among 411 (N=422) newly-admitted Bench Sheko and West Omo zone correctional center prisoners by using a consecutive sampling technique. A semi-structured and interviewer administered psychopathy checklist revised tool was used for screening psychopathy. WHO, ASSIST tool was used for screening risk use of khat, tobacco, and alcohol. Trauma, maltreatment, and social support were assessed with a life event checklist, adverse life experience screening tool, and Oslo social support scale, respectively. In addition, Criminal and clinical history of the prisoner was also assessed. The data was entered into Epi-data 3.1 and exported to Statistical Package for Social Science (SPSS) Version 21 for statistical analysis. A logistic regression model was used. Variables with a p-value less than 0.05 in the final fitting model were declared as independent predictors of psychopathy.Results: The prevalence of psychopathy was 24.3%. Childhood maltreatment (AOR=6, 95% CI=2.2– 17.5), risky khat use (AOR=4.6, 95% CI=2.4– 8.7), poor social support (AOR=3.5, 95% CI=1.9– 6.6), family history of imprisonment (AOR=3, 95% CI=1.5– 6), history of trauma (AOR=2.3, 95% CI=1.1– 4.8), and reoffending (AOR=2, 95% CI=1.1– 3.8) were positively associated variables with psychopathy.Conclusion: Psychopathy is highly prevalent among newly-admitted prisoners. Integrated efforts involving relevant stakeholders are needed to design strategies for early screening of psychopathy to prevent reoffending, and management of risk substance use at admission is crucial.Keywords: psychopathy, prisoners, crime, khat use, Ethiopia

BackgroundResearch suggests that mindfulness-based interventions may improve mindfulness-related capacities (e.g., decentering, non-judging, and non-reacting) and emotion regulation. Previously, our group reported that ayahuasca could be a potential analogue of mindfulness practice. The main aim of the current study was to examine the effects of ayahuasca on emotional regulation and mindfulness-related capacities. Secondarily, we sought to explore the effects of ayahuasca on individuals with borderline personality disorder (BPD) traits.MethodThis is an observational study of 45 volunteers who participated in an ayahuasca session. The volunteers completed various self-report instruments designed to measure emotional dysregulation (Difficulties in Emotion Regulation Scale (DERS)) and mindfulness traits (Five Facet Mindfulness Questionnaire (FFMQ)-Short Form and Experiences Questionnaire (EQ)) prior to and 24h after the ayahuasca session. The volunteers were divided into two subgroups based on their score on the McLean Screening Instrument for BPD (MSI-BPD). Twelve participants were grouped into the BPD-like traits subgroup while the rest of them were included in the non-BPD-like subgroup. We performed within-subjects and between-group analyses.ResultsOverall, the participants showed significant improvements on the FFMQ subscales observing, acting with awareness, non-judging, and non-reacting and also significantly improved on decentering (EQ scale) and on the DERS subscales emotional non-acceptance, emotional interference, and lack of control. The BPD-like subgroup also showed significant improvements on the DERS subscales emotional interference and lack of control but not in mindfulness capacities.ConclusionsThese findings suggest a potential therapeutic effect for ayahuasca in emotion regulation and mindfulness capacities (including decentering, acceptance, awareness, and sensitivity to meditation practice). Based on these results, we believe that ayahuasca therapy could be of value in clinical populations, such as individuals with BPD, affected by emotion dysregulation.

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level'' dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity'' by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach. (C) 2020 Published by Elsevier Masson SAS.

BACKGROUND: Although several authors have suggested that a single externalizing spectrum encompassing both antisocial behavioral syndromes and substance use disorder is to be preferred, this assumption has not been evaluated systematically throughout studies.PURPOSE: The objective was to establish the generalizability of transdiagnostic models of externalizing disorders across different types of disorders and populations, in regard to the strength of the evidence.METHOD: We conducted a systematic literature review using combinations of two sets of keywords: 1) "antisocial", "externalizing", "conduct disorder", "disruptive behavior disorder", "substance abuse", "substance-related disorder", "cannabis", "cocaine", "hallucinogen", "alcoholism", "opioid"; 2) "latent structure", "factor analysis", "multivariate analysis".RESULTS: Models supporting a superordinate factor appeared dominant in a limited set of different populations, on which the majority of the research sample was focused.CONCLUSIONS: Although the externalizing spectrum model is a promising angle for future research and treatment, extending research on this model in a higher diversity of populations is recommended to enhance the understanding and applicability of the externalizing spectrum model.

PurposeProblems in emotional functioning have been identified as a risk factor for both sexual and violent offending, yet the precise pattern of impairment in emotional functioning that is experienced by sexual and violent offenders remains unclear.MethodsIn this study, we examined self-reported difficulties in emotion regulation, the use of different strategies for regulating emotions, levels of trait alexithymia, and dispositional mindfulness in men with a history of sexual offending, non-sexual violent offending, homicide, and community controls.ResultsA comparison between these groups showed that while sexual offenders had some circumscribed difficulties in emotional nonacceptance, violent offenders showed more generalized problems in emotional nonacceptance, alexithymia, and mindfulness. In contrast, homicide offenders reported few difficulties compared with other offender groups.ConclusionsOur results have implications for the allocation of individuals to treatment modules aimed at improving emotion regulation to reduce negative affect and offending behavior.

Item does not contain fulltext Background: Although several authors have suggested that a single externalizing spectrum encompassing both antisocial behavioral syndromes and substance use disorder is to be preferred, this assumption has not been evaluated systematically throughout studies. Purpose: The objective was to establish the generalizability of transdiagnostic models of externalizing disorders across different types of disorders and populations, in regard to the strength of the evidence. Method: We conducted a systematic literature review using combinations of two sets of keywords: 1) "antisocial", "externalizing", "conduct disorder", "disruptive behavior disorder", "substance abuse", "substance-related disorder", "cannabis", "cocaine", "hallucinogen", "alcoholism", "opioid"; 2) "latent structure", "factor analysis", "multivariate analysis". Results: Models supporting a superordinate factor appeared dominant in a limited set of different populations, on which the majority of the research sample was focused. Conclusions: Although the externalizing spectrum model is a promising angle for future research and treatment, extending research on this model in a higher diversity of populations is recommended to enhance the understanding and applicability of the externalizing spectrum model. 10 p.

Genetic discovery in psychiatry and clinical psychology is hindered by suboptimal phenotypic definitions. We argue that the hierarchical, dimensional, and data-driven classification system proposed by the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium provides a more effective approach to identifying genes that underlie mental disorders, and to studying psychiatric etiology, than current diagnostic categories. Specifically, genes are expected to operate at different levels of the HiTOP hierarchy, with some highly pleiotropic genes influencing higher order psychopathology (e.g., the general factor), whereas other genes conferring more specific risk for individual spectra (e.g., internalizing), subfactors (e.g., fear disorders), or narrow symptoms (e.g., mood instability). We propose that the HiTOP model aligns well with the current understanding of the higher order genetic structure of psychopathology that has emerged from a large body of family and twin studies. We also discuss the convergence between the HiTOP model and findings from recent molecular studies of psychopathology indicating broad genetic pleiotropy, such as cross-disorder SNP-based shared genetic covariance and polygenic risk scores, and we highlight molecular genetic studies that have successfully redefined phenotypes to enhance precision and statistical power. Finally, we suggest how to integrate a HiTOP approach into future molecular genetic research, including quantitative and hierarchical assessment tools for future data-collection and recommendations concerning phenotypic analyses. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

ispartof: PSYCHOANALYTIC PSYCHOLOGY vol:36 issue:4 pages:328-334 status: published

For more than a century, research on psychopathology has focused on categorical diagnoses. Although this work has produced major discoveries, growing evidence points to the superiority of a dimensional approach to the science of mental illness. Here we outline one such dimensional system—the Hierarchical Taxonomy of Psychopathology (HiTOP)—that is based on empirical patterns of co-occurrence among psychological symptoms. We highlight key ways in which this framework can advance mental-health research, and we provide some heuristics for using HiTOP to test theories of psychopathology. We then review emerging evidence that supports the value of a hierarchical, dimensional model of mental illness across diverse research areas in psychological science. These new data suggest that the HiTOP system has the potential to accelerate and improve research on mental-health problems as well as efforts to more effectively assess, prevent, and treat mental illness.

Only for ergodic processes will inferences based on group-level data generalize to individual experience or behavior. Because human social and psychological processes typically have an individually variable and time-varying nature, they are unlikely to be ergodic. In this paper, six studies with a repeated-measure design were used for symmetric comparisons of interindividual and intraindividual variation. Our results delineate the potential scope and impact of nonergodic data in human subjects research. Analyses across six samples (with 87-94 participants and an equal number of assessments per participant) showed some degree of agreement in central tendency estimates (mean) between groups and individuals across constructs and data collection paradigms. However, the variance around the expected value was two to four times larger within individuals than within groups. This suggests that literatures in social and medical sciences may overestimate the accuracy of aggregated statistical estimates. This observation could have serious consequences for how we understand the consistency between group and individual correlations, and the generalizability of conclusions between domains. Researchers should explicitly test for equivalence of processes at the individual and group level across the social and medical sciences.

Objective: To examine the two constitutes of cortical volume, that is, cortical thickness and surface area, in individuals with dissociative identity disorder (DID) with the view of gaining important novel insights into the underlying neurobiological mechanisms mediating DID.Methods: The current study included 32 female patients with DID and 43 matched healthy controls. Between-group differences in cortical volume, thickness, and surface area, the degree of spatial overlap between differences in cortical thickness and surface area, and their relative contribution to differences in regional cortical volume were assessed using a novel spatially-unbiased vertex-wise approach. Whole-brain correlation analyses were performed between measures of cortical anatomy and dissociative symptoms and traumatization.Results: Individuals with DID differed from controls in cortical volume, thickness, and surface area, with significantly decreased cortical thickness in the insula, anterior cingulate and parietal regions and reduced cortical surface area in temporal and orbitofrontal cortices. Abnormalities in cortical thickness and surface area shared only about 3% of all significantly different cerebral surface locations and involved distinct contributions to the abnormality of cortical volume in DID. Significant negative associations between abnormal brain morphology (surface area and cortical volume) and dissociative symptoms and early childhood traumatization (0 and 3 years of age) were found.Conclusions: In DID, neuroanatomical areas with decreased cortical thickness and surface area are in different locations in the brain. As cortical thickness and surface area have distinct genetic and developmental origins, our findings may indicate that different neurobiological mechanisms and environmental factors impact on cortical morphology in DID, such as early childhood traumatization.

The present study examined associations between psychopathic traits and deviant sexual interests across gender in a large community sample (N = 429, 24% men). Correlation analyses supported the positive link between psychopathic traits and deviant sexual interests. Regression analyses indicated that the unique variance in the antisocial facet of psychopathy predicted all six deviant sexual interests. The interpersonal facet predicted voyeuristic and exhibitionistic interests, whereas the affective facet predicted pedophilic interests. Moderation analyses revealed that gender moderated most of the relations between the antisocial facet of psychopathy and deviant sexual interests, such that those positive associations were stronger among women. On the contrary, the associations between the interpersonal facet and voyeuristic interests, as well as between the lifestyle facet and sadistic interests, were stronger among men. Findings appear to suggest that deviant sexual interests represent a domain in which the manifestation of psychopathic traits may differ across gender. These findings emphasize the relevance of psychopathic traits for the understanding and risk assessment of sexual deviance, while suggesting the need for gender-sensitive considerations. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Youth antisocial behaviour (ASB) is frequently considered to be displayed by children and adolescents who suffer from behavioural disorders. Consequently, attempts to reduce ASB have increasingly comprised mental health interventions. Moreover, early signalling of children at risk and early prevention of behavioural problems are regarded as crucial remedies. Critical investigations of these developments, however, are in particular concerned with the consequent medicalization of society and the behaviour exhibited by infants, children and adolescents. Consequently, the new Dutch youth law even refers to demedicalization as a central aim. From an ethical point of view, this article critically discusses the meaning and relevance of the medicalization reproach in the context of ASB. The aim is to show that the term medicalization (M) can reasonably be attached to three different developments: the biomedical turn (M1), an increase in (forensic) youth mental health care (M2) and early signalling and prevention (M3). The ethical implications of these developments, however, are diverse, referring to both risks and benefits. By itself, neither the term medicalization nor demedicalization carries a self-evident normative meaning. Therefore, a careful ethical analysis is needed to reveal which social developments are actually recommendable or disadvantageous.

Patients' attributions of effects of treatment are important, as these can affect long-term outcome. Most studies so far focused on the influence of attributions to medication for anxiety and depression disorders. We investigated the effects of patients' attributions made after acute treatment on the long-term outcome of antidepressant medication (ADM) and psychological treatment (behavioural activation, BA). Data are based on a randomized trial testing the effectiveness of BA vs. ADM for major depression (MDD) in Iran. Patients with MDD (N = 100) were randomized to BA (N = 50) or ADM (N = 50). Patients' attributions were assessed at post-test (after completion of the treatments). Scores on an attribution questionnaire were factor analysed, and factor scores were retained as predictors of depressive symptoms at 1-year follow-up. Regression analysis was used to test whether attributions predicted depressive symptoms at 1-yr follow-up, controlling for symptom level, condition, and their interaction at post-test. Belief in coping efficacy was the only attribution factor significantly predicting 1-year HRSD scores, controlling for condition, post-test HRSD and their interaction. It also mediated the condition differences at follow-up. Credit to self was the single attribution factor that predicted BDI follow-up scores, controlling for condition, posttest BDI, and their interaction. It partially mediated the condition differences on the BDI at follow-up. Attribution to increased coping capacities and giving credit to self appear essential. In the long-term (at 1 year follow-up), the difference in outcome between BA and ADM (with BA being superior to ADM) is at least partially mediated by attributions.

Background: Health anxiety is an under-recognised but frequent cause of distress that is potentially treatable but there are few studies in secondary care. Objective: To determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive-behaviour therapy (CBT-HA) for health anxiety compared with standard care in medical outpatients Design: Randomised controlled trial Setting: Five general hospitals in London, Middlesex and Nottinghamshire Participants: 444 patients aged 16-75 seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored 20 or more on the Health Anxiety Inventory (HAI), and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded but those concurrent medical illnesses were not. Interventions: Cognitive behaviour therapy for health anxiety (CBT-HA): 4-10 one-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care. Main outcome measures: Primary: Researchers masked to allocation assessed patients at baseline, 3m, 6m, 12m, 24m and 5 years. The primary outcome was change in HAI score between baseline and 12 months. Main secondary outcome: Costs of care in the two groups after 24 months and 60 months, change in health anxiety (HAI), generalised anxiety and depression (Hospital Anxiety and Depression (HADS-A and HADS-D) scores, social functioning using the Social Functioning Questionnaire (SFQ), and quality of life using the Euroqol (EQ-5D), at 6, 12, 24 and 60 months, deaths over 5 years. Results: Of 28,991 patients screened over 21m, 5769 had HAI scores of 20 or above. CBT-HA patients (mean sessions 6) had significantly greater improvement in HAI scores than those in standard care at 3m and this was maintained over the five-year period (overall P

OBJECTIVE: Understanding how treatments work is a goal of psychotherapy research, however the strength of relationships between therapy processes and outcomes is inconsistent. DeRubeis, Cohen, et al. (2014) proposed that process-outcome relationships are moderated by patient characteristics. These "patient response patterns" (PRPs) indicate individuals' responsiveness to the active ingredients of treatment. Given the same quality of therapy, one individual may receive more benefit than another depending on their PRP. The "prognosis moderation hypothesis" states that PRPs can be defined by pretreatment prognostic indicators. Medium prognosis groups ("pliant-like") will have stronger process-outcome relationships than good ("easy-like") or poor ("challenging-like") groups.METHOD: N = 190 individuals received unguided computerized CBT. They were 58% women, aged 44.7 years. Engagement with the cCBT program was the process variable. PRPs were defined by predicted scores from a prognostic regression model. Outcomes were BDI scores at 3, 6, and 12 months. "Easy-like," "pliant-like" and "challenging-like" groups were created and the engagement-outcome relationship was assessed as a function of group.RESULTS: Engagement-outcome correlations by PRP were: easy-like, r = -.27 (p < .05); pliant-like, r = -.36 (p < .01); and challenging-like, r = .05 (p = .70). The pliant-like group was found to be the only moderator of the engagement-outcome relationship. Results were similar at 6 months but faded at 12.CONCLUSIONS: The engagement-outcome relationship varied as a function of prognosis, providing support for the prognosis moderation hypothesis. The "pliant-like" group appeared most sensitive to treatment procedures. Future research is needed to refine the methods for identifying PRPs. (PsycINFO Database Record

Background Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the “The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders” (UP-CBT) for group delivery in Mental Health Service (MHS), and shown effects comparable to traditional CBT in a naturalistic study. As the use of one manual instead of several diagnosis-specific manuals could simplify logistics, reduce waiting time, and increase therapist expertise compared to diagnosis specific CBT, we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT. Methods/design The study is a partially blinded, pragmatic, non-inferiority, parallel, multi-center randomized controlled trial (RCT) of UP-CBT vs diagnosis specific CBT for Unipolar Depression, Social Anxiety Disorder and Agoraphobia/Panic Disorder. In total, 248 patients are recruited from three regional MHS centers across Denmark and included in two intervention arms. The primary outcome is patient-ratings of well-being (WHO Well-being Index, WHO-5), secondary outcomes include level of depressive and anxious symptoms, personality variables, emotion regulation, reflective functioning, and social adjustment. Assessments are conducted before and after therapy and at 6 months follow-up. Weekly patient-rated outcomes and group evaluations are collected for every session. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and fidelity assessors will monitor manual adherence. Discussion The current study will be the first RCT investigating the dissemination of the UP in a MHS setting, the UP delivered in groups, and with depressive patients included. Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS. The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in psychotherapy and the association between patient characteristics and treatment effect. Trial registration Clinicaltrials.gov NCT02954731. Registered 25 October 2016 Electronic supplementary material The online version of this article (doi:10.1186/s12888-016-1175-0) contains supplementary material, which is available to authorized users.

This study examined rates of irritable bowel syndrome (IBS) over 10 years of prospective follow-up among recovered and non-recovered patients with borderline personality disorder (BPD). Subsequently, risk factors for IBS were examined in female BPD patients. As part of the McLean Study of Adult Development, 264 BPD patients were assessed at baseline, and their medical conditions and time-varying predictors of IBS were assessed over five waves of follow-up (from 6-year follow-up to 16-year follow-up). Semi-structured interviews were used to assess both our IBS outcome variable and our baseline and time-varying predictor variables. Rates of IBS were not significantly different between recovered and non-recovered borderline patients when men and women were considered together and when men were considered alone. However, a significant difference in IBS rates was found between recovered and non-recovered female BPD patients, with the latter reporting significantly higher rates. The rates of IBS in women with BPD were found to be significantly predicted by a family history of IBS and a childhood history of verbal, emotional and/or physical abuse. Taken together, the results of this study suggest that both biological/social learning factors and childhood adversity may be risk factors for IBS in women with BPD. Copyright (c) 2013 John Wiley & Sons, Ltd.

Background: The Symptom Checklist-90 (SCL-90) is a questionnaire that is widely used to measure subjective psychopathology. In this study we investigated the psychometric properties of the SCL-90 among adolescent inpatients and community youth matched on age and gender. Methods: The final SCL-90 respondents comprised three subsets: 201 inpatients at admission, of whom 152 also completed the instrument at discharge, and 197 controls. The mean age at baseline was 15.0 years (SD 1.2), and 73 % were female. Differential SCL-90 item functioning between the three subsets was assessed with an iterative algorithm, and the presence of multidimensionality was assessed with a number of methods. Confirmatory factor analyses for ordinal items compared three latent factor models: one dimension, nine correlated dimensions, and a one-plus-nine bifactor model. Sensitivity to change was assessed with the bifactor model's general factor scores at admission and discharge. The accuracy of this factor in detecting the need for treatment used, as a gold standard, psychiatric diagnoses based on clinical records and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) interview. Results: Item measurement properties were largely invariant across subsets under the unidimensional model, with standardized factor scores at admission being 0.04 higher than at discharge and 0.06 higher than those of controls. Determination of the empirical number of factors was inconclusive, reflecting a strong main factor and some multidimensionality. The unidimensional factor model had very good fit, but the bifactor model offered an overall improvement, though subfactors accounted for little item variance. The SCL-90s ability to identify those with and without a psychiatric disorder was good (AUC = 83 %, Glass's. = 1.4, Cohen's d = 1.1, diagnostic odds ratio 12.5). Scores were also fairly sensitive to change between admission and discharge (AUC 72 %, Cohen's d = 0.8). Conclusions: The SCL-90 proved mostly unidimensional and showed sufficient item measurement invariance, and is thus a useful tool for screening overall psychopathology in adolescents. It is also applicable as an outcome measure for adolescent psychiatric patients. SCL-90 revealed significant gender differences in subjective psychopathology among both inpatients and community youth.

BackgroundCognitive theory points to the importance of negative self-schemas in the onset and maintenance of depression and anxiety disorders. Hereby, it is important to distinguish between automatic and explicit self-schemas, reflecting different cognitive-motivational systems. This study tested whether patients with a current major depression and/or anxiety disorder are characterized by automatic self-anxious and self-depressive associations and whether these associations are disorder specific.MethodPatients (n=2329) and non-clinical controls (n=652) were tested as part of The Netherlands Study of Depression and Anxiety, a multi-center, longitudinal, cohort study with patients from different health care settings. Patient groups and non-clinical controls (18–65 years of age) were compared with regard to automatic self-anxious and self-depressive associations measured with the Implicit Association Test.ResultsIndividuals with an anxiety disorder showed enhanced self-anxious associations, whereas individuals with a depression showed enhanced self-depressive associations. Individuals with co-morbid disorders scored high on both automatic self-associations. Although remitted individuals showed weaker automatic self-associations than people with a current disorder, their automatic self-anxious/depressed associations were still significantly stronger than those of the control group. Importantly, automatic self-associations showed predictive validity for the severity of anxious and depressive symptoms over and above explicit self-beliefs.ConclusionsThis study represents the first evidence that automatic self-anxious and self-depressive associations are differentially involved in anxiety disorders and depression. This may help to explain the refractoriness of these disorders and points to the potential importance of automatic self-associations in the development of psychopathological symptoms.

The present article reports on two studies that investigated the utility of Young’s cognitive theory Young et al. (Schema therapy: A practitioner’s guide, Guilford Publications, New York, 2003) in adolescents. Study 1 focused on the factorial validity of the Young Schema Questionnaire (YSQ) in youth. In Study 2, the dimensionality of Young’s schemas and their (content-specific) association with psychopathology were investigated. In Study 1, 635 adolescents were asked to complete the YSQ. In Study 2, participants were 112 non-referred and 104 referred adolescents. They were interviewed with the Structured Clinical Interview for DSM-IV-Child edition and completed the YSQ and the Youth Self Report. Their parents were asked to fill out the Child Behavior Checklist. It was demonstrated that Young’s theoretically proposed taxonomy of schemas and domains can be retrieved in adolescents. Referred youth displayed a higher severity of maladaptive schemas as compared with non-referred adolescents. A content-specific association of schemas and psychopathology was established. Young’s schema theory might constitute a valuable framework to understand psychopathology in youth.

Differential role of the 5-HT1A receptor in aggressive and non-aggressive mice: an across-strain comparison. PHYSIOL BEHAV 00(0) 000-000, 2006. According to the serotonin (5-HT)-deficiency hypothesis of aggression, highly aggressive individuals are characterized by low brain 5-HT neurotransmission. Key regulatory mechanisms acting on the serotonergic neuron involve the activation of the somatodendritic inhibitory 5-HT1A autoreceptor (short feedback loop) and/or the activation of postsynaptic 5-HT1A receptors expressed on neurons in cortico-limbic areas (long feedback loop). In this study, we examined whether low serotonin neurotransmission is associated with enhanced 5-HT I A (auto)receptor activity in highly aggressive animals. Male mice (SAL-LAL, TA-TNA, NC900-NC100) obtained through different artificial-selection breeding programs for aggression were observed in a resident-intruder test. The prefrontal cortex level of 5-HT and its metabolite 5-HIAA were determined by means of HPLC. The activity of the 5-HT1A receptors was assessed by means of the hypothermic response to the selective 5-HT1A agonists S-15535 (preferential autoreceptor agonist) and 8-OHDPAT (full pre- and postsynaptic receptor agonist). Highly aggressive mice had lower serotonin levels in the prefrontal cortex and two out of three aggressive strains had higher 5-HT1A (auto)receptor sensitivity. The results strengthen the validity of the serotonin-deficiency hypothesis of aggression and suggest that chronic exaggerated activity of the 5-HT I A receptor may be a causative link in the neural cascade of events leading to 5-HT hypofunction in aggressive individuals. (c) 2007 Elsevier Inc. All rights reserved.

Youth antisocial behaviour (ASB) is frequently considered to be displayed by children and adolescents who suffer from behavioural disorders. Consequently, attempts to reduce ASB have increasingly comprised mental health interventions. Moreover, early signalling of children at risk and early prevention of behavioural problems are regarded as crucial remedies. Critical investigations of these developments, however, are in particular concerned with the consequent medicalization of society and the behaviour exhibited by infants, children and adolescents. Consequently, the new Dutch youth law even refers to demedicalization as a central aim. From an ethical point of view, this article critically discusses the meaning and relevance of the medicalization reproach in the context of ASB. The aim is to show that the term medicalization (M) can reasonably be attached to three different developments: the biomedical turn (M1), an increase in (forensic) youth mental health care (M2) and early signalling and prevention (M3). The ethical implications of these developments, however, are diverse, referring to both risks and benefits. By itself, neither the term medicalization nor demedicalization carries a self-evident normative meaning. Therefore, a careful ethical analysis is needed to reveal which social developments are actually recommendable or disadvantageous.

In light of the new DSM-5 autism spectrum disorders diagnosis in which the autism spectrum reflects a group of neurodevelopmental disorders existing on a continuum from mild to severe expression of autistic traits, and recent empirical findings showing a continuous distribution of autistic traits in the general population, our voxel based morphometry study compares normal individuals with high autistic traits to normal individuals with low autistic traits. We hypothesize that normal individuals with high autistic traits in terms of empathizing and systemizing (HS/LE) share brain irregularities with individuals that fall within the clinical autism spectrum disorder. We find differences in several social brain network areas between our groups. Specifically, we find increased grey matter volume in the orbitofrontal cortex, the cuneus, the hippocampus and parahippocampus and reduced grey matter volume in the inferior temporal cortex, the insula and the amygdala in our HS/LE individuals. Our findings are in line with brain abnormalities typically reported in autism spectrum disorders and therefore support a dimensional view of autistic traits from a neurobiological perspective.

This study examined rates of irritable bowel syndrome (IBS) over 10 years of prospective follow-up among recovered and non-recovered patients with borderline personality disorder (BPD). Subsequently, risk factors for IBS were examined in female BPD patients. As part of the McLean Study of Adult Development, 264 BPD patients were assessed at baseline, and their medical conditions and time-varying predictors of IBS were assessed over five waves of follow-up (from 6-year follow-up to 16-year follow-up). Semi-structured interviews were used to assess both our IBS outcome variable and our baseline and time-varying predictor variables. Rates of IBS were not significantly different between recovered and non-recovered borderline patients when men and women were considered together and when men were considered alone. However, a significant difference in IBS rates was found between recovered and non-recovered female BPD patients, with the latter reporting significantly higher rates. The rates of IBS in women with BPD were found to be significantly predicted by a family history of IBS and a childhood history of verbal, emotional and/or physical abuse. Taken together, the results of this study suggest that both biological/social learning factors and childhood adversity may be risk factors for IBS in women with BPD. Copyright (c) 2013 John Wiley & Sons, Ltd.

Depression is a recurrent disorder. Given the high risk of relapse it is important to study how patients relapse in depression. This thesis, which focused on recurrent depression specifically, showed that it is not so much mood activated dysfunctional thinking patterns that predict relapse in depression, but rather mood itself. Moreover, Preventive Cognitive Therapy, an effective treatment to prevent relapse in depression, did not appear to work through reduction of activation of mood-linked thinking patterns. However, we have to keep the restrictions of our statistical analysis in mind. Currently we still do not know how preventive interventions exert their effects. Having remitted patients rate their own mood by marking a cross on a 10-centimeter line was able to predict relapse in depression over 5.5 years, with patients scoring higher being more vulnerable for relapse. This ‘emotion meter’ was also able to predict current depression status quite accurately, although it somewhat overestimated the number of patients truly having a current depression (false positives). It appeared to be the case that remitted patients who had a higher number of previous depressive episodes had higher levels of sad mood after remission. Possible, an ‘emotional scar’ is formed in terms of sad mood that remains after exposure to more previous depressive episodes. With our design we can however not exclude an alternative explanation, being that high levels of sadness prior to first-episode onset exposed these patients to higher risk of developing recurrent depression to begin with. This should be examined more closely. Finally, daily hassles also predicted depressive symptomatology later in time. Having a comorbid personality disorder was also related to characteristics that we know make patients vulnerable to relapse in depression.

Depression is a recurrent disorder. Given the high risk of relapse it is important to study how patients relapse in depression. This thesis, which focused on recurrent depression specifically, showed that it is not so much mood activated dysfunctional thinking patterns that predict relapse in depression, but rather mood itself. Moreover, Preventive Cognitive Therapy, an effective treatment to prevent relapse in depression, did not appear to work through reduction of activation of mood-linked thinking patterns. However, we have to keep the restrictions of our statistical analysis in mind. Currently we still do not know how preventive interventions exert their effects. Having remitted patients rate their own mood by marking a cross on a 10-centimeter line was able to predict relapse in depression over 5.5 years, with patients scoring higher being more vulnerable for relapse. This ‘emotion meter’ was also able to predict current depression status quite accurately, although it somewhat overestimated the number of patients truly having a current depression (false positives). It appeared to be the case that remitted patients who had a higher number of previous depressive episodes had higher levels of sad mood after remission. Possible, an ‘emotional scar’ is formed in terms of sad mood that remains after exposure to more previous depressive episodes. With our design we can however not exclude an alternative explanation, being that high levels of sadness prior to first-episode onset exposed these patients to higher risk of developing recurrent depression to begin with. This should be examined more closely. Finally, daily hassles also predicted depressive symptomatology later in time. Having a comorbid personality disorder was also related to characteristics that we know make patients vulnerable to relapse in depression.

Depression is a recurrent disorder. Given the high risk of relapse it is important to study how patients relapse in depression. This thesis, which focused on recurrent depression specifically, showed that it is not so much mood activated dysfunctional thinking patterns that predict relapse in depression, but rather mood itself. Moreover, Preventive Cognitive Therapy, an effective treatment to prevent relapse in depression, did not appear to work through reduction of activation of mood-linked thinking patterns. However, we have to keep the restrictions of our statistical analysis in mind. Currently we still do not know how preventive interventions exert their effects.Having remitted patients rate their own mood by marking a cross on a 10-centimeter line was able to predict relapse in depression over 5.5 years, with patients scoring higher being more vulnerable for relapse. This ‘emotion meter’ was also able to predict current depression status quite accurately, although it somewhat overestimated the number of patients truly having a current depression (false positives). It appeared to be the case that remitted patients who had a higher number of previous depressive episodes had higher levels of sad mood after remission. Possible, an ‘emotional scar’ is formed in terms of sad mood that remains after exposure to more previous depressive episodes. With our design we can however not exclude an alternative explanation, being that high levels of sadness prior to first-episode onset exposed these patients to higher risk of developing recurrent depression to begin with. This should be examined more closely. Finally, daily hassles also predicted depressive symptomatology later in time. Having a comorbid personality disorder was also related to characteristics that we know make patients vulnerable to relapse in depression.

Background: Disturbances of affect, impulse regulation and autoaggressive behavior which are all said to be related to an altered function of the central serotonergic (5-HT) system, are prominent features of borderline personality disorder (BPD). A high coincidence of childhood physical and sexual abuse is reported in these patients. Animal studies indicate that early, sustained stress correlates with a dysfunctional central 5-HT system. Therefore, we hypothesize that sustained traumatic stress in childhood affects the responsivity of the postsynaptic serotonergic system of traumatized BPD patients. Methods: Following Axis I, Axis II, and trauma assessment, a neuroendocrine challenge test was performed with the postsynaptic serotonergic agonist meta-chlorophenylpiperazine (m-CPP) in 12 impulsive and autoaggressive female patients with BPD and 9 matched healthy volunteers. Results: The cortisol and prolactin responses to the m-CPP challenge in BPD patients were significantly lower compared to those in controls. Within the group of patients with BPD, the net prolactin response showed a high inverse correlation with the frequency of the physical (r = -.77) and sexual abuse (r = -.60). Conclusions: Our data suggest that severe and sustained traumatic stress in childhood affects the 5-HT system and especially 5-HT1A receptors, This finding confirms the data from animal research. The blunted prolactin response to m-CPP appears to be the result of severe traumatization and independent of the BPD diagnosis. (C) 2000 Society of Biological Psychiatry.

We investigated the reliability of the Structured Interview for Schizotypy-Revised (SIS-R). The original interview (SIS) was developed by Kendler, We revised the SIS, primarily by standardizing the rating procedures. Operational definitions and explicit criteria for rating were given. We introduced a four-point scale and provided clear criteria for rating severity of symptoms and signs (frequency, duration, and level of conviction) to operationalize schizotypal features, We divided schizotypal signs of global affect and global organization of speech into three separate signs of affect and five separate signs of thinking and speech. The main goal of this study was the assessment of test-retest reliability of the SIS-R, A robust test-retest design using different interviewers at both times, with a mean interval of 19 days, was used. The sample consisted of 42 psychiatric patients, almost all with personality disorders. The strong linear-weighted kappa statistic was used to evaluate reliability. The first conclusion is that most schizotypal symptoms can be reliably assessed with the SIS-R, The second conclusion Is that most schizotypal signs do not reach sufficient levels of reliability, After unreliable items are excluded, the shortened SIS-R is a reliable research instrument for measuring schizotypal features (as far as it concerns our mixed samples). It covers all three dimensions of schizotypy.

Non-suicidal self-injury (NSSI) is being increasingly recognised as a behaviour of significant clinical importance. Yet, there remains uncertainty regarding the underlying mechanisms of NSSI. This study aimed to explore the relationship between maladaptive schema modes, parental bonding, and NSSI. Seventy psychiatric outpatients with a history of NSSI completed the Deliberate Self-Harm Inventory, Schema Mode Inventory, and Parental Bonding Inventory. Results revealed that maladaptive schema modes were significantly associated with low parental care and with an earlier age of onset, longer duration, and higher number of methods of NSSI. Maladaptive schema modes also significantly mediated the relationship between parental care and age of onset of NSSI and between parental care and duration of NSSI. Two maladaptive schema modes (namely, Punitive Parent and Angry Child) were also found to be significant mediators in this relationship. The clinical implications of this research are discussed.

BackgroundSchizotypy is conceptualized as a subclinical manifestation of the same underlying biological factors that give rise to schizophrenia and other schizophrenia spectrum disorders. Individuals with psychometric schizotypy (PS) experience subthreshold psychotic signs and can be psychometrically identified among the general population. Previous research using magnetic resonance imaging (MRI) has shown gray-matter volume (GMV) abnormalities in chronic schizophrenia, in subjects with an at-risk mental state (ARMS) and in individuals with schizotypal personality disorder (SPD). However, to date, no studies have investigated the neuroanatomical correlates of PS.MethodSix hundred first- and second-year university students completed the Community Assessment of Psychic Experiences (CAPE), a self-report instrument on psychosis proneness measuring attenuated positive psychotic experiences. A total of 38 subjects with high and low PS were identified and subsequently scanned with MRI. Voxel-based morphometry (VBM) was applied to examine GMV differences between subjects with high and low positive PS.ResultsSubjects with high positive PS showed larger global volumes compared to subjects with low PS, and larger regional volumes in the medial posterior cingulate cortex (PCC) and the precuneus. There were no regions where GMV was greater in low than in high positive PS subjects.ConclusionsThese regions, the PCC and precuneus, have also been sites of volumetric differences in MRI studies of ARMS subjects and schizophrenia, suggesting that psychotic or psychotic-like experiences may have common neuroanatomical correlates across schizophrenia spectrum disorders.

BACKGROUND: Adults exhibiting severe impulsive and aggressive behaviors have multiple indices of low serotonin (5-HT) neurotransmission. It remains unclear though whether low 5-HT mediates the behavior or instead reflects a pre-existing vulnerability trait. METHODOLOGY/PRINCIPAL FINDINGS: In the present study, positron emission tomography with the tracer alpha-(11)Cmethyl-L-tryptophan ((11)C-AMT) was used to compare 5-HT synthesis capacity in two groups of adult males from a 21-year longitudinal study (mean age +/- SD: 27.1+/-0.7): individuals with a history of childhood-limited high physical aggression (C-LHPA; N = 8) and individuals with normal (low) patterns of physical aggression (LPA; N = 18). The C-LHPA males had significantly lower trapping of (11)C-AMT bilaterally in the orbitofrontal cortex and self-reported more impulsiveness. Despite this, in adulthood there were no group differences in plasma tryptophan levels, genotyping, aggression, emotional intelligence, working memory, computerized measures of impulsivity, psychosocial functioning/adjustment, and personal and family history of mood and substance abuse disorders. CONCLUSIONS/SIGNIFICANCE: These results force a re-examination of the low 5-HT hypothesis as central in the biology of violence. They suggest that low 5-HT does not mediate current behavior and should be considered a vulnerability factor for impulsive-aggressive behavior that may or may not be expressed depending on other biological factors, experience, and environmental support during development. Language: en

The major aim of the treatment of forensic psychiatric patients is to reduce risk of future violence by means of a positive change in the factors associated with the offence. In this article, we argue that information on patients' social network patterns and the content of their relationships provide detailed information about relational behavior that can be an important complement of information on behavior provided by the traditional psycho-diagnostics. We use data on networks of 60 patients in five Terbeschikkingstelling groups and investigate how their relations are associated with three domains of risk-related psychosocial functioning; problem awareness, impulse control, and skills. All three domains were found to be associated with relational patterns, impulse control, and skills showing the strongest associations.

Background. Controlled prospective studies of the simultaneous long-term outcome of several mental disorders are rare. This study sought to determine if there were important differences between the outcome of anxiety and depressive disorders after 12 years and to examine their main predictors.Method. A cohort of 210 people seen in general practice psychiatric clinics with a DSM-III diagnosis of generalized anxiety disorder (71), panic disorder (74), or dysthymic disorder (65), including combined anxiety-depressive disorder (cothymia) (67) was followed up after 12 years. Interview assessments of symptoms, social functioning and outcome were made, the latter using a new scale, the Neurotic Disorder Outcome Scale. Seventeen baseline predictors were also examined.Results. Data were obtained from 201 (96%) patients, 17 of whom had died. Only 73 (36%) had no DSM diagnosis at the time of follow-up. Using univariate and stepwise multiple linear regression those with cothymia, personality disorder, recurrent episodes and greater baseline self-rated anxiety and depression ratings had a worse outcome than others; initial diagnosis did not contribute significantly to outcome and instability of diagnosis over time was much more common than consistency.Conclusion. Only two out of five people with the common neurotic disorders have a good outcome despite alleged advances in treatment. Those with greater mood symptoms and pre-morbid personality disorder have the least favourable outcome. It is suggested that greater attention be paid to the concurrent treatment of personality disorder and environmental factors rather than symptoms as these may be the real cause of apparent treatment resistance.