Psychopathy and community violence among civil psychiatric patients: Results from the MacArthur Violence Risk Assessment Study.

Although psychopathy is recognized as a relatively strong risk factor for violence among inmates and mentally disordered offenders, few studies have examined the extent to which its predictive power generalizes to civil psychiatric samples. Using data on 1,136 patients from the MacArthur Violence Risk Assessment project, this study examined whether the 2 scales that underlie the Psychopathy Checklist: Screening Version (PCL:SV) measure a unique personality construct that predicts violence among civil patients. The results indicate that the PCL:SV is a relatively strong predictor of violence. The PCL:SV's predictive power is substantially reduced, but remains significant, after controlling for a host of covariates that reflect antisocial behavior and personality disorders other than psychopathy. However, the predictive power of the PCL:SV is not based on its assessment of the core traits of psychopathy, as traditionally construed. Implications for the 2-factor model that underlies the PCL measures and for risk assessment practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based strategies improve assessment of pediatric bipolar disorder by community practitioners.

The misdiagnosis of pediatric bipolar disorder (PBD) has become a major public health concern. Would available evidence-based assessment (EBA) strategies help improve diagnostic accuracy and are clinicians willing to consider these strategies in practice? The purpose of the present study was to document the extent to which using an EBA decision tool—a probability nomogram—improves the interpretation of family history and test data by clinicians and to examine the acceptability of the nomogram technique to clinicians. Over 600 clinicians across the U.S. and Canada attending continuing education seminars were trained to use the nomogram. Participants estimated the probability that a youth in a clinical vignette had bipolar disorder, first using clinical judgment and then using the nomogram. Brief training of clinicians (less than 30 minutes) in using the nomogram for assessing PBD improved diagnostic accuracy, consistency, and agreement. The majority of clinicians endorsed using the nomogram in practice. EBA decision aids, such as the nomogram, may lead to a significant decrease in overdiagnosis and help clinicians detect true cases of PBD. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Using a Five-Factor Lens to Explore the Relation Between Personality Traits and Violence in Psychiatric Patients.

Recent work suggests that predictors of violence are similar for individuals with and without mental illness. Although psychopathy is among the most potent of such predictors, the nature of its relation to violence is unclear. On the basis of a sample of 769 civil psychiatric patients, the authors explore the possibility that measures of psychopathy provide a glimpse of higher order personality traits that predispose individuals toward violence. Results indicate that general traits captured by a measure of the 5-factor model, particularly antagonism, were relatively strongly associated with violence and shared most of their violence-relevant variance with a leading measure of psychopathy. Because interpersonal and affective features of psychopathy are less important than basic traits of antagonism in postdicting violence, it may be appropriate to broaden focus in risk assessment to patients' basic personality traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unresolved controversies concerning psychopathy: Implications for clinical and forensic decision making.

At some point in their careers, clinicians who work or consult in forensic and correctional settings will almost certainly encounter individuals who exhibit psychopathic personality features. Because of the widespread use of this disorder to inform legal and clinical decision making, psychologists should be exceedingly familiar with the relevant research literature on this topic before venturing into these settings. This article reviews the empirical bases of several clinically relevant claims and assertions regarding psychopathy and concludes that many areas of research are decidedly more equivocal in their findings than is commonly perceived. Although there is much to be gained by assessing psychopathy in various contexts, clinicians need to be cautious about drawing overzealous and empirically questionable conclusions about an important disorder that also has great potential for abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is criminal behavior a central component of psychopathy? Conceptual directions for resolving the debate.

The development of the Psychopathy Checklist—Revised (PCL–R; R. D. Hare, 2003) has fueled intense clinical interest in the construct of psychopathy. Unfortunately, a side effect of this interest has been conceptual confusion and, in particular, the conflating of measures with constructs. Indeed, the field is in danger of equating the PCL–R with the theoretical construct of psychopathy. A key point in the debate is whether criminal behavior is a central component, or mere downstream correlate, of psychopathy. In this article, the authors present conceptual directions for resolving this debate. First, factor analysis of PCL–R items in a theoretical vacuum cannot reveal the essence of psychopathy. Second, a myth about the PCL–R and its relation to violence must be examined to avoid the view that psychopathy is merely a violent variant of antisocial personality disorder. Third, a formal, iterative process between theory development and empirical validation must be adopted. Fundamentally, constructs and measures must be recognized as separate entities, and neither reified. Applying such principles to the current state of the field, the authors believe the evidence favors viewing criminal behavior as a correlate, not a component, of psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violent storms and violent people: How meteorology can inform risk communication in mental health law.

Meteorology is often thought of as a field with highly developed techniques for forecasting rare and severe events. Risk assessment of another type of rare and severe event—violence to others—occurs in mental health law. The analogy between these 2 forms of risk assessment is explored in this article. How meteorologists go about assessing the risk of harmful weather is described. Implications from the meteorological analogy are drawn for 1 aspect of violence prediction that is routinely ignored in mental health law: the communication of risk "forecasts." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Without conscience: The disturbing world of the psychopaths among us.

Reviews the book, Without conscience: The disturbing world of the psychopaths among us by Robert D. Hare (see record 2001-00418-000). Too often we hear about adults, and now more than ever, adolescents, who perpetrate violence so horrific and seemingly meaningless that their actions defy the understanding of professionals, let alone of the perpetrators' families. The republication of Robert Hare's popular work on the psychopathic personality is a testament to the success and importance of this book. Hare paints an intriguing yet scary portrait of this, the most dangerous type of personality disorder. His colourful, but accurate portrayal of the psychopath makes this book equally important alike for parents and clinicians. Without conscience is based on more than 30 years of the author's research on psychopathy. The book is written in a sincere and easily readable fashion for a general audience. The research and clinical literature is described in nontechnical terms with a minimum of jargon, making the work accessible to a wide audience. Much of Hare's research has been devoted to the reliable identification of psychopaths. His development of the Psychopathy Checklist (PCL) may represent the single, most important advancement to date toward what hopefully will become our ultimate understanding of psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discriminant validity of the Psychopathy Checklist in a forensic psychiatric population.

The association between psychopathy and other mental disorders was investigated in 80 male forensic patients. Psychopathy was assessed with the Psychopathy Checklist (PCL; R. D. Hare [see PA, Vol 67:2477]). Diagnoses of other mental disorders were based on Axis I and Axis II criteria listed in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and on two standardized psychiatric rating scales. PCL diagnoses were significantly related only to antisocial and histrionic personality disorder (PD) and to nonalcohol substance abuse disorders. PCL ratings were also positively correlated with prototypicality ratings of antisocial, histrionic, and narcissistic PD and negatively correlated with ratings of avoidant PD. The results provide evidence for the convergent and discriminant validity of the PCL and are consistent with the view that psychopathy is a distinct clinical syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the Hare Psychopathy Checklist: Youth Version (PCL: YV) in incarcerated adolescents.

Two studies are reported on the underlying dimensions of the psychopathy construct in adolescents as measured by the Hare Psychopathy Checklist-Youth Version (PCL: YV; Forth, Kosson, & Hare, 2003). In Study 1, the PCL: YV item ratings for 505 male adolescents incarcerated in 5 different settings in North America were used to test the fit of 3 models that have been hypothesized to represent the structure of psychopathy in adults. A 4th model based on parceling PCL: YV items was also tested. In Study 2, these models were tested with a sample of 233 male adolescents incarcerated in 2 facilities in the United Kingdom. Model fit results indicated that the 18-item 4-factor model developed by Hare (2003) and a modified version of a 13-item 3-factor model developed by Cooke and Michie (2001) were associated with generally good fit. Because the 4-factor model is a less saturated model than the 3-factor model (better parameter to data point ratio), it survived a riskier test of disconfirmation. Implications for the nature of psychopathy in youth are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy and violence: The importance of factor level interactions.

The power of scales based on the Psychopathy Checklist (PCL; R. D. Hare, 1980) for prediction of violent behavior is well established. Although evidence suggests that this relationship is chiefly due to the impulsive and antisocial lifestyle component (Factor 2), the predictive power of psychopathy for violence may also reflect the multiplicative effects of this component with interpersonal and unemotional traits (Factor 1). The determination of the extent to which psychopathy subcomponents interact to predict violence has theoretical and practical implications for PCL-assessed psychopathy. However, the relationship between violence and the interactive effects of psychopathy subcomponents remains largely undetermined. The authors used prospective and cross-sectional designs to examine the independent and interactive effects of the factors of PCL-assessed psychopathy in 2 samples: (a) 199 county jail inmates and (b) 863 civil psychiatric patients. The Factor 1 × Factor 2 interaction predicted violence in both samples, such that the predictive power of Factor 2 was attenuated at lower levels of Factor 1. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meeting the challenge of early identification of HIV infection in primary care

The authors review the role of human immunodeficiency virus (HIV) testing in primary care, including an overview of epidemiologic trends of the HIV epidemic; avenues for HIV counseling and testing; HIV testing assays; guidelines for HIV test counseling in primary care; special situations involving testing of pregnant women, infants, and young children; post-exposure prophylaxis; and related resources available to Wisconsin primary care clinicians. HIV disease is a major cause of premature death and disability in the United States. Advances in the understanding of the pathogenesis of HIV and developments of newer antiretroviral therapies have resulted in dramatic changes in the management of HIV disease. Combination antiretroviral drug therapy has resulted in prolonged and near complete suppression of detectable HIV replication in many HIV-infected persons. These clinical developments underscore the importance of early identification and intervention in HIV disease. Intervention during primary HIV infection, the time when the viral burden "set point" is achieved, may present a special window of opportunity to effectively intervene in limiting viral replication in an infected individual. This earliest intervention may have major benefits for infected persons and society at large. Decreasing viral load during primary HIV infection may decrease an individual's infectiousness and thereby decrease the overall rate of transmission of infection to others. Primary care clinicians play a critical role in diagnosing, managing, and preventing HIV infection. Because of the ongoing relationship between patient and health care provider, the primary health care clinician is in the best position to provide HIV risk assessment, testing, related prevention education, and coordination of needed health care. This article presents guidelines for conducting HIV counseling and testing in primary care for purposes of furthering the public health objective of early identification of HIV infection. Clinicians can achieve this objective by including HIV risk assessment during the initial history and physical exam of every patient.     

Multidimensional assessment of criminal recidivism: Problems, pitfalls, and proposed solutions.

All states have statutes in place to civilly commit individuals at high risk for violence. The authors address difficulties in assessing such risk but use as an example the task of predicting sexual violence recidivism; the principles espoused here generalize to predicting all violence. As part of the commitment process, mental health professionals, who are often psychologists, evaluate an individual's risk of sexual recidivism. It is common for professionals conducting these risk assessments to use several actuarial risk prediction instruments (i.e., psychological tests). These tests rarely demonstrate close agreement in the risk figures they provide. Serious epistemological and psychometric problems in the multivariate assessment of recidivism risk are pointed out. Sound psychometric, or in some cases heuristic, solutions to these problems are proffered, in the hope of improving clinical practice. The authors focus on how to make these tests' outputs commensurable and discuss various ways to combine them in coherent, justifiable fashions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applicability of traditional and revised models of psychopathy to the Psychopathy Checklist: Screening Version.

Recently, psychopathy has become virtually synonymous with the Psychopathy Checklist (PCL) measures. However, the "gold standard" 2-factor model that underlies these measures has been questioned for its uncertain empirical support and emphasis on antisocial behavior that is not specific to psychopathic personality deviation. This study (N=870 civil psychiatric patients) compares the fit of the traditional 2-factor model with that of a revised 3-factor model of psychopathy. The revised model better describes the structure of the Screening Version of the PCL (PCL:SV) than the traditional model. Although the revised model's exclusion of some items that assess antisocial behavior reduces the PCL:SV's power in predicting patient violence, this model arguably assesses psychopathy in a more specific, theoretically coherent fashion that may reduce misapplications of the construct. Implications for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability of the Revised Psychopathy Checklist in substance abuse patients.

Examined the 1-mo test–retest reliability of the revised Psychopathy Checklist (PCL—R) in 88 methadone-maintained male patients (average age nearly 40 yrs) as well as the effects of increased information (interview, clinical chart review, partial and complete criminal records) on PCL—R scores and on 2 diagnostic derivations of the PCL—R. PCL—R scores and diagnostic proportions were not found to differ significantly between baseline and 1 mo. However, increased amounts of rater information resulted in significantly higher PCL—R scores and more positive diagnoses. Test–retest reliabilities of PCL—R scores were found to be excellent, and the reliabilities of each of its 2 factors were also quite good. Diagnostic reliabilities were also good, based on the interview alone, but appeared to improve with increasing information available to the rater. The findings suggest that the PCL—R continues to show promise as a research tool. However, because clinical and criminal records may be difficult to obtain for nonprison populations and settings, there may be limitations in the use of the PCL—R to diagnose psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In the echoes of gunfire: Practicing psychologists' responses to school violence.

The recent rash of school shootings has thrust practicing psychologists into the role of assisting communities prevent such high profile incidents of juvenile violence. Although many psychologists are involved in assessing and treating children at risk for violent behavior, their efforts are rarely linked with other organized prevention efforts. This article describes how practicing psychologists represent a critical resource to school districts in developing and implementing a comprehensive violence prevention strategy. The authors outline a model school and mental health clinic collaborative program that can be replicated in various practice settings and discuss the benefits and essential steps for building such a collaboration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic labeling in juvenile justice settings: Do psychopathy and conduct disorder findings influence clinicians?

Do provocative diagnostic labels such as psychopathy or conduct disorder influence clinicians who work in juvenile justice settings? Juvenile justice clinicians (N = 109) responded to a mock psychological evaluation of a juvenile, which varied antisocial history, psychopathic personality features, and diagnosis (psychopathy, conduct disorder, or none). Psychopathic personality features and antisocial behavioral history led to higher clinician ratings of the juvenile's risk for future criminality. A psychopathy label also led to higher clinician ratings of risk, but only when there was a minimal history of antisocial behavior. No diagnostic labels influenced clinician ratings regarding treatment. Viewed alongside other research on labeling in the juvenile justice system, clinicians appear to be somewhat more responsive to mention of the psychopathy construct than are nonclinical juvenile justice professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of domestic violence on the maternal-child relationship and preschool-age children's functioning.

Although preschool-age children are at risk for witnessing domestic violence, the majority of research has focused on children ages 6 to 12 years. This study examines the mediating role of the mother-child relationship on preschool-age children's functioning in families experiencing domestic violence. Maternal report and behavioral observations of mother-child interactions were used to assess relationship quality. Participants consisted of 103 children and their mothers. The data fit the model well but indicated that some of the correlations were not in the expected direction. Although depressed mothers were struggling with parenting, other mothers appeared to be compensating for the violence by becoming more effective parents. Domestic violence negatively impacted children's behavior with their mothers in interactions but did not influence maternal report of problem behaviors, suggesting that the impact of domestic violence begins very early and in the realm of relationships rather than in mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hereditary cancer risk notification and testing: how interested is the general population?

PURPOSE: Great interest in predictive testing for hereditary cancer syndromes has been reported. Prior research has focused on testing for specific hereditary syndromes and/or among individuals at high risk for positive carrier status. Given anticipated expansion of both the range of hereditary syndromes for which testing will be available, as well as the clinical settings in which testing will occur, assessment of interest in hereditary cancer risk testing and notification in the general public is warranted. METHODS: As part of an annual statewide telephone survey, adults' (N = 654) interest in hereditary cancer risk testing and notification was assessed. RESULTS: Interest in both risk testing (82%) and risk notification (87%) was high. Logistic regression analyses indicated that disinterest in risk notification was associated with female sex, performance of fewer health protective behaviors, and better perceptions of personal health. Disinterest in risk testing was associated with these same variables as well as older age, less concern over developing cancer, and a more extensive history of cancer in first degree relatives. CONCLUSION: In the absence of risk-reducing behaviors with demonstrable efficacy, hereditary risk testing programs may have difficulty attracting the interest of those at greatest risk for carrier status. In contrast, many individuals at low risk for positive carrier status might seek testing, perhaps as a means of seeking reassurance regarding their low hereditary risk.     

Review of Assessing and managing violence risk in juveniles.

Reviews the book, Assessing and managing violence risk in juveniles by Randy Borum and David Verhaagen (see record 2006-12484-000). This book is a compilation of research findings designed to accomplish the goal of equipping the reader to "conduct risk assessments that are thorough, fair, helpful, and developmentally and empirically sound." New school psychologists will find an excellent framework for learning how to approach the daunting task of assessing risk of violence in children and adolescents. Experienced practitioners will find new research results integrated throughout the book to improve the precision of their risk assessments as well. This book is written for mental health professionals in schools, therapy settings, and juvenile justice systems. Although these three contexts are presented as very different from each other (differences in treatment plans are noted), the basic principles of assessment are applicable to all. (PsycINFO Database Record (c) 2010 APA, all rights reserved)