Explore the vast range of titles available.

Violent 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. We 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. Patients 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: (5308) = 9.40, < 0.001; unsupervised leave, treatment*time: (5472) = 3.45, = 0.004), and showed faster improvements on PD scales (treatment*time: (1387) = -2.85, = 0.005). These 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.

Background Because of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future – Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical item-level per patient class. Method A cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure. Results Four classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge. Discussion Different risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention.

Background Many patients residing in forensic psychiatric centers have difficulties regulating their aggression in an adequate manner. Therefore, they are frequently involved in conflicts. Evidenced-based aggression therapies in forensic psychiatry are scarce, and due to the highly secured environment, it is hard to practice real-life provocations. We have developed a Virtual Reality aggression prevention training (VRAPT), providing safe virtual environments, in which patients can practice controlling their aggressive behaviors in an adequate way. The main objective of this study is to examine whether VRAPT is effective in reducing aggression among forensic psychiatric inpatients. Methods Four forensic psychiatric centers in the Netherlands are participating in this study. Participants will be randomly assigned to either VRAPT or a waiting list. The two groups will be compared at several different time points: baseline (12 weeks before intervention), pre-intervention, post-intervention and at 12 weeks follow-up. After follow-up measurements are completed, participants from the waiting list will also receive VRAPT. The primary outcome is level of aggressive behavior, consisting of staff-reported and self-reported measures. Secondary outcomes are self-report questionnaires on e.g., anger, impulsivity and aggression. Discussion To the best of our knowledge this is the first study to examine the effectiveness of a VR aggression prevention training in forensic psychiatric centers. Further details on the methodological issues are discussed in this paper. Trial registration Dutch Trial Register ( NTR, TC = 6340 ). Retrospectively registered 14–04-2017.

This study investigated the effect of the poly-victimization pattern of traumatic childhood experiences on aggression via the impulsivity traits positive urgency, negative urgency, lack of perseverance, lack of premeditation, and sensation-seeking in 102 poly-victims of childhood trauma (71.57% were females; Mage = 35.76; SDage = 15.91). Analyses with poly-victimization as an independent variable, impulsivity traits as parallel mediators, (1) reactive aggression or (2) proactive aggression as dependent variables, and gender as a covariate revealed that the poly-victimization did not have a direct or indirect effect on reactive or proactive aggression, nor did it have an effect on any of the impulsivity traits. Moreover, lack of premeditation had a positive direct effect on reactive aggression, while gender was a significant covariate in both models, with males reporting more aggression than females. Findings suggest that the poly-victimization does not influence impulsivity traits and aggression in adulthood. However, in males, the poly-victimization had a positive and moderate correlation with reactive aggression and negative urgency, while these correlations were absent in females. This finding implies that males are more vulnerable to the adverse effects of childhood poly-victimization than females.

BackgroundPregnancy is characterised by many biological and psychosocial changes. Adequate maternal thyroid function is important for the developing fetus throughout gestation. Latent class analyses recently showed three different patterns of change in thyroid function throughout pregnancy with different associations with obstetric outcome. Maternal distress during the pregnancy (anxiety and depression) negatively affects obstetric outcome. Pregnancy distress in turn may be affected by personality traits and attachment styles. Moreover, during the pregnancy, substantial social changes occur in the partner relationship and work experience. The aim of the Brabant study is to investigate the association between thyroid function trajectories and obstetric outcomes. Moreover, within the Brabant study, we will investigate how different trajectories of pregnancy distress are related to obstetric outcome, and the role of personality in this association. We will evaluate the possible role of maternal distress and attachment style on maternal–fetal bonding. Finally, we will study social changes in the perinatal period regarding partner relationship and well-being and performance at work.Methods and analysisThe Brabant study is a longitudinal, prospective cohort study of an anticipated 4000 pregnant women. Women will be recruited at 8–10 weeks gestation among community midwife practices in South-East Brabant in the Netherlands. Thyroid function parameters (TSH and fT4), thyroid peroxidase antibody and human chorionic gonadotrophin will be assessed at 12, 20 and 28 weeks gestation. Moreover, at these three time points women will fill out questionnaires assessing demographic and obstetric features, life style habits and psychological and social variables, such as depressive symptoms, personality, partner relationship quality and burnout. Data from the obstetric records will also be collected.Ethics and disseminationThe study has been approved by the Medical Ethical Committee of the Máxima Medical Center Veldhoven. Results will be submitted to peer-reviewed journals in the relevant fields and presented on national and international conferences.

Previous research has consistently linked childhood trauma to criminal behavior in adulthood, yet the mechanisms driving this association remain poorly understood. This study investigated whether identity mediates this relationship, focusing on three identity constructs: consolidated identity, disturbed identity, and lack of identity. Criminal behavior was operationalized as a dichotomous variable, distinguishing between 103 community participants (53.9%) and 88 forensic psychiatric patients (46.1%) in a sample of 191 male participants (Mage = 39.82, SDage = 14.14). Mediation analysis was conducted using PROCESS macro model 4, controlling for age and overall personality dysfunction. The results demonstrated that childhood trauma was associated with adult criminal behavior. Additionally, childhood trauma was positively associated with lack of identity but showed no significant effect on consolidated and disturbed identity. Likewise, lack of identity was the only identity variable associated with criminal behavior and emerged as the sole mediator between childhood trauma and criminal behavior. These findings underscore the important role of identity, particularly the lack of identity, in understanding pathways to criminal behavior. Interventions aimed at strengthening individuals’ sense of self may help mitigate criminal tendencies in individuals with a history of childhood trauma, though longitudinal research is needed to further validate these findings.

Although crime victimisation is as prevalent in psychiatric patients as crime perpetration (and possibly more so), few European figures for it are available. We therefore assessed its one-year prevalence and incident rates in Dutch severely mentally ill outpatients, and compared the results with victimisation rates in the general population. This multisite epidemiological survey included a random sample of 956 adult severely mentally ill outpatients. Data on victimisation were obtained using the victimisation scale of the Dutch Crime and Victimisation Survey, which assesses crime victimisation over the preceding 12 months. Comparison data were derived from the nationwide survey on safety and victimisation in the Netherlands. Prevalence and incident rates were weighted for sex, age, ethnicity and socioeconomic status, and compared with a general population sample matched by region (N = 38,227). In the past year, almost half of the severely mentally ill outpatients (47%) had been victim of a crime. After control for demographic differences, prevalence rates of overall and specific victimisation measures were significantly higher in severely mentally ill outpatients than in the general population. The relative rates were especially high for personal crimes such as violent threats (RR = 2.12, 95% CI: 1.72-2.61), physical assaults (RR = 4.85, 95% CI: 3.69-6.39) and sexual harassment and assaults (RR = 3.94, 95% CI: 3.05-5.09). In concordance, severely mentally ill outpatients reported almost 14 times more personal crime incidents than persons from the general population (IRR = 13.68, 95% CI: 12.85-14.56). Crime victimisation is a serious problem in Dutch severely mentally ill outpatients. Mental-healthcare institutions and clinicians should become aware of their patients' victimisation risk, and should implement structural measures to detect and prevent (re-)victimisation.

Background: Radicalization, violent extremism, and terrorism are risks to societal security. Although research on terrorism-related behaviors is increasing, thorough empirical studies are rare. Methods: This study investigates radicalization processes and transitions in a matched sample of female and male terrorist suspects and convicts (N = 26) residing in Dutch penitentiary terrorism wings. Results: Results show that both men and women often experienced discrimination. A subgroup of women grew up in a stressful family environment and lacked emotional support from their family, whereas the other women did not experience such circumstances. The majority of the study sample was susceptible to connecting with radicalized friends or family members. Interestingly, factors that initially led to radicalization (e.g., a utopian image of the Islamic State) could later turn out to be factors associated with abandoning extremism. Conclusions: In this study, differences in radicalization processes and transitional phases between women and men emerged. Men more often had police contact prior to a terrorism-related offense. Making an effort to right old mistakes seemed important in the radicalization processes of men, whereas women had a stronger desire for emotional support and were more driven by experienced trauma and feelings of loneliness. This study provides input for gender-specific prevention and disengagement interventions.

Rehabilitation in forensic psychiatry is achieved gradually with different leave modules, in line with the Risk Need Responsivity model. A forensic routine outcome monitoring tool should measure treatment progress based on the rehabilitation theory, and it should be predictive of important treatment outcomes in order to be usable in decision-making. Therefore, this study assesses the predictive validity for both positive (i.e., leave) and negative (i.e., inpatient incidents) treatment outcomes with the Instrument for Forensic Treatment Evaluation (IFTE). Two-hundred and twenty-four patients were included in this study. ROC analyses were conducted with the IFTE factors and items for three leave modules: guided, unguided and transmural leave for the whole group of patients. Predictive validity of the IFTE for aggression in general, physical aggression specifically, and urine drug screening (UDS) violations was assessed for patients with the main diagnoses in Dutch forensic psychiatry, patients with personality disorders and the most frequently occurring co-morbid disorders: those with combined personality and substance use disorders. Results tentatively imply that the IFTE has a reasonable to good predictive validity for inpatient aggression and a marginal to reasonable predictive value for leave approvals and UDS violations. The IFTE can be used for information purposes in treatment decision-making, but reports should be interpreted with care and acknowledge patients' personal risk factors, strengths and other information sources.

The patient group who had not received transmural leave approval also differed significantly from patients who had received transmural leave approval, on protective behaviour (t (496) = -2.20, p = .03) and problem behaviour, t (39.06) = 3.91, p = .00). Granted leave requests. https://doi.org/10.1371/journal.pone.0200868.t001 thumbnail Download: * PPT PowerPoint slide * PNG larger image * TIFF original image Table 4. AUCs for the co-morbid personality and substance use disorder. https://doi.org/10.1371/journal.pone.0200868.t004 1. van der Veeken FCA, Lucieer J, Bogaerts S (2016) Routine Outcome Monitoring and Clinical Decision-Making in Forensic Psychiatry Based on the Instrument for Forensic Treatment Evaluation.