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Borderline personality disorder (BPD) is highly prevalent among incarcerated populations; however, research has yet to examine whether prisoners diagnosed with BPD experience greater interpersonal dysfunction and institutional misconduct while incarcerated. This study drew from a sample of 184 male and female prisoners diagnosed with major depressive disorder (MDD) in a randomized trial of depression treatment. The presence of a BPD diagnosis (n = 69) was analyzed as a predictor of disciplinary incidents/infractions (i.e., fights, arguments with staff, disciplinary infractions, isolation), time spent in isolation, and types of aggression and victimization experiences during incarceration. There was a trend suggesting prisoners with BPD were about twice as likely as those without BPD to report disciplinary incidents/infractions (OR = 1.76 [0.93, 3.32], p = 0.075). Having a BPD diagnosis was unrelated to time in isolation and overall aggression and victimization. However, prisoners with BPD were more likely than those without BPD to perpetrate and be victimized by psychological aggression. Due to high rates of antisocial personality disorder (ASPD) in the sample as a whole (72%), additional analyses compared outcomes across prisoners with no BPD or ASPD diagnosis, BPD diagnosis only, ASPD diagnosis only, and comorbid BPD and ASPD. Prisoners with comorbid BPD and ASPD were no more likely than prisoners with ASPD only to report disciplinary incidents/infractions, but were significantly more likely than those with ASPD only to report perpetrating and being victimized by psychological aggression. Among prisoners with MDD, those with a BPD diagnosis have increased risk of psychological aggression and disciplinary infractions during incarceration. •Examined institutional misconduct, aggression, & victimization in inmates with BPD•Compared outcomes in inmates with co-occurring BPD and ASPD to those with either disorder alone•Inmates with BPD had higher risk of disciplinary infractions & psychological aggression.•Co-occurring BPD and ASPD associated with more psychological aggression than ASPD only•Inmates with BPD at risk of verbal misconduct during incarceration

The impact of the Fast Track intervention on externalizing disorders across childhood was examined. Eight hundred-ninety-one early-starting children (69% male; 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention addressed parent behavior-management, child social cognitive skills, reading, home visiting, mentoring, and classroom curricula. Outcomes included psychiatric diagnoses after grades 3, 6, 9, and 12 for conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder, and any externalizing disorder. Significant interaction effects between intervention and initial risk level indicated that intervention prevented the lifetime prevalence of all diagnoses, but only among those at highest initial risk, suggesting that targeted intervention can prevent externalizing disorders to promote the raising of healthy children.

Introduction Accurate prediction of short-term offending in young people exhibiting antisocial behaviour could support targeted interventions. Here we develop a set of machine learning (ML) models that predict offending status with good accuracy; furthermore, we show interpretable ML analyses can complement models to inform clinical decision-making. Methods This study included 679 individuals aged 11–17 years who displayed moderate-to-severe antisocial behaviour, from a controlled trial of Multisystemic-therapy in England. The outcome was any criminal offence in the 18 months after study baseline. Four types of ML algorithms were trained: logistic regression, elastic net regression, random forest, and gradient boosting machine (GBM). Prediction models were developed (1) using predictors readily available to clinicians (e.g. sociodemographics, previous convictions), and (2) with additional information (e.g. parenting). Model agnostic feature importance values were calculated and the most important predictors identified. Nested cross-validation with 100 iterations of random data splits and 10-fold cross-validation within each iteration was employed, and the average predictive performance was reported. Results Among the ML models using readily available predictors, the GBM is the strongest model (AUC 0.85, 95% CI 0.85–0.86); the other models have average AUCs of 0.82. This performance was better than using only the total number of previous offences as the predictor (0.67, 0.66–0.68), and the model simply assuming past offending status as the prediction (0.81, 0.80–0.81). Additional predictors slightly increased the performance of logistic regression and random forest models but decreased the performance of elastic net regression and gradient boosting machine-based models. Conclusion The potential utility of ML approaches for accurately predicting criminal offences in high-risk youth is demonstrated. Interpretable ML-based predictive models could be utilised in youth services or research to help develop and deliver effective interventions.

Background Antisocial personality disorder (ASPD), although associated with very significant health and social burden, is an under-researched mental disorder for which clinically effective and cost-effective treatment methods are urgently needed. No intervention has been established for prevention or as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment that has shown some promising preliminary results for reducing personality disorder symptomatology by specifically targeting the ability to recognize and understand the mental states of oneself and others, an ability that is compromised in people with ASPD. This paper describes the protocol of a multi-site RCT designed to test the effectiveness and cost-effectiveness of MBT for reducing aggression and alleviating the wider symptoms of ASPD in male offenders subject to probation supervision who fulfil diagnostic criteria for ASPD. Methods Three hundred and two participants recruited from a pool of offenders subject to statutory supervision by the National Probation Service at 13 sites across the UK will be randomized on a 1:1 basis to 12 months of probation plus MBT or standard probation as usual, with follow-up to 24 months post-randomization. The primary outcome is frequency of aggressive antisocial behaviour as assessed by the Overt Aggression Scale – Modified. Secondary outcomes include violence, offending rates, alcohol use, drug use, mental health status, quality of life, and total service use costs. Data will be gathered from police and criminal justice databases, NHS record linkage, and interviews and self-report measures administered to participants. Primary analysis will be on an intent-to-treat basis; per-protocol analysis will be undertaken as secondary analysis. The primary outcome will be analysed using hierarchical mixed-effects linear regression. Secondary outcomes will be analysed using mixed-effects linear regression, mixed-effects logistic regression, and mixed-effects Poisson models for secondary outcomes depending on whether the outcome is continuous, binary, or count data. A cost-effectiveness and cost-utility analysis will be undertaken. Discussion This definitive, national, multi-site trial is of sufficient size to evaluate MBT to inform policymakers, service commissioners, clinicians, and service users about its potential to treat offenders with ASPD and the likely impact on the population at risk. Trial registration ISRCTN 32309003 . Registered on 8 April 2016.

Objective. This study examined the concurrent diagnostic validity of the Semi‐Structured Assessment for the Genetics of Alcoholism (SSAGA) across alcohol and drug dependencies, major depression, anxiety disorders and ASPD. The Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was selected as the comparison instrument because it arises from a different tradition and uses a different format for its administration. The SCAN has been shown to be valid and applicable cross‐culturally. Method. Subjects included 38 men and 42 women volunteers from another study and from an outpatient psychiatry clinic. Selected sections of both the SSAGA and the SCAN interviews were administered to all subjects, approximately 1 week apart, in a randomized order. Because the SCAN does not assess Antisocial Personality Disorder (ASPD), the ASPD section of the Structured Clinical Interview for DSM‐III‐R (SCID) was substituted for this comparison. Results. The Kappa statistic was used to measure concordance between the two instruments. Kappa for alcohol dependence was in the acceptable range (0.63). Kappas were lower for sedative dependence (0.48) and for cannabis dependence (0.53), but higher for cocaine and stimulant dependence (0.85) and for opioid dependence (0.73). Kappa for major depression and the ASPD diagnoses were high (0.71 and 0.70), but slightly lower agreement was found for panic disorder (0.62). Kappa for social phobia was 0.47. Conclusion. These data, combined with results from two previous studies which examined reliability, indicate that the SSAGA is a highly reliable and valid instrument for use in studies of a variety of psychiatric disorders, including alcohol and drug dependence.

Little information exists on treatment effectiveness in antisocial personality disorder (ASPD). We investigated the feasibility and effectiveness of carrying out a randomized controlled trial of cognitive behaviour therapy (CBT) in men with ASPD who were aggressive. This was an exploratory two-centre, randomized controlled trial in a community setting. Fifty-two adult men with a diagnosis of ASPD, with acts of aggression in the 6 months prior to the study, were randomized to either treatment as usual (TAU) plus CBT, or usual treatment alone. Change over 12 months of follow-up was assessed in the occurrence of any act of aggression and also in terms of alcohol misuse, mental state, beliefs and social functioning. The follow-up rate was 79%. At 12 months, both groups reported a decrease in the occurrence of any acts of verbal or physical aggression. Trends in the data, in favour of CBT, were noted for problematic drinking, social functioning and beliefs about others. CBT did not improve outcomes more than usual treatment for men with ASPD who are aggressive and living in the community in this exploratory study. However, the data suggest that a larger study is required to fully assess the effectiveness of CBT in reducing aggression, alcohol misuse and improving social functioning and view of others. It is feasible to carry out a rigorous randomized controlled trial in this group.

To estimate the spectrum of familial risk for psychopathology in first-degree relatives of children with unabridged DSM-IV bipolar-I disorder (BP-I). We conducted a blinded, controlled family study using structured diagnostic interviews of 157 children with BP-I probands (n=487 first-degree relatives), 162 attention deficit hyperactivity disorder (ADHD) (without BP-I) probands (n=511 first-degree relatives), and 136 healthy control (without ADHD or BP-I) probands (n=411 first-degree relatives). The morbid risk (MR) of BP-I disorder in relatives of BP-I probands (MR=0.18) was increased 4-fold [95% confidence interval (CI) 2.3-6.9, p<0.001] over the risk to relatives of control probands (MR=0.05) and 3.5-fold (95% CI 2.1-5.8, p<0.001) over the risk to relatives of ADHD probands (MR=0.06). In addition, relatives of children with BP-I disorder had high rates of psychosis, major depression, multiple anxiety disorders, substance use disorders, ADHD and antisocial disorders compared with relatives of control probands. Only the effect for antisocial disorders lost significance after accounted for by the corresponding diagnosis in the proband. Familial rates of ADHD did not differ between ADHD and BP-I probands. Our results document an increased familial risk for BP-I disorder in relatives of pediatric probands with DSM-IV BP-I. Relatives of probands with BP-I were also at increased risk for other psychiatric disorders frequently associated with pediatric BP-I. These results support the validity of the diagnosis of BP-I in children as defined by DSM-IV. More work is needed to better understand the nature of the association between these disorders in probands and relatives.

Hintergrund: Ziel der Studie war die Evaluation ambulanter analytischer Kinder- und Jugendpsychotherapie im naturalistischen Versorgungskontext bei Kindern und Jugendlichen mit externalisierender Symptomatik. Diese externalisierenden Auffälligkeiten gehen mit oppositionellen Störungen, Störungen des Sozialverhaltens und hyperkinetischen Störungen einher. Methode: 93 Kinder und Jugendliche in ambulanter analytischer Psychotherapie mit externalisierender Symptomatik nahmen an der Studie teil (Interventionsgruppe: n = 65; Wartelisten-Kontrollgruppe/minimale supportive Intervention: n = 28). Die Daten wurden von Patienten (≥ 11 J.) und Eltern zu Therapiebeginn und -ende, sowie sechs und zwölf Monate nach Therapieende erhoben. Die Effekte der Langzeitbehandlungen wurden im Längsschnittdesign betrachtet. Ergebnisse: Zu Therapieende zeigte sich eine signifikante Reduktion der externalisierenden Symptomatik aus Eltern- und Patientensicht (Elternurteil: d = .69; Patientenurteil: d = .63). Dieser Effekt war auch zwölf Monate nach Therapieende stabil (Elternurteil: d = .77; Patientenurteil: d = .68). Um die 70% der Patienten können zu Therapieende als verbessert angesehen werden. Schlussfolgerungen: Psychoanalytische Therapie kann zu einer Verbesserung externalisierender Symptomatik führen mit Effekten, die auch ein Jahr nach Therapieende erhalten bleiben. Objectives: This partly waitlist-controlled prospective field study aimed to evaluate the effectiveness of psychoanalytic psychotherapy for children and adolescents with severe externalising symptoms. Externalising symptoms are associated with diagnoses of conduct disorders, hyperkinetic disorders, and disorders of social functioning. Methods: Participants were 93 children and adolescents in psychoanalytic therapy with a diagnosed psychiatric disorder with externalising symptomatology (intervention group: n = 65; minimal supportive treatment/waitlist control group: n = 28). Data was collected from parents and patients (≥ 11 years) at beginning/end of treatment, 6- and 12-month follow-up. The effects of long-term psychoanalytical treatment were analysed using a longitudinal design. Results: At the end of therapy, externalising symptoms were significantly reduced rated by both parents and patients (parent-rated: d = .69, patient-rated: d = .63). This effect was stable at the 1-year follow-up (parent-rated: d = .77, patient-rated: d = .68). About 70% of the patients may be considered as recovered or improved by the end of therapy. Conclusions: Psychoanalytic therapy may be successful in alleviating psychiatric disorders with externalising symptoms with effects stable at the 1-year follow-up.

The association between the development of antisocial behavior, affiliation with deviant friends, and peer rejection was tested with a preventive intervention; 664 boys and girls were randomly assigned to a universal classroom-based intervention targeting disruptive behavior or a control condition. Peer nominations of antisocial behavior, friends' antisocial behavior, and peer rejection were assessed annually for 4 years. A high, a moderate, and a stable low antisocial behavior trajectory were identified. Large reductions in antisocial behavior were found among intervention children who followed the high trajectory. These reductions coincided with affiliations with nondeviant peers and with decreases in peer rejection. The affiliation between deviant and nondeviant peers was initiated by nondeviant children. The results support a causal role of deviant friends and peer rejection in the development of antisocial behavior. The implications for our understanding of the mechanisms leading to reductions in antisocial behavior are discussed. [PUBLICATION ABBSTRACT]

Background Antisocial behaviour and adult criminality often have their origins in childhood and are best addressed early in the child’s life using evidence-based treatments such as the ‘Incredible Years Parent Programme’. However, families with additional risk factors who are at highest risk for poor outcomes do not always make sufficient change while attending such programmes. Additional support to address barriers and improve implementation of positive parenting strategies while these families attend the Incredible Years Programme may improve overall outcomes. The study aims to evaluate the efficacy of adding a structured home visiting intervention (Home Parent Support) to improve outcomes in families most at risk of poor treatment response from the Incredible Years intervention. This study will inform the design of a larger prospective randomised controlled trial. Methods/design A pilot single-blind, parallel, superiority, randomised controlled trial. Randomisation will be undertaken using a computer-generated sequence in a 1:1 ratio to the two treatments arranged in permuted blocks with stratification by age, sex, and ethnicity. One hundred and twenty six participants enrolled in the Incredible Years Parent Programme who meet the high-risk criteria will be randomly allocated to receive either Incredible Years Parent Programme and Home Parent Support, or the Incredible Years Parent Programme alone. The Home Parent Support is a 10-session structured home visiting intervention provided by a trained therapist, alongside the usual Incredible Years Parent Programme, to enhance the adoption of key parenting skills. The primary outcome is the change in child behaviour from baseline to post-intervention in parent reported Eyberg Child Behavior Inventory Problem Scale. Discussion This is the first formal evaluation of adding Home Parent Support alongside Incredible Years Parent Programme for families with risk factors who typically have poorer treatment outcomes. We anticipate that the intervention will help vulnerable families stay engaged, strengthen the adoption of effective parenting strategies, and improve outcomes for both the children and families. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612000878875 .