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"Forensic Psychiatry methods."
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A randomized controlled trial of cognitive remediation for a national cohort of forensic patients with schizophrenia or schizoaffective disorder
Background
Evidence is accumulating that Cognitive Remediation Training (CRT) is effective for ameliorating cognitive deficits experienced by patients with schizophrenia and accompanying functional impairment. There has been no randomized controlled trial of CRT using a nationally representative population of forensic patients, despite the significant cognitive deficits frequently present within this group.
Methods
Sixty-five patients with schizophrenia or schizoaffective disorder were enrolled in a single blind randomized controlled trial of CRT versus treatment as usual (TAU); representing 94% of those eligible within a national forensic cohort. The primary outcome measure was the composite score of the MATRICS Consensus Cognitive Battery (MCCB). Secondary outcome measures included neurocognitive and social cognitive domains, symptoms, and ‘real world’ functioning. Patient satisfaction was examined using an exit interview. Participants were reassessed at 8 months follow up. All data were analyzed using an intention to treat design (ITT).
Results
For the primary outcome measure, the MCCB composite score, there were significant differences between those who participated in CRT and those receiving TAU at both end of treatment and 8 months follow up (Cohen’s d = 0.34. Significant improvements were observed in visual and working memory. Mediation analysis found that those who cognitively benefited from CRT had corresponding improved functioning, and more net positive therapeutic moves i.e. moves to units with lower security within the hospital. Ninety-six percent believed their cognitive gains positively affected their daily lives.
Conclusions
CRT may be an acceptable and efficacious intervention for forensic patients with schizophrenia or schizoaffective disorder.
Trial registration
ClinicalTrials.gov Identifier:
NCT02360813
. Trial registered Feb 4th 2015, last updated May 1st 2015.
Journal Article
Landmark cases in forensic psychiatry
This book is the first of its kind to combine concise, easy-to-understand summaries of 116 landmark mental health cases for practicing clinicians, attorneys, educators and students with over 130 board-style multiple-choice questions to help consolidate knowledge. It is an invaluable resource for both test preparation and clinical practice.
eBook
Forensic case formulation
Forensic Case Formulation is the first text that describes the principles and application of case formulation specifically to forensic clinical practice.
* Addresses risk assessment and its implications for case formulation and treatment
* Covers a range of serious forensic problems such as violence, sexual offending, personality disorder, and substance misuse
* Offers guidance in training clinicians on ways to create useful formulations
eBook
The science of false memory
This book encompasses and weaves together the common threads of the four major topics that comprise the core of false memory research: theories of false memory, adult experimental psychology of false memory, false memory in legal contexts, and false memory in psychotherapy. By integrating material on all four of these topics, the book provides a comprehensive picture of our current understanding of human false memory.
eBook
Study protocol: a randomised controlled trial of cognitive remediation for a national cohort of forensic mental health patients with schizophrenia or schizoaffective disorder
Background
Evidence is accumulating that cognitive remediation therapy (CRT) is an effective intervention for patients with schizophrenia or schizoaffective disorder. To date there has been no randomised controlled trial (RCT) cohort study of cognitive remediation within a forensic hospital. The goal of this study is to examine the effectiveness of a trial of cognitive remediation for forensic mental health patients with schizophrenia or schizoaffective disorder.
Methods
An estimated sixty patients will be enrolled in the study. Participants will be randomised to one of two conditions: CRT with treatment as usual (TAU), or TAU. CRT will consist of 42 individual sessions and 14 group sessions. The primary outcome measure for this study is change in cognitive functioning using the MATRICS Consensus Cognitive Battery (MCCB). Secondary outcomes include change in social and occupational functioning, disorganised symptoms, negative symptoms, violence, participation in psychosocial treatment and recovery. In addition to these effectiveness measures, we will examine patient satisfaction.
Discussion
Cognitive difficulties experienced by schizophrenia spectrum patients are associated with general functioning, ability to benefit from psychosocial interventions and quality of life. Research into the treatment of cognitive difficulties within a forensic setting is therefore an important priority. The results of the proposed study will help answer the question whether cognitive remediation improves functional outcomes in forensic mental health patients with schizophrenia or schizoaffective disorder. Forensic mental health patients are detained for the dual purpose of receiving treatment and for public protection. There can be conflict between these two roles perhaps causing forensic services to have an increased length of stay compared to general psychiatric admissions. Ultimately a focus on emphasising cognition and general functioning over symptoms may decrease tension between the core responsibilities of forensic mental health services.
Trial Registration
ClinicalTrials.gov Identifier:
NCT02360813
. Trial registered Feb 4th 2015 and last updated May 1
st
2015.
Journal Article
Forensic mental health assessment of children and adolescents
Most professional forensic resources address the assessment of adults yet neglect the necessary differences that arise when working with minors. Forensic Mental Health Assessment of Children and Adolescents presents the reader with essential knowledge and practical suggestions regarding the forensic assessment of minors involved in a variety of legal applications. Methods of evaluation are described by leading experts regarding topics frequently encountered and of great importance to the courts, including physical and sexual abuse, domestic violence, child custody in divorce proceedings, risk assessment for violence, potential for rehabilitation in juvenile court cases, special education, and childhood development and trauma as mitigating circumstances in death penalty cases.
eBook
Study to assess the effect of a structured communication approach on quality of life in secure mental health settings (Comquol): study protocol for a pilot cluster randomized trial
Background
Forensic mental health services have largely ignored examining patients’ views on the nature of the services offered to them. A structured communication approach (DIALOG) has been developed with the aim of placing the patient’s perspective on their care at the heart of the discussions between patients and clinicians. The effectiveness of the structured communication approach in community mental health services has been demonstrated, but no trial has taken place in a secure psychiatric setting. This pilot study is evaluating a 6-month intervention combining DIALOG with principles of solution-focused therapy on quality of life in medium-secure settings.
Methods and design
A cluster randomized controlled trial design is being employed to conduct a 36-month pilot study. Participants are recruited from six medium-secure inpatient services, with 48 patients in the intervention group and 48 in the control group. The intervention uses a structured communication approach. It comprises six meetings between patient and nurse held monthly over a 6-month period. During each meeting, patients rate their satisfaction with a range of life and treatment domains with responses displayed on a tablet. The rating is followed by a discussion of how to improve the current situation in those domains identified by the patient. Assessments take place prior to the intervention (baseline), at 6 months (postintervention) and at 12 months (follow-up). The primary outcome is the patient’s self-reported quality of life.
Discussion
This study aims to (1) establish the feasibility of the trial design as the basis for determining the viability of a large full-scale trial, (2) determine the variability of the outcomes of interest (quality of life, levels of satisfaction, disturbance, ward climate and engagement with services), (3) estimate the costs of the intervention and (4) refine the intervention following the outcome of the study based upon the experiences of the nurses and patients. The intervention allows patients to have a greater say in how they are treated and targets care in areas that patients identify as important to them. It is intended to establish systems that support meaningful patient and caregiver involvement and participation.
Trial registration
Current Controlled Trials,
ISRCTN34145189
Journal Article
Effects of Social Support on Children's Eyewitness Reports
Research on children's eyewitness testimony demonstrates that interviewer-provided social support given during a mock forensic interview helps children resist an interviewer's misleading suggestions about past events. We proposed and tested 1 potential mechanism underlying support effects: \"Resistance Efficacy,\" or children's perceived self-efficacy for resisting an interviewer's suggestions. Eighty-one 6- and 7-year-old children experienced a play event, then were interviewed about the event with misleading and specific questions. Consistent with prior research, children interviewed by a supportive person were more resistant to misleading suggestions than were those interviewed by a nonsupportive person. Although Resistance Efficacy did not mediate the effects of interviewer support in the full sample, additional analyses revealed that Resistance Efficacy may be a mediator for older, but not younger, children. Contrary to predictions, children's preexisting social support reserves were not related to children's interview accuracy nor to perceived Resistance Efficacy. Implications for psychological theory are discussed, as well as implications for understanding and improving children's eyewitness reports.
Journal Article