Faculty Bibliography

After adjudication by the courts that an individual is not criminally responsible for the offense committed, forensic psychiatrists/psychologists are tasked with evaluating an acquittees' ongoing risk of violence. These findings determine whether an acquittee is retained in a forensic hospital or transferred to a civil psychiatric setting or into the community. Better understanding of risk factors that affect decisions to retain or release acquittees from secure forensic facilities would increase clarity in decision-making, assist evaluators in identifying who may be successful outside of secure settings, and potentially assist in the development and implementation of targeted treatments to address risk factors before and after transfer. The current study evaluated which risk factors of the Historical-Clinical-Risk Management 20, Version 3 differentiated acquittees whom clinicians opined to have a dangerous mental disorder and required retention from those whom clinicians opined to be ready for transfer to a less secure setting. Results indicated that the Clinical and Risk Management scales predicted opinions regarding readiness for transfer, even after accounting for acts of violence in the hospital. These findings suggest clinicians are attuned to relevant and current risk factors in evaluations, rather than disproportionately focused on historical factors. Implications for practice and future research are discussed.

The current study compared offender and offense characteristics of pretrial defendants found incompetent to stand trial (IST) against those described as general offenders by victims in the 2008 Bureau of Justice Statistics (BJS) survey and evaluated factors that differentiated IST defendants who allegedly used weapons from those who did not during the course of a violent offense. IST defendants were older and used 'weapons' more frequently than those reported in the BJS survey; however, other characteristics, including use of firearms, did not differ. No demographic, clinical, or legal factors differentiated pretrial defendants who used weapons from those who did not. Overall, pretrial defendants were frequently diagnosed with a comorbid substance use disorder, and were homeless, unemployed, and had an extensive history of psychiatric hospitalizations and prior arrests at the time of their alleged offenses. Such results indicate that models for comprehensive discharge planning may have utility in addressing the unique needs of this subgroup of mentally disordered offenders. The findings also raise questions about the federal and state prohibition of gun rights to all IST defendants

The current archival study assesses risk factors associated with recommitment of 142 individuals adjudicated Not Guilty by Reason of Insanity (NGRI) from civil settings to a forensic hospital in New York State. Within 10 years of transfer from a forensic hospital, 40 (28.2%) were recommitted. Using survival analyses to account for the wide range in opportunity for recommitment, period of transfer (i.e., pre versus post the 1995 case of George L, which clarified factors related to assessments of dangerousness) and the Historical scale and specific items of the HCR-20 emerged as important risk factors for recommitment. Specifically, hazard of recommitment was 2.9 times higher for those with high Historical scores as compared to those with low scores. However, few individual risk factors were associated with recommitment. Prior supervision failure, negative attitude, problems with substance use, and absent or less serious major mental illness and relationship problems were informative in predicting recommitment over 10 and 3 year follow-up periods

A program evaluation examined a long-term cognitive skills inpatient program (STAIR) in reducing rehospitalization and rearrest rates in mental illness. Psychiatric and criminal histories were obtained. Psychological tests were administered. After discharge, monthly follow-up was obtained. One hundred forty-five patients completed the STAIR program and were followed for a range of six to 60 months after discharge. Thirty-one (21.4%) remained stable, 67 (46.2%) were rehospitalized, and 47 (32.4%) were rearrested and/or rehospitalized. Group membership was predicted by STAIR admission age and outpatient medication compliance. Significantly, fewer arrests, hospitalizations, and days institutionalized occurred post-STAIR. Medication compliance is the single most enduring factor associated with clinical stability and prevention of criminal behavior. Other factors' impact may vary depending on the length of stay in the community. Long-term inpatient programs (e.g., STAIR) may be helpful to some of these patients.

Standard psychiatric treatment programs have limited success in reducing recidivistic violent and criminal behavior in patients with persistent mental illness. A specialized, cognitive behavioral treatment program was developed for such a population. The purpose of this study was to identify factors that contribute to the patients' completing the program and to improve the selection criteria for program admission, so that those who participate are more likely to complete the program and be discharged. One hundred eighty-one patients with persistent mental illness with histories of aggression, crime, or both participated in a cognitive skills inpatient treatment program adapted for use with psychiatric patients. Ninety patients were able to complete the program and were discharged into the community. In comparison with the 91 who did not complete the program, those who did were less cognitively impaired and less impulsive. We present a new, intensive treatment program and define the predictors of successful completion of the program

OBJECTIVE: There is limited evidence suggesting a link between posttraumatic stress disorder (PTSD) and Attention-Deficit/ Hyperactivity Disorder (ADHD). This study examined the association between PTSD and ADHD using retrospective and current clinical evaluations. METHOD: Twenty-five male veterans with PTSD and 22 male veterans with panic disorder were evaluated for ADHD. The data was analyzed using chi-square and student's t-tests. RESULTS: Thirty-six percent of participants with PTSD and 9% of participants with panic disorder met criteria for childhood ADHD. Twenty-eight percent of participants with PTSD and 5% of participants with panic disorder met criteria for current ADHD. CONCLUSIONS: There appears to be a significant association of PTSD with ADHD. ADHD or common predisposing factors may increase the vulnerability for developing PTSD

OBJECTIVE: Patients exhibiting aggressive or criminal behavior present a challenge to treaters and caregivers. After discharge from an inpatient facility, such patients are at high risk of rehospitalization and rearrest. A long-term behaviorally based cognitive skills program was developed and administered to a group of such high-risk inpatients. The authors report the results of a postdischarge follow-up of this group. METHODS: After patients entered the inpatient treatment program, their psychiatric and criminal histories were recorded, and a battery of psychological measures were administered, including IQ tests and the Hare Psychopathy Checklist. After discharge, multiple sources were used to obtain information about patients' outcomes. RESULTS: Eighty-five patients were followed for between six months and two years after discharge. Thirty-three of these patients (39 percent) remained stable in the community, 35 (42 percent) were rehospitalized, and 17 (20 percent) were arrested. Several variables that were ascertained before discharge predicted rehospitalization or arrest rates: comorbid antisocial personality disorder, higher score on the Psychopathy Checklist, history of arrests for violent crimes, and history of a learning disability. In addition, patients who developed substance use problems or did not adhere to medication treatment after discharge were more likely to be rehospitalized or arrested. CONCLUSIONS: Arrest rates were low compared with those observed in studies with similar populations. Although this outcome may be attributable to the treatment program, this naturalistic study could not prove that. The predictors of poor outcome may be used to develop a follow-up treatment program that focuses more resources on patients who are at the highest risk

BACKGROUND: Neurocognitive deficits are recognized as a cardinal feature of schizophrenia, but the determinants of these deficits remain unknown. Recent reports have suggested that a functional polymorphism, Val(158)Met in exon III of the catechol-O-methyltransferase gene, shares approximately 4% variance with performance on the Wisconsin Card Sorting Test. These findings led to suggestions that the catechol-O-methyltransferase polymorphism may exert its effects by modulating prefrontal dopamine function, but few other neurocognitive measures have been examined, leaving open questions about phenotypic specificity. METHODS: We examined the effects of the catechol-O-methyltransferase Val(158)Met polymorphism in 58 individuals with chronic schizophrenia who completed a battery of 15 neurocognitive tests, which were reduced to four reliable neurocognitive domain scores. We examined the effects of genotype on these four domains and on global neurocognitive ability. RESULTS: The Met allele was associated with better performance in the Processing Speed and Attention domain, but not with other domain scores measuring executive and visuoperceptual functions, declarative verbal learning and memory, simple motor ability, or global neurocognitive function. Genotype shared approximately 11% of variance with Processing Speed and Attention scores, and approximately 2% of variance with Wisconsin Card Sorting Test scores. CONCLUSIONS: The findings provide independent support for the hypothesis that the catechol-O-methyltransferase Val(158)Met polymorphism influences neurocognitive function in schizophrenia, and suggest that the functional effects may be expressed on measures of Processing Speed and Attention. This information may prompt reconsideration of the 'prefrontal dopamine' hypothesis and invites examination of a broader range of effects in efforts to refine the neurocognitive phenotype that is most relevant to variation in catechol-O-methyltransferase expression