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Individuals with childhood experience of out-of-home care (OHC) face elevated risks of criminal behavior and poor mental health compared with the majority population. Evidence on how trajectories of offending and psychiatric disorders covary among individuals with experience of OHC is needed. This study is based on a cohort of 14,608 individuals (n = 1,319 with OHC experience) born in the Stockholm metropolitan area in 1953 (49% women) from birth to age 63 (2016). Group-based multi-trajectory modeling among those with at least one offense or psychiatric disorder (40.5% of the men, 16.6% of the women) identified four co-occurring trajectories for both sexes. Multinomial regression analyses showed that adolescent OHC placement, particularly in institutions and for behavioral reasons, was linked to higher odds of early-adulthood-limited or decreasing offending and psychiatric trajectories. Most individuals recover from offending and psychiatric disorders by retirement, but placed individuals in particular remain at high risk for offending, alongside psychiatric disorders, throughout early adulthood. Early assessment and tailored attention to needs and risk levels is important when designing long-term care services to mitigate this. Research on underlying mechanisms, and on collaboration between the welfare, justice, and psychiatric care systems, can help to design effective intervention strategies and policies.
Little is known about the diagnostic trajectories following a first psychiatric diagnosis in childhood or adolescence. Such knowledge could aid clinicians in treatment, risk prediction, and psychoeducation. This study presents a comprehensive nationwide overview of diagnostic trajectories in children and adolescents after their first diagnosis in child and adolescent psychiatric hospitals.
Methods
Patients aged 0 to 17 years who received their first psychiatric diagnosis between January 1996 and December 2011 were identified through the Danish National Patient Registries. Shifts at the International Classification of Diseases (ICD-10) two-cipher level (F00-F99), grouped into 19 categories, were identified. Subsequent diagnoses during 10 years of follow-up until December 2021 were identified and analyzed using state sequence analysis and Cox proportional hazard regression models.
Results
A total of 77,464 children and adolescents (32,733 [42.26%] girls) were identified with a first-time psychiatric diagnosis. Among these, 46.7% of girls and 37.6% of boys had at least one diagnostic shift after 10 years of follow-up. High entropy and low diagnostic stability were found in first-time diagnoses often presenting in adolescence, such as affective disorders, psychotic illness, and personality disorders, while lower entropy and high diagnostic stability were found in neurodevelopmental disorders and eating disorders. For most categories, girls had higher mean entropy measures than boys (P < 0.05).
Conclusions
Diagnostic shifts are common in child and adolescent psychiatric services, particularly when the first contact occurs in adolescence. Adequate focus on psychoeducation about emerging diagnostic shifts, and on timely detection, particularly in girls, and particularly in adolescence, is warranted.
Chapter 6 identifies the doctrine of diminished responsibility as the closest antecedent of the Universal Partial Defence (UPD), and a suitable template from which to forge the proposal. Taking a particularised theoretical approach, the chapter draws on case law and empirical studies to arrive at a more fine-grained account of the operation of the defence. It reveals a penumbral approach to its interpretation in the courts, through the subtle inclusion of factors that sit at the edge of what might be considered a recognised medical condition or mental disorder. The chapter maintains that this flexibility suggests a stomach for moral complexity on the part of fact-finders, arguing for a broader, normative test that can include consideration of circumstance, as the basis of the UPD. The analysis considers the role of key decision-makers, and it serves to inform the development of a bounded causal theory of partial excuse in Chapter 7.
This chapter explores legislative time limits on the prosecution of crime in civil and common law jurisdictions. It addresses the rationales for barring the prosecution of old crimes and undertakes a comparative analysis of three jurisdictional groupings: Continental Europe (with a focus on Germany and France), the Commonwealth (with a focus on England and Wales) and the United States (with a focus on federal law). The analysis identifies comparable features in limitation doctrine across jurisdictions while revealing how the theory and practice of statutes of limitation differs markedly in different legal systems. In broad terms, Continental systems codify general and categorical time limits on the prosecution of offences; Commonwealth systems tend not to have any statutory time bars on the prosecution of offences other than minor offences; and in the United States, most offences, other than the most serious, are subject to statutory limitation periods. The chapter concludes by drawing together the points of comparison between the three jurisdictional groupings, commenting on their distinctions and similarities.
There are no such things as “personality disorders” distinct from other mental disorders. Distinct personality disorders cannot be identified based on their developmental course or their symptoms. The new ICD and DSM concept of personality disorder as self and interpersonal dysfunction identifies important forms of psychopathology but is not more (or less) related to personality than are other disorders. Rather, personality traits contribute to risk for all forms of mental disorder, and most symptom dimensions are coextensive with dimensions of normal personality, such that persistent symptoms of psychopathology are typically extreme or maladaptive variants of normal personality traits. However, symptoms are merely indicators of risk rather than necessary and sufficient indicators of psychopathology. We draw on our cybernetic dysfunction theory of psychopathology to clarify the role of personality in mental disorder. Psychopathology is defined as “persistent failure to move toward one’s goals, due to failure to generate effective new goals, interpretations, or strategies when existing ones prove unsuccessful.” Personality is exhaustively described by personality traits and characteristic adaptations, the latter being relatively stable goals, interpretations, and strategies that are specified relative to an individual’s particular life circumstances. Psychopathology always involves failure of characteristic adaptations and thus breakdown in personality functioning.
Madness, as a form of suffering, has existed as long as humankind. Only in the nineteenth century did it come under the aegis of medicine, giving rise to the birth of psychiatry/alienism as a discipline. Prior to this, madness had attracted the attention of many agents, including the Church, medics, philosophers, and others. During the seventeenth century in the context of secularization, the scientific revolution, and other factors, it began to be viewed as a natural kind and thereby a medical object. In the nineteenth century, the medicalization of madness was further associated with a growth of mental asylums, enabling alienists to observe patients longitudinally, to classify their complaints, and to construct the language for the description/construction/capture of mental symptoms, namely, descriptive psychopathology. In contrast to the signs available to medical doctors, alienists had to develop different clinical criteria, and the emerging social sciences became the natural source for these. Thus, from the beginning, descriptive psychopathology was a hybrid construct, incorporating the frameworks of both the natural sciences and the social sciences. The tension resulting from this incongruent union has persisted ever since and contributed to the polarities in current conceptions of mental disorders as well as the challenges facing psychiatry today.
Current empirical understanding of the relationship between psychopathology and terrorist behaviours in women is limited, because most research focuses on male perpetrators and relies on secondary sources. Addressing this gap is crucial, particularly given previous research that highlights significant differences in mental health problems between women and men involved in non-terrorist violent activities.
Aims
To empirically examine the presence of psychopathology in women exhibiting terrorist behaviours, as well as its potential role in these behaviours.
Method
A case series study of 14 Dutch female convicts associated with the (so-called) Islamic State of Iraq and Syria (ISIS), examining the occurrence and types of mental disorders, psychopathological problems and pathological personality traits, and exploring their potential role in terrorist behaviours based on forensic mental health reports from psychiatrists and psychologists.
Results
Half of the women (n = 7) exhibited mental disorders during terrorist activities, primarily personality disorders. Psychopathological problems included susceptibility to influence (71%, n = 10), identity problems (64%, n = 9), feelings of inferiority (57%, n = 8) and naivety (50%, n = 7). A significant link between terrorism and mental disorders, psychopathological problems or pathological personality traits was identified in almost half of the women (43%, n = 6).
Conclusions
Psychopathology is present in some women involved in terrorist behaviours, influencing their involvement, but is absent or irrelevant in others. Identifying psychopathology in women with terrorist tendencies is essential for early prevention and should be a core competency for psychiatrists.
Several studies have used a network analysis to recognize the dynamics and determinants of psychotic-like experiences (PLEs) in community samples. Their synthesis has not been provided so far. A systematic review of studies using a network analysis to assess the dynamics of PLEs in community samples was performed. Altogether, 27 studies were included. The overall percentage ranks of centrality metrics for PLEs were 23.5% for strength (20 studies), 26.0% for betweenness (5 studies), 29.7% for closeness (6 studies), 26.9% for expected influence (7 studies), and 29.1% for bridge expected influence (3 studies). Included studies covered three topics: phenomenology of PLEs and associated symptom domains (14 studies), exposure to stress and PLEs (7 studies), and PLEs with respect to suicide-related outcomes (6 studies). Several other symptom domains were directly connected to PLEs. A total of 6 studies investigated PLEs with respect to childhood trauma (CT) history. These studies demonstrated that PLEs are directly connected to CT history (4 studies) or a cumulative measure of environmental exposures (1 study). Moreover, CT was found to moderate the association of PLEs with other symptom domains (1 study). Two studies that revealed direct connections of CT with PLEs also found potential mediating effects of cognitive biases and general psychopathology. PLEs were also directly connected to suicide-related outcomes across all studies included within this topic. The findings imply that PLEs are transdiagnostic phenomena that do not represent the most central domain of psychopathology in community samples. Their occurrence might be associated with CT and suicide risk.
There is an unprecedented societal focus on young people’s mental health, including efforts to expand access to child and adolescent mental health services (CAMHS). There has, however, been a lack of research to date to investigate adult mental health outcomes of young people who attend CAMHS.
Methods
We linked Finland’s healthcare registries for all individuals born between 1987 and 1992. We investigated mental disorder diagnoses recorded in specialist adult mental health services (AMHS) and both inpatient and outpatient service use by age 29 (December 31, 2016) for former CAMHS patients.
Results
Before the end of their 20s, more than half (52.4%, n = 21,183) of all CAMHS patients had gone on to attend AMHS. The most prevalent recorded adult psychiatric diagnoses received by former CAMHS patients were depressive disorders (30%, n = 11,768), non-phobic anxiety disorders (21%, n = 7,910), alcohol use disorders (9.5%, n = 3,427), personality disorders (9.3%, n = 3,366), and schizophrenia-spectrum disorders (7.6%, n = 2,945). In the total population, more than half of all AMHS appointments (53.1%, k = 714,239/1,345,060) were for former CAMHS patients. More than half of all inpatient psychiatry bed days were for former CAMHS patients (53.1%, k = 1,192,991/2,245,247).
Conclusion
While there is a strong focus on intervening in childhood and adolescence to reduce the burden of mental illness, these findings suggest that young people who receive childhood intervention very frequently continue to require specialist psychiatric interventions in adulthood, including taking up a majority of both outpatient and inpatient service use. These findings highlight the need for a greater focus on research to alter the long-term trajectories of CAMHS patients.
Mounting evidence suggests that the Mediterranean diet has a beneficial effect on mental health. It has been hypothesised that this effect is mediated by a variety of foods, nutrients and constituents; however, there is a need for research elucidating which of these components contribute to the therapeutic effect. This scoping review sought to systematically search for and synthesise the research on olive oil and its constituents and their impact on mental health, including the presence or absence of a mental illness or the severity or progression of symptoms. PubMed and OVID MEDLINE databases were searched. The following article types were eligible for inclusion: human experimental and observational studies, animal and preclinical studies. Abstracts were screened in duplicate, and data were extracted using a piloted template. Data were analysed qualitatively to assess trends and gaps for further study. The PubMed and OVID MEDLINE search yielded 544 and 152 results, respectively. After full-text screening, forty-nine studies were eligible for inclusion, including seventeen human experimental, eighteen observational and fourteen animal studies. Of these, thirteen human and four animal studies used olive oil as a comparator. Observational studies reported inconsistent results, specifically five reporting higher rates of mental illness, eight reporting lower and five reporting no association with higher olive oil intake. All human experimental studies and nine of ten animal studies that assess olive oil as an intervention reported an improvement of anxiety or depression symptoms. Olive oil may benefit mental health outcomes. However, more experimental research is needed.
Determining whether the incidence of suicidal behavior during the COVID-19 pandemic changed for those with severe mental disorders is essential to ensure the provision of suicide preventive initiatives in the case of future health crises.
Methods
Using population-based registers, quarterly cohorts from the first quarter of 2018 (2018Q1) to 2021Q4 were formed including all Swedish-residents >10 years old. Interrupted time series and generalized estimating equations analyses were used to evaluate changes in Incidence Rates (IR) of specialised healthcare use for suicide attempt and death by suicide per 10 000 person-years for individuals with or without specific severe mental disorders (SMDs) during, compared to before the pandemic.
Results
The IR (95% Confidence interval, CI) of suicide in individuals with SMDs decreased from 16.0 (15.0–17.1) in 2018Q1 to 11.6 (10.8–12.5) in 2020Q1 (i.e. the quarter before the start of the pandemic), after which it dropped further to 6.7 (6.3–7.2) in 2021Q2. In contrast, IRs of suicide attempt in SMDs showed more stable trends, as did the trends regarding suicide and suicide attempt for individuals without SMD. These discrepancies were most evident for individuals with substance use disorder and ASD/ADHD. Changes in IRs of suicide v. suicide attempt for one quarter during the pandemic for substance misuse were 11.2% v. 3.6% respectively. These changes for ASD/ADHD were 10.7% v. 3.6%.
Conclusions
The study shows pronounced decreases in suicide rates in individuals with SMDs during the pandemic. Further studies aiming to understand mechanisms behind these trends are warranted to consult future suicide prevention strategies.
This book draws on the disciplines of law, philosophy, and psychiatry to interrogate whether the Mental Capacity Act 2005 meets the challenges posed by mental disorder to decision-making. It is often assumed that to allow space for individuality, any test for capacity must focus only on decision-making processes and not on the substance of the values that underpin decisions. Auckland challenges this assumption, arguing that the current law serves merely as a façade, behind which judgements can be made about the nature of a person's values, free from proper scrutiny. This book provides an in-depth analysis of when and how a person's disordered values should be relevant to the determination of their capacity, offering novel suggestions for reforming the capacity test to better reflect the impact of disorder on decision-making. It also explores the implications of this analysis for people found to lack capacity, concluding that reforms to the best interest provisions are urgently needed. This title is part of the Flip it Open Programme and may also be available Open Access. Check our website Cambridge Core for details.
The National Health Service Race and Health Observatory provides an evidence-based approach to tackling racial disparities in health and making policy recommendations. Its Mental Health Advisory Group is responsible for commissioning research into racial and ethnic disparities in mental health, and in this regard, improving access to psychological therapies became a key focus.
The Introduction summarises the core themes of the book and outlines how the argument will proceed over the course of its chapters. It explains why the issue it centres around – namely, how the law grapples with the impact of mental disorder on decision-making – is so important, and why successfully navigating the tension between respect for (and deference to) idiosyncratic values, and protection from disorder or impairment, must be a precondition of England and Wales adopting ‘fused’ mental capacity and health legislation, or a more CRPD-compliant statutory framework. It also explains how the book relates to the existing literature in this area, which has focused in recent years on concerns about the binary nature of the capacity framework, and on the individualistic and rational ‘liberal subject’ on which this framework rests. Finally, it elaborates briefly on some of the concepts which the book will draw upon, in particular what is meant by ‘values’ and ‘beliefs’.
Where the real basis for finding someone to lack capacity is that you consider the beliefs or values that motivate their decision to be distorted by a mental illness, such that the decision is not authentically desired and so is unworthy of respect, this entails a number of empirical and normative claims. This chapter will interrogate these claims by reference to the wide-ranging literature on the nature of mental disorder, and on differing conceptions of autonomy and authenticity (as a component of autonomous decision-making). It will be concluded that while an agent acting on the basis of disordered beliefs or values will often be acting inauthentically (and thus non-autonomously), this will not always be the case, and situations could arise in which there is reason to believe that the agent would endorse or sanction their belief, even knowing it is derived from illness. Moreover, once the shaky conceptual ground on which such judgements must be made is acknowledged, it becomes essential that these judgements are brought out into the open, where they can be subject to appropriate scrutiny.
This chapter will explore a key problem with the current law’s approach – namely, that it is impossible to assess a person’s capacity to ‘use or weigh’ the information relevant to a decision without engaging with the values that underpin their decision. It will suggest that while some recourse to the person’s values is unavoidable, the current approach gives assessors ample room to invoke other values when assessing the person’s capacity, thus creating space for paternalistic judgments to go unchecked. Despite this risk, it will be claimed that in many of the cases in which this occurs, underpinning the assessment is in fact a concern that the values or beliefs that motivate a person’s decision have been affected by an illness or impairment, such that the decision reached is not one that the agent would have made, but for that disorder or impairment. The current law cannot account for this, and so assessors are forced to manipulate the test for capacity instead. While this prevents unnecessary harm, it has the effect of obscuring the value-laden and highly controversial claims that may underpin such decisions, which remain insulated from scrutiny or challenge.
Violence is common and is a public health issue. Forensic psychiatrists offer treatment for the small amount of violence that is due to mental disorder. It is essential to distinguish between meaningful explanations and causes. Violence is not a unitary concept. Evidence for the specific causal associations between mental illness and violence is reviewed. Anger, anxiety, moral and amoral actions are reviewed including intoxication and withdrawal, deception, antisocial personality and psychopathy, and a range of mental illnesses and developmental disorders. Social and developmental factors are also important. Memes, media and social contagion influence the forms of violence. Court reports and treatments are considered critically in relation to violence.
This chapter describes some commonly used nonhuman paradigms for assessing animal behavior and the figures that are used to present those data. The chapter opens with an overview of some animal species used in neuroscience research, a discussion about nonhuman housing, and a description of types of validity that behavioral neuroscientists concern themselves with. The behavioral tests described here are divided into five major categories: motor behaviors; pain; learning and memory; mental disorders such as anxiety, depression, and substance use disorder; and social behaviors. Included is a description of a survival analysis and an explanation of interpreting Kaplan–Meier curves.
This chapter seeks to provide clinicians with a better understanding of prisons and overcome many of the myths and misconceptions, with the objective of making the environment more attractive and interesting for future psychiatrists. In addition to a wide need and a rich variety of conditions, the psychiatrist in prison must contend with barriers to care such as working without a mental health act and, when a patient needs to be transferred and treated outside of prison, navigating complicated pathways to care. Mental disorder is prevalent in all prison systems. Pathways into prison may be related to general factors, specific factors such as delusions and comorbidities and complications of mental illness such as homelessness and breakdown of relationships, as well as service provision issues. The prevailing policy has been to divert prisoners in need of hospital care out of prisons. Court diversion models can focus on any point in the pathway from community to the criminal justice system. In prison, specialist mental health services are needed to address the high levels of morbidity due to self-harm, drug use, suicide and self-harm, hunger strikes and many other manifestations of developmental problems and traumatic experiences.
It is well-known that socioeconomic status is associated with mental illness at both the individual and population levels, but there is a less clear understanding of whether socioeconomic development is related to poor mental health at the country level.
Aims
We aimed to investigate sociodemographic disparities in burden of mental disorders, substance use disorders and self-harm by age group.
Method
Estimates of age-specific disability-adjusted life years (DALY) rates for mental disorders, substance use disorders and self-harm from 1990 to 2019 for 204 countries were obtained. The sociodemographic index (SDI) was used to assess sociodemographic development. Associations between burden of mental health and sociodemographic development in 1990 and 2019 were investigated, and sociodemographic inequalities in burden of mental health from 1990 to 2019 by age were estimated using the concentration index.
Results
Differential trends in sociodemographic disparities in diseases across age groups were observed. For mental disorders, particularly depressive disorder and substance use disorders, DALY rates in high SDI countries were higher and increased more than those in countries with other SDI levels among individuals aged 10–24 and 25–49 years. By contrast, DALY rates for those over 50 years were lower in high SDI countries than in countries with other SDI levels between 1990 and 2019. A higher DALY rate among younger individuals accompanied a higher SDI at the country level. However, increased sociodemographic development was associated with decreased disease burden for adults aged ≥70 years.
Conclusions
Strategies for improving mental health and strengthening mental health system should consider a broader sociocultural context.