Mental health-related limitations and political leadership in Germany: A multidisciplinary analysis of legal, psychiatric, and ethical frameworks.

In recent years, political events have reignited contentious debates about psychiatry and democratic governance. This discourse has largely centred around the ethics and morality of public commentary, particularly in relation to the American Psychiatric Association's Goldwater Rule. Yet, few studies have examined the practical implications of health-related limitations due to mental illness in national leadership and the constitutional and legal provisions that surround these issues, including voluntary or involuntary proceedings. Accordingly, this theoretical paper analyses these topics in a German context using the position at the head of the executive: the chancellorship. Germany was selected as a case example as the biggest democracy in Europe with modern legal frameworks representative of the post-World War Two era in European constitutionalism, and for its economic and political influence within the European Union. Throughout this paper, we do not speculate on the mental health of any individual (past or present), but instead explore jurisdictional mechanisms around health-related limitations in German high office. Consequently, we outline relevant constitutional and legal scenarios, and how short- or long-term medical incapacity may determine requisite responses and contingent complexities. This underpins our discussion, where we consider legal ambiguities, functional capacity, and ethical concerns in psychiatric practice.

Examining the economic costs of crime associated with psychopathic personality disorder: A reply to Verona and Joyner (2022).

In our article, "How much does that cost? Examining the economic costs of crime in North America attributable to people with psychopathic personality disorder" (Gatner et al., 2023, pp. 391-400), we estimated that psychopathic personality disorder (PPD) was associated with substantial crime costs, using a top-down approach of national costs in the United States and Canada. Verona and Joyner (2023) raised several concerns about our findings. Although we think some of their points help to map directions for future research, we disagree with others they raised related to the conceptualization of PPD, the problem of undetected crimes, and their concerns with putative national comparisons. We strongly welcome debate about the societal impacts of PPD in the hope that it spurs increased attention and innovation regarding the treatment and management of PPD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

How much does that cost? Examining the economic costs of crime in North America attributable to people with psychopathic personality disorder.

Cost of illness research has established that mental disorders lead to significant social burden and massive financial costs. A significant gap exists for the economic burden of many personality disorders, including psychopathic personality disorder (PPD). In the current study, we used a top-down prevalence-based cost of illness approach to estimate bounded crime cost estimates of PPD in the United States and Canada. Three key model parameters (PPD prevalence, relative offending rate of individuals with PPD, and national costs of crime for each country) were informed by existing literature. Sensitivity analyses and Monte Carlo simulations were conducted to provide bounded and central tendency estimates of crime costs, respectively. The estimated PPD-related costs of crime ranged from $245.50 billion to $1,591.57 billion (simulated means = $512.83 to $964.23 billion) in the United States and $12.14 billion to $53.00 billion (simulated means = $25.33 to $32.10 billion) in Canada. These results suggest that PPD may be associated with a substantial economic burden as a result of crime in North America. Recommendations are discussed regarding the burden-treatment discrepancy for PPD, as the development of future effective treatment for the disorder may decrease its costly burden on health and justice systems. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Forecasting Stalking Recidivism Using the Guidelines for Stalking Assessment and Management (SAM).

We examined the long-term risk for stalking recidivism and the predictive validity of ratings made using the Guidelines for Stalking Assessment and Management (SAM) in 100 stalking offenders from a forensic clinic. Overall, 45 offenders were convicted of, charged with, or the subject of police investigation for stalking-related offenses during a potential time at risk that averaged 13.47 years. Survival analyses using the Cox proportional hazards model indicated that a composite score of the presence of SAM risk factors was significantly predictive of recidivism and had significant incremental validity relative to total scores on two scales commonly used in violence risk assessment, the Screening Version of the Hare Psychopathy Checklist-Revised (PCL:SV) and the Violence Risk Appraisal Guide (VRAG). Overall ratings of risk made using the SAM, however, were not significantly predictive of recidivism. We discuss the potential uses of the SAM in stalking risk assessment and provide recommendations for future research.

"Examining the incremental and interactive effects of boldness with meanness and disinhibition within the triarchic model of psychopathy": Correction.

Reports an error in "Examining the incremental and interactive effects of boldness with meanness and disinhibition within the triarchic model of psychopathy" by Dylan T. Gatner, Kevin S. Douglas and Stephen D. Hart (Personality Disorders: Theory, Research, and Treatment, 2016[Jul], Vol 7[3], 259-268). In the original article, there were several errors in the reporting of data from the Social Emotional Questionnaire. In the "Outcome Measures" section of the Method, under the "Social and emotional functioning" heading, the Sociability subscale was incorrectly identified as the Social Conformity scale. The sentence referencing the data should have read, "However, the Antisocial Behavior (α = .39, MIC = .14) and Sociability (α = -.09, MIC = .02) subscales had poor internal consistency; the Sociability subscale was removed from our analyses." In the last paragraph of the "Research Question 2: Incremental Value of Boldness" section in the Results, the data for the Sociability scale have been replaced with the data for the Social Conformity scale. Additionally, the data reported for the Sociability scale in Tables 2 and 3 have been replaced with the data reported for the Social Conformity scale. (The following abstract of the original article appeared in record 2016-13473-001). The triarchic model of psychopathy (Patrick, Fowles, & Krueger, 2009) comprises 3 phenotypic domains: Meanness, Disinhibition, and Boldness. Ongoing controversy surrounds the relevance of Boldness in the conceptualization and assessment of psychopathy. In the current study, undergraduate students (N = 439) completed the Triarchic Psychopathy Measure (Patrick, 2010) to examine the association between Boldness and a host of theoretically relevant external criteria. Boldness was generally unrelated to either prosocial or harmful criteria. Boldness rarely provided incremental value above or interacted with Meanness and Disinhibition with respect to external criteria. Curvilinear effects of Boldness rarely emerged. The findings suggest that Boldness might not be a central construct in the definition of psychopathic personality disorder. Implications for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) psychopathic specifier are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluating the Test Validity of the Comprehensive Assessment of Psychopathic Personality Symptom Rating Sale (CAPP SRS).

The Comprehensive Assessment of Psychopathic Personality Symptom Rating Scale (CAPP SRS) is a relatively new measure of psychopathic personality disorder (PPD) based on the CAPP concept map of psychopathy. To investigate the CAPP SRS, we identified the most plausible formal test structure for the test using the framework proposed by Slaney and Maraun, identified an appropriate quantitative characterization of that test structure, and then statistically evaluated it based on analysis of CAPP SRS data collected from a multisite sample of 314 adult male correctional offenders and secure hospital patients in Scotland and England. Overall, the CAPP SRS survived falsification when observed test data were compared to expectations based on the unidimensional monotone latent variable or UMLV model of Holland and Rosenbaum. CAPP SRS composite scores calculated consistent with the UMLV model had good measurement precision and good external validity with respect to scores on an established test of PPD. The findings provide provisional support for the test validity of the CAPP SRS and highlight the importance of theory-driven evaluations of test validity.

The Assessment and Management of Stalking Perpetrated by Clients Against Their Counselors.

Mental health professionals are at heightened risk of stalking victimization, however minimal research has examined empirically supported risk factors for stalking and the efficacy of risk management strategies. Three hundred and six counselors were surveyed, and the present study focuses on the 7% (n = 23) who had been stalked by clients. Results describe the characteristics of stalking, perpetrators, and victims and the perceived efficacy of management strategies employed. Stalking behaviors tended to be of lower severity. Common perpetrator risk factors included relationship problems, anger, and obsession. Victim vulnerabilities were identified, where many victims engaged in behavior considered ineffective in response to stalking. Victims often encountered problems coping with victimization due to inadequate access to resources. Results indicate that risk management plans must be individualized and highlight ways that mental health professionals can and would like to be protected from stalking.

Interrater Reliability and Concurrent Validity of the Risk for Sexual Violence Protocol for Korean Sexual Offenders: A Field Study.

The Risk for Sexual Violence Protocol (RSVP) is a set of structured professional judgment guidelines for conducting management-oriented sexual violence risk assessments. We investigated the interrater reliability (IRR) and the concurrent validity of the RSVP in the Republic of Korea. A total of 32 experienced and specially trained correctional psychologists in teams of four used an authorized translation of the RSVP to independently assess 47 adult male sexual offenders through a case history review and interviews. IRR, as indexed using intraclass correlations coefficients, was typically good to excellent for rating the presence and relevance of risk factors. Concurrent validity was also good, as indexed by correlations between RSVP ratings and total scores on two instruments for assessing risk for sexual violence: the Hallym Assessment Guide for Sex Offender Risk and Static-99R. Implications for the use of the RSVP by professionals and agencies, both within and outside Korea, are discussed.

Interrater reliability, concurrent validity, and predictive validity of the risk for sexual violence protocol.

OBJECTIVE: This study empirically evaluated risk judgments made using the Risk for Sexual Violence Protocol (RSVP; Hart et al., 2003), a widely used set of structured professional guidelines for assessing and managing sexual violence risk. HYPOTHESIS: Based on evaluations of other structured professional judgment guidelines, we hypothesized that judgments made using the RSVP would demonstrate good interrater reliability, concurrent validity, and predictive validity. METHOD: Based on file review, research assistants made ratings using the RSVP and two commonly used actuarial tools for sexual violence risk assessment in a sample of 100 adult male sexual offenders who successfully completed a community-based sex offender treatment program. Recidivism information was obtained from official records 10 years after treatment completion. RESULTS: With respect to interrater reliability, judgments of the presence and relevance of individual risk factors ranged from moderate to almost perfect, and those for composite scores reflecting the sum of these ratings were almost perfect. Interrater reliability for integrative summary risk ratings was substantial to almost perfect. Regarding concurrent validity, the findings indicated that judgments made using the RSVP had moderate to large and statistically significant correlations with scores on the actuarial tools. Finally, with respect to predictive validity, RSVP presence total scores and summary risk ratings were predictive of new sexual violence over the follow-up, and the magnitude of their predictive validity effect sizes was similar to that of scores on the actuarial tools. CONCLUSIONS: The findings supported the potential utility of the RSVP in practice. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

¿Está asociado el abuso/dependencia de drogas a un funcionamiento ejecutivo específico en maltratadores? / No disponible

Aunque se ha explorado el perfil neuropsicológico de los maltratadores, no existe suficiente información sobre su funcionamiento ejecutivo considerando la gravedad del consumo de sustancias. Un conocimiento amplio y sólido del desempeño ejecutivo de esta población ayudaría a esclarecer su aportación específica a la diferenciación de ciertos subtipos de maltratador. Con este propósito se administró un protocolo conformado por pruebas que evalúan algunas funciones ejecutivas a 39 maltratadores con antecedentes de abuso/dependencia de sustancias (MC) (M = 38,79; DT = 6,74) y 39 maltratadores sin esta clase de antecedentes (MS) (M = 35,59; DT = 7,95), todos ellos procedentes de dos prisiones de Granada (España). Los MC presentaron un rendimiento más pobre que los MS en flexibilidad cognitiva, memoria de trabajo y control inhibitorio. Los hallazgos corroboran la asociación del abuso/dependencia de sustancias a un funcionamiento ejecutivo específico en los maltratadores, a la vez que contribuyen a la optimización de las estrategias de prevención de la violencia contra la pareja/expareja y de los programas de intervención con esta población

Although the neuropsychological profile of batterers has been explored, there is not enough information about their executive functioning according to the severity of substance use. A broad and solid knowledge of the executive performance of this population would help to clarify its specific contribution to the differentiation of certain batterer subtypes. For this purpose, a protocol consisting of tests that evaluate some executive functions was administered to 39 batterers with a history of substance abuse/dependence (MC) (M = 38.79, SD = 6.74) and 39 batterers without this kind of background (MS) (M = 35.59, SD = 7.95), all of them from two prisons in Granada (Spain). The MC presented less cognitive flexibility and worse working memory and inhibitory control than the MS. The findings corroborate the association of substance abuse/dependence to a specific executive functioning in batterers, while contributing to the optimization of strategies to prevent intimate partner violence and intervention programs with this population

Comparing the lexical similarity of the triarchic model of psychopathy to contemporary models of psychopathy.

OBJECTIVE: The triarchic model of psychopathy (Patrick, Fowles, & Krueger, 2009) posits that psychopathic personality comprises three domains: boldness, meanness, and disinhibition. The present study aimed to clarify conceptual overlap between contemporary definitions of psychopathy, with particular emphasis given to the relevance of boldness (i.e., social dominance, venturesomeness, emotional resiliency)-a topic of recent debate. METHOD: Undergraduate students (N = 439) compared the lexical similarity of triarchic domains with two contemporary models of psychopathy: the Comprehensive Assessment of Psychopathic Personality (CAPP; Cooke, Hart, Logan, & Michie, 2012) and the Five-Factor Model of psychopathy (FFM; Widiger & Lynam, 1998). RESULTS: From a content validity perspective, meanness and disinhibition were lexically similar to both the CAPP and FFM psychopathy, whereas boldness was less strongly associated with these models. Meanness showed the strongest lexical similarity in comparison with past prototypicality ratings of the CAPP and FFM psychopathy. CONCLUSIONS: These findings bear implications for defining and comparing conceptualizations of psychopathy that underpin its assessment.

The Taxonic Latent Structure and Taxometrics in Forensic Mental Health.

Recently, researchers in the field of forensic mental health have attempted to address the technical, empirical question of whether important clinical problems, such as psychopathy or malingering, constitute taxa (i.e., discrete conditions). In this paper, we provide a detailed elucidation of the foundational logic of the quantitative methods employed to answer this question, focusing on the taxometric procedures developed by Paul Meehl and colleagues. We attempt to demonstrate that research on taxonicity is hampered by (a) researchers' unfamiliarity with or misunderstanding of the logic underlying latent variable technologies and (b) the fundamental incapacity of Meehlian procedures to provide a test of taxonicity. We conclude by discussing the utility of taxometric procedures to research in forensic mental health and, more broadly, in the field of applied psychological measurement.

Examining the incremental and interactive effects of boldness with meanness and disinhibition within the triarchic model of psychopathy.

The triarchic model of psychopathy (Patrick, Fowles, & Krueger, 2009) comprises 3 phenotypic domains: Meanness, Disinhibition, and Boldness. Ongoing controversy surrounds the relevance of Boldness in the conceptualization and assessment of psychopathy. In the current study, undergraduate students (N = 439) completed the Triarchic Psychopathy Measure (Patrick, 2010) to examine the association between Boldness and a host of theoretically relevant external criteria. Boldness was generally unrelated to either prosocial or harmful criteria. Boldness rarely provided incremental value above or interacted with Meanness and Disinhibition with respect to external criteria. Curvilinear effects of Boldness rarely emerged. The findings suggest that Boldness might not be a central construct in the definition of psychopathic personality disorder. Implications for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) psychopathic specifier are discussed. (PsycINFO Database Record

Psychometric properties of the Hare Psychopathy Checklist-Revised (PCL-R) in a representative sample of Canadian federal offenders.

The Hare Psychopathy Checklist-Revised (PCL-R; Hare, 2003) is a commonly used psychological test for assessing traits of psychopathic personality disorder. Despite the abundance of research using the PCL-R, the vast majority of research used samples of convenience rather than systematic methods to minimize sampling bias and maximize the generalizability of findings. This potentially complicates the interpretation of test scores and research findings, including the "norms" for offenders from the United States and Canada included in the PCL-R manual. In the current study, we evaluated the psychometric properties of PCL-R scores for all male offenders admitted to a regional reception center of the Correctional Service of Canada during a 1-year period (n = 375). Because offenders were admitted for assessment prior to institutional classification, they comprise a sample that was heterogeneous with respect to correctional risks and needs yet representative of all offenders in that region of the service. We examined the distribution of PCL-R scores, classical test theory indices of its structural reliability, the factor structure of test items, and the external correlates of test scores. The findings were highly consistent with those typically reported in previous studies. We interpret these results as indicating it is unlikely any sampling limitations of past research using the PCL-R resulted in findings that were, overall, strongly biased or unrepresentative.

Remorse, psychopathology, and psychopathy among adolescent offenders.

Remorse has long been important to the juvenile justice system. However, the nature of this construct has not yet been clearly articulated, and little research has examined its relationships with other theoretically and forensically relevant variables. The present study was intended to address these issues by examining relationships among remorse, psychopathology, and psychopathy in a sample of adolescent offenders (N = 97) using the theoretically and empirically established framework of guilt and shame (Tangney & Dearing, 2002). Findings indicated that shame was positively related to behavioral features of psychopathy, whereas guilt was negatively related to psychopathic characteristics more broadly. In addition, shame was positively associated with numerous mental health problems whereas guilt was negatively associated with anger, depression, and anxiety. These results provide empirical support for theory that psychopathy is characterized by lack of remorse (e.g., Hare, 1991), and also underscore shame and guilt as potentially important treatment targets for adolescent offenders.

Domains of psychopathy: evaluating the structure of a lexical model of psychopathic personality disorder.

This study examines the structure of the Comprehensive Assessment of Psychopathic Personality (CAPP) from a card sort perspective. The CAPP is a lexically based construct map of psychopathy comprising 33 symptoms organized by its developers into 6 broad functional domains of personality (i.e., Attachment, Behavioral, Cognitive; Dominance; Emotional, Self). Groups of mental health workers and students were asked to sort the CAPP symptoms into the model's 6 proposed domains. Overall, both mental health workers and students were able to categorize the symptoms speedily and intuitively according to model. This suggests that the CAPP model's hierarchical structure is plausible, and that the lexical nature of the model is successful in facilitating people's ability to understand features of psychopathy in a way that requires limited cognitive effort. Together, these findings support the validity of the CAPP model as a lexically based concept map of psychopathy. Yet, some exceptions to the overall pattern of agreement with model were identified.

An examination of violence risk communication in practice using a structured professional judgment framework.

The increased use of violence risk assessment tools in professional practice has sparked the development of best-practice guidelines for communicating about violence risk. The present study examined 166 pre-sentence reports, authored by clinicians and probation officers, to determine the extent to which they are consistent with those guidelines. We examined the frequency with which reports contained information about five topics: the presence of risk factors; the relevance of risk factors; scenarios of future violence; recommended management strategies; and summary risk judgments. Analyses revealed that the topics addressed most frequently in reports were the presence of risk factors and recommended management strategies, but none of the five topics was addressed consistently, completely, or clearly in reports. This was especially the case for probation reports. The findings highlight the need to improve practice through better implementation of guidelines for risk communication. Also needed is research on the extent to which information in risk communications is comprehended, accepted, and used by various stakeholder groups.

Cross-language consistency of the Comprehensive Assessment of Psychopathic Personality (CAPP) model.

This study is the first to our knowledge to examine the cross-language consistency across the original version of the Comprehensive Assessment of Psychopathy (CAPP) and a translated version. The CAPP is a lexically based construct map of psychopathy comprising 33 symptoms from 6 broad domains of personality functioning. English-language CAPP prototypicality ratings from 124 mental health workers were compared with ratings from 211 Norwegian mental health workers using the Norwegian translation. High agreement was found across languages in regard to which symptoms where perceived as central to psychopathy or not. Multigroup confirmatory factor analyses (MGCFA) indicated that, overall, the symptoms had similar associations with the 6 proposed underlying dimensions across the 2 language versions. Finally, in general, the probability for a given prototypicality rating on an individual symptom was similar across language version samples at the same level of the underlying trait, as analyzed with Item Response Theory (IRT). Together these findings lend support to the validity of the construct of psychopathy, the validity of the CAPP as a concept map of psychopathy, and the validity of the Norwegian translation of the CAPP.

Predictive validity of dynamic factors: assessing violence risk in forensic psychiatric inpatients.

There is general consensus that dynamic factors ought to be considered in the assessment of violence risk, but little direct evidence exists to demonstrate that within-individual fluctuations in putative dynamic factors are associated with changes in risk. We examined these issues in a sample of 30 male forensic psychiatric inpatients using a pseudoprospective design. Static and dynamic factors were coded on the basis of chart review using 2 structured measures of violence risk: Version 2 of the Historical-Clinical-Risk Management-20 (HCR-20; C. D. Webster, K. S. Douglas, D. Eaves, & S. D. Hart, 1997, HCR-20: Assessing risk for violence, Version 2, Vancouver, BC, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University) and the Short-Term Assessment of Risk and Treatability (START; C. D. Webster, M. L. Martin, J. Brink, T. L. Nicholls, & S. L. Desmarais, 2009, Short-Term Assessment of Risk and Treatability [START], Version 1.1, Coquitlam, BC, Canada: British Columbia Mental Health and Addiction Services). HCR-20 and START assessments were repeated every 3 months for a period of 1 year. Institutional violence in the 3 months following each assessment was coded using a modified version of the Overt Aggression Scale (S. C. Yudofsky, J. M. Silver, W. Jackson, J. Endicott, & D. W. Williams, 1986, The Overt Aggression Scale for the objective rating of verbal and physical aggression, The American Journal of Psychiatry, Vol. 143, pp. 35-39). Dynamic risk and strength factors showed predictive validity for institutional aggression. Results of event history analyses demonstrated that changes in dynamic risk factors significantly predicted institutional violence, even after controlling for static risk factors. This is one of the first studies to provide clear and direct support for the utility of dynamic factors in the assessment of violence risk.

Another look at the (im-)precision of individual risk estimates made using actuarial risk assessment instruments.

We investigated the precision of individual risk estimates made using actuarial risk assessment instruments (ARAIs) by discussing some major conceptual issues and then illustrating them by analyzing new data. We used a standard multivariate statistical procedure, logistic regression, to create a new ARAI based on data from a follow-up study of 90 adult male sex offenders. We indexed predictive precision at the group level using confidence intervals for group mean probability estimates, and at the individual level using prediction intervals for individual probability estimates. Consistent with past research, ARAI scores were moderately and significantly predictive of failure in the aggregate, but group probability estimates had substantial margins of error and individual probability estimates had very large margins of error. We conclude that, without major advances in our understanding of the causes of violence, ARAIs cannot be used to estimate the specific probability or absolute likelihood of future violence with any reasonable degree of precision or certainty. The implications for conducting violence risk assessments in forensic mental health are discussed.