Validation of the Levenson Self-Report Psychopathy (LSRP) scale in the non-institutionalized Lebanese population.

BACKGROUND: Psychopathy has been described as "the first personality disorder to be recognized in psychiatry". It has three core features: affective, interpersonal, and behavioral. The Levenson Self-Report Psychopathy (LSRP) scale is used to screen for and measure psychopathy. Our study aims to validate the LSRP as a tool to measure psychopathy in the non-institutionalized Lebanese population. METHODS: We surveyed Lebanese individuals residing in Lebanon and aged 18 through 65. It was a convenience sample collected via an online survey. 534 Lebanese participants completed the survey and were included in our analyses. Nearly 80% were female, 90% were college educated, and 60% were employed. We used exploratory graph analysis and confirmatory factor analyses to measure internal validity of the LSRP. We also used the HEXACO Personality Inventory-Revised (HEXACO-PI-R), the Subtypes of Antisocial Behavior Questionnaire (STAB), and the Short version of the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency, Impulsive Behavior Scale (S-UPPS-P) to measure external validity of LSRP. RESULTS: The exploratory graph analysis showed that the LSRP had a three-factor structure (Egocentric, Callous and Antisocial) in the Lebanese population. This three-factor structure (RMSEA = 0.05, CFI = 0.83, SRMR = 0.06) yielded a better fit than the two-factor, and three-factor Brinkley models. The LSRP was negatively correlated with the Honesty-Humility dimension of the HEXACO-PI-R and positively correlated with the STAB and S-UPPS-P subscales. CONCLUSIONS: The LSRP scale is a valid measure of psychopathy in the Lebanese non-institutionalized population, adding to the currently limited literature addressing psychopathy in the Arab World.

Insights on Female Sex Offenders from the Missouri Registry.

There is limited research on female sex offenders and their offending characteristics. The sociocultural description of women as being nurturing, nonaggressive and, more significantly, nonsexual has diverted the attention from female sexual offending. Although reports have shown that female sex offenders make up two percent of the whole sex offender population, the true rate is remarkably higher because the caretaking behavior of women masks their sexual offenses. The purpose of our study is to explore the characteristics of female sex offenders. We analyzed the publicly available Missouri sex offender registry database and selected all female sex offenders (n = 532) of any age who committed their crimes in Missouri and were convicted in Missouri. We found that the 532 female offenders had a mean age of 29.8 years at the time of their first offense and were convicted for a total of 992 offenses. The calculated recidivism rate was close to 0.6 percent. Moreover, 89.5 percent of offenders had strictly contact offenses, whereas five percent had strictly pornography offenses. Implications for risk assessment are discussed.

Self-immolation in the Arab world: A systematic review.

Self-immolation is the act of setting fire to oneself. Recent spikes in self-immolation events have been noticed in the Arab world, specifically in the aftermath of the Arab Spring in 2011. We aimed to examine the literature assessing the characteristics and patterns of suicide by self-immolation in the Arab world. We registered our systematic review in Prospero. We searched PubMed, Medline, PsycInfo, Embase, and Scopus databases from inception until 9 July 2022, along with other sources, following the PRISMA 2020 guidelines. We collected relevant articles tackling suicide by self-immolation in the Arab world via title and abstract screening followed by full-text screening. We then conducted a narrative synthesis of the results. Out of 326 records from databases and 17 additional records identified through other sources, 31 articles (27 quantitative and 4 qualitative) were included. The studies came from Iraq (n = 16), Tunisia (n = 6), Kingdom of Saudi Arabia (n = 3), Jordan (n = 2), Libya (n = 2), Bahrain (n = 1), and Egypt (n = 1). The quantitative studies had a sample size ranging from 22 to 600 self-inflicted burn victims. Studies showed that self-immolators were mostly married women with low educational level and low socioeconomic status. Self-immolation was more likely to happen at home, usually following marital conflicts. Kerosene was the accelerant used the most. Depression was the most comorbid mental health diagnosis. Studies highlighted that self-immolation was being increasignly used as a form of protest. Self-immolation is not uncommon in the Arab world. Specific interventions directed at the population at risk are warranted.

Anxiety, depression and post-traumatic stress disorder in patients on hemodialysis in the setting of the pandemic, inflation, and the Beirut blast: a cross-sectional study.

BACKGROUND: In 2020, Lebanon has witnessed its worst economic crisis, exacerbated by the COVID-19 pandemic and a massive explosion of its capital. Amidst these stressors, this study aims at assessing the prevalence of depression, anxiety, suicidality, post-traumatic stress disorder (PTSD) and cognitive impairment in patients undergoing hemodialysis in an academic hospital destroyed by the explosion. METHODS: This cross-sectional study conducted 6 months after the blast included adults on hemodialysis, with no previous diagnoses of dementia or intellectual disability. It explores prevalence rates of psychiatric disorders, in addition to other medical and psychosocial variables such as frailty, malnutrition, sarcopenia, quality of life and religiosity. RESULTS: Forty two patients (mean age 66.1; SD: 11.2 years) undergoing hemodialysis for 6.12 years (SD:7.22 years) were included. Anxiety and depression rates reached 54.8% and 57.1% using cut-offs of 6 and 7 respectively on the Hospital Anxiety and Depression rating Scale. 9.5% of the patients reported being in the hospital at the time of the blast and 7.1% reported being injured. 33.3% screened positively for PTSD using a cut-off of 23 on the PCL-5. 26.2% had passive death wishes and 7.1% had suicide plans, however no one had attempted it. 23.8% were found cognitively impaired as shown by the Mini-Cog (<3). Around two-third of participants were moderately to severely malnourished per the GLIM criteria. One third suffered from frailty, according to the FRAIL screening tool. Around 60% suffered from sarcopenia, based on handgrip strength measures. These findings contrast with "acceptable to good" quality of life subjectively reported by participants on the Short Form 36 (SF-36) Health Survey. While one-third of participants participated in organizational religious activities, 88% reported significant subjective meaning of religion in their heart. CONCLUSIONS: Rates of depression, anxiety, PTSD, suicidality, and cognitive impairment were found to be alarming in the setting of an urban dialysis unit following a major explosion. Psychiatric disorders were found to be compounded with increased prevalence of malnutrition, frailty, and sarcopenia. These findings urge healthcare providers to implement early diagnostic and intervention strategies to improve both mental and physical wellbeing of this vulnerable population, in similar settings.

Association between Cannabis Use Disorder and Self- and Other-Directed Aggression.

Cannabis is the most widely used drug worldwide. Data about the association of cannabis use with aggression is heterogeneous. The objective of the current study was to assess the nature of the association between cannabis use disorder (CUD) and self-directed, other-directed, and combined aggression. We used data from the National Survey on Drug Use and Health across 2008 to -2014, with a pooled sample of 270,227 adult respondents. We used regression models to estimate the odds ratios (ORs) for those having CUD perpetrating each form of aggression compared with no aggression and other-directed compared with self-directed aggression. CUD was associated with significantly increased odds of committing other-directed (adjusted OR [aOR] = 1.42, 95 percent CI = 1.26-1.60) and combined aggression (aOR = 2.11, 95 percent CI = 1.36-3.26) compared with no aggression. CUD was associated with a nonstatistically significant risk of other-directed compared with self-directed aggression (aOR = 1.29, 95 percent CI = .97-1.69). In those 18 to 25 years old, CUD was significantly associated with an increased differential risk of other-directed versus self-directed aggression (aOR = 1.29, 95 percent CI = 1.03-1.62). Cannabis use disorder seems to increase the risk of other-directed aggression compared with self-directed aggression, especially among youths.

Mechanisms of new-onset psychosis during the COVID-19 pandemic: What ignited the fire?

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has been associated with the emergence of various psychiatric illnesses, although very little literature has focused on the effect of COVID-19 on psychosis. Preliminary data have shown possible increases in new-onset psychosis. METHODS: Using MEDLINE, we performed a review of the current literature to identify the mechanisms by which pandemics may increase psychosis risk and generate evidence-based recommendations to control surges of psychosis. We identified 85 relevant studies, of which 34 were case reports on psychosis during the COVID-19 pandemic. RESULTS: Underlying mechanisms of psychosis include "direct viral mechanisms," such as neuroinflammation linked with the coronavirus, and "nonviral mechanisms," such as stress, isolation, and uncertainty. CONCLUSIONS: Improvement of our understanding of the pathophysiology of psychosis related to COVID-19 along with implementation of strategies to fight against stress and social isolation in addition to awareness campaigns regarding new-onset psychotic symptoms are much needed to optimize early detection and management of psychosis.

Associations between religiosity, aggression and crime: results from the National Survey on Drug Use and Health.

PURPOSE: To explore the association between religiosity, aggression (self- and other-directed) and law-breaking behaviors. METHODS: We used data from the National Survey on Drug Use and Health (NSDUH) in the United States of America across 2008-2014, with a pooled sample of 270,227 adult respondents. We categorized respondents as religious if they considered religious beliefs to be important parts of their lives and/or to be influential in making decisions and/or if they considered it important that friends share their beliefs and/or if they reported attending at least one service over the past 12 months. We used regression models to calculate the odds ratio for committing different forms of aggression and for breaking the law when measuring positively on religiosity and its parameters. RESULTS: More than 85% of our sample qualified as religious. A positive religiosity was correlated with a statistically significant lower risk of self-directed aggression [aOR = 0.83, 95% CI (0.69-0.99)]. Importance of religious beliefs and influence of religious beliefs were inversely correlated to perpetration of self-directed aggression [aOR = 0.81, 95% CI (0.70-0.95)] and [aOR = 0.82, 95% CI (0.70-0.96)], respectively. Positive religiosity was not significantly correlated to lower odds of other-directed aggression. All religiosity parameters were associated with significantly reduced odds of breaking the law, except for infrequent service attendance which was associated with a significantly higher risk of breaking the law [aOR = 1.07, 95% CI (1.03-1.12)]. CONCLUSION: Religiosity has components with a differential impact on aggressive and law-breaking behaviors. Future longitudinal studies are needed to analyze whether religiosity protects against suicidality and promotes pro-social actions.

Substance Misuse and the Older Offender.

Substance misuse is prevalent among older adults involved in the criminal justice system. The different classes of older offenders, primarily defined as individuals 50 years and older, as well as their offending behaviors vary in their association with substance misuse. Most prison health care systems do not adequately integrate substance use services. Screening for and treatment of substance misuse should be part of comprehensive mental health programs tailored to older offenders. This article reviews different types of offenses among older offenders, their association with substance misuse, and available treatment services.

Stigma Towards Mental Illness at an Academic Tertiary Care Center in Lebanon.

OBJECTIVE: Individuals with mental illness may fall victim to stigma. In this cross-sectional study, the authors aimed to explore correlates of stigma towards mental health in a Lebanese private university and its associated tertiary medical center. METHODS: The authors surveyed students, staff, and faculty at the American University of Beirut and its associated medical center. They assessed stigmatizing behaviors via the Reported and Intended Behavior Scale (RIBS), perceived stigma via the Perceived Devaluation and Discrimination Scale (PDDS), and attitudes towards collaborating with mental health professionals via the Doctors' Attitudes toward Collaborative Care for Mental Health (DACC-MH). RESULTS: A total of 270 participants (response rate of 18%) provided their responses. The mean scores on the RIBS and PDDS were 15.26 ± 4.75 and 32.25 ± 2.70, respectively. Participants who had higher scores on RIBS were more likely to be younger than 25 years of age (OR=1.869; p=0.026), to have a history of mental illness (OR=2.657; p=0.003), and to interact with individuals with a psychiatric disorder (OR=2.287; p=0.028). CONCLUSIONS: Results show a mixed pattern of stigmatizing behaviors and perceptions towards mental illness. This highlights the need for mental health awareness campaigns and interventions in the country.

Comparative effects of psychotropic medications on sleep architecture: a retrospective review of diagnostic polysomnography sleep parameters.

OBJECTIVE: To study the effects of different psychotropic drugs on sleep architecture and sleep-related disorders. MATERIAL AND METHODS: In this retrospective review of 405 consecutive de-identified diagnostic polysomnograms performed at a sleep laboratory from 2007 until 2011, we grouped 347 polysomnograms into five categories: controls, antidepressants (AD), antidepressants + anticonvulsants (ADAC), antidepressants + antipsychotics (ADAP), antidepressants + anticonvulsants + antipsychotics (ADACP). We conducted pairwise comparisons for demographic characteristics, medical history, specific psychotropic medication uses and sleep architecture variables, and adjusted for multiple testing. We used logistic regression to determine the odds ratio of having elevated apnea-hypopnea index (AHI) and periodic limb movement index (PLMI) within each group as compared to controls. RESULTS: Compared to controls, all groups had a significantly higher prevalence of benzodiazepines and trazodone use. AD and ADACP had significantly longer REM latency and lower REM percentage of total sleep time compared to controls. ADAP had a significantly lower AHI compared to controls, but that association was lost in the regression model. AD was associated with a higher PLMI compared to controls. CONCLUSION: Psychotropic polypharmacy does not seem to be associated with significantly deleterious effects on sleep architecture. Adjunct anticonvulsants or antipsychotics to antidepressants may protect against periodic limb movement disorder.

A Retrospective Review of the Use of Clozapine in Restoration of Competency to Stand Trial.

Most defendants found incompetent to stand trial have psychotic illnesses. Clozapine has been shown to be superior to other antipsychotic medications in treatment-resistant schizophrenia. It is vastly underutilized, however, including in forensic settings. To our knowledge, there have been no studies exploring the risks and benefits of clozapine for incompetent to stand trial defendants with severe mental illness. We sought to explore the characteristics of patients who were prescribed clozapine in a retrospective sample of defendants deemed incompetent to stand trial with diagnoses of psychotic and bipolar disorders. We found that 25 of 240 defendants (10%) were prescribed clozapine, with 15 (60%) eventually being discharged on it. Of those 15, 8 defendants were successfully restored to competency to stand trial. The restoration rate in the clozapine group was much lower than in the non-clozapine group (32% versus 87%). Our results emphasize the need for prospective comparative studies assessing the efficacy and tolerability of clozapine and other antipsychotic medications related to restoration of competency to stand trial.

Characteristics of Older Adult First-Time Sex Offenders: Insights From the Missouri Registry.

OBJECTIVE: To explore the characteristics of older adult first-time sex offenders (who offended for the first time at the age of 65 years or above). DESIGN: The authors retrieved and analyzed data from the publicly available Missouri sex offender registry database up to December 2018 and the Missouri public case management system website. PARTICIPANTS: Registered older (≥65 years) sex offenders in the state of Missouri, United States. MEASUREMENTS: Sociodemographic characteristics of the offender, offense type(s), offense, and conviction dates; age and sex of the victim(s); and case disposition information (whether the trial was waived or not and what were the sentences imposed). RESULTS: One hundred and ninety-four older adult sex offenders all males were identified, of which 172 were first-time offenders. The majority were white; the median age of offense was 68.6 years old. One hundred and thirty-nine (80.8%) first-time offenders were convicted strictly of non-pornography offenses, with prepubescent girls the predominant victim pool. The most prevalent charge in this subgroup was Child Molestation, First Degree (36.5%). Twenty-eight (16.3%) offenders were convicted strictly of pornography offenses, the most prevalent one being Possession of Child Pornography (96.6%). The recidivism rate among first-time offenders was close to 1%. CONCLUSION: A substantial proportion of older registered sex offenders are first-time sex offenders and most of them have underage victims. Although the offense and recidivism rates seem to be low, future longitudinal studies should focus on the predictors of sexual offending in the older population, in order to design targeted preventive measures, risk assessment, and treatment options.

Mental illness and the risk of self- and other-directed aggression: Results from the National Survey on Drug Use and Health.

Aggression and mental illness have been classically interlinked, often causing controversy and debate. Previous studies have shown that mental illness can be a risk factor to self- and other-directed aggression. However, these associations have rarely been simultaneously studied within the same population. Therefore, we aimed to study whether psychiatric disorders differentially increase the likelihood of one subtype of aggression over the other. We used the publicly available data of the National Survey on Drug Use and Health (NSDUH) from 2008 through 2014, for a total sample of 270,227 adult respondents. We designed our independent variable according to three categories: no mental illness (NMI), low or moderate (LMMI) and serious (SMI). We constructed regression models to estimate the odds ratios for those having a mental illness committing (a) a subtype of aggression over the past year compared with no aggression and (b) other-directed compared to self-directed aggression. We found that most respondents with mental illness reported no past-year aggression of any type. However, respondents with mental illness had higher odds of perpetrating all subtypes of aggression. Additionally, respondents with LMMI and SMI were respectively 1.7 and 3 times more likely to engage in self- rather than other-directed aggression. Future research should focus on identifying accurate and reliable predictors of self- and other-directed aggression among individuals with mental illness.

Mental illness and the Lebanese criminal justice system: Practices and challenges.

Forensic mental health services are a necessity for individuals involved in the criminal justice system. Such services involve two generally independent functions: assessment and treatment. A jurisdiction's legal system is a determinant of how such services are provided and to whom. In our study, we identified the Lebanese laws that address the rights and protections given to a mentally disordered defendant in the criminal justice system. We then analyzed how the Lebanese judicial system interprets and applies the written law in cases where the mental health of the defendant was brought up as an issue. We found that Lebanon's insanity test has a cognitive and a volitional component. However, there does not seem to be a uniform process regulating the use of the insanity defense: statutes do not address the procedural details and the cases we reviewed used various processes to reach their decisions. Based on our findings, we explored avenues for potential improvement in the Lebanese forensic mental health system.

Selective serotonin reuptake inhibitors and Alzheimer's disease.

Given the failure to develop disease-modifying therapies for Alzheimer's disease (AD), strategies aiming at preventing or delaying the onset of the disease are being prioritized. While the debate regarding whether depression is an etiological risk factor or a prodrome of AD rages on, a key determining factor may be the timing of depression onset in older adults. There is increasing evidence that untreated early-onset depression is a risk factor and that late-onset depression may be a catalyst of cognitive decline. Data from animal studies have shown a beneficial impact of selective serotonin reuptake inhibitors on pathophysiological biomarkers of AD including amyloid burden, tau deposits and neurogenesis. In humans, studies focusing on subjects with a prior history of depression also showed a delay in the onset of AD in those treated with most selective serotonin reuptake inhibitors. Paroxetine, which has strong anticholinergic properties, was associated with increased mortality and mixed effects on amyloid and tau deposits in mice, as well as increased odds of developing AD in humans. Although most of the data regarding selective serotonin reuptake inhibitors is promising, findings should be interpreted cautiously because of notable methodological heterogeneity between studies. There is thus a need to conduct large scale randomized controlled trials with long follow up periods to clarify the dose-effect relationship of specific serotonergic antidepressants on AD prevention.

Long-Acting Injectable versus Oral Antipsychotics for Restoration of Competency to Stand Trial.

Treatment with antipsychotics is a mainstay of trial competency restoration, particularly given that most defendants deemed incompetent to stand trial have psychotic illnesses. We explored the association between competency restoration and antipsychotic type in a retrospective sample of defendants diagnosed with psychotic disorders and deemed incompetent to stand trial. Using regression models, we calculated the odds ratio of being competent to stand trial, adjusting for relevant confounders. We found that the use of long-acting injectable antipsychotics was not significantly associated with increased odds of restoration of trial competency. Our results highlight the need for larger, longitudinal studies to further explore the efficacy and tolerability of long-acting injectable drugs compared with oral antipsychotics. Future research will help develop treatment guidelines within the setting of trial competency restoration.

Association between substance use disorders and self- and other-directed aggression: An integrated model approach.

Our study's objective is to determine whether substance use disorders' association with aggression differs according to the type of substance and/or the form of aggression, within the same population. We used data from the National Survey on Drug Use and Health across 2008-2014, with a pooled sample of 270,227 adult respondents. We used regression models to estimate the odds ratios for those having alcohol and/or drug use disorder(s) perpetrating (a) each form of aggression compared with no aggression and (b) other-directed compared with self-directed aggression. Alcohol use disorder alone and drug use disorder(s) alone were both associated with significantly increased odds of committing self-directed, other-directed, and combined aggression. Individuals with drug use disorder(s) alone were more likely to commit other-directed than self-directed aggression (adjusted odds ratio = 1.46, 95% CI = 1.04-2.05). Individuals with alcohol use disorder alone were not likely to commit one over the other (adjusted odds ratio = 1.20, 95% CI = 0.90-1.61). In conclusion, the integrated model of aggression based on the stress-diathesis model is a relevant framework to study risk factors for aggression. Further research is needed to identify longitudinal predictors of directionality of aggression.

Commonwealth v. Carter and Legal Interpretations of Facilitated Suicide.

In June 2017, a media frenzy ensued after Michelle Carter was convicted of involuntary manslaughter in the state of Massachusetts for facilitating the suicide of Conrad Roy. The verdict stirred controversy and cast a spotlight on facilitation of suicide, i.e., a person's act(s) done with the purpose of helping another to die by suicide. One form of facilitation, physician-assisted suicide, has been extensively debated in the existing literature. In this article, we set out to explore the legal and forensic ramifications of non-physician-assisted suicide, which we refer to as facilitated suicide. We first conducted a review of all fifty states' legislation regarding facilitated suicide: forty-four states prohibit it by statute, and three states prohibit it through common law. Thirteen states specifically outlaw verbal facilitation of suicide. We then surveyed the case law to identify legal precedent to the Commonwealth v. Carter verdict. Final Exit Network, Inc. v. State and State v. Melchert-Dinkel provide contrasting yet complementary perspectives on the interplay between speech and assisted suicide. Finally, we detailed the role of forensic psychiatry in investigating facilitated suicide, specifically among adolescents and youths.

Prevalence and Correlates of Criminal Behavior Among the Non-institutionalized Elderly: Results From the National Survey on Drug Use and Health.

OBJECTIVES: First to explore the prevalence of criminal behavior committed by the non-institutionalized geriatric American population. Second to determine the correlates of criminal behavior among this population. METHODS: We used data of the non-institutionalized adults aged ≥65 years in the National Survey on Drug Use and Health from 2008 through 2014. We compared socio-demographic and mental health profiles of arrestees to non-arrestees and lawbreakers to non-lawbreakers and then determined the correlates of being arrested and breaking the law through regression analyses. RESULTS: Around 0.4% of the population reported being arrested, and 5% reported breaking the law in the past year. The most prevalent offense was driving while intoxicated. Arrestees were significantly more likely to be male and to have had an alcohol or a drug(s) use disorder in the past year. Lawbreakers had a significant likelihood of being male, having a high educational level, and having an alcohol or a drug(s) use disorder in the past year. CONCLUSIONS: Elderly lawbreakers seem to have distinct characteristics that not just separate them from non-offenders but also probably from younger lawbreakers.