Further validation of the psychopathic personality inventory among offenders: personality and behavioral correlates.

The Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996) is a relatively new self-report measure that has shown considerable promise as an index of psychopathic traits in both nonoffender and offender samples. The present study examined the construct validity and predictive utility of the PPI by examining its association with theoretically relevant scales of the Personality Assessment Inventory (PAI; Morey, 1991) among 60 male prison inmates, and its ability to predict institutional misbehavior in an expanded sample (n = 89). As expected, correlations with the PAI scales were highest for the Antisocial Features (ANT) and Aggression (AGG) scales (rs = .68 and .57, respectively). The PPI also predicted various forms of nonviolent and physically aggressive disciplinary infractions significantly better than chance (point biserial correlations ranging from .26 to .37).

Factors differentiating successful versus unsuccessful malingerers.

Relatively little is known about the processes in which "successful" malingerers engage to avoid detection. This study summarizes the response strategies used by participants (N = 540) instructed to feign a specific mental disorder while completing various self-report instruments designed to detect faking. Postexperiment questionnaires indicated that those who were able to appear symptomatic while avoiding being detected as feigning (n = 60) were more likely to endorse a lower rate of legitimate symptoms, to avoid overly unusual or bizarre items, and to base their responses on their own personal experiences.

Improving understanding of research consent disclosures among persons with mental illness.

OBJECTIVE: The objective of this study was to evaluate alternative procedures for improving the understanding of research consent disclosures by persons who have mental illness. METHODS: Three groups participated in the study: persons with schizophrenia (N=79), persons with depression (N=82), and a healthy control group (N=80). The participants were guided through an informed consent process in which two factors were manipulated. One was the structure of the disclosure form; either a typical disclosure form involving standard dense text was used, or a graphically enhanced form was used. The other was the interpersonal process: the presence or absence of a third-party facilitator, with iterative feedback given to participants for whom a facilitator was not present. Participants' understanding of the disclosure was assessed with the use of recall tests that involved paraphrasing and recognition tests that involved multiple choice. RESULTS: The mean understanding scores did not differ significantly between the depression and control groups, and the mean scores of the schizophrenia group were significantly lower than those of the other two groups. Neither the graphically enhanced consent disclosure form nor the presence of a third-party facilitator was associated with improved understanding. The use of iterative feedback was associated with improvement in comprehension scores in all groups. CONCLUSIONS: The use of a feedback procedure in the consent disclosure process during the recruitment of persons who are mentally ill may be a valuable safeguard for ensuring adequate understanding and appropriate participation in research.

The relationship between psychopathic personality features and malingering symptoms of major mental illness.

This study examined the relationship between psychopathy and malingering in a subsample of male prison inmates (n = 55) participating in a larger study of the clinical utility of various assessment measures in correctional settings. Participants' capacity to feign major mental illness successfully was evaluated using standard cutoff scores for the detection of malingering on a variety of instruments, including the Structured Inventory of Malingered Symptomatology (SIMS; G. P Smith & G. O. Burger, 1997), the Structured Interview of Reported Symptoms (SIRS; R. Rogers, R. M. Bagby, & S. E. Dickens, 1992), and the Personality Assessment Inventory (PAI; L. Morey, 1991). Psychopathic traits were assessed via the Psychopathic Personality Inventory (PPI; S.O. Lilienfeld & B. P Andrews, 1996). Correlations between the malingering indices and the PPI were low (-.14 to .14) and not statistically significant. These findings fail to support the clinical intuition that individuals with higher levels of psychopathy are likely to be more adept at malingering.

Procedural justice in the context of civil commitment: an analogue study.

Procedural justice theory posits that the process by which disputes are resolved influences perceptions of fairness and satisfaction with outcomes, even if the outcomes are unfavorable. Within the context of civil commitment, Tyler (1992) has suggested that enhancing respondents' perceptions of procedural justice (i.e., participation, dignity, and trust) during commitment proceedings might facilitate accommodation to an adverse judicial determination (i.e., commitment) and subsequently enhance therapeutic outcomes. The study reported here used videotapes of mock commitment hearings to examine whether patients committed for involuntary treatment are sensitive to procedural justice manipulations. Results suggest that patients are sensitive to procedural justice manipulations and, further, that such manipulations are likely to influence the patients' attitude toward psychiatric care. These findings suggest that the development of strategies to enhance patients' perceptions of procedural justice in commitment hearings may indeed have positive therapeutic implications and warrants further investigation.

Effects of state organizational structure and forensic examiner training on pretrial competence assessments.

States differ widely in their delivery of pretrial forensic evaluation services, in terms of organizational structure and training requirements of forensic examiners. It was hypothesized that defendants adjudicated incompetent to proceed in states using community-based, private-practitioner systems would show less impairment on a competence assessment measure, the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), than defendants adjudicated incompetent in states using traditional, inpatient systems. It also was hypothesized that mean MacCAT-CA scores for incompetent defendants from states requiring forensic training/certification would be lower than for defendants from states lacking such requirements. Results indicated significant differences across the four types of service delivery systems examined. However, planned comparisons revealed no differences between a state using a traditional, inpatient model and a state employing a community-based, private-practitioner model. Analyses examining the effects of mandatory forensic training failed to support the hypothesis that training requirements result in the adoption of higher thresholds for determining incompetence.

Identifying inmates at risk for disciplinary infractions: a comparison of two measures of psychopathy.

Poythress, Edens, and Lilienfeld (1998) recently reported a moderately strong correlation between Hare's (1991) Psychopathy Checklist-Revised (PCL-R) and a newly developed self-report measure of psychopathy, the Psychopathic Personality Inventory (PPI) of Lilienfeld and Andrews (1996), in an ethnically diverse sample of 50 inmates from a youthful offender prison. The present study reports follow-up data regarding disciplinary infractions in this sample and examines the utility of the PCL-R and PPI for identifying those at risk for institutional misbehavior. Generally modest, but statistically significant, correlations were obtained between both measures and indices of aggressive institutional behavior. Multiple regression analyses revealed that both measures accounted for common variance in the criterion but that neither accounted for significant unique variance. Results are discussed in terms of the clinical utility of these measures in populations of young offenders.

The competence-related abilities of women criminal defendants.

A new research instrument, the MacArthur Structured Assessment of Competencies of Criminal Defendants (MacSAC-CD), was administered to three groups of women defendants: those adjudicated incompetent and committed to forensic hospitals for treatment (n = 38), jail inmates receiving mental health treatment (n = 18) who had not been adjudicated incompetent, and randomly selected jail inmates (n = 50). Measures of the competence-related abilities of understanding and reasoning were found to have satisfactory indices of internal consistency (coefficient alpha), and all measures correlated in the expected direction with measures of global psychopathology, psychoticism, and verbal cognitive functioning. Between-group mean scores were all in the expected direction and were statistically significant for four of seven measures. No differences in MacSAC-CD performance were found in comparisons of male and female defendants who had been adjudicated incompetent, nor were differences found in the performance of male and female jail inmates.

Stability of psychiatric patients' perceptions of their admission experience.

The primary aim of this study was to evaluate the stability (i.e., consistency of patients' responses over time) of newly developed scales to measure the admission experience of psychiatric hospitalization. Eighty-four psychiatric patients involuntarily committed to a crisis stabilization unit participated. All participants were admitted under an emergency petition or ex parte order for a psychiatric evaluation. Patients were interviewed soon after admission (M = 3.33 days, SD = 1.86 days). The test-retest interval was 24-48 hours with most (83.3%) re-evaluated at 24 hours. Overall, the measures showed acceptable levels of stability (r's range from .62 to .72). Factors associated with reliable responses were lower overall psychiatric symptom severity, less severe psychotic symptoms, and mentioning the same person as an influence of perceptions about the admission experience at each assessment point.

Capacity to consent to voluntary hospitalization: searching for a satisfactory Zinermon screen.

Half a decade ago, the Zinermon court announced the need for clinicians to evaluate the competence of people with mental illness to consent to voluntary hospital admission, but the court did not specify the test of capacity that mental health professionals should use. As has occurred in other areas dealing with legal competence, there is a need for the field to develop standardized assessment procedures for evaluating capacity to consent to voluntary hospitalization. Both theoretical and practical considerations suggest that these procedures should be modeled after what S. K. Hoge has termed a "weak" model of consent. This and other studies of the ability of mentally ill persons to understand disclosed information suggest that their level of understanding may be assessed optimally with measures that utilize recognition rather than recall response elicitation formats.

Pretrial evaluations for criminal courts: contemporary models of service delivery.

Pretrial forensic evaluations are provided for the criminal courts throughout the United States. A variety of models of service delivery exists, and these models vary in ways that are important to the organization and finding of state mental health services. The first part of this paper describes several models of service delivery, which vary primarily in terms of centrality (central state institution vs. community service provider) and the use of inpatient vs. outpatient procedures. The second part compares these models on a number of important measures, including cost and efficiency. The final section of the paper indicates the importance of specialized forensic training and describes important components of such training.

Avoiding negligent release: contemporary clinical and risk management strategies.

Mental health professionals often must decide whether to release a psychiatric patient who has been committed for treatment on the basis of being mentally ill and dangerous. This decision involves liability risks if the patient becomes violent after release. The author draws together several recommendations made in the literature regarding the careful development and implementation of hospital release procedures, including 1) special consultation at the policy development stage, 2) preemptive judgments regarding the adequacy of hospital policies in relation to the professional standard of care, and 3) the use of videotaped exit interviews with patients at the time of their release.

The validity of MMPI interpretations based on the Minimult and the FAM.

In this study 29 clinicians provided Q-sort descriptions for 36 patients' MMPI profiles prepared in the standard way or prepared according to Kincannon's (1968) Minimult or Faschingbauer's (1974) FAM. For each patient, correlations between Q sorts based on the standard profile and each short form profile were computed as a measure of interpretive similarity between the long form and short form. Correlations between Q sorts by independent raters both interpreting the long form profile served as the standard for comparison. Data analyses revealed that at least for the FAM, interpretive similarity between the short form and long form MMPI may be sufficient to warrant its clinical use for individual profile interpretation.