Readiness for treatment in high risk offenders with personality disorders

Low engagement and non-completion of therapeutic interventions are important issues in the treatment and rehabilitation of offenders and mentally disordered offenders. Such factors influence a range of outcomes, including the reduction of clinical and criminogenic needs. In this paper it is proposed that low engagement and non-completion are usefully viewed as a consequence of low readiness for treatment. The dimensions of readiness are summarized (from the Multifactor Offender Readiness Model) and applied to high risk offenders with severe personality disorders. A readiness analysis has implications for the assessment and treatment of this patient/offender population and is useful in identifying future research and clinical priorities.

The use of auricular examination for screening heaptic disorders

Researches on auricular acupuncture (AA) have examined mainly its treatment effects. This study aimed to investigate the accuracy and precision of using auricular examination (AE) as a complementary diagnostic tool for screening hepatic disorders. Twenty patients suffering from liver dysfunction and 25 controls aged 18–60 years were recruited from an acute hospital. Participants were examined using three AE methods including visual inspection, electrical skin resistance measurement, and tenderness testing on the liver AA zone of both ears. Significant differences were found in visual inspection and electrical skin resistance on the AA zones between the two groups. Patients suffering from liver dysfunction tended to have at least one abnormality in skin color, appearance, presence of papules, abundance of capillary and desquamation on the ear (Relative Risk—Right ear: RR = 2.9, 95% confidence interval (CI) 1.4, 6.2; Left: RR = 1.8, 95% CI, 1.01, 3.1). The sensitivity for visual inspection was 0.7 for both ears; specificity was 0.76 for the (R) and 0.6 for the (L) ear. The mean difference in electrical skin resistance was 4.3 MΩ (95% CI, 1.7, 6.9) for the (L) ear; 4.5 MΩ (95% CI, 1.5, 7.6) for the (R) ear. Our results suggest that malfunction of the liver appeared to be reflected by the presence of morphological changes on the liver AA zone. Visual inspection and electrical skin resistance on the liver AA zone are potentially sensitive to screen hepatic disorders.

Enablers and barriers to accessing mental health services for adults with high prevalence psychological disorders in South West Victoria

Knowing what services are available and how to access them can be challenging in rural areas. The aim of the South West Mental Health Mapping project was to identify the level, accessibility and effectiveness of mental health services for high prevalence psychological disorders amongst the adult population in the South West region of Victoria. This study includes data from a number of sources: regional records of the number and location of health professionals; a telephone survey of 1297 people in five Local Government Areas in the region; and a social network analysis of contact points. Additional qualitative interviews and surveys were conducted with 25 service recipients and 37 health professionals to identify issues from different perspective. This paper will focus on the social network analysis of the project. It highlights the relative prominence of each type of service provider within the overall network. The social network map shows the centrality of the General Practitioner and the wide range of agencies that become involved in supporting people with mental health issues. The discussion identifies primary contact points for people seeking help and places of referral. The main barrier acknowledged by people requiring assistance was lack of knowledge about where to go for help. Enablers included Medicare Better Access funded schemes. The findings show that there is a reasonable range of mental health professionals across the region, although there are challenges with recruitment and retention of staff. Even with available services, a major problem is communicating this information to potential consumers

Choosing qualitative methods for entrepreneurial cognition research : a canonical development approach

This article presents a structured, manageable approach to the complex problem of how to choose, from the vast arsenal loosely labeled "qualitative methods," sets of techniques appropriate to advancement of the emerging field of entrepreneurial cognition. Summary consideration is given to four key issues of philosophical context as a necessary predicate to presentation of a "canonical development" approach, stylized in diagrammatic form. The approach is able to accommodate due regard for both methodological controversy and operational complexity without being overwhelmed by either. Three illustrative examples indicate how use of the approach can stimulate a researcher to create productive matches between questions evolved from the entrepreneurial cognition canon and techniques selected from the complex array of qualitative methods.

Metamemory training for memory disorders in adults with a closed head injury

The purpose of the present study was to investigate the efficacy of a memory and metamemory training program on memory performance and metamemory judgement accuracy in adults with a closed head injury. A multiple baseline across subjects design was used with six subjects. All subjects were seen at least two years post-injury. Training included general metamemory information about the nature of memory, use of a specific memory strategy to assist verbal recall (to Preview, Question, Read, State and Test- PQRST), specific metamemory information about the strategy, and a self instruction procedure (WTSC- What is the task, Select a strategy to use, Try out strategy, Check to evaluate strategy effectiveness). During the training period all subjects recalled greater than fifty percent of paragraph ideas while using PQRST. Follow-up tests showed that five of the six subjects maintained recall levels but a gradual decrease in slope was observed over eight weeks post-training. Tests of recall, recognition and metamemory judgements on Sentence and Action Tasks were used to evaluate generalisation of training. Two subjects showed improved recall and two subjects showed improved recognition performance. In addition, four subjects demonstrated greater metamemory judgement accuracy about recognition performance following training. Improved performance post-training was also observed for three subjects on the Rivermead Behavioral Memory Test and the Logical Memory subtest of the Wechsler Memory Scale-Revised, greater than that expected for repeated testing. Several factors were identified as having a role in subjects’ ability to benefit from training.

Spurious precision : variability in procedural validity of diagnostic procedures in psychotic disorders and implications for research and treatment

Very few studies have quantified the level of agreement among alternative diagnostic procedures that use a common set of fixed operational criteria. The authors examined the procedural validity of four independent methods of assigning DSM-III-R diagnoses of psychotic disorders. METHOD: The research was conducted as a satellite study to the DSM-IV Field Trial for Schizophrenia and Related Psychotic Disorders. The setting was the National Health and Medical Research Council Schizophrenia Research Unit's Early Psychosis Prevention and Intervention Centre, which focuses on first-episode psychosis. Consecutively admitted patients (N = 50) were assessed by independent raters who used four different procedures to determine a DSM-III-R diagnosis. These procedures were 1) the diagnostic instrument developed for the DSM-IV field trial, 2) the Royal Park Multidiagnostic Instrument for Psychosis, 3) the Munich Diagnostic Checklists, and 4) a consensus DSM-III-R diagnosis assigned by a team of clinician researchers who were expert in the use of diagnostic criteria. RESULTS: Concordance between pairs of diagnostic procedures was only moderate. Corresponding levels of percent agreement, however, ranged from 66% to 76%, with converse misclassification rates of 24%-34% (assuming one procedure to be "correct"). CONCLUSIONS: These findings have significant research and clinical implications. Despite the introduction of operationally defined diagnoses, there remained an appreciable level of differential classification or misclassification arising from variability in the method of assigning the diagnostic criteria rather than the criteria themselves. Such misclassification may impede neurobiological research and have harmful clinical effects on patients with first-episode psychosis.