Mother–infant psychotherapy and perinatal psychiatry: current clinical practice and future directions

Objective: To explore trends in the practice of mother-infant psychotherapy among perinatal psychiatry clinicians based in Melbourne.Methods: A cross-sectional survey with a purpose designed self-report questionnaire was used to assess the attitudes and practices of 47 perinatal and infant psychiatry clinicians in their use and understanding of mother-infant psychotherapy.Results: Seventy per cent of clinicians in this field of psychotherapy who responded to the questionnaire subscribe to a psychodynamic model, although cognitive behavioural models are also used. The interventions were mostly used in conjunction with other interventions, would be more accurately described as 'parent-infant psychotherapy', and non-psychiatrists in the area tended to be more likely to be formally trained in psychotherapy, but only 4% were formally trained in specific mother-infant psychotherapy. There was a unanimous request for further clinical training in this area.Conclusions: The emerging field of perinatal psychiatry needs to develop coherent therapeutic models and conduct outcome trials on specific interventions. Specific trainings in these models, in assessment and in diagnostic frameworks are required to enhance clinical efficacy, for research and service development purposes.

Effect of morphine on the growth rate of Calliphora stygia (Fabricius) (Diptera : Calliphoridae) and possible implications for forensic entomology

Insect specimens collected from decomposing bodies enable forensic entomologists to estimate the minimum post-morten interval (PMI). Drugs and toxins within a corpose may affect the development rate of insects that feed on them and it is vital to quantify these effects to accurately calculate minimum PMI.... This suggests that C. sygia is a reliable model to use to accurately age a corpse containing morphine at any of the concentrations investigated.

Perspectives of a nurse, a social-worker and a psychiatrist, regarding patient assessment in acute inpatient psychiatry settings : a case study approach

This case study explores what informs and organizes the assessment of patients, as undertaken by a nurse, a social worker and a psychiatrist in public, metropolitan, acute mental health service settings. The research data are the transcripts of in-depth interviews with three experienced practitioners, one from each of the three disciplines. The analysis draws on Foucauldian concepts: discourse as constructed through practices of discipline and the gaze. We explored examples of taken-for-granted assessment practices and their interplay with discourse. The findings suggest that participating practitioners use language in assessment in ways that support the powerful discourses of the professional disciplines. The competing discourse of management, associated with industry and economics, is evident in hospital admission processes, dictating the times and places of assessment. Professional and management discourses both effectively marginalize the perspective of another player in assessment, the patient.

Public and private psychiatry : can they work together and is it worth the effort?

OBJECTIVE: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative 'shared care' arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems.

METHOD: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area.

RESULTS: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: 'Difficulty communicating' endorsed by 71.4% of public clinicians and 72% of private psychiatrists, 'Confusion of roles and responsibilities' endorsed by 62.9% and 66%, respectively, and 'Different treatment approach' by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors.

CONCLUSIONS: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.

Clinical and demographic differences between sexually violent predators and other commitment types in a state forensic hospital

Sexual offenders who are involuntarily civilly committed to a secure state hospital as Sexually Violent Predators (SVPs) appear to differ significantly from other current patient populations. Demographically, SVPs are older and more predominantly Caucasian than other patients. They are less frequently psychotic than patients committed under other state statutes such as those found incompetent to stand trial, not guilty by reason of insanity and mentally ill prison transfers. Another salient dimension which distinguishes SVPs is the degree of psychopathy observed in these patients. As a group, SVPs display only slightly higher levels of psychopathy than other patient groups as measured by the revised Psychopathy Checklist. Yet when considered by offender type, rapists are found to have significantly higher average psychopathy scores than other patients, while child molesters are assessed as having lower average psychopathy scores than most other patient commitment categories.

The relationship among malingering, psychopathy, and the MMPI-2 validity scales in maximum security forensic psychiatric inpatients

The records of 392 men hospitalized in a maximum security forensic psychiatric hospital were reviewed. Demographic information was collected as well as data from the men's performance on the Psychopathy Checklist-Revised (PCL-R) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Prevalence rates for malingering were low across the sample. However, results of chi-square analysis revealed that those who scored high on the PCL-R received a diagnosis of malingering significantly more frequently than those who scored low on the PCL-R. Clinical applications and theoretical implications of the results are discussed.

Malingering and denial among forensic populations

The issue of malingering and denial is significantly important for clinicians working with forensic clients who are mandated to attend assessments and treatments, or in respect to pre-sentence reports. Four case studies are presented. Explanatory models of defensiveness and malingering are based upon the clients' motivations and include pathogenic, criminalogical and adaptional models.

Synthesis and determination of illicit drugs for improved forensic detection

This research describes the development of several innovative methodologies for the rapid and sensitive determination of analytes of forensic and social significance. The project incorporated separation technology and chemiluminescence (light from a chemical reaction) to determine the active compounds and excipients in illicit drugs and natural products including 'magic mushrooms'

A performance testing framework for digital forensic tools

This thesis surveys the latest development of digital forensic tools designed for anti-cybercrime purposes. It discusses the necessity of testing the digital forensics tools, and presents a novel testing framework. This new testing framework takes the viewpoint of software vendors rather than traditional software engineering approaches.

Robust correctness testing for digital forensic tools

In previous work, the authors presented a theoretical lower bound on the required number of testing runs for performance testing of digital forensic tools. We also demonstrated a practical method of testing showing how to tolerate both measurement and random errors in order to achieve results close to this bound. In this paper, we extend the previous work to the situation of correctness testing. The contribution of this methodology enables the tester to achieve correctness testing results of high quality from a manageable number of observations and in a dynamic but controllable way. This is of particular interest to forensic testers who do not have access to sophisticated equipment and who can allocate only a small amount of time to testing.

Robust performance testing for digital forensic tools

In previous work, the authors presented a theoretical lower bound on the required number of testing runs for performance testing of digital forensic tools. However, experimental errors are inevitable in laboratory settings, occurring as measurement errors or as random errors and can result in practical situations where the number of testing runs is far from the theoretical bound. This paper adapts our former work to tolerate such errors in the testing results. The contribution of our new methodology enables the tester to achieve performance testing results of high quality from a manageable number of observations and in a dynamic but controllable way. This is of particular interest to forensic testers who do not have access to sophisticated equipment and who can allocate only a small amount of time to testing.

Mindfulness in forensic mental health : does it have a role?

Treatment and rehabilitation in forensic settings have been largely based on cognitive behavioural models and therapies. In the past decade, “third wave” approaches have developed in cognitive behavioural therapy, strongly influenced by spiritual and contemplative traditions such as Buddhism. Mindfulness is the most analysed and researched of such approaches. In this paper, we ask whether mindfulness is relevant to therapeutic work with offenders in forensic mental health and criminal justice services. We review the known criminogenic and other needs of offender groups and discuss whether the psychological processes affected by mindfulness are relevant to reducing risk, alleviating distress and facilitating coping. We conclude that they are. Finally, we address some of the problems that may arise in implementing mindfulness interventions in forensic settings.