Much energy has been expended over recent years in debating the relative merits of actuarial versus clinical approaches to violence risk prediction. Although it has gradually become apparent that scores based on more or less static factors obtainable from the record do indeed associate with outcome violence over years of follow-up, there is no reason to suppose that, at least potentially, dynamic variables do not hold as much or more promise when it comes to projections over weeks or months. Clinicians involved in release decision-making might wish to consider the following, in order of importance: (a) the legal framework within which the decision is being made, (b) the thoroughness with which scientific methods have been applied to the particular case at issue, (c) the precision of the individualized statement of violence risk being offered, (d) the steps which could be taken to reduce that risk, and (e) if available, the individual's violence risk assessment score in relation to already amassed pertinent statistical data.

Photodynamic therapy is an effective treatment for actinic keratosis. 5-aminolevulinic acid nanoemulsion (BF-200 ALA) and methyl-5-aminolevulinate (MAL) are both prodrugs for the treatment of actinic keratosis with photodynamic therapy. A comparison of the efficacy and safety between the drugs is critical for clinical practice.To investigate if photodynamic therapy in combination with BF-200 ALA is superior to photodynamic therapy with MAL for actinic keratosis.We performed a meta-analysis to investigate the combination of photodynamic therapy with BF-200 ALA and with MAL. The PubMed, Cochrane Library, Web of Science and EMBASE databases were searched to select eligible randomized controlled trials. Our search was conducted on April 1, 2019, and included the search terms “5-aminolevulinic acid nanoemulsion or BF-200 ALA”, “methyl-5-aminolevulinate or methyl aminolaevulinate” and “actnic keratosis”. Cochrane Risk of Bias Tool was used to estimate the risk of bias.The meta-analysis consisted of 5988 actinic keratosis lesions in five eligible randomized controlled trials, with a total of 2953 actinic keratosis lesions treated with BF-200 ALA and 3035 actinic keratosis lesions treated with MAL. BF-200 ALA in combination with photodynamic therapy showed significantly higher overall complete clearance rates (RR: 1.07, 95% CI 1.02–1.12, p = 0.01) and 3 month complete clearance rates (RR: 1.09, 95% CI 1.06–1.12, p < 0.00001) compared to MAL. A subgroup analysis was performed for photodynamic therapy combined with BF-200 ALA, revealing increased complete clearance rates of grade II-III lesions in comparison with MAL (RR: 1.24, 95% CI 1.05–1.46, p = 0.01). Compared with MAL, the pooled relative risk for the meta-analysis for recurrence was 0.67 (95% CI 0.48-0.92, p = 0.01) at 12 month after BF-200 ALA treatment.Photodynamic therapy with BF-200 ALA has a 9% better chance of complete clearance at 3 months and a 24% better chance of grade II-III lesions after treatment than with MAL for patients with actinic keratosis.

Kahneman and Tversky (Psychological Review, 1973, 80, 237–251) found that subjects given both base-rate information about the prevalence of some characteristic within a population and brief personality sketches of individual members of the population base their predictions almost solely on the sketches. Three experiments were done to determine the conditions under which subjects would rely on base-rate information in making predictions about individuals. In Experiment 1 it was found that the combination of a small population, exhaustive sampling of that population, and population percentages corresponding to an exact whole number partition of the sample (the “translatability” feature), resulted in substantial reliance on base rates. The results of Experiment 2 suggested that the translatability feature might be especially important in encouraging such usage. However, the results of Experiment 3 indicated that the enhanced use of translatable base-rates was limited to situations in which uninformative personality sketches were used. These findings were discussed in terms of Kahneman and Tversky's representativeness construct.

The results of this study provide some preliminary support for the use of the FIT as a method for providing structure to interviewers. The FIT may be particularly useful as a guide for making initial decisions about fitness. It was suggested that a screening evaluation based on the FIT could be completed by any properly trained individual with some professional background. The more difficult cases can be referred for lengthier evaluations. Of course, further research on the use of the FIT with actual defendants in real assessments will need to occur before such a procedure can be used as a matter of routine. Finally, the FIT promises to be an effective research tool for isolating professional group differences in definitions of fitness and the importance of different aspects of it, from both a legal and a mental health perspective.

Taken generally, the literature over the past ten or fifteen years casts considerable doubt on the ability of forensic psychiatrists to predict dangerous behavior of their patients.' Much of this work has been based on large-scale studies of persons found not guilty by reason of insanity or incompetent to stand trial. • Such studies, though extremely important, are limited because they deal only with patients who are alleged to have committed extremely serious crimes. Other problems are that in these previous ventures clinicians have not recorded their predictions in a reasonably standard fashion and that interclinician reliabilities of predictions have been lacking. an important recent study Mullen and Reinehr put the matter well when, after having found essentially no relationship between clinical predictions of dangerousness and outcome at four years, they stated: In point of fact, dangerousness has never been demonstrated to be an identifiable personality dimension and go on to provide the challenge that gives impetus to the present article: No investigator has been able to show agreement between judges or other instruments which purport to predict it (p. 230). a previous study published in this journal, 5 we offered data based on a sample of 598 persons assessed within the Brief Assessment Unit (BAU) at METFORS. The group-based, court-ordered assessment procedures used in the BAU are described in a recent book.6 Four psychiatrists made predictions about future dangerousness on a four-point scale, and all patients were followed via searches of records after an interval of two years. The methodology employed in the previous study was similar to that described below for the present project. We discovered in the previous study that aside from previous offense patterns, most demographic variables (age, sex, previous psychiatric history, and so forth) could not be used to predict outcomes but that clinical opinion was reasonably effective (though with many false positives).

Recent evidence shows that dangerous acts, especially serious ones, are highly likely to be directed against family members. This fact calls for interpersonal assessment of dangerous behavior. The present authors have undertaken preliminary study of fighting behavior (verbal and physical) between married couples. A semistructured interview procedure has been devised to establish the methods used by both partners in carrying on their disputes. The authors propose that there are three broad types of fighting patterns to be found:constant high—sustained level of balanced antagonism;unpredictable volatile—low level of overt antagonism with occasional difficult-to-predict highly violent episodes;steady escalation—increasing levels of violence over time. Data from one couple representing each pattern are presented to demonstrate different parts of the interview schedule.

The past decade has witnessed a number of serious attempts at empirically investigating the ability of mental health professionals, especially of psych iatrists, to discriminate between those individuals who will not act dangerously and those individuals who eventually will act dangerously .1-:1 These investigations have concentrated on the assessment of patients in hospitals for the criminally insane since it is in this context mental health professionals are called on routinely to offer their opinion regarding future post-release dangerousness. Based on data arising from these studies, less-thanfavorable conclusions have been drawn regarding the accuracy of dangerousness assessments and the associated clinical skills of the predicting psychiatrists. The problem of "over-prediction" has been widely documented in the literature so that, to use Monahan's recent summary of the findings, "psychiatrists and psychologists are accurate in no more than one out of three predictions of violent behavior over a several-year period among institutionalized populations that had both committed violence in the past (and thus had high base rates for it) and who were diagnosed as mentally ill."4 With the publication of these results has come. needless to say. a surge of criticism regarding the role of psychiatry in the courtroom, nowhere more thoroughly and persuasively argued than in the work of Ennis and Litwack.:; As convincing an argument, however, has been leveled at the interpretation of these results and the manner in which they are purported to apply to the task of clinically predicting dangerousness. Shah and, more recently, Monahan7 are very clear in their conceptions of the issue. Each maintains that the conclusions of investigations in this area that seek to discredit the clinical ability of the mental health professional to predict future dangerousness in individuals may not be altogether justified given (a) the' 'yes" versus "no" requirement of the prediction task imposed on the clinician to date in the area of dangerousness represents a far more stringent demand than does

Forensic psychiatrists in six Canadian municipalities completed a single-page form following each court-ordered assessment conducted during the month of July 1978. A total of 248 cases accumulated during the study period. During the following 18 months researchers collected court dispositions on the sample. With data from all six cities pooled, 85% of patients were found fit to stand trial. Almost all, 96%, were accorded a diagnosis with 39% classified as psychotic. Overall the examining psychiatrists considered 36% to be dangerous to others in the future. When psychiatrists recommended a custodial setting, in 73% of cases the person was incarcerated. Recommendations for hospitalization were observed in 59% of cases. Although the data would seem to suggest that judges take psychiatrists’ recommendations into account, the investigators were nonetheless struck by the general lack of communication between clinic and court. They offer a number of suggestions for improvement.

A light-hearted view of methods guaranteed to slow the course of child care research is presented with the intent to illuminate some artificial obstacles to agency-based research.

Decreasing the stigma of mental illness is not sufficient. Rather promoting important ideas, such as recovery, empowerment, and self-determination, is important to increase social inclusion, or more broadly, affirming attitudes. The goal of this article is to evaluate the psychometrics of a battery of measures that assess both stigmatizing and affirming attitudes toward people with mental illnesses. The aforementioned battery was used in four separate RCTs on stigma change with different samples: college students, adults, health care providers, and mental health service providers. Test–retest indices were satisfactory for all samples except for the Empowerment Scale score for the mental health providers. Attribution Questionnaire-9 (AQ-9) scores were significantly and inversely associated with the three affirming attitude scale scores for eight of twelve correlations, with five of these meeting the Bonferroni Criterion. Research on social attitudes and structures needs to incorporate assessment of affirming perspectives about a group and effective anti-stigma programs need to promote social inclusion and affirming attitudes.

Back to table of contents Previous article Next article ArticleNo AccessMore On Predicting DangerousnessC. D. WEBSTER, R. J. MENZIES, and D. J. SLOMENC. D. WEBSTERSearch for more papers by this author, R. J. MENZIESSearch for more papers by this author, and D. J. SLOMENSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.137.2.261-bAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "More On Predicting Dangerousness." American Journal of Psychiatry, 137(2), pp. 261-b–262 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 137Issue 2 February 1980Pages 261-b-262 Metrics PDF download History Published online 1 April 2006 Published in print 1 February 1980

This article summarizes data collected from 248 pretrial cases assessed by forensic psychiatrists for the criminal courts in six Canadian cities during July 1978. The discussion focuses upon purposes for court referrals, statutes employed for psychiatric remands, characteristics of forensic patients, diagnoses and recommendations rendered by clinicians, and the relationship between psychiatric recommendation and judicial outcome. It is suggested that legal and policy analysis of the court-ordered forensic assessment to date is lacking in detail and comprehensiveness, and that research needs to be directed more toward the decision-making and referral practices of the courts.