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Regarding the relatively high relapse rates of sex offenders, an increasing need for forensic prognosis reports, doubts about their validity, and a continued lack of qualified forensic experts makes the supposedly simple application of instruments such as the Psychopathy Check List Screening Version (PCL-SV), HCR-20+3, or the Sexual Violence Risk 20 (SVR-20) very tempting. Those tools supply numeric values for quantifying assumed risk and have begun appearing more frequently in forensic reports. Their use for specific collectives without prior examination of accuracy, admissibility, and accountability may lead to serious mistakes and risks. This study by the Forensic Department of the Psychiatric University Hospital in Basel, Switzerland, is part of a larger cohort study on forensic risk assessment. It investigates among others the differential indication for PCL-SV, HCR-20+3, and SVR-20. In the present study, 64 sex offenders were retrospectively rated with these three instruments based on their respective reports for prior risk assessment, including criminal reports. Those ratings were then compared with prior results from the Structured Risk Assessment of Basel, as performed by the experts. Results of this study confirm the utility of PCL-SV, HCR-20+3 and SVR-20 in a German-speaking sample of sex offenders primarily as a scientific instrument. Beyond that, these instruments may also be used literally as a checklist. Their use for risk quantification should be limited primarily to the subgroup of antisocial and physically aggressive sex offenders.
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PMID:[Risk assessment of sex offenders in a German-speaking sample. Applicability of PCL-SV, HCR-20+3, and SVR-20]. 1695 14

The role of daily living skills in forensic psychiatric patients in relation to psychotherapeutic progress and the potential reduction of dangerous behaviour has been neglected in the scientific discussion about clinical instruments for the evaluation of dangerousness and recidivism. This is mainly due to the lack of adequate observationally based instruments allowing for valid and reliable therapeutic assessments. Therefore, a new means of assessment focusing on daily living skills and social risk (the BEST-Index [Behavioural Status Index] was applied to n = 86 German forensic psychiatric patients. Two widely known actuarial instruments tapping violence risk were administered for cross validation (Psychopathy Checklist Revised [PCL-R], HCR-20). Within intervals of nine months, all instruments were applied three times. Sufficient inter rater reliability and good convergent validity of the sub-scales in relation to the actuarial instruments (HCR-20, PCL-R) could be demonstrated; supported by empirical data, clinicians working with the BEST-Index may use it to monitor behavioural change over long treatment periods. It is suggested that treatment planning and evaluation of mentally ill offenders might profit from its use.
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PMID:[The evaluation of living skills in forensic-psychiatric patients]. 1733 70

Although psychopathy usually is treated as a unitary construct, a seminal theory posits that there are 2 variants: Primary psychopathy is underpinned by an inherited affective deficit, whereas secondary psychopathy reflects an acquired affective disturbance. The authors investigated whether psychopathy phenotypically may be disaggregated into such types in a sample of 367 prison inmates convicted of violent crimes. Model-based cluster analysis of the Revised Psychopathy Checklist (PCL-R; R. D. Hare, 2003) and trait anxiety scores in the psychopathic subgroup (n = 123; PCL-R > or = 29) revealed 2 clusters. Relative to primary psychopaths, secondary psychopaths had greater trait anxiety, fewer psychopathic traits, and comparable levels of antisocial behavior. Across validation variables, secondary psychopaths manifested more borderline personality features, poorer interpersonal functioning (e.g., irritability, withdrawal, poor assertiveness), and more symptoms of major mental disorder than primary psychopaths. When compared with the nonpsychopathic subgroup (n = 243), the 2 psychopathic variants manifested a theoretically coherent pattern of differences. Implications for etiological research and violence prevention are discussed.
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PMID:Two subtypes of psychopathic violent offenders that parallel primary and secondary variants. 1751 70

Although the construct of psychopathy is related to community violence and recidivism in various populations, empirical evidence suggests that its association with institutional aggression is weak at best. The current study examined, via both variable-level and group-level analyses, the relationship between standard violence risk instruments, which included a measure of psychopathy, and institutional violence. Additionally, the incremental validity of dynamic risk factors also was examined. The results suggest that PCL-R was only weakly related to institutional aggression and only then when the behavioral (Factor 2) aspects of the construct were examined. The clinical and risk management scales on the HCR-20, impulsivity, anger, and psychiatric symptoms all were useful in identifying patients at risk for exhibiting institutional aggression. These data suggest that factors other than psychopathy, including dynamic risk factors, may be most useful in identifying forensic patients at higher risk for exhibiting aggression.
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PMID:Examining the role of static and dynamic risk factors in the prediction of inpatient violence: variable- and person-focused analyses. 1759 88

This study examined the utility of The Violence Risk Scale 2nd Edition (VRS-2) [Wong, S., Gordon, A., 1999. Manual for the Violence Risk Scale. University of Saskatchewan, Saskatchewan, Canada] as an institutional violence risk predictor. The VRS-2 and the Psychopathy Checklist: Screening Version (PCL: SV) were rated independently from pre-admission/admission case records in 147 patients in a medium security facility. Inpatient aggression post-admission was recorded by an independent researcher. Aggressive patients had significantly higher scores on both measures. The VRS-2 and the PCL: SV were only modest predictors of inpatient aggression. The VRS-2 putative "dynamic" items showed the highest predictive accuracy. The results tentatively support the use of the VRS-2 as a predictor of inpatient violence in mentally ill patients in medium security settings, with the dynamic component of this instrument showing most promise. Further studies validating this instrument are required before it is adopted into routine clinical practice.
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PMID:The Violence Risk Scale Second Edition (VRS-2) as a predictor of institutional violence in a British forensic inpatient sample. 1808 38

Promising new adolescent risk assessment tools are being incorporated into clinical practice but currently possess limited evidence of predictive validity regarding their individual and/or combined use in risk assessments. The current study compares three structured adolescent risk instruments, Youth Level of Service/Case Management Inventory (YLS/CMI), Structured Assessment of Violence Risk in Youth (SAVRY), and Psychopathy Checklist: Youth Version (PCL:YV), for both predictive and incremental validity with respect to general and violent recidivism. Receiver operating characteristic and hierarchical logistic regression analyses revealed that the risk tools predicted general and violent recidivism to varying degrees of accuracy, but the SAVRY offered the most in incremental validity. Clinical implications and future directions for youth risk assessment are discussed.
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PMID:A comparative study of adolescent risk assessment instruments: predictive and incremental validity. 1825 37

This prospective study examined the predictive validity of the Structured Assessment of Violence Risk in Youth (SAVRY) and the Psychopathy Checklist: Youth Version (PCL: YV) in 99 male adolescents who were assessed in custody and followed up 12 months post release. Outcome data on recidivism were based on official Home Office records. The base rates for violent and general recidivism, respectively, were 38.4% and 70.7%. The predictive validity of the SAVRY Risk Total and the SAVRY Risk Rating was moderate for both violent and general recidivism, but both showed incremental validity in predicting outcomes compared with the PCL: YV. Data are discussed in relation to the limited published international literature.
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PMID:The Structured Assessment of Violence Risk in Youth as a predictor of recidivism in a United Kingdom cohort of adolescent offenders with conduct disorder. 1831 97

In this paper, a study of personality disorders and psychopathy in imprisoned male batterers is carried out. A sample of 76 batterers sentenced for a severe offence of violence against their intimate partner was selected. All the participants were assessed with the MCMI-II before beginning a treatment program in prison for gender violence. Likewise, all participants were assessed with the PCL-R in order to identify psychopathic symptoms. According to the results, 86.8% of the sample showed at least one personality disorder. The most prevalent one was the Obsessive-compulsive Personality Disorder (57.8% of cases), followed by the Dependent Personality Disorder (34.2% of cases) and Paranoid Personality Disorder (25%). Regarding psychopathy, the results of PCL-R showed that there were 11 people (14.4% of the sample) who met the criteria for psychopathy or probable psychopathy. Finally, implications of this study for clinical practice and future research in this field are commented upon.
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PMID:[Personality disorders and psychopathy in men convicted for severe intimate partner violence]. 1841 77

High violent inmates (N = 126) were administered the Psychopathy Checklist-Revised (PCL-R; Hare, Clark, Grann, & Thornton, 2000; Hare et al., 1990) and neuropsychological measures. No significant correlations were present between the overall PCL-R score and 14 cognitive measures. A violence score, computed as the total number of violent acts across all situations and types, was significantly correlated with the PCL-R total score and Facet 2 but not with the other three facets. Our data suggest that Facet 2 elevations may prove relevant to violence risk assessment; this link, however, needs further exploration with larger samples.
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PMID:Four-facet PCL-R structure and cognitive functioning among high violent criminal offenders. 1844 14

Childhood traumatization is expected to have a significant impact on the development of antisocial and aggressive behavior in adulthood. Psychopathy as a syndrome that can predict future violent and aggressive behavior in adults is therefore believed to be associated with early traumatization. The association between early childhood victimization and violence might at least be mediated through psychopathy. The present study examined the relationship between early emotional, physical or sexual trauma and neglect and psychopathy in incarcerated delinquent female and male juveniles using the Childhood Trauma Questionnaire (CTQ) and the Psychopathy Checklist-Youth Version (PCL-YV). A sample of detained adolescents (n=185) was compared to adolescent students (n=98). Also, gender differences were analyzed with respect to the association of trauma and psychopathy. As expected, our analyses revealed higher scores of traumatization in delinquent juveniles compared to school adolescents. Hypothesized relationships between physical traumatization and the PCL-YV total score could be confirmed among criminal boys, but not among delinquent girls. Results, therefore, indicated that an association exists between early physical, but also emotional traumatic experience and psychopathy in detained boys. In girls, however, other family-related variables, such as non-parental living arrangements, seemed to be more influential in developing the psychopathy syndrome than traumatization.
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PMID:Early traumatization and psychopathy in female and male juvenile offenders. 1851 3


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