Neuropsychological deficits in the antisocial personality and their relationship to progress in treatment

Background: Antisocial personality is characterised by impulsive behaviour and a pervasive disregard for the rights of others. Its consequences are often debilitating and its presentation poses considerable treatment challenges. While it may be associated with a range of neuropsychological deficits, the literature is often contradictory and no research has examined their effect on treatment. Method: A systematic review of the neuropsychological literature on male adults with antisocial personality was conducted to facilitate generation of hypotheses. Pooled evidence from 132 studies suggested robust cognitive deficits in motor regulation, affect recognition, and concept formation. Findings were less consistent for other functions and differences between operationalisations of the antisocial personality were present. To further investigate the neurocognitive deficits and examine their effect on treatment, the Cambridge Neuropsychological Assessment Battery (CANTAB) was administered on 102 adult male offenders (divided into those with antisocial vs. other personality disorders) and on 20 healthy controls in a between-subjects design. Two operationalisations were examined in parallel for the first time: Antisocial Personality Disorder (ASPD) and psychopathy. Progress in treatment was measured using a two-part, standardised instrument – the Progress Rating Schedule (PRS) – developed systematically via thematic analysis as part of the project. Results: ASPD demonstrated impairments in executive, memory, attentional, and visual processing functions while psychopathy showed primarily executive but overall milder deficits. Impairments in motor regulation, set-shifting, working memory, and visual perception appeared present in the antisocial personality (ASPD and psychopathy) but not offenders with other personality disorders. Regarding progress in treatment, the PRS showed good reliability (intra-class correlations: 0.63-0.92; internal consistency: 0.77-0.87) and concurrent and predictive validity. However, cognitive difficulties predicted outcomes only to a limited extent. In ASPD, fronto-temporal deficits predicted poorer progress through the forensic pathway. However, higher risk-taking (Cambridge Gambling Task) predicted better outcomes while intellectual functioning and presence of psychopathy mediated some effects. In psychopathy, only visual short-term memory and planning predicted progress; impairments in the former predicted slower progress but there were inconsistencies for the latter. Conclusions: A range of neuropsychological deficits appeared to characterise the antisocial personality and some may have adverse effects on progress in treatment. Further research is required in other, larger samples and cognitive functions not included in the CANTAB to confirm and extend these findings

Psychological intervention to alleviate distress in haematopoietic stem cell transplantation: a phase II study

Background. Haematopoietic stem cell transplantation (HSCT) is an intensive procedure associated with psychological distress particularly during the first weeks (acute phase). Based on the self-regulatory model of adjustment to illness, a preparatory group intervention was developed aiming at alleviating distress by reducing negative perceptions of HSCT and fostering helpful coping. Aims. The present study aimed to evaluate the feasibility of delivering the intervention and of conducting a trial to assess its efficacy. It also aimed to explore the applicability of the self-regulatory model in HSCT. Methods. Participants were adults from consecutive referrals at two transplant centres. Half were randomised to the intervention and half to treatment as usual at each site. Psychological distress, HSCT perceptions, and coping were assessed at baseline (following consent), on transplant day, two weeks, and four weeks after transplantation. Results. Of 99 eligible patients, 45 consented. Main barriers included inability to consent prior to transplantation, competing priorities, being unwell, and long travel distance. Of 21 participants randomised to intervention, five attended. Main barriers included being unable to attend prior to transplantation and having competing priorities. Groups could not be held sufficiently frequently to enable attendance prior to transplantation, as randomising participants to the control group prevented sufficient accrual at each site. Anxiety peaked two weeks following transplantation but depression increased throughout the acute phase. Intervention effects were small but sample sizes for a full trial appeared feasible. Negative perceptions of HSCT and use of a range of coping styles (including styles considered helpful) predicted higher distress throughout the period. Conclusions. The findings revealed considerable barriers to delivering a group-based intervention and conducting a trial to assess its effectiveness. This highlighted a need for better integration with routine care and alternative trial procedures. However, the findings illustrated complex psychological needs during the acute phase of HSCT and the role of negative HSCT perceptions and unhelpful coping in underpinning distress

Psychological intervention to alleviate distress in haematopoietic stem cell transplantation: a phase II study

Background. Haematopoietic stem cell transplantation (HSCT) is an intensive procedure associated with psychological distress particularly during the first weeks (acute phase). Based on the self-regulatory model of adjustment to illness, a preparatory group intervention was developed aiming at alleviating distress by reducing negative perceptions of HSCT and fostering helpful coping. Aims. The present study aimed to evaluate the feasibility of delivering the intervention and of conducting a trial to assess its efficacy. It also aimed to explore the applicability of the self-regulatory model in HSCT. Methods. Participants were adults from consecutive referrals at two transplant centres. Half were randomised to the intervention and half to treatment as usual at each site. Psychological distress, HSCT perceptions, and coping were assessed at baseline (following consent), on transplant day, two weeks, and four weeks after transplantation. Results. Of 99 eligible patients, 45 consented. Main barriers included inability to consent prior to transplantation, competing priorities, being unwell, and long travel distance. Of 21 participants randomised to intervention, five attended. Main barriers included being unable to attend prior to transplantation and having competing priorities. Groups could not be held sufficiently frequently to enable attendance prior to transplantation, as randomising participants to the control group prevented sufficient accrual at each site. Anxiety peaked two weeks following transplantation but depression increased throughout the acute phase. Intervention effects were small but sample sizes for a full trial appeared feasible. Negative perceptions of HSCT and use of a range of coping styles (including styles considered helpful) predicted higher distress throughout the period. Conclusions. The findings revealed considerable barriers to delivering a group-based intervention and conducting a trial to assess its effectiveness. This highlighted a need for better integration with routine care and alternative trial procedures. However, the findings illustrated complex psychological needs during the acute phase of HSCT and the role of negative HSCT perceptions and unhelpful coping in underpinning distress

Neuropsychological deficits in the antisocial personality and their relationship to progress in treatment

Background: Antisocial personality is characterised by impulsive behaviour and a pervasive disregard for the rights of others. Its consequences are often debilitating and its presentation poses considerable treatment challenges. While it may be associated with a range of neuropsychological deficits, the literature is often contradictory and no research has examined their effect on treatment. Method: A systematic review of the neuropsychological literature on male adults with antisocial personality was conducted to facilitate generation of hypotheses. Pooled evidence from 132 studies suggested robust cognitive deficits in motor regulation, affect recognition, and concept formation. Findings were less consistent for other functions and differences between operationalisations of the antisocial personality were present. To further investigate the neurocognitive deficits and examine their effect on treatment, the Cambridge Neuropsychological Assessment Battery (CANTAB) was administered on 102 adult male offenders (divided into those with antisocial vs. other personality disorders) and on 20 healthy controls in a between-subjects design. Two operationalisations were examined in parallel for the first time: Antisocial Personality Disorder (ASPD) and psychopathy. Progress in treatment was measured using a two-part, standardised instrument – the Progress Rating Schedule (PRS) – developed systematically via thematic analysis as part of the project. Results: ASPD demonstrated impairments in executive, memory, attentional, and visual processing functions while psychopathy showed primarily executive but overall milder deficits. Impairments in motor regulation, set-shifting, working memory, and visual perception appeared present in the antisocial personality (ASPD and psychopathy) but not offenders with other personality disorders. Regarding progress in treatment, the PRS showed good reliability (intra-class correlations: 0.63-0.92; internal consistency: 0.77-0.87) and concurrent and predictive validity. However, cognitive difficulties predicted outcomes only to a limited extent. In ASPD, fronto-temporal deficits predicted poorer progress through the forensic pathway. However, higher risk-taking (Cambridge Gambling Task) predicted better outcomes while intellectual functioning and presence of psychopathy mediated some effects. In psychopathy, only visual short-term memory and planning predicted progress; impairments in the former predicted slower progress but there were inconsistencies for the latter. Conclusions: A range of neuropsychological deficits appeared to characterise the antisocial personality and some may have adverse effects on progress in treatment. Further research is required in other, larger samples and cognitive functions not included in the CANTAB to confirm and extend these findings

Group psychological intervention for emotional distress in haematopoietic stem cell transplantation: A feasibility randomised clinical trial

Purpose Haematopoietic stem cell transplantation (HSCT) is an intensive procedure associated with elevated psychological distress, particularly during the initial stages. Based on self-regulatory theory, a prophylactic group intervention was developed to mitigate this distress by targeting perceptions of HSCT and coping. This study evaluated the feasibility of delivering the intervention and of conducting a randomised clinical trial to assess efficacy. Methods Adults from consecutive referrals at two transplant centres were randomised to the intervention or to treatment as usual at each site. Psychological distress (primary outcome), HSCT perceptions, and coping were assessed at baseline, on transplant day, and two and four weeks after transplantation. Results Of 99 eligible patients, 45 consented. Main barriers to consent were insufficient time prior to transplantation, competing priorities, being unwell, and travel distance. Of 21 participants randomised to the intervention, five attended. Main barriers to attendance included insufficient time prior to transplantation and having competing priorities. Groups could not be held sufficiently frequently to enable attendance prior to transplantation, as randomising participants to the control group limited accrual. Anxiety peaked two weeks following transplantation. Depression increased throughout the acute phase. Clinical levels of distress were observed in 42% of patients during HSCT. Intervention effects were small but sample sizes for a full trial appeared feasible. Conclusions Multimodal prehabilitation is required but there are specific barriers to delivering a group-based intervention and conducting a trial. Group prehabilitation requires personalisation and better integration with routine care, such as patient screening, personalisation, and options for remote delivery

The Authentic Personality: A Theoretical and Empirical Conceptualization and the Development of the Authenticity Scale

This article describes the development of a measure of dispositional authenticity and tests whether authenticity is related to well-being, as predicted by several counseling psychology perspectives. Scales were designed to measure a tripartite conception of authenticity, comprising self-alienation, authentic living, and accepting external influence, which was supported with exploratory factor analysis. Multigroup confirmatory factor analysis showed that the factor loadings were invariant across sample, ethnicity, and gender. The scale showed substantial discriminant validity from the Big Five personality traits, nonsignificant correlations with social desirability, and 2- and 4-week test-retest correlations ranging from r = .78 to .91. Each subscale was strongly related to self-esteem and aspects of both subjective and psychological well-being. This article provides the first direct test of several theoretical models that view authenticity as integral to well-being. © 2008 American Psychological Association

Consensus Good Practice Guidelines for the Use of Long-Term Segregation (LTS) with Autistic People: A Delphi Study

Long-Term Segregation (LTS) is used disproportionately with autistic people in Assessment and Treatment Units (ATUs). Recent investigations into the use of LTS with autistic people have highlighted how often LTS was used primarily due to the main ward environment being unsuitable and distressing for the autistic person, rather than due to the need to manage the risk presented by the patient. There have also been instances of LTS being used in an individualised way with autistic people as a means of providing a more appropriate environment in which to provide care whilst they remain in the ATU. This clinical reality presents a difficulty for Multidisciplinary Team (MDT) staff, as current guidance (i.e. The Mental Health Act Code of Practice 1983) stipulates that the use of LTS must end as soon as possible, with the person being integrated back onto the main ward. However, doing so may reinstate the distress that triggered the use of LTS initially. As such there is an urgent need to develop good practice guidelines that can support the MDT to implement LTS with autistic people in a truly person-centred way which is able to meet the needs of this population whilst minimising the risks of poor care highlighted by recent reports. The current study aimed to produce a set of practice guidelines to inform the good practice of LTS with autistic people. The Delphi method was used to build consensus through a series of four survey rounds. Participants were 14 MDT members who were either currently working or who had recently worked in ATUs with autistic people in LTS. Prior to the survey rounds an interview asking for three proposed guidelines was completed with each panellist. The round one survey comprised the 41 guidelines generated from the interviews and was sent out to the panel to rate in terms of importance and provide comments. Subsequent rounds were informed by the panels previous round of ratings and comments, with feedback being used to amend and combine guidelines. Consensus was set a priori at 80% or more agreement among panellists that a guideline was essential. This narrow level of consensus was used to make use of the iterative process of the Delphi method in developing and refining the guidelines. The panel reached consensus that 11 guidelines were essential. These formed the final set and were supplemented by clinical vignettes illustrating the guidelines. Guidelines were grouped under two broad categories, those relating to direct LTS care, and those relating to the wider service setting around LTS. The study was limited by the lack of inclusion of family/carer perspectives. The final set of guidelines contained implications for multiple organisational levels related to LTS, from immediate implementation of LTS to wider service factors such as autism training for staff and regular reflective practice specific to LTS. Consequently, effective implementation of the guidelines will require targeting various organisational layers of ATUs to improve the implementation of LTS with autistic people

Consensus Good Practice Guidelines for the Use of Long-Term Segregation (LTS) with Autistic People: A Delphi Study

Long-Term Segregation (LTS) is used disproportionately with autistic people in Assessment and Treatment Units (ATUs). Recent investigations into the use of LTS with autistic people have highlighted how often LTS was used primarily due to the main ward environment being unsuitable and distressing for the autistic person, rather than due to the need to manage the risk presented by the patient. There have also been instances of LTS being used in an individualised way with autistic people as a means of providing a more appropriate environment in which to provide care whilst they remain in the ATU. This clinical reality presents a difficulty for Multidisciplinary Team (MDT) staff, as current guidance (i.e. The Mental Health Act Code of Practice 1983) stipulates that the use of LTS must end as soon as possible, with the person being integrated back onto the main ward. However, doing so may reinstate the distress that triggered the use of LTS initially. As such there is an urgent need to develop good practice guidelines that can support the MDT to implement LTS with autistic people in a truly person-centred way which is able to meet the needs of this population whilst minimising the risks of poor care highlighted by recent reports. The current study aimed to produce a set of practice guidelines to inform the good practice of LTS with autistic people. The Delphi method was used to build consensus through a series of four survey rounds. Participants were 14 MDT members who were either currently working or who had recently worked in ATUs with autistic people in LTS. Prior to the survey rounds an interview asking for three proposed guidelines was completed with each panellist. The round one survey comprised the 41 guidelines generated from the interviews and was sent out to the panel to rate in terms of importance and provide comments. Subsequent rounds were informed by the panels previous round of ratings and comments, with feedback being used to amend and combine guidelines. Consensus was set a priori at 80% or more agreement among panellists that a guideline was essential. This narrow level of consensus was used to make use of the iterative process of the Delphi method in developing and refining the guidelines. The panel reached consensus that 11 guidelines were essential. These formed the final set and were supplemented by clinical vignettes illustrating the guidelines. Guidelines were grouped under two broad categories, those relating to direct LTS care, and those relating to the wider service setting around LTS. The study was limited by the lack of inclusion of family/carer perspectives. The final set of guidelines contained implications for multiple organisational levels related to LTS, from immediate implementation of LTS to wider service factors such as autism training for staff and regular reflective practice specific to LTS. Consequently, effective implementation of the guidelines will require targeting various organisational layers of ATUs to improve the implementation of LTS with autistic people

improving Pain mAnagement for childreN and young people attendeD by Ambulance (PANDA): protocol for a realist evaluation and consensus workshops. [version 1; peer review: awaiting peer review]

BackgroundPrehospital pain management in children and young people (CYP) is a top research priority in paediatric emergency medicine. Approximately 90,000 CYP under 18 years of age are transported to hospital by ambulance each year for conditions associated with acute pain in England. Approximately half of the children suffering from acute pain do not receive analgesics from paramedics, and approximately 60% do not experience a meaningful reduction in their pain severity. The aim of these studies is to explore the experiences of key stakeholders, refine our programme theory, and prioritise candidate intervention components to address the gaps in care.MethodsA realist evaluation using a multiple case study approach following the RAMESIS II guidance and consensus workshops using the modified nominal group technique will be performed. The realist evaluation will collect qualitative data (interviews, diaries, electronic messaging, arts-based materials) from CYP aged 4 – 17 years who have experienced acute pain and needed an ambulance in the previous 12 months, parents and carers, and ambulance clinicians. Recruitment will occur across England within three NHS ambulance services, two NHS children’s emergency departments, and via social media. We will also collect routine quantitative clinical record data from two NHS ambulance services. We will use a realist logic of analysis to code the data into conceptual buckets, develop context-mechanism-outcome configurations, and refine the programme theory developed from a previous realist review. Two consensus workshops will be held: one for CYP aged 8-17 years, parents and carers, public representatives, and members of the Young Persons Advisory Group, and one for ambulance clinicians, quality leads, and educators. Workshop attendees will review the study findings and candidate intervention components, vote on their importance, and review voting results. High-priority intervention components will be considered for incorporation into an intervention