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  • 1. af Klinteberg, Britt
    et al.
    Johansson, Sven-Erik
    Gacono, Carl
    Alm, Per-Olof
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Projective risk variables in early adolescence and subsequent disinhibitory psychopathology2008In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 31, no 3, p. 210-218Article in journal (Refereed)
    Abstract [en]

    The objective was to examine early adolescent projective risk indicators for the development of antisocial behaviour as related to adult personality traits, psychopathy, and violent behaviour over the life span. Assessment data included Rorschach (Rr) ratings (at age 11-14 years), personality inventories (EPQ-I and KSP scales), and a shortened Psychopathy Check List (PCL) (administered at age 32-40 years), obtained from a group of 199 male subjects; and smoking habits (at age 36-44 years) obtained from 125 of those subjects. Results, controlled for intelligence, indicated that the high and very high risk groups, as determined by level of total Rr risk scores, were (1) significantly higher on self-rated IVE Impulsiveness, the anxiety-related KSP Muscular Tension, and nonconformity traits, as compared to the low Rr risk group - the very high risk group also scoring significantly higher on the EPQ Psychoticism scale, related to aggressiveness and cruelty; (2) higher on clinically rated PCL total sum and factor scores; and (3) they were overrepresented among Ss with subsequent violent offence, and Ss with heavy smoking habits. The results are discussed in terms of the possible usefulness of psychodynamic oriented cognitive-emotional indicators in the search for underlying mechanisms in the development of disinhibitory psychopathology.

  • 2. Fritz, Marie Väfors
    et al.
    Wiklund, Gunnar
    Koposov, Roman A
    af Klinteberg, Britt
    Ruchkin, Vladislav V
    Yale Child Study Center.
    Psychopathy and violence in juvenile delinquents: what are the associated factors?2008In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 31, no 3, p. 272-9Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was a) to examine the discriminative power of the Antisocial Process Screening Device (APSD), aggressive traits, impulsiveness, antisocial attitudes and alcohol-related problems between subgroups of Russian juvenile delinquents (n=175) with low versus high levels of violent behavior; and b) to compare the predictive value of these variables in two subgroups defined by higher versus lower levels of psychopathic traits. Results demonstrated that the APSD score, traits of physical aggression and alcohol-related problems were able to discriminate between groups with various levels of violence. Furthermore, the level of violence was the only variant factor when comparing levels of psychopathy. Finally, different sets of predictors emerged for the group with higher versus lower psychopathy scores. The results are discussed in relation to specific features of psychopathy and environmental factors in general and the use of alcohol in particular.

  • 3. Grann, Martin
    et al.
    Sturidsson, Knut
    Haggård-Grann, Ulrika
    Hiscoke, Ulrika L
    Alm, Per-Olof
    Dernevik, Mats
    Gumpert, Clara
    Hallqvist, Johan
    Centre for Violence Prevention (CVP), Karolinska Institute, P.O. Box 23000, SE-104 35 Stockholm, Sweden.
    Hallquist, Tommy
    Kullgren, Gunnar
    Långström, Niklas
    Lotterberg, Malin
    Nordström, Kristina
    Ståhle, Birgitta
    Woodhouse, Anni
    Methodological development: structured outcome assessment and community risk monitoring (SORM)2005In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 28, no 4, p. 442-456Article in journal (Refereed)
    Abstract [en]

    This paper describes an effort to develop a clinical tool for the continuous monitoring of risk for violence in forensic mental health clients who have left their institutions and who are dwelling in the community on a conditional release basis. The model is called Structured Outcome Assessment and Community Risk Monitoring (SORM). The SORM consists of 30 dynamic factors and each factor in SORM is assessed in two ways: The current absence, presence or partial och intermittent presence of the factors, which is an actuarial (systematized and 'objective') assessment. Secondly, the risk effect, i.e. whether the presence/absence of factors currently increases, decreases or is perceived as unrelated to violence risk, is a clinical (or impressionistic) assessment. Thus, the factors considered via the SORM can be coded as risk factors or protective factors (or as factors unimportant to risk of violence) depending on circumstances that apply in the individual case. Further, the SORM has a built-in module for gathering idiographical information about risk-affecting contextual factors. The use of the SORM and its potential as a risk monitoring instrument is illustrated via preliminary data and case vignettes from an ongoing multicenter project. In this research project, patients leaving any of the 9 participating forensic hospitals in Sweden is assessed at release on a variety of static background factors, and the SORM is then administered every 30 days for 2 years.

  • 4. Kindström Dahlin, Moa
    et al.
    Hellner Gumpert, Clara
    Torstensson-Levander, Marie
    Svensson, Lupita
    Radovic, Susanna
    Mentally disordered criminal offenders: Legal and criminological perspectives2009In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 32, p. 377-382Article in journal (Refereed)
  • 5. Kindström Dahlin, Moa
    et al.
    Leviner, Pernilla
    Kaldal, Anna
    Gumpert, Clara
    Swedish legal scholarship concerning protection of vulnerable groups: Therapeutic and proactive dimensions2010In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 33, p. 398-405Article in journal (Refereed)
  • 6.
    Maycraft Kall, Wendy Katherine
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Same law - same rights?: Analyzing why Sweden's disability legislation failed to create equal rights in mental health2014In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 37, no 6, p. 609-618Article in journal (Refereed)
    Abstract [en]

    This article analyzed the apparent paradox of disability rights in Sweden. Despite strong welfare state traditions and stated Government ambitions to create generous statutory entitlements for all disabled people using a single, comprehensive Disability Act, psychiatric disabilities were principally excluded from the Disability Act's rights and provisions. The study focused on Sweden's Mental Health Reform and Disability Reform using governance perspectives that traced and analyzed the policy-processes of both reforms. Theoretically guided analytical frameworks were developed to help understand the divergent reform outcomes. The first focused on legislative arguments of regulatory specificity and legal enforcement mechanisms to consider whether the Disability Act was formulated in a manner that was easier to apply to certain disabilities. The second analyzed ideological arguments and the influence of Government political beliefs that signaled specific reform ‘visions’ to implementers and thereby influenced policy implementation. The main findings are that both perspectives matter as the dual influences of legislative and ideological differences tended to exclude mental health service users from the Act's generous disability rights. The overall conclusion was that while legislation was an important regulatory mechanism, the Government's underlying ideological reform vision was also an essential governance instrument that signaled Government intentions to implementing agencies and thus influenced the creation of enduring disability rights.

  • 7. Ruchkin, V V
    The forensic psychiatric system of Russia.2000In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 23, no 5-6, p. 555-65Article in journal (Refereed)
  • 8.
    Sjöström, Stefan
    Umeå universitet, Institutionen för socialt arbete.
    Invocation of coercion context in compliance communication: power dynamics in psychiatric care2006In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 29, no 1, p. 36-47Article in journal (Refereed)
    Abstract [en]

    This article draws on observations from ethnographic fieldwork to develop a theoretical understanding of the power dynamics in psychiatric care. The aim is to analyze how psychiatric clinicians solve compliance problems by invoking "coercion context".

    It is suggested that clinicians take a rather instrumental approach to laws regulating coercive intervention. Clinicians may invoke a coercion context even with voluntary patients. For example, they may use wordings that connote coercion, or they may make use of how treatment wards are set up to accommodate involuntary patients, thus stalling voluntary patients who cannot exit through locked doors. A coercion context can also be invoked to solve mundane practical problems, e.g. when clinicians talk about "coerced showers". The management of information and maintaining a suitable "awareness context"with regards to coercion is an essential feature in clinical attempts to achieve compliance from patients.

    In conclusion, the notion of coercion context helps explain the confusing findings from previous research about patients' apparent misconceptions of their formal legal status. Furthermore, it is argued that research that rely on decontextualised, objectifications of "coercion" risk to miss the meaning coercion is assigned in everyday clinical practice.

  • 9.
    Sjöström, Stefan
    et al.
    Umeå universitet, Institutionen för socialt arbete.
    Zetterberg, Liv
    Umeå universitet, Institutionen för socialt arbete.
    Markström, Urban
    Umeå universitet, Institutionen för socialt arbete.
    Why community compulsion became the solution: reforming mental health law in Sweden2011In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 34, no 6, p. 419-428Article in journal (Refereed)
    Abstract [en]

    The aimof this article is to understand how compulsory community care (CCC) has become a solution in mental health policy in so many different legal and social contexts during the last 20 years. The recent introduction of CCC in Sweden is used as a case in point, which is then contrasted against the processes in Norway, England/Wales and New York State. In Sweden, the issue of CCC was initiated following high-profile acts of violence. Contrary to several other states, therewas agreement about the (lack of) evidence about its  effectiveness. Rather than focusing on dangerousness, the government proposal about CCC was framedwithin an ideology of integrating the disabled. The new legislation allowed for a broad range ofmeasures to control patients at the same time as itwas presented as a means to protect positive rights for patients. Compared to previous legislation in Sweden, the scope of social control has remained largely the same, although the rationale has changed — from medical treatment via community treatment and rehabilitation, to reducing the risk of violence, and then shifting back to rehabilitation in the community. The Swedish approach to CCC is similar to Norway, while New York and England/Wales have followed different routes. Differences in ideology, social control and rights orientations can be understood with reference to the general welfare and care regimes that characterize the four states.

     

  • 10. Väfors Fritz, Marie
    et al.
    Ruchkin, Vladislav
    Koposov, Roman
    Af Klinteberg, Britt
    Antisocial process screening device: validation on a Russian sample of juvenile delinquents with the emphasis on the role of personality and parental rearing.2008In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 31, no 5, p. 438-46Article in journal (Refereed)
    Abstract [en]

    The objectives of the present study were 1) to validate the Antisocial Process Screening Device (APSD) in a sample of Russian juvenile delinquents; 2) to examine subgroups of delinquents with higher versus lower levels of childhood problem behaviors with respect to the APSD subscales, personality traits, and parental rearing; and 3) to attempt to replicate the previous finding that the APSD subscale measuring callous/unemotional traits can differentiate subgroups of delinquents with different precursors for problem behaviors (predominantly biological versus predominantly social). A group of 250 Russian juvenile inmates (mean age=16.4) was examined by means of the APSD completed by the staff at the correctional institution. The inmates completed several self-reports assessing their current and childhood behavior problems, personality traits and experienced parental rearing practices. A factor structure of the APSD was obtained that is similar, albeit not identical, to that from the original studies by Frick and colleagues [Frick, P.J., O'Brien, B.S., Wootton, J.M., McBurnett, K., (1994). Psychopathy and conduct problems in children. Journal of Abnormal Psychology, 103, 700-707]; [Frick, P.J., Barry, C.T., Bodin, S.D., (1999). Applying the concept of psychopathy to children: Implications for the Assessment of antisocial youth. In Gacono, C.B. (Ed), The clinical and forensic assessment of psychopathy: A practitioners guide. Hillsdale, NJ: Erlbaum]; [Frick, P.J., Lilienfeld, S.O., Ellis, M., Loney, B., Silverthorn, P., (1999). The association between anxiety and psychopathy dimensions in children. Journal of Abnormal Child Psychology, 27, 383-392]; callous unemotional traits in the present sample were expressed in manipulative behavior. Results further disclosed higher levels of antisocial and aggressive activities, higher levels of personality attributes such as narcissism and novelty seeking, as well as lower cooperativeness, and negatively perceived parental rearing in a subgroup with higher (versus lower) number of childhood symptoms of conduct disorder and oppositional disorder. The juvenile delinquents with higher levels as compared to lower levels of callous unemotional traits also perceived their parents as using more negative rearing strategies. The findings are discussed in terms of interactional processes between personality of the juvenile delinquents and parental rearing in the development of antisocial behavior.

  • 11. Wiklund, Gunnar
    et al.
    Ruchkin, Vladislav V.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Koposov, Roman A.
    af Klinteberg, Britt
    Pro-bullying attitudes among incarcerated juvenile delinquents: Antisocial behavior, psychopathic tendencies and violent crime2014In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 37, no 3, p. 281-288Article in journal (Refereed)
    Abstract [en]

    The objective was to evaluate a new scale aimed at assessing antisocial attitudes, the Pro-bullying Attitude Scale (PAS), on a group of 259 voluntarily-recruited male juvenile delinquents from a juvenile correctional institution in Arkhangelsk, North-western Russia. Exploratory factor analysis gave a two-factor solution: Factor 1 denoted Callous/Dominance and Factor 2 denoted Manipulativeness/Impulsiveness. Subjects with complete data on PAS and Childhood Psychopathy Scale (CPS) (n = 171) were divided into extreme groups (first and fourth quartiles) according to their total scores on PAS and the two factor scores, respectively. The extreme groups of total PAS and PAS Factor 1 differed in CPS ratings and in violent behavior as assessed by the Antisocial Behavior Checklist (ABC). They also differed in the personality dimension Harm Avoidance as measured by use of the Temperament and Character Inventory (TCI), and in delinquent and aggressive behavior as assessed by the Youth Self Report (YSR). The extreme groups of PAS Factor 2, in turn, differed in aggressive behavior as assessed by the YSR, and in the TCI scale Self-Directedness. When PAS was used as a continuous variable, total PAS and PAS Factor 1 (Callous/Dominance) were significantly positively related to registered violent crime. The possible usefulness of PAS in identifying high-risk individuals for bullying tendencies among incarcerated delinquents is discussed.

  • 12.
    Zetterberg, Liv
    et al.
    Umeå universitet, Institutionen för socialt arbete.
    Sjöström, Stefan
    Umeå universitet, Institutionen för socialt arbete.
    Markström, Urban
    Umeå universitet, Institutionen för socialt arbete.
    The compliant court: Procedural fairness and social control in compulsory community care2014In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 37, no 6, p. 543-550Article in journal (Refereed)
    Abstract [en]

    Compulsory community care (CCC) was introduced in Sweden in 2008. This article investigates all written court decisions regarding CCC over a 6 month period in 2009 (N = 541). The purpose is to examine how the legal rights of patients are protected and what forms of social control patients are subjected to. 51% of CCC patients are women and 84% are being treated for a psychosis-related disorder. In the court decisions, only 9% of patients are described as dangerous to themselves, while 18% are regarded a danger to others. The most common special provisions that patients are subjected to are medication (79%) and a requirement that they must maintain contact with either community mental health services (51%) or social services (27%). In the decisions, both the courts and court-appointed psychiatrists agree with treating psychiatrists in 99% of cases. Decisions lack transparency and clarity, and it is often impossible to understand the conclusions of the courts. There is considerable variation between regional courts as regards the provisions to which patients are subjected and the delegation of decision-making to psychiatrists. This means that decisions fail to demonstrate clarity, transparency, consistency and impartiality, and thus fail to meet established standards of procedural fairness. Surveillance techniques of social control are more common than techniques based on therapy or sanctions. Because of the unique role of medication, social control is primarily imposed on a physical dimension, as opposed to temporal and spatial forms. The article concludes that patients are at risk of being subjected to new forms of social control of an unclear nature without proper legal protection.

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