Psychopathy and standardized risk assessment
ABSTRACT Throughout history most societies have assumed a link between mental disorder and violence to others. In recent times there has been increasing concern in the UK over law and order, specifically the risk of violence, and these issues are now high on the political and mental health agendas. In mental health services, clinical decisions on risk are made at all stages of the patient care process. For mental health professionals violence risk assessment and management are key components of clinical practice. In response there is a need to adopt a clear structured approach to violence risk assessment and management that is evidence-based. Psychopathy, as described by Robert Hare and colleagues, has received much attention from both clinicians and researchers in recent times, mainly due to impressive research findings from North America and Europe that demonstrate the significant predictive validity of the Psychopathy Checklist scales. The research findings are briefly discussed and a method of comparing predictive accuracy of risk-assessment tools, using receiver operating characteristics, is illustrated. The advantages of clinical and actuarial approaches to risk assessment are briefly reviewed and a structured professional judgement approach is discussed that combines these approaches. Actuarial prediction tools and recently developed schemes from Canada and North America that promote structured professional judgement are described, and practical implementation considerations are suggested.
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ABSTRACT: Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders. To review the current status of violence risk prediction research. Literature search (Medline). Key words: violence, risk prediction, mental disorder. Systematic/structured risk assessment approaches may enhance the accuracy of clinical prediction of violent outcomes. Data on the predictive validity of available clinical risk assessment tools are based largely on American and North American studies and further validation is required in British samples. The Psychopathy Checklist appears to be a key predictor of violent recidivism in a variety of settings. Violence risk prediction is an inexact science and as such will continue to provoke debate. Clinicians clearly need to be able to demonstrate the rationale behind their decisions on violence risk and much can be learned from recent developments in research on violence risk prediction.The British Journal of Psychiatry 11/2000; 177(4):303-11. DOI:10.1192/bjp.177.4.303 · 7.34 Impact Factor
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ABSTRACT: Differences in the prevalence and presentation of psychopathic personality disorder between North America and Scotland were evaluated. R. D. Hare's (1991) Psychopathy Checklist--Revised ratings obtained from a sample of 2,067 North American male prisoners and forensic patients were compared with ratings obtained from 246 Scottish male prisoners. Item response theory methods were used to examine differences in the performance of items and to equate the scale across settings. The items had equal relevance to the description of psychopathic personality disorder in both settings; however, the Scottish prisoners had to have higher levels of the underlying latent trait before certain characteristics became apparent. The prevalence of the disorder appears to be lower in Scotland. Explanations for the observed differences in terms of enculturation, socialization, and migration are explored.Journal of Abnormal Psychology 03/1999; 108(1):58-68. DOI:10.1037//0021-843X.108.1.58 · 4.86 Impact Factor
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ABSTRACT: The Psychopathy Checklist--Revised (PCL-R) is an important measure in both applied and research settings. Evidence for its validity is mostly derived from male Caucasian participants. PCL-R ratings of 359 Caucasian and 356 African American participants were compared using confirmatory factor analysis (CFA) and item response theory (IRT) analyses. Previous research has indicated that 13 items of the PCL-R can be described by a 3-factor hierarchical model. This model was replicated in this sample. No cross-group difference in factor structure could be found using CFA; the structure of psychopathy is the same in both groups. IRT methods indicated significant but small differences in the performance of 5 of the 20 PCL-R items. No significant differential test functioning was found, indicating that the item differences canceled each other out. It is concluded that the PCL-R can be used, in an unbiased way, with African American participants.Psychological Assessment 01/2002; 13(4):531-42. DOI:10.1037/1040-3522.214.171.1241 · 2.99 Impact Factor