Terrorism Typologies and Considerations for Clinical Practice in Psychiatry

Typology development entails systematically clustering related attributes among individuals or groups to examine trends that might explain complex human interactions and behaviours. This approach has demonstrated its usefulness in behavioural sciences with important implications for policy, etiology, course, and treatment. Our review article provides an overview of terrorism typologies and examines their implications for clinical practice. We argue that the theoretical nature and heterogeneity of existing terrorism typologies limit their clinical usefulness, highlighting the need to develop empirically driven typologies.

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Psychiatric Assessment of Individuals Charged with Terrorism and Those at Risk of Engaging in Acts of Terrorism

Terrorism is a multi-faceted phenomenon that entails a strategic and instrumental use of violence to achieve ideological or political goals. Despite decades of research in the field, empirical data to guide clinical practice is lacking, and controversies surround the role of psychiatrists in assessing terror subjects. Our paper provides an overview of the social, psychological, and political-cultural risk factors for radicalization to terrorism; the assumed link between mental illness and terrorism; the relevant legal issues; and the threat assessment and management tools. In the absence evidence-based clinical guidelines, a thorough understanding of these issues helps inform psychiatric assessments of individuals charged with terrorism or those at risk of engaging in acts of terrorism.

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Ethical Issues in the Assessment of Terror Subjects

The psychiatric evaluation of people who have committed acts of terrorism requires a unique sensitivity to cultural and political context. This is because terrorism has multiple definitions and can be used to silence political and ethnic minorities. There- fore, professional appraisals of risk and threat may require an ethics approach that intertwines individual and community factors, considering history and culture along- side individual risks. Narrative ethics using root cause and liberation theories may be one method to assess both contextual and personal contributions to terrorist behaviour, and provide a robust account of the cultural and contextual realities of terrorism.

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Violence Risk Assessment of Older Adults

The forensic psychiatric and psychological arena has long been tasked to understand the correlates of aggression and provide opinions about an individual’s risk to commit a violent act. Violence can be physical, sexual, psychological, or any combination. It is an act that is intended to harm another. Our understanding of the factors that contribute to violence has certainly evolved over the past two to three decades. And, with this, the introduction of risk assessment methods has served to improve our ability to make predictions about someone’s risk to act out violently. Most tools currently available to assist in the prediction of violence, however, are largely intended for youth and working-aged adults who have justice involvement. At the current time, there are no tools available that assess the risk of violence posed by older adults.

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Convergent, Discriminant and Predictive Validity of Two Instruments to Assess Recidivism Risk Among Released Individuals Who Have Sexually Offended: The SORAG and the VRAG-R

Recidivism risk assessment has played an essential role in the criminal justice system for many years. Various risk assessment tools have been developed and recalibrated over the years for the purpose. Two such instruments, the Violence Risk Appraisal Guide (VRAG) and the Sex Offender Risk Appraisal Guide (SORAG), were both revised before being combined into the VRAG-R. The aim of our study was to evaluate the convergent, discriminant and predictive validity of the SORAG and the VRAG-R in a cohort of 294 released individuals who have sexually offended in French Belgium. Results suggest that the tools have good convergent validity and the ability to discriminate the risk level of individuals who have sexually offended with victims younger than 14 years old, whether intra- or extra-familial, from that of others at higher risk for re-offending. Where predictive validity is concerned, the scores on both instruments predict nonviolent nonsexual recidivism with a large effect size, and general recidivism (any type of recidivism) and violent nonsexual recidivism with a medium effect size. Sexual recidivism is not predicted at a statistically significant level by either the SORAG or the VRAG-R. Violent recidivism (sexual and non-sexual combined) is moderately predicted by the SORAG and the VRAG. However, these predictive qualities vary by the age of the victim. Certain combinations of items can be good predictors. In this regard, the VRAG-R items “failure on conditional release” and “marital status” together constitute a predictive model for general recidivism and sexual recidivism. The addition of the item “age at index offense” improves this model for general recidivism.

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Examination of the Structured Assessment of Protective Factors for Violence Risk – Youth Version (SAPROF-YV) in Canadian Adolescents

The Structured Assessment of Protective Factors for Violence Risk – Youth Version (SAPROF-YV) is a new measure of protective factors. It is used with a risk-focused tool, such as the Structured Assessment of Violence Risk in Youth (SAVRY), to provide a more balanced and comprehensive assessment of violence risk in adolescents. Our study investigated the relationship between the SAPROF-YV and aggression in a sample of 69 adolescents. Using a retrospective follow-up study design, we reviewed files at an inpatient treatment centre and a probation office. The SAPROF-YV showed good convergent and discriminant validity with the SAVRY. The SAPROF-YV was predictive of the absence of minor verbal aggression. While the SAPROF-YV added incremental predictive validity to SAVRY Protective factors for minor verbal aggression, it did not add incrementally to SAVRY Risk factors in the prediction of any type of aggression. We discuss implications for future research and clinical applications.

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Psychiatrie légale canadienne et française : application dans le domaine pénal

L’expertise psychiatrique est une des disciplines de la psychiatrie légale. Sa pratique est spécifique aux juridictions où elle s’exerce et aux ressources qui lui sont attribuées. L’évolution des connaissances en psychiatrie et psychopathologie, ainsi que les décisions politiques ont un impact majeur sur la nature et le déroulement des missions d’expertise. Il existe des différences significatives entre les pays, ce qui surprend fréquemment, puisque la pratique de la psychiatrie générale est quant à elle la même. Nous proposons dans cet article une comparaison entre la pratique de l’expertise psychiatrique pénale en France et au Canada.

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Clinicians’ Perceptions of the Implementation of the Structured Assessment of Protective Factors for Violence Risk (SAPROF) on an Inpatient Forensic Unit

The Structured Assessment of PROtective Factors for Violence Risk (SAPROF) is an assessment tool that examines protective factors when assessing violence risk. There is limited research on clinicians’ perceptions of the use and implementation of risk assessment tools, and this study aimed to examine the experiences of clinicians using the SAPROF in a low secure forensic rehabilitation inpatient unit in Canada. An exploratory research design was used, and five clinicians participated in semi-structured interviews. Data was analyzed using a thematic approach and three central themes were identified: “understanding of the patient from a strengths-based point of view, providing clinicians with a focus on how to help the patient, and bringing in opportunities to collaborate as a team”. The findings highlight the additional value of the SAPROF as a tool in helping forensic teams to adopt strengths- based approaches to risk assessment, enhancing treatment planning, and inter- professional collaboration.

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