McGauley Gill, Ferris Scott, Marin-Avellan Luisa, Fonagy Peter
Centre for Medical and Healthcare Education, St George's University of London and Central and North West London NHS Foundation Trust, London, UK.
Crim Behav Ment Health. 2013 Oct;23(4):274-89. doi: 10.1002/cbm.1889.
Forensic mental health professionals attach considerable importance to their patient's description of his or her index offence. Despite this, there is no systematic approach to examining and formulating the patient's offence narrative.
To use the index offence narratives and capacity to mentalize of violent offender-patients with personality disorder to develop a tool to predict their progress and to evaluate that tool.
In a prospective, cohort study, the index offence narratives of 66 violent high security hospital patients with personality disorder were obtained from a semi-structured interview and used to generate the Index Offence Representational Scales (IORS). The predictive validity of these scales was investigated across a range of outcome variables, controlling for the association between initial and final value of the dependent variable.
The degree to which patients held internal representations of interpersonal violence and malevolence, as measured by the IORS, predicted subsequent violent behaviour. In contrast to their actual aggressive behaviour, these patients rated themselves as having fewer symptoms on the Symptom Checklist-90-R (SCL-90-R) and fewer problems in interpersonal relationships on the Inventory of Interpersonal Problems. A more empathic victim representation on the IORS predicted better engagement with treatment.
The IORS show promise for helping clinicians formulate the early institutional pathway of seriously violent people with personality disorder, particularly with respect to their overt aggression and prosocial engagement. Replication studies are, however, indicated.
法医精神健康专业人员十分重视患者对其首次犯罪的描述。尽管如此，目前尚无系统的方法来审视和构建患者的犯罪叙述。
利用首次犯罪叙述以及人格障碍暴力罪犯患者的心理化能力，开发一种预测其进展的工具并对该工具进行评估。
在一项前瞻性队列研究中，通过半结构化访谈获取了66名患有人格障碍的高安全级医院暴力患者的首次犯罪叙述，并用于生成首次犯罪表征量表（IORS）。在一系列结果变量中研究了这些量表的预测效度，同时控制了因变量初始值和最终值之间的关联。
通过IORS测量，患者对人际暴力和恶意的内在表征程度可预测其随后的暴力行为。与他们实际的攻击行为形成对比的是，这些患者在症状自评量表90修订版（SCL-90-R）上给自己评定的症状较少，在人际关系问题量表上评定的人际关系问题也较少。IORS上更具同理心的受害者表征预示着更好的治疗参与度。
IORS有望帮助临床医生制定患有人格障碍的严重暴力者的早期机构治疗路径，特别是在他们的公开攻击行为和亲社会参与方面。然而，需要进行重复研究。
