Papers by Luca Castelletti
Official Journal of the Italian Society of Psychopathology, Jul 3, 2014
Objectives In the last decades, interest and research on violence risk assessment tools for patie... more Objectives In the last decades, interest and research on violence risk assessment tools for patients suffering from mental disease has significantly increased, providing different approaches that vary from actuarial to structured clinical judgement. From a national perspective, it may be useful for psychiatrists not directly involved in forensic context to become familiar with tools that are mostly studied and used elsewhere. The imminent announced closing of the six national OPGs (Ospedali Psichiatrici Giudiziari) will inevitably increase the number of mentally disordered offenders directly managed by mental health services (Dipartimenti di Salute Mentale), which will be asked by the courts to assess the risk of danger of some of their clients. Our aim herein is to review the international literature over the last 10 years in terms of evidence for the predictive validity of major violence risk assessment tools in correctional, forensic and general psychiatric settings. Materials and methods A research through Medline and Embase database of clinical trials, prospective and retrospective cohort studies, systematic reviews and meta-analyses in the period 2002-2012. Results Analysis of the literature stress the evidence that violence risk assessment tools are more efficient than unstructured clinical judgement in the prediction of future violent and aggressive behavioural expressions, including rate of reconvictions. Actuarial tools, specifically VRAG, developed in the correctional sector, appear to be efficient in the prediction of this population. Structured clinical judgement tools, in particular HCR-20, are supported by a large number of studies on their predictive features, in different settings, including some evidence for the assessment of the level of security that is most appropriate for the patient within the forensic psychiatric care pathway. Conclusions The introduction and routine use of violence risk assessment tools in the correctional and forensic contexts appears to be valid. Usage of appropriate, validated risk assessment tools can augment standard clinical approaches in a number of ways. Some of their advantages derive simply from having a well-structured approach, others from consideration of specific kinds of risk factors: 'static' and 'dynamic'. The inappropriate use of tools without a firm evidence base, however, is unlikely to enhance clinical practice significantly: their utility at the level of general psychiatry is still controversial. Additional considerations are discussed.
BJPsych international, Apr 17, 2023
believed to contribute to older adults' physical, intellectual and social development. A recent s... more believed to contribute to older adults' physical, intellectual and social development. A recent study examined both the feasibility of a weekly programme over a period of 1 year and its efficacy in improving physical activity levels and well-being. The researchers used a mixed-methods intervention design, recruiting adults over 55 years of age from local community groups in Yorkshire, UK. Each weekly session involved mixed-genre dance for 60 min. They used self-report measures of minutes per week of physical activity, and wellbeing was assessed using the EuroQol visual analogue scale (EQVAS) at baseline and at 3, 6 and 12 months. The results were assessed using the Friedman test. The researchers also carried out a thematic analysis of qualitative data. Feasibility was assessed based on class attendance, and 685 male and female participants with a mean age of 75 years were recruited to form focus groups. Thirty-eight per cent of the participants were considered to be highly deprived as per the Index of Multiple Deprivation.
Frontiers in Psychiatry, Apr 3, 2020
The Italian forensic psychiatric system underwent drastic reforms. The newly developed facilities... more The Italian forensic psychiatric system underwent drastic reforms. The newly developed facilities are inspired by psychiatric community services, embracing a recovery-oriented approach. Needs and quality of life are broader concepts that consider the more rehabilitative and humanitarian aspects of treatment. In one of the new Italian forensic psychiatric services, this cross-sectional study aimed to investigate the needs and quality of life of forensic psychiatric patients. A second aim was to validate the Italian version of the Forensic inpatient Quality of Life questionnaire Short Version (FQL-SV). Overall, 42 forensic psychiatric patients were assessed using the Forensic version of the Camberwell Assessment of Need (CANFOR), the Historical-Clinical-Risk-Management-20 (HCR-20), the FQL-SV, and the World Health Organization Quality of Life (WHOQoL-Bref). Patients reported significantly fewer needs, whether met or unmet, than their treating clinicians. The general level of agreement between patients and clinicians on specific needs was low Kappa values were < .40 for 64% of the total needs and 46% of the unmet needs. Risk factors according to the HCR-20 mean scores were 13.1, 4.6, and 6.4 for the historical, clinical and risk management subscale. Quality of life was moderate to high for 74% of the patients. Our results showed that lower numbers of needs, whether reported by patients or clinicians, were associated with a better quality of life. The Italian FQL-SV had a Cronbach's alpha of 0.86 and correlated as expected with the WHOQoL-Bref. The FQL-SV is a valid and reliable tool, justifying its use for routinely assessing QoL in Italian forensic psychiatric services. This study enhances our understanding of needs and quality of life of forensic psychiatric patients and how their assessment could have an additional value for recoveryoriented treatment in forensic psychiatry. Although the detained status of forensic patients imposes real limits on the capacity for autonomy and choice, incorporating the patient's perspective on decision-making processes, in relation to aspects of treatment, care, and daily life, may have benefits such as a better treatment adherence or therapeutic alliance. Future research should clarify how routinely assessing needs and quality of life can contribute to the recovery of these forensic psychiatric patients.
Criminal Behaviour and Mental Health, Jul 18, 2023
BackgroundThere has been a substantial change in the law on the provision of secure health servic... more BackgroundThere has been a substantial change in the law on the provision of secure health services for offender‐patients in Italy, a country currently with the lowest general psychiatry bed availability per head of the population in Europe, raising questions about possible differences in offender‐patient admissions between European countries.AimsIn this multicentre case–control study, our aim was to compare the socio‐demographic, clinical and criminological characteristics of a sample of Italian forensic in‐patients with schizophrenia or similar psychosis with patients in a similar diagnostic range in specialist in‐patient services elsewhere in Europe.MethodsSecure hospital unit in‐patients with psychosis were recruited across five European countries (Italy, Austria, Germany, Poland and England). Consenting patients were interviewed by researchers and assessed using a multidimensional standardised process. Within country similarities between Austria, Germany, Poland and England were confirmed.ResultsOverall, 39 Italian participants had had fewer years of education than the 182 patients in the other countries and were less likely to have ever had skilled or professional employment. The Italian patients had been older at first contact with any mental health services than the other Europeans. Diagnosed comorbidity rates were similar, but the Italian group reported higher levels of disability. Although the other European forensic patients were more likely to be undergoing treatment at the time of their index offence, they were also more likely to have been poorly compliant with treatment. The rate of suicide‐related behaviours was significantly lower among the Italian patients than among the others.ConclusionsNotwithstanding similar diagnoses, important differences emerged between patients in Italian forensic mental health resident services and those in four other European countries, some possibly reflecting less access to earlier relevant services in Italy. Others, including lower disability ratings among the Italian patients and a lower rate of suicide‐related behaviours, may indicate that the Italian reforms carry benefits. This is worthy of further evaluation.
Epidemiology and Psychiatric Sciences, Oct 13, 2014
Background. The Camberwell Assessment of Need-Forensic Version (CANFOR) is a standardised assessm... more Background. The Camberwell Assessment of Need-Forensic Version (CANFOR) is a standardised assessment tool specifically designed to assess needs for care in forensic psychiatric populations. The original English version of the instrument has shown good psychometric properties. The aim of this study was to validate the Italian version of the CANFOR-staff tool. Method. After translation and back-translation, the Italian CANFOR tool was administered to a sample of 50 forensic psychiatric patients. Convergent validity was tested using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) by applying Kendall's tau-b. Inter-rater and test-retest reliabilities were measured by ICCs for need dimensions (total and unmet) and Cohen's kappa coefficients for individual need items. Results. Regarding convergent validity, a higher number of needs (total and unmet) were associated with more severe psychiatric symptoms (BPRS). Higher numbers of unmet needs were also associated with lower levels of global functioning (GAF). ICCs for total and unmet needs scores indicated a good level of agreement for inter-rater reliability and a very good level for test-retest, respectively. Regarding the specific items, inter-rater Cohen's kappa was high (moderate to very good agreement) for 18 items in relation to the presence of a need and for 15 items in the rating of an unmet need, whereas Cohen's kappa for test-retest reliability was very high for all the items in the presence of a need and high for 18 of the unmet need domains. Conclusions. The Italian version of CANFOR has adequate psychometric properties. It can be considered a promising instrument for the assessment of needs of forensic psychiatric patients.
European Psychiatry, Apr 1, 2017
41S (2017) S583-S644 tendency which promotes different expressions in terms of age, a tendency wh... more 41S (2017) S583-S644 tendency which promotes different expressions in terms of age, a tendency which also measures capacity in terms of age. Objective To evaluate elder physical abuse-cases reviewed at the Forensic Institute, Tirgu Mures County, Romania. Methods An experimental design was used, focusing on elder physical abuse cases involving victims aged 65 or older, who requested a forensic certificate. All cases were reviewed at the Forensic Institute Tg. Mures, Mures County, Romania between 1st of Jan-31st Dec 2014. Variables included: age, gender, environmental origin, physical abuse, sexual abuse, relationship with the perpetrator (relative, known person/neighbor, unknown person, husband/wife), the required number of days of hospitalization, victim previous psychiatric diagnosis, aggressor previous psychiatric diagnosis. Results A total of 5252 forensic medical certificates were issued at request by the Forensic Institute of Tg Mures. One hundred and twenty (2.28%) were related to acknowledgement of the aggression of an elderly peIntroductionrson (≥65 years, with an average age of 69.89 years CI: 68.8903-70.8930). The majority of subjects were males (65%), of rural origin (64.17%). The same address as the aggressor's was identified in most of the cases (41.66%). 35.83% were hurt by neighbours/acquaintances, 22.5% were attacked by strangers. Conclusion We are aware of that an elder abuse appears to occur most often in domestic home situations, men from rural, more often than women, are involved that victims and may be perpetrated by adult family members, or other persons. The authors have not supplied their declaration of competing interest.
PLOS ONE
Background Goal-directed decision-making is a central component of the broader reward and motivat... more Background Goal-directed decision-making is a central component of the broader reward and motivation system, and requires the ability to dynamically integrate both positive and negative feedback from the environment in order to maximize rewards and minimize losses over time. Altered decision-making processes, in which individuals fail to consider the negative consequences of their decisions on both themselves and others, may play a role in driving antisocial behaviour. Aim The main study aim was to investigate possible differences in loss and risk aversion across matched patients, all with a schizophrenia spectrum disorder (SSD), but who varied according to whether they had a history of serious interpersonal violence or not, and a sample of healthy controls with no history of violence. Results The sample included 14 forensic and 21 non-forensic patients with SSD, and 41 healthy controls. Among the three decision-making variables under investigation, risk aversion was the only signif...
Criminal Behaviour and Mental Health
BackgroundThere has been a substantial change in the law on the provision of secure health servic... more BackgroundThere has been a substantial change in the law on the provision of secure health services for offender‐patients in Italy, a country currently with the lowest general psychiatry bed availability per head of the population in Europe, raising questions about possible differences in offender‐patient admissions between European countries.AimsIn this multicentre case–control study, our aim was to compare the socio‐demographic, clinical and criminological characteristics of a sample of Italian forensic in‐patients with schizophrenia or similar psychosis with patients in a similar diagnostic range in specialist in‐patient services elsewhere in Europe.MethodsSecure hospital unit in‐patients with psychosis were recruited across five European countries (Italy, Austria, Germany, Poland and England). Consenting patients were interviewed by researchers and assessed using a multidimensional standardised process. Within country similarities between Austria, Germany, Poland and England wer...
RIVISTA SPERIMENTALE DI FRENIATRIA
BJPsych International, 2022
This paper compares across six nations the mental health systems available to prisoners with the ... more This paper compares across six nations the mental health systems available to prisoners with the highest acuity of psychosis and risk combined with the lowest level of insight into the need for treatment. Variations were observed within and between nations. Findings highlight the likely impact of factors such as mental health legislation and the prison mental health workforce on a nation's ability to deliver timely and effective treatment close to home for prisoners who lack capacity to consent to treatment for their severe mental illness. The potential benefits of addressing the resulting inequalities are noted.
Schizophrenia Research: Cognition
This chapter sets out to describe the range of services currently provided for mentally disordere... more This chapter sets out to describe the range of services currently provided for mentally disordered offenders in order to describe the teaching and training needs for forensic mental health professionals who will provide sustainable high-quality services. Other chapters in this book will have to serve that purpose in such areas as specialist personality disorder services, forensic child and adolescent services, intellectual and developmental disorder services, substance misuse and acquired brain injury co-morbidity services and many more.
BJPsych International
This paper compares across six nations the mental health systems available to prisoners with the ... more This paper compares across six nations the mental health systems available to prisoners with the highest acuity of psychosis and risk combined with the lowest level of insight into the need for treatment. Variations were observed within and between nations. Findings highlight the likely impact of factors such as mental health legislation and the prison mental health workforce on a nation's ability to deliver timely and effective treatment close to home for prisoners who lack capacity to consent to treatment for their severe mental illness. The potential benefits of addressing the resulting inequalities are noted.
Social Psychiatry and Psychiatric Epidemiology, 2020
Purpose While the number of forensic beds and the duration of psychiatric forensic psychiatric tr... more Purpose While the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patients and of shared indicators on forensic care within Europe is an obstacle to comparative research. The reasons for such variation are not well understood. Methods Experts from seventeen EU states submitted data on forensic bed prevalence rates, gender distributions and average length of stay in forensic in-patient facilities. Average length of stay and bed prevalence rates were examined for associations with country-level variables including Gross Domestic Product (GDP), expenditure on healthcare, prison population, general psychiatric bed prevalence rates and democracy index scores. Results The data demonstrated substantial differences bet...
International journal of law and psychiatry
Italy is the only country in the world to have closed forensic psychiatric hospitals and converte... more Italy is the only country in the world to have closed forensic psychiatric hospitals and converted to fully-residential services. The international interest around this reform has not been matched by research. This scoping review aims to report the determinants of the reform, the most updated information on how the system operates, its benefits and its challenges. We further aim to discuss the implications for policy, research and practice. 1. Selection of relevant sources through electronic search on four databases, Google, relevant printed materials and personal communication with practitioners currently working in REMS. 2. Study quality monitoring. 3. Data extraction onto NVivo 4. Data synthesis through content analysis. 43 papers were selected for inclusion in our review. Two main themes were identified: 1. Historical chronology of the closure of forensic psychiatric hospitals; 2. The current model of residential forensic psychiatric care. The closing down of Italian forensic ps...
ITALIAN JOURNAL OF CRIMINOLOGY, 2019
The transition from the old model of the Judicial Psychiatric Hospitals to the reformed system of... more The transition from the old model of the Judicial Psychiatric Hospitals to the reformed system of the REMS (territorial residences forthe execution of detention security measures) has produced a decrease of about half the number of places available in Detention SecurityMeasures. Predictably, in these 4 years of operation of the new system, there has been an imbalance between demand and availability ofthese places, thus creating the phenomenon of so-called “waiting lists”. These are subjects already assigned to a custodial measure, whichthey await in prison or in the territory until a place is freed in the REMS.In this paper we will examine how the Veneto regional governmental health system has developed strategies to implement care pathwayswithin the detention security measures circuit during these years. First of all through the drafting of a Memorandum of Understandingbetween the judicial system and the mental health protection system. The first, partial data on the flows indicate...
Long-Term Forensic Psychiatric Care, 2019
This chapter describes the legislative, organizational, and clinical innovations supporting the n... more This chapter describes the legislative, organizational, and clinical innovations supporting the national and regional plan of closing the six Italian forensic hospitals. We illustrate the historical determinants of the contemporary situation, shedding light on the cultural heritage that has preserved the previous hospital-based system. The asylum organization had remained unchanged throughout the reformist period in the last decades, as correctional and general mental health sectors were totally separated in their organization.
Journal of Forensic Nursing
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Papers by Luca Castelletti