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class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/j-paul-fedoroff-md">J. Paul Fedoroff, MD</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Mini Quiz: Treatment for Pedophilia?" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" fill="white"></path></svg></button><button aria-label="twitter" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg fill="#DC7633" xmlns="http://www.w3.org/2000/svg" width="32" zoomAndPan="magnify" viewBox="0 0 375 374.9999" height="32" preserveAspectRatio="xMidYMid meet" version="1.0"><defs><path d="M 7.09375 7.09375 L 367.84375 7.09375 L 367.84375 367.84375 L 7.09375 367.84375 Z M 7.09375 7.09375 " fill="#000000"></path></defs><g><path d="M 187.46875 7.09375 C 87.851562 7.09375 7.09375 87.851562 7.09375 187.46875 C 7.09375 287.085938 87.851562 367.84375 187.46875 367.84375 C 287.085938 367.84375 367.84375 287.085938 367.84375 187.46875 C 367.84375 87.851562 287.085938 7.09375 187.46875 7.09375 " fill-opacity="1" fill-rule="nonzero" fill="#000000"></path></g><g transform="translate(85, 75)"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" version="1.1" height="215" width="215"><path d="M18.244 2.25h3.308l-7.227 8.26 8.502 11.24H16.17l-5.214-6.817L4.99 21.75H1.68l7.73-8.835L1.254 2.25H8.08l4.713 6.231zm-1.161 17.52h1.833L7.084 4.126H5.117z" fill="#ffffff"></path></svg> </g></svg></button><button aria-label="linkedin" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#007fb1"></circle><path d="M20.4,44h5.4V26.6h-5.4V44z M23.1,18c-1.7,0-3.1,1.4-3.1,3.1c0,1.7,1.4,3.1,3.1,3.1 c1.7,0,3.1-1.4,3.1-3.1C26.2,19.4,24.8,18,23.1,18z M39.5,26.2c-2.6,0-4.4,1.4-5.1,2.8h-0.1v-2.4h-5.2V44h5.4v-8.6 c0-2.3,0.4-4.5,3.2-4.5c2.8,0,2.8,2.6,2.8,4.6V44H46v-9.5C46,29.8,45,26.2,39.5,26.2z" fill="white"></path></svg></button><button title="Mini Quiz: Treatment for Pedophilia?" aria-label="pinterest" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#cb2128"></circle><path d="M32,16c-8.8,0-16,7.2-16,16c0,6.6,3.9,12.2,9.6,14.7c0-1.1,0-2.5,0.3-3.7 c0.3-1.3,2.1-8.7,2.1-8.7s-0.5-1-0.5-2.5c0-2.4,1.4-4.1,3.1-4.1c1.5,0,2.2,1.1,2.2,2.4c0,1.5-0.9,3.7-1.4,5.7 c-0.4,1.7,0.9,3.1,2.5,3.1c3,0,5.1-3.9,5.1-8.5c0-3.5-2.4-6.1-6.7-6.1c-4.9,0-7.9,3.6-7.9,7.7c0,1.4,0.4,2.4,1.1,3.1 c0.3,0.3,0.3,0.5,0.2,0.9c-0.1,0.3-0.3,1-0.3,1.3c-0.1,0.4-0.4,0.6-0.8,0.4c-2.2-0.9-3.3-3.4-3.3-6.1c0-4.5,3.8-10,11.4-10 c6.1,0,10.1,4.4,10.1,9.2c0,6.3-3.5,11-8.6,11c-1.7,0-3.4-0.9-3.9-2c0,0-0.9,3.7-1.1,4.4c-0.3,1.2-1,2.5-1.6,3.4 c1.4,0.4,3,0.7,4.5,0.7c8.8,0,16-7.2,16-16C48,23.2,40.8,16,32,16z" fill="white"></path></svg></button><button aria-label="email" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#7f7f7f"></circle><path d="M17,22v20h30V22H17z M41.1,25L32,32.1L22.9,25H41.1z M20,39V26.6l12,9.3l12-9.3V39H20z" fill="white"></path></svg></button><a class="print-wrap flex justify-center items-center cursor-pointer"><svg id="print" xmlns="http://www.w3.org/2000/svg" width="24" height="24" fill="currentColor" class="print bi bi-printer" viewBox="0 0 16 16"> <path d="M2.5 8a.5.5 0 1 0 0-1 .5.5 0 0 0 0 1z"></path> <path d="M5 1a2 2 0 0 0-2 2v2H2a2 2 0 0 0-2 2v3a2 2 0 0 0 2 2h1v1a2 2 0 0 0 2 2h6a2 2 0 0 0 2-2v-1h1a2 2 0 0 0 2-2V7a2 2 0 0 0-2-2h-1V3a2 2 0 0 0-2-2H5zM4 3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1v2H4V3zm1 5a2 2 0 0 0-2 2v1H2a1 1 0 0 1-1-1V7a1 1 0 0 1 1-1h12a1 1 0 0 1 1 1v3a1 1 0 0 1-1 1h-1v-1a2 2 0 0 0-2-2H5zm7 2v3a1 1 0 0 1-1 1H5a1 1 0 0 1-1-1v-3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1z"></path></svg></a></div><style> .print-wrap { width: 32px; height: 32px; background: #7F7F7F; border-radius: 100%; } .print { background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div></div></div></div><div class=" lg:w-full flex flex-col lg:flex-row lg:items-center lg:justify-end"></div><p class="py-2 mb-2 text-sm italic text-gray-600">What does the scientific evidence tell us about treatment for pedophilia? The answer might surprise you.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class=""><div style="width:auto%;float:top;max-width:525px;margin:0 auto 1rem;clear:both;cursor:pointer" class=" figure"><div class="flex-none relative text-center"><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%27172%27%20height=%27163%27/%3e"/></span><img alt="" title="" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain"/><noscript><img alt="" title="" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F2bd7c3e90cd493265431d6bde3f2b59e68a64c8f-172x163.gif%2FPsychTimesQuiz_11.gif%3Ffit%3Dcrop%26auto%3Dformat&w=256&q=75 1x, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F2bd7c3e90cd493265431d6bde3f2b59e68a64c8f-172x163.gif%2FPsychTimesQuiz_11.gif%3Ffit%3Dcrop%26auto%3Dformat&w=384&q=75 2x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F2bd7c3e90cd493265431d6bde3f2b59e68a64c8f-172x163.gif%2FPsychTimesQuiz_11.gif%3Ffit%3Dcrop%26auto%3Dformat&w=384&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain" loading="lazy"/></noscript></span></div><div class="top-[-100%] block w-[1px] transition-opacity duration-500 ease-in-out opacity-0 overflow-hidden"><img class="m-auto absolute inset-0 max-w-[0%] max-h-[0%] border-[3px] border-solid border-white shadow-[0px_0px_8px_rgba(0,0,0,0.3)] box-border transition ease-in-out duration-500" src="https://cdn.sanity.io/images/0vv8moc6/psychtimes/2bd7c3e90cd493265431d6bde3f2b59e68a64c8f-172x163.gif/PsychTimesQuiz_11.gif?fit=crop&auto=format"/></div></div><style> #image-caption p{ font-size: 12px; max-width: 525px; margin: 0 auto; text-align: center; } </style></div><div class="mb-6 bg-gray-300/30 p-4 rounded-md shadow-[0_0_6px_rgb(0,0.5,0.5,0.2)] clear-both"><p class="font-weight-bold">Which of the following statements is true?</p><form><div data-index="0" class="flex flex-row items-center py-2 text-left my-2 cursor-pointer shadow-[0_0_10px_rgb(0,0.5,0.5,0.2)] rounded hover:bg-gray-400/[0.5]"><label class="pl-2"></label><input type="radio" class="mr-1" id="male" name="pollText" value="d2e85d7f21ea2a7e00f49710230d3b38"/> A. Pedophilia is incurable</div><div data-index="1" class="flex flex-row items-center py-2 text-left my-2 cursor-pointer shadow-[0_0_10px_rgb(0,0.5,0.5,0.2)] rounded hover:bg-gray-400/[0.5]"><label class="pl-2"></label><input type="radio" class="mr-1" id="male" name="pollText" value="82ea0a6aaef13813b96f73ff8cd349ec"/> B. Pedophilia is an orientation</div><div data-index="2" class="flex flex-row items-center py-2 text-left my-2 cursor-pointer shadow-[0_0_10px_rgb(0,0.5,0.5,0.2)] rounded hover:bg-gray-400/[0.5]"><label class="pl-2"></label><input type="radio" class="mr-1" id="male" name="pollText" value="cbf513c43fb2aebc4d94e2f23ad1afea"/> C. A child molester is by definition a pedophile</div><div data-index="3" class="flex flex-row items-center py-2 text-left my-2 cursor-pointer shadow-[0_0_10px_rgb(0,0.5,0.5,0.2)] rounded hover:bg-gray-400/[0.5]"><label class="pl-2"></label><input type="radio" class="mr-1" id="male" name="pollText" value="d0df9ed5c95ad37b235078d2a55b8188"/> D. 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Pedophilia is incurable","_type":"pollText","choiceCount":3100,"_key":"d2e85d7f21ea2a7e00f49710230d3b38","choiceAnswer":false},{"choiceText":"B. Pedophilia is an orientation","_type":"pollText","choiceCount":2850,"_key":"82ea0a6aaef13813b96f73ff8cd349ec","choiceAnswer":false},{"_type":"pollText","choiceCount":4719,"_key":"cbf513c43fb2aebc4d94e2f23ad1afea","choiceAnswer":false,"choiceText":"C. A child molester is by definition a pedophile"},{"choiceAnswer":false,"choiceText":"D. None of the above","_type":"pollText","choiceCount":5102,"_key":"d0df9ed5c95ad37b235078d2a55b8188"}],"upload_doc":null,"medias":null,"uploadAudio":null,"question":"Which of the following statements is true?","response":[{"_key":"XIGUmHRW","markDefs":[],"children":[{"_type":"span","marks":[],"text":" ","_key":"rgMloxUQ"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Answer D. ","_key":"NR5D3Z4v"},{"_type":"span","marks":[],"text":"None of the above","_key":"x7LnS8Eu"}],"_type":"block","style":"normal","_key":"p7b4UpV4","markDefs":[]},{"children":[{"_key":"beumj4VF","_type":"span","marks":["strong"],"text":"Discussion: "}],"_type":"block","style":"normal","_key":"IZSPP3bO","markDefs":[]},{"markDefs":[],"children":[{"text":"Evidence suggest that paraphilic interests do change. These include the fact that the incidence of sex crimes decreases as people age, and the likelihood that a known high-risk sex offender will ever reoffend decreases the longer the offender does not commit a crime-as well as the self-report of men and women with paraphilic disorders.","_key":"3NjCS18G","_type":"span","marks":[]},{"marks":["superscript"],"text":"1","_key":"nffosxeP","_type":"span"}],"_type":"block","style":"normal","_key":"Lm804AuE"},{"_type":"block","style":"normal","_key":"541621627b75","markDefs":[{"href":"https://www.sexualbehavioursclinic.ca","_key":"a2548a21a649","blank":true,"_type":"link"},{"blank":true,"_type":"link","href":"https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.661010","_key":"2718efb580ae"},{"_key":"05ac826e07dd","_type":"link","href":"https://med.uottawa.ca/en/news/uottawa-professor-and-clinician-royal-honoured-award-making-ottawa-safer"}],"children":[{"_key":"5897378bc56e","_type":"span","marks":[],"text":"Some approaches seek to change the manner in which sex offenders against children are assessed and treated, even in the face of popular media. One such program is the "},{"_type":"span","marks":["a2548a21a649"],"text":"Sexual Behaviours Clinic","_key":"31a5df9d75d8"},{"_type":"span","marks":[],"text":" (SBC) at The Royal Ottawa Mental Health Centre. In 2015, the SBC ","_key":"136a393915de"},{"_type":"span","marks":["2718efb580ae"],"text":"received","_key":"b71cadadec70"},{"_key":"eb00153f0bab","_type":"span","marks":[],"text":" the Global Achievement Award by the American Psychiatric Association. In 2018, SBC received the "},{"_key":"e73badb11968","_type":"span","marks":["05ac826e07dd"],"text":"Crime Prevention Ottawa's Innovation Award"},{"_type":"span","marks":[],"text":" for its contribution to public saftey. In the past 15 years, the known hands-on reoffence rate of sex offenders treated in the SBC has fallen to virtually zero. ","_key":"1334a4a2fbc4"}]},{"_type":"block","style":"normal","_key":"82651fc10c89","markDefs":[{"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/pedophilia-interventions-work","_key":"href_1582646604164169030"}],"children":[{"_type":"span","marks":[],"text":"For more on this topic, see “","_key":"f3da787087d1"},{"_type":"span","marks":["href_1582646604164169030"],"text":"Pedophilia: Interventions That Work","_key":"oBcOeNAU"},{"marks":[],"text":"”","_key":"ccc5a69fbb92","_type":"span"},{"_type":"span","marks":["superscript"],"text":"2","_key":"f7Pxh9iA"},{"_type":"span","marks":[],"text":" by J. Paul Fedoroff, MD, on which this quiz was based. In his article, Dr Fedoroff explains some of the realities about sex offenders and why psychiatrists should be more optimistic about their patients’ prognoses.","_key":"Yv65Eez1"}]},{"style":"normal","_key":"8rP2QLws","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"vg76JgjW"}],"_type":"block"},{"_key":"0d2d6f28dd9b","markDefs":[],"children":[{"text":"1.","_key":"25995d19569e","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" Fedoroff JP. Managing versus successfully treating paraphilic disorders: the paradigm is changing. In: Levine CB, Althof SE, eds. ","_key":"569iSe1V"},{"_type":"span","marks":["em"],"text":"Handbook of Clinical Sexuality for Mental Health Professionals.","_key":"j7LiPTuU"},{"_type":"span","marks":[],"text":" New York: Taylor and Francis; 2016:345-361.","_key":"n8zcHd8n"}],"_type":"block","style":"normal"},{"style":"normal","_key":"kCwXx25l","markDefs":[],"children":[{"_key":"mtQVvrka","_type":"span","marks":["strong"],"text":"2."},{"_type":"span","marks":[],"text":" Fedoroff JP. Pedophilia: interventions that work. ","_key":"z8uQ9S0C"},{"_type":"span","marks":["em"],"text":"Psychiatric Times","_key":"iFk7qhPp"},{"marks":[],"text":". 2016;32(7): 39-41.","_key":"EGFCE7V8","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["em","superscript"],"text":"This quiz was originally posted on August 16, 2016 and has since been updated.","_key":"c3fa2d5afbe5"}],"_type":"block","style":"normal","_key":"3eec69bdced9"}]}],"pdfUrl":null,"internalTag":["Sexual Disorders","Forensic Psychiatry","Quizzes"],"issueGroup":null,"factCheckAuthorMapping":null,"taxonomyMapping":[{"_rev":"O1wC9GkHdIg9ab2yABu5pL","_type":"taxonomy","perKeywordMapping":["Psychiatry","Neurology"],"pixelTrackingCode":null,"_updatedAt":"2024-02-28T20:46:27Z","identifier":"topics/sex-sexuality","_createdAt":"2020-03-26T06:11:21Z","parent":null,"_id":"pst_taxonomy_369_sexualdisorders","name":"Sexual \u0026 Sexuality","cmeType":"per"},{"identifier":"topics/forensic","name":"Forensic Psychiatry","_id":"pst_taxonomy_173_forensicpsychiatry","_type":"taxonomy","pixelTrackingCode":null,"_createdAt":"2020-03-26T06:11:21Z","perKeywordMapping":["Psychiatry","Neurology"],"cmeType":"per","_updatedAt":"2023-03-31T19:16:52Z","parent":{"_type":"taxonomy","identifier":"topics","isMainTopic":true,"_createdAt":"2020-03-26T06:11:21Z","name":"Topics","parent":null,"_id":"pst_taxonomy_53202_clinical","_updatedAt":"2023-03-31T19:15:59Z","_rev":"uvXJooXtzvjNOyx50HTt8m"},"_rev":"uvXJooXtzvjNOyx50HTwBg"},{"name":"Quizzes","identifier":"resources/quizzes","pixelTrackingCode":null,"_createdAt":"2020-03-26T06:11:21Z","_rev":"snQqhhB4O8T5bi1viUSkee","_type":"taxonomy","parent":{"_createdAt":"2020-03-26T06:11:21Z","_rev":"CT8kz40NBv9JvHKzAk1WJ4","_type":"taxonomy","name":"Resources","_id":"pst_taxonomy_53203_resources","_updatedAt":"2021-10-07T14:44:15Z","parent":null,"identifier":"resources"},"_id":"pst_taxonomy_341_quizzes","_updatedAt":"2020-06-10T19:45:36Z"}],"is_visible":true,"documentGroupMapping":null,"contentGroup":null,"documentGroup":null,"gptSummary":"I'm sorry, but it seems there is no article text provided for me to summarize and extract key takeaways from. Could you please provide the text of the article","nodeId":"385983","summary":"What does the scientific evidence tell us about treatment for pedophilia? The answer might surprise you.","gptTakeaways":"?","_id":"pst_poll_385983","filter":null,"disableAds":false,"disableRelatedContent":false,"relatedArticles":[{"is_visible":true,"_updatedAt":"2024-11-21T16:02:57Z","_createdAt":"2024-11-14T19:48:48Z","factCheckAuthorMapping":null,"_rev":"LMsvoO9kT4cTyaW2IJui8f","body":[{"_key":"347006c3dbb3","disableTextWrap":false,"widthP":50,"_type":"figure","imgcaption":[{"_type":"block","style":"normal","_key":"88789e455911","markDefs":[],"children":[{"_key":"94ea4a7381a70","_type":"span","marks":[],"text":"rolffimages/AdobeStock"}]}],"alignment":"left","disableLightBox":true,"asset":{"_type":"reference","_ref":"image-d83dbdbc3902e16c8b0970cd5584988f4f9c4852-3092x2019-jpg"},"alt":"forensic psychiatry"},{"_key":"c19f670f9506","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"SPECIAL REPORT: FORENSIC PSYCHIATRY","_key":"d8719e416f260"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"1ee9e3f4835c0","_type":"span","marks":[],"text":"Malingering, also known as the intentional feigning of symptoms for a secondary gain, is an ever-present entity in the realm of forensic and correctional facilities. However, within the same spheres, it proves to be a double-edged sword. While these settings themselves prove to be fertile grounds for falsification of symptoms, cue secondary gain, falsely applying the diagnosis of malingering can invite its own set of consequences. It can also raise profound connotations as psychiatric diagnoses are often viewed as labels, and what could be more stigmatizing, more labeling, as calling someone with mental illness a malingerer? This is not to imply that this is common practice but serves to act as a cautionary note to the reader."}],"_type":"block","style":"normal","_key":"14b6c6abcaae"},{"markDefs":[],"children":[{"marks":[],"text":"In forensic and correctional facilities, motives for malingering illness can occur as an adaptation to the environment. Motives to malinger illness may include transfer within or to a less restrictive facility, extending length of stay to avoid jail time, procuring medications to divert, and many more. In September 2023, the Department of Justice published a report that states the US prison population numbered around 1.2 million in 2022.","_key":"0d8016b117410","_type":"span"},{"_type":"span","marks":["superscript"],"text":"1","_key":"476cb576c3a4"},{"_type":"span","marks":[],"text":" By the end of 2023, this number stood at 1.8 million.","_key":"f065dd69a72d"},{"_type":"span","marks":["superscript"],"text":"2","_key":"d6a47278b6d7"},{"marks":[],"text":" Keeping in mind that the US has the largest prison population in the world, this number is likely to keep growing. The era of deinstitutionalization, which began 6 decades ago, led to a decline in long-term psychiatric hospitalizations, however, resulting in increasing rates of incarceration.","_key":"3bc27499ce95","_type":"span"},{"_type":"span","marks":["superscript"],"text":"3","_key":"dd157e3a889c"}],"_type":"block","style":"normal","_key":"7b242fe440dc"},{"markDefs":[],"children":[{"_key":"fde13b1f0f690","_type":"span","marks":[],"text":"Much has been written about the living conditions of individuals who are incarcerated and that of the facilities themselves. With the COVID-19 pandemic, the added burden on the system has increased exponentially."},{"_type":"span","marks":["superscript"],"text":"4","_key":"ba143a7dbcd1"},{"_type":"span","marks":[],"text":" Therefore, overcrowding; confinement for long periods of time in a high-stress environment; high levels of stress; ongoing communicable diseases; and undiagnosed, untreated mental illness can create the optimal setting for feigning symptoms to facilitate transfer to better conditions. However, the very same conditions can lead to and exacerbate mental illnesses. Hence, the vitality of a complete psychiatric assessment combined with the utilization of data from historical sources and staff observations cannot be overemphasized.","_key":"ce681b6ca85c"}],"_type":"block","style":"normal","_key":"7f420b67858a"},{"_key":"9a7218e7a783","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6988b3f079420"}],"_type":"block","style":"normal"},{"style":"normal","_key":"6dd4b201a566","markDefs":[],"children":[{"text":"Categories of Malingering","_key":"9828ea3e25250","_type":"span","marks":["strong"]}],"_type":"block"},{"style":"normal","_key":"85fd07369e59","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Based on the production of symptoms, malingering can be further categorized as pure malingering, partial malingering, and false imputation.","_key":"3620c546b8130"},{"_key":"d936eb4cca5c","_type":"span","marks":["superscript"],"text":"5"},{"_key":"b523b975d65e","_type":"span","marks":[],"text":" Simply put, the conscious production of nonexistent symptoms is termed as "},{"marks":["em"],"text":"pure malingering","_key":"3620c546b8131","_type":"span"},{"_type":"span","marks":[],"text":". When there is voluntary embellishment of already present symptoms of a disorder, it is considered ","_key":"3620c546b8132"},{"_key":"3620c546b8133","_type":"span","marks":["em"],"text":"partial malingering"},{"_type":"span","marks":[],"text":". Consciously ascribing preexisting symptoms to a completely unrelated cause constitutes ","_key":"3620c546b8134"},{"text":"false imputation","_key":"3620c546b8135","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". Malingering can occur in individuals with or without preexisting mental illnesses. The ","_key":"3620c546b8136"},{"_type":"span","marks":["strong"],"text":"Figure ","_key":"3620c546b8137"},{"_key":"3620c546b8138","_type":"span","marks":[],"text":"illustrates the categories of malingering."}],"_type":"block"},{"disableLightBox":true,"_key":"e389ee9c4e3d","alignment":"right","widthP":50,"blank":true,"disableTextWrap":false,"_type":"figure","asset":{"_ref":"image-733042258ffcf0d609c429ea644bdf5acb03033b-1632x652-png","_type":"reference"},"alt":"Figure. Categories of Malingering","imgcaption":[{"_key":"bc23356e7fb0","markDefs":[],"children":[{"marks":["strong"],"text":"Figure. ","_key":"0098dff292cf0","_type":"span"},{"_type":"span","marks":[],"text":"Categories of Malingering","_key":"03e181d268a0"}],"_type":"block","style":"normal"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"4ff67c1788be0"}],"_type":"block","style":"normal","_key":"aed1a3d0ad61","markDefs":[]},{"markDefs":[],"children":[{"marks":["strong"],"text":"The Parable of 2 Hats","_key":"f06e7a936b370","_type":"span"}],"_type":"block","style":"normal","_key":"94ad2aa5c93e"},{"style":"normal","_key":"00799eb96d56","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Much has been conjectured and written about the ethical principles of forensic psychiatrists. In his 1982 address to the American Psychiatric Association (APA) and its subsequent iterations, Alan Stone, MD, called into question the veracity of psychiatric testimony and equated his own questioning the ethicality of forensic psychiatry as him “coming down from the ivory tower.”","_key":"f871b2cf73720"},{"marks":["superscript"],"text":"6","_key":"4296adafd165","_type":"span"},{"_type":"span","marks":[],"text":" Close to a decade later, Paul Appelbaum, MD, put forth the aphorism that the forensic psychiatrist’s central role lay in the advancement of justice, honesty, and objectivity.","_key":"e28cb96f2190"},{"text":"7","_key":"29965150fdc4","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" These are guidelines that are adhered to by the American Association of Psychiatry and Law (AAPL) and ingrained into every trainee in a forensic psychiatry fellowship.","_key":"918a22e92c43"},{"_type":"span","marks":["superscript"],"text":"8","_key":"f5ea180b03f4"},{"marks":[],"text":" More than any others, malingering is an area that blurs the line between the 2 hats.","_key":"a421163343e5","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"Forensic psychiatrists are experts at juggling between the 2 roles, and this is imperative, especially when considering the diagnosis of malingering in a forensic or correctional setting. Being highly contingent upon the environment, malingering can also be seen as an adaptation to it. In the forensic setting, one of the main drives to malinger symptoms of illness is to avoid prison sentences, the length of which could often be long-term or even life.","_key":"80e65d1f4dbe0","_type":"span"},{"marks":["superscript"],"text":"9","_key":"79c057c5df36","_type":"span"},{"_type":"span","marks":[],"text":" A 2013 study by McDermott et al found that prevalence rates of malingering in forensic settings range between 8% and 21%.","_key":"fc1199084cac"},{"_type":"span","marks":["superscript"],"text":"10","_key":"da586f43bbdb"},{"_key":"2ac91afa59b3","_type":"span","marks":[],"text":" In the same study, about 18% of patients deemed incompetent to stand trial were found to be malingering, and nearly 65% of incarcerated individuals needing psychiatric interventions were found to be malingering as well. Therefore, it is a clear and ever-present entity in these settings. These rates have stayed consistent across the board."}],"_type":"block","style":"normal","_key":"d8f673629aeb"},{"_key":"88d1a66522fe","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"221c5b3eb7c40"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"The Burden of Malingering","_key":"0c91b15692250"}],"_type":"block","style":"normal","_key":"bd85aac062c2"},{"markDefs":[],"children":[{"marks":[],"text":"From a public health perspective, malingering can be a costly affair. In forensic settings, it can delay outcomes such as trial and sentencing and unwarranted spending towards housing and medications. Other factors to consider include transport of patients to and from courts, referrals to specialists, and specialized testing outside facilities for further diagnostic clarifications. Most state systems are already facing a backlog of individuals awaiting competency to stand trial evaluations and malingering symptoms delays this process further.","_key":"0294f39082f90","_type":"span"},{"_type":"span","marks":["superscript"],"text":"11","_key":"6c0fb7ae5f65"},{"_type":"span","marks":[],"text":" When individuals falsely impute symptoms to a cause other than their illness, this can result in treatment that would not only be unhelpful but invite unnecessary medication adverse effects.","_key":"9bc6dd370b6c"}],"_type":"block","style":"normal","_key":"68ff7f94094b"},{"style":"normal","_key":"fa4f4ed18258","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Dissimulation, which involves minimizing symptoms of mental illness to portray good health, can lead to individuals not receiving much-needed treatment.","_key":"93068a73c21f0"},{"text":"12","_key":"7cd0aac9f829","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" Although there are differences in lengths of stay, services offered, and the metrics considered for billing purposes, admission to psychiatric inpatient facilities in the community costs about $1000 per patient.","_key":"80d5abcbcf5d"},{"text":"13","_key":"b13986b4fa10","_type":"span","marks":["superscript"]},{"marks":[],"text":" A 2024 cost study of Texas state hospitals showed the daily cost of an operational bed to be $736.41 for civil and $744.96 for forensic hospitals.","_key":"d280609bfc24","_type":"span"},{"_type":"span","marks":["superscript"],"text":"14","_key":"4b4285f2abc1"},{"_type":"span","marks":[],"text":" Considering for example, an individual who is deemed incompetent to stand trial, admission to a forensic state facility may last anywhere from 90 days to a year or longer, depending on restorability. When these numbers are extrapolated together, the cost and expenditures are staggering.","_key":"92aa8e0ce82b"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"141d6db7928a0"}],"_type":"block","style":"normal","_key":"d986bdfcbc1a"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Malingered Psychiatric Symptoms in Forensic and Correctional Settings","_key":"5475cae376f80"}],"_type":"block","style":"normal","_key":"42be35d4eec1"},{"style":"normal","_key":"320f6cb4316f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Psychosis is often most malingered, due to its overt and reproducible nature. Incentives to malinger psychosis typically involve psychiatric hospitalization to avoid prison or jail time; however, it is usually dynamic and multifaceted. Within the sphere of psychosis, individuals are more likely to report visual hallucinations, followed by auditory hallucinations and delusions.","_key":"ce92d87ef4b80"},{"_type":"span","marks":["superscript"],"text":"12","_key":"86901f4e5168"},{"text":" It is imperative to consider and rule out pathologies such as substance use and organic conditions in which visual hallucinations are seen as well. Malingered psychotic symptoms are characteristically noted to be atypical, out of proportion with the overall severity of the individual’s illness, and with notable inconsistencies in self and staff reports.","_key":"e64971f0ddd7","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"text":"At the same time, it is important to keep in mind that atypical symptoms by themselves do not directly equate to malingering. As noted by McCarthy-Jones and Resnick, atypical auditory hallucinations ranged from being completely silent (reported by 5% of patients) to playing out like an idea inside their head (44% of patients) as opposed to coming from outside. In addition, the voices could also be heard as coming from different parts of the body.","_key":"a9d81aa2aa210","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"15","_key":"d7233d373266"},{"_type":"span","marks":[],"text":" This further emphasizes the need for contextual considerations and an extremely thorough evaluation using multiple sources of information. When individuals feign delusional content, the onset and abatement of symptoms are generally atypical compared with the norm.","_key":"c358f7386860"},{"marks":["superscript"],"text":"12","_key":"0ca77017c981","_type":"span"},{"_type":"span","marks":[],"text":" Delusions are environment-driven and closely correlate with the degree of the individual’s disorganization. Anecdotally, this writer has observed a patient reporting delusions of misidentification, that security staff have been replaced by family members connected to the patient’s instant offense, and another patient endorsing ideas of reference from the static generated by the security staff’s radios.","_key":"6d2f60bbc157"}],"_type":"block","style":"normal","_key":"f8cd5908d610"},{"_type":"block","style":"normal","_key":"223963a7c9e0","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Another relatively common pattern of malingering involves feigning cognitive symptoms. Individuals in forensic or correctional facilities awaiting competency evaluations can grossly exaggerate cognitive deficits to undergo transfer to a civil facility or plead insanity to avoid long periods of incarceration.","_key":"f702833e330e0"},{"_key":"4a49cc61d016","_type":"span","marks":["superscript"],"text":"16"},{"_type":"span","marks":[],"text":" In such instances, psychometric testing such as performance and symptom validity testing has been shown to be highly specific in detecting feigning. Furthermore, incarcerated individuals can also malinger suicidal ideation to be transferred to community hospitals or forensic facilities for psychiatric stabilization.","_key":"41a53c91033f"},{"_key":"a139bb246c93","_type":"span","marks":["superscript"],"text":"17"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"995dc69c62ea0"}],"_type":"block","style":"normal","_key":"9bb1d124ffa6"},{"_key":"44427ae53e99","markDefs":[],"children":[{"_key":"71c44b1e52720","_type":"span","marks":["strong"],"text":"Concluding Thoughts (and Myths) to Consider"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"Forensic and correctional settings prove to be ripe environments for malingering symptoms, especially of mental illnesses. However, the consideration and investigation of malingering must be done with exquisite caution, as it can worsen stigma and result in individuals not getting much-needed interventions. When making the diagnosis, a complete evaluation combined with psychological testing and collateral information from sources such as staff, previous records, and even family must be carefully weighed along with clinical judgement. There is a wealth of literature on interview techniques and indicators to consider when suspecting malingering.","_key":"85b59ab745370"}],"_type":"block","style":"normal","_key":"b1c541349f0b","markDefs":[]},{"_type":"block","style":"normal","_key":"558e7d3104a1","markDefs":[],"children":[{"_key":"1ca09bab06250","_type":"span","marks":[],"text":"Individuals who feign symptoms can have prior mental illnesses, and this does not preclude malingering. The reporting of purely atypical symptoms does not default to malingering as well. Another commonly encountered trope is that individuals diagnosed with antisocial personality disorder have a higher propensity to malinger, and this has been proven to be false across many bodies of research. On a final note, diagnosing malingering can include dire consequences such as loss of much-needed privileges and sentencing enhancements, and therefore, it is best to view it as the diagnosis of exclusion, within the diagnosis of exclusion that is psychiatry."}]},{"_type":"block","style":"normal","_key":"5e4d0f20fb67","markDefs":[],"children":[{"text":"","_key":"7ae391e4285c0","_type":"span","marks":[]}]},{"children":[{"_type":"span","marks":["strong"],"text":"Dr Kumar ","_key":"a44d790c922c0"},{"_type":"span","marks":["em"],"text":"is an early career forensic psychiatrist. 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","_key":"813ea86b7d790"},{"_type":"span","marks":["7e0a67ebbed3"],"text":"The relationship between psychiatric and cognitive symptom feigning among forensic inpatients adjudicated incompetent to stand trial.","_key":"813ea86b7d791"},{"_key":"fe8fb79dbf23","_type":"span","marks":[],"text":" "},{"_type":"span","marks":["em"],"text":"Assessment","_key":"813ea86b7d792"},{"text":". 2016;23(6):672-682.","_key":"813ea86b7d793","_type":"span","marks":[]}]},{"style":"normal","_key":"7a0419d528de","markDefs":[{"href":"https://pubmed.ncbi.nlm.nih.gov/32768118/","_key":"26d5c9505d97","blank":true,"_type":"link"}],"children":[{"text":"17. Obegi JH. ","_key":"2740cb58a5150","_type":"span","marks":[]},{"_type":"span","marks":["26d5c9505d97"],"text":"Differentiating genuine from feigned suicidality in corrections: a necessary but perilous task.","_key":"2740cb58a5151"},{"_key":"0efead0ea6ea","_type":"span","marks":[],"text":" "},{"_type":"span","marks":["em"],"text":"Int J Law Psychiatry","_key":"2740cb58a5152"},{"_type":"span","marks":[],"text":". 2020;71:101573.","_key":"2740cb58a5153"}],"_type":"block"}],"taxonomyMapping":[{"_rev":"uvXJooXtzvjNOyx50HTwBg","identifier":"topics/forensic","parent":{"name":"Topics","_id":"pst_taxonomy_53202_clinical","_updatedAt":"2023-03-31T19:15:59Z","isMainTopic":true,"_type":"taxonomy","parent":null,"identifier":"topics","_createdAt":"2020-03-26T06:11:21Z","_rev":"uvXJooXtzvjNOyx50HTt8m"},"_createdAt":"2020-03-26T06:11:21Z","cmeType":"per","name":"Forensic Psychiatry","_id":"pst_taxonomy_173_forensicpsychiatry","_updatedAt":"2023-03-31T19:16:52Z","pixelTrackingCode":null,"_type":"taxonomy","perKeywordMapping":["Psychiatry","Neurology"]},{"parent":null,"_id":"pst_taxonomy_385_specialreports","_updatedAt":"2020-03-26T06:11:21Z","identifier":"special-reports","_createdAt":"2020-03-26T06:11:21Z","_rev":"IlP9l41tH9jB20SbSpsYNi","_type":"taxonomy","name":"Special Reports","pixelTrackingCode":null}],"summary":"Learn more about malingering in this forensic psychiatry overview. ","authors":[{"displayName":"Vikram Kumar, MD","url":"vikram-kumar-md"}],"title":"Malingering in the Forensic and Correctional Settings","thumbnail":{"_type":"mainImage","alt":"forensic psychiatry","caption":"rolffimages/AdobeStock","asset":{"_ref":"image-d83dbdbc3902e16c8b0970cd5584988f4f9c4852-3092x2019-jpg","_type":"reference"}},"_type":"article","gptTakeaways":"• Malingering in forensic settings is driven by motives like avoiding incarceration and obtaining medications, necessitating careful psychiatric assessments to avoid misdiagnosis and stigma.\n\n• Malingering can be categorized into pure, partial, and false imputation, with psychosis being the most commonly feigned condition due to its overt nature.\n\n• The financial and systemic burdens of malingering are significant, affecting trial processes and healthcare costs, highlighting the need for thorough evaluations.\n\n• Ethical considerations in diagnosing malingering are crucial, requiring comprehensive assessments and adherence to forensic psychiatry guidelines to ensure justice and objectivity.","ExcludeFromPubMedXML":false,"published":"2024-11-21T16:00:00.000Z","documentGroup":null,"documentGroupMapping":null,"authorMapping":[{"displayName":"Vikram Kumar, MD","_updatedAt":"2024-11-14T19:50:07Z","url":{"current":"vikram-kumar-md","_type":"slug"},"authorType":"author","_createdAt":"2024-11-14T19:49:19Z","_rev":"19MLiwy94z3PqhCfQiTD4L","_type":"author","_id":"827796e8-2ad9-42b4-b015-ac60eb1d270b","biography":[{"_type":"block","style":"normal","_key":"66c5ffd42ffd","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Kumar ","_key":"2c066121bd9f0"},{"_type":"span","marks":["em"],"text":"is an early career forensic psychiatrist. He is an attending physician at a State forensic facility for the New York Office of Mental Health.","_key":"2c066121bd9f1"}]}]}],"drugMentions":"{\"drug_mentions\": []}","_id":"d7832425-aeca-42fe-be93-2b01217d8e08","gptSummary":"Malingering, the intentional feigning of symptoms for secondary gain, is prevalent in forensic and correctional settings, driven by motives such as avoiding incarceration or obtaining medications. The complexity of diagnosing malingering is compounded by the potential for stigma and misdiagnosis, necessitating comprehensive psychiatric assessments. Malingering can manifest as pure, partial, or false imputation, with psychosis being the most commonly feigned condition. The financial and systemic burdens of malingering are significant, impacting trial processes and healthcare costs. 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This is especially important for estimating the risk of perpetration of violence and criminality, which is increased in those with severe mental illness and affects a minority of patients.","_key":"d66cf3de82c4"}],"_type":"block","style":"normal","_key":"1ae5daf67eb4"},{"markDefs":[],"children":[{"text":"For example, individuals with schizophrenia spectrum disorders have a risk that is 2 to 5 times higher than the general population (including in studies with careful adjustment for confounders, in individuals without diagnosed comorbidities, and in sibling comparisons that inherently account for shared background familial factors such as early environment).","_key":"1a109cc2b7780","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"2","_key":"497d91c036f8"},{"marks":[],"text":" This risk increases further with comorbid substance misuse,","_key":"56852276fdce","_type":"span"},{"_type":"span","marks":["superscript"],"text":"2","_key":"5e0206cac464"},{"_type":"span","marks":[],"text":" and absolute rates vary according to illness stage and setting.","_key":"547af719606d"},{"marks":["superscript"],"text":"3","_key":"231368380f6a","_type":"span"},{"_type":"span","marks":[],"text":" Moreover, a review of the prevalence of violent outcomes in psychiatric patients found some patient groups with elevated rates. This included around a fifth of individuals who present in psychiatric emergency settings in the next 12 months and more than one-third in involuntarily committed patients and patients with first-episode psychosis, also over the subsequent 12 months (","_key":"cf963e393a5b"},{"marks":["strong"],"text":"Figure 1","_key":"2aa9c335258b","_type":"span"},{"_type":"span","marks":[],"text":").","_key":"1e6a21db7e51"},{"_type":"span","marks":["superscript"],"text":"3","_key":"666280fd9420"},{"text":" More recent work in first-episode psychosis has also found that around 1 in 10 individuals have violent outcomes that lead to police contact in the year after referral to mental health services.","_key":"43ea909d8562","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"4","_key":"1ba2af06664a"}],"_type":"block","style":"normal","_key":"5214b2ed531f"},{"widthP":50,"blank":true,"disableLightBox":true,"imgcaption":[{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"FIGURE 1.","_key":"d362335b542f0"},{"_type":"span","marks":[],"text":" Estimated Mean Prevalence of Violence Perpetration in Psychiatric Patients by Study Setting Over 6 to 12 Months: Pooled Estimate","_key":"366cda27c871"},{"_type":"span","marks":["superscript"],"text":"3","_key":"5a007a942761"}],"_type":"block","style":"normal","_key":"acf28e65a04f"}],"_type":"figure","alt":"FIGURE 1. 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For example, some of these older risk assessment approaches, particularly those described as structured clinical judgment tools, take up to 16 hours to complete,","_key":"212c41bd62ff0","_type":"span","marks":[]},{"text":"5","_key":"4a65aa5a0a95","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" making them impractical for clinical use. Another shortcoming is that they do not provide probability scores for individuals but only categorize them into broad groups of low, medium, and high risk. However, classification (using cutoffs) is not a good aim when models are relatively accurate—here, you will want to know probabilities. This is exactly how the Framingham Risk Score (or, for that matter, the weather) is communicated—not in a categorical way of yes/no but in relation to probabilities, which allows individuals to decide how to act depending on the decision to be made and its implications (eg, changing diet or adding a statin or not). Additionally, structured clinical judgment tools typically show poor predictive accuracy in real-world clinical settings compared with research settings, raising concerns about their everyday clinical use. This is likely because these tools were developed using small sample sizes, focused on a specific patient population (eg, forensic patients), and were not externally tested in real-world settings different from the one in which they were developed.","_key":"f25dc72cbe86"},{"text":"6,7","_key":"7c8f494d55b2","_type":"span","marks":["superscript"]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"55d332db9b1b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Therefore, novel tools are required to assist clinicians in making well-informed decisions, facilitating early interventions, and ensuring consistency in risk assessment within and across clinical teams. A new generation of tools that provide probability scores have been developed using population-based registers that cover a wide range of patient populations and provide extensive information about them over time.","_key":"6c8c69ab12560"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"One of these tools, using data from more than 75,000 individuals with severe mental illness in Sweden, is the Oxford Mental Illness and Violence (OxMIV) tool, which aims to assist clinicians in assessing the risk of violence within 12 months of assessment among individuals with schizophrenia spectrum and bipolar disorders. The tool was built with 16 risk factors, including demographic, criminal history, and clinical variables, such as age, sex at birth, previous violent crime, past drug or alcohol misuse, and recent antipsychotic treatment.8 The OxMIV tool has been validated and updated across diverse patient populations in England, Germany, and the Netherlands,","_key":"c0ff2f747c430"},{"_type":"span","marks":["superscript"],"text":"9-11","_key":"f3a1bc465b62"},{"_key":"26f7eb275f50","_type":"span","marks":[],"text":" demonstrating applicability in different clinical settings. Clinicians can easily access its user-friendly interface online, making it simple to integrate into practice ("},{"text":"Figure 2","_key":"fc3ab48e755c","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":").","_key":"e6ebd0daf448"}],"_type":"block","style":"normal","_key":"4327941e1fed"},{"blank":true,"asset":{"_ref":"image-0ab8198b867b312bc4f2067a32a243dee32e4d81-686x516-png","_type":"reference"},"widthP":50,"disableTextWrap":false,"disableLightBox":true,"imgcaption":[{"markDefs":[],"children":[{"text":"FIGURE 2. ","_key":"4b7388eb885e0","_type":"span","marks":["strong"]},{"_key":"303c518bf90a","_type":"span","marks":[],"text":"OxMIV’s Web-Based Interface"}],"_type":"block","style":"normal","_key":"9ff88cc1cd3a"}],"_key":"f57094982d32","alignment":"right","alt":"FIGURE 2. OxMIV’s Web-Based Interface","_type":"figure"},{"children":[{"_type":"span","marks":[],"text":"For example, when a clinician assesses the risk of violence in an individual with schizophrenia spectrum disorders or bipolar disorder, they can quickly enter all necessary data into the OxMIV calculator and estimate the individual’s risk level in percentages. Risk estimates become less accurate and clinically useful at very high levels; therefore, they are presented at a maximum of 20%. Importantly, OxMIV allows unknown values for some risk factors (providing a range of predicted risks).","_key":"29d9291453e60"}],"_type":"block","style":"normal","_key":"16f75c2811b1","markDefs":[]},{"_key":"1a69a99f417b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Integrating OxMIV and similar novel tools into clinical practice can complement clinical assessment and improve clinician confidence in making early personalized decisions to improve patient care, such as:","_key":"f25c274cc0e10"}],"_type":"block","style":"normal"},{"listItem":"bullet","markDefs":[],"children":[{"marks":[],"text":"Initiating early discussions on strategies to reduce medium- and longer-term violence risk with patients and their families.","_key":"71a636dc392a0","_type":"span"}],"level":1,"_type":"block","style":"normal","_key":"d9c91ff3db5a"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Collaborating with multidisciplinary teams to identify appropriate next steps for more detailed assessment and care.","_key":"b28e1c34df640"}],"level":1,"_type":"block","style":"normal","_key":"96f792976223","listItem":"bullet"},{"level":1,"_type":"block","style":"normal","_key":"7b148b666335","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Targeting modifiable risk factors, such as substance misuse, nonadherence, and/or effectiveness of medication, impulsivity, unstable living conditions, and disengagement from services.","_key":"dac17ef2dc820"}]},{"_type":"block","style":"normal","_key":"04d180c88012","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Developing crisis plans with caregivers, family, and staff to efficiently manage emergencies.","_key":"2a3cb3c584700"}],"level":1},{"style":"normal","_key":"b7c815bc0a45","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Collaborating with other services, including police, probation, substance misuse, housing, and social services.","_key":"4e4c4f88e9420"},{"marks":["superscript"],"text":"12","_key":"d88d8e396af0","_type":"span"}],"level":1,"_type":"block"},{"style":"normal","_key":"f29666e395d1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"As psychiatry embraces precision medicine, the use of validated and scalable risk prediction tools can potentially improve mental health outcomes. Integrating these tools into clinical practice can assist violence risk assessment and allow for more personalized decisions early on in the treatment process, benefiting patients and their families while improving safety and well-being.","_key":"1264294b83cb0"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Fazel ","_key":"4f21306bfd400"},{"_type":"span","marks":["em"],"text":"is a professor of forensic psychiatry at the University of Oxford in England.","_key":"e77a6374976e"},{"_key":"bed19c404ad4","_type":"span","marks":[],"text":" "},{"text":"Mr Scola ","_key":"5eeb56745d4a","_type":"span","marks":["strong"]},{"_type":"span","marks":["em"],"text":"is a postdoctoral research associate (pending PhD viva) in psychiatric epidemiology at the University of Oxford in England.","_key":"fa353f3eb6b2"}],"_type":"block","style":"normal","_key":"71cc7567b7d0"},{"style":"normal","_key":"6368883e9356","markDefs":[],"children":[{"marks":["strong"],"text":"References","_key":"75d5ccd8d4b10","_type":"span"}],"_type":"block"},{"_key":"c3bfe4faf777","markDefs":[{"_key":"8f77be7483cd","blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/38408535/"}],"children":[{"_type":"span","marks":[],"text":"1. 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University of Oxford; 2021.","_key":"ef6af8cd022f2"}],"_type":"block","style":"normal"},{"children":[{"_key":"0f3391f4ab3b0","_type":"span","marks":[],"text":"\n"}],"_type":"block","style":"normal","_key":"68b319366ac4","markDefs":[]}],"issueGroup":{"_ref":"7d283d85-869a-4578-b7e0-00266f149eb6","_type":"reference"},"_type":"article","_id":"bb065c1c-c7a4-4984-a153-3d6821c66b83","title":"Violence Risk Assessment: Using the Oxford Mental Illness and Violence Tool","documentGroup":null,"summary":"The use of validated and scalable risk prediction tools can potentially improve mental health outcomes.","drugMentions":"{\"drug_mentions\": [\"antipsychotic treatment\"]}","articleType":"Publication","gptTakeaways":"• Precision medicine in psychiatry uses big data to personalize diagnosis, prognosis, and treatment, moving away from one-size-fits-all strategies.\n\n• Clinical prediction models offer individual-level risk estimates for adverse mental health outcomes, aiding evidence-based decision-making.\n\n• Traditional risk assessment tools are being replaced by novel tools like OxMIV, which provide probability scores for better clinical assessments.\n\n• Integrating these tools into practice enhances patient care, safety, and well-being through personalized, data-driven decisions.","_createdAt":"2024-11-15T20:59:11Z","contentCategory":{"_type":"contentCategory","name":"Articles","_id":"8bdaa7fc-960a-4b57-b076-75fdce3741bb","_updatedAt":"2020-02-25T09:35:56Z","_createdAt":"2020-02-06T09:15:47Z","_rev":"snQqhhB4O8T5bi1viURsgs"},"authors":[{"displayName":"Seena Fazel, MBChB, MD, FRCPsych","url":"seena-fazel-mbchb-md-frcpsych"},{"displayName":"Giulio 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