Probation officers assume a large level of responsibility for the offenders in their care and the community at large. They are responsible for monitoring criminal offenders and assessing what level of risk they pose to the general public. When offenders commit an infraction, such as a technical violation of not meeting the conditions of their probation, it is up to the probation officer to manage that infraction and ultimately decide the consequence. Individuals who struggle with mental health issues such as depression, schizophrenia, and bipolar account for a large percentage of offenders. Unlike offenders with substance abuse problems, the main cause of reincarceration for mentally ill offenders is a technical violation, not a new criminal offense. Research has shown that in fact, mentally ill offenders are just as unlikely to commit a new offense as are offenders with no history of mental illness or drug abuse. But unfortunately, mentally ill offenders are monitored more closely and assessed more harshly than substance abusing offenders.

Jennifer Eno Louden of the Department of Psychology at the University of Texas recently conducted a study to better evaluate the conditions by which probation officers assess and manage mentally ill offenders. Her goal was to determine whether these offenders were being unfairly assessed, resulting in increased rates of reincarceration. Louden enlisted 234 probation officers and presented them with probation violation scenarios committed by a mentally ill offender, an offender with substance use issues, an offender with both problems, and an offender with neither. She evaluated their risk assessments and management recommendations and found that even though statistics show substance users as more likely to engage in violent acts, the officers rated the mentally ill offenders as being 13% more likely to commit acts of violence.

The primary risk management strategy recommended by the officers was forced psychological treatment, usually in the form of medication. Although mental health treatment is not a negative recommendation, forcing the treatment is seen as a cause for concern. For these individuals, many of whom have schizophrenia, the negative side effects of medication can cause more harm than good. The goal of treatment was not helping the offenders address their mental health problems but rather managing their behavior; however, it did not help them decrease their chance of reoffending. Louden believes this study demonstrates the need for further training and education for probation officers who work with mentally ill offenders. She said, “By targeting interventions away from a sole focus on mental disorder toward robust predictors of recidivism, real improvements can be made in the criminal justice outcomes for offenders with mental disorders.”

Reference:
Eno Louden, J., Skeem, J. L. (2012). How do probation officers assess and manage recidivism and violence risk for probationers with mental disorder? An experimental investigation. Law and Human Behavior. Advance online publication. doi: 10.1037/h0093991

Any caregiver is likely to be vulnerable to stress. However, parents who care for a child with a serious mental illness (SMI) are at increased risk for adverse physical symptoms resulting from stress. Those who care for an adult child with SMI are even more likely to experience the negative effects of stress because of the length of time that they have had to cope with the difficult task of caring for a loved one with mental health issues. Although there is a vast amount of evidence showing how caring for a child with SMI can negatively impact a parent’s psychological health, there is scant clinical evidence highlighting the deleterious physiological effects to the caregiver. Erin T. Barker of the Waisman Center at the University of Wisconsin-Madison addressed this specific dynamic in a recent study by examining the cortisol levels in individuals charged with the care of adult children with SMI.

For her study, Barker asked 61 parents of adults with depression, schizophrenia, or bipolar to complete a stress diary and submit daily saliva samples over a period of several days. The cortisol levels of the participants were compared to the levels of 321 parents of adult children who had no mental health concerns. Barker discovered that the cortisol awakening response (CAR) of the parents of adult children with SMI increased less significantly half an hour after they arose in the morning than the control group. This suggests that the caregivers had a higher stress level upon waking than did the control group. Additionally, Barker found that the cortisol levels of the caregivers declined less throughout the day than did the cortisol levels found in the parents of adult children who did not have SMI.

[fat_widget_right]

“The fact that a similar pattern of hypoactivated daily cortisol in response to stress has been found across studies of parents of individuals with different diagnoses (i.e., schizophrenia, autism, developmental disabilities, and in the present analysis, SMI) and that used different measures of stress (i.e., behavioral problems of the adult child with the diagnosis, time spent with the adult child, and in the present analysis, daily stress not necessarily associated with the adult child) provides strong converging evidence for this effect,” Barker said. She added that these findings underscore the importance of addressing the mental health, physiological health, and coping needs of aging parents who care for adult children with serious mental health issues.

Reference:
Barker, E. T., Greenberg, J. S., Seltzer, M. M., Almeida, D. M. Daily Stress and Cortisol Patterns in Parents of Adult Children with a Serious Mental Illness. Health Psychology 31.1 (2012): 130-34. Print.

Abilify (aripiprazole), manufactured by Bristol-Myers Squibb, was approved for use by the U.S. Food and Drug Administration in 2002. An antipsychotic medication, Abilify has shown noteworthy success in treating the symptoms of schizophrenia. Since its introduction, this medication has also been used for easing manic depression in adults. In people who have not responded well to traditional antidepressants, Abilify is sometimes prescribed as a secondary, additional treatment. As a result of increasingly diverse uses, this medication has entered the top 15 in terms of total drug sales. Like all psychotropic drugs, Abilify works by altering the levels of certain chemicals in the brain called neurotransmitters.

Determining the toxic dose of any new medication is essential in developing appropriate safety guidelines. According to the authors of a study published in Clinical Toxicology, “Limited data exist describing the characteristics of [Abilify] poisonings” (Young et al., 2009). Part of the reason for such limited data is undoubtedly the newness of the medication itself. In an effort to fill in these gaps in knowledge, researchers performed an analysis of Abilify overdose events recorded in the California Poison Control Center database. They excluded cases where the record was not sufficiently complete or other substances were ingested along with Abilify. After eliminating such results, researchers were left with 286 usable cases.

Slightly more than half of these cases were female, and the overall median age was about 19 years. The youngest recorded overdose patient was 6 months old. Researchers divided the cases into three distinct age groups (0-6, 7-17, 18+ years) to determine whether there might be an age-related response to Abilify overdose. A standard dosage for this medication depends a great deal on the individual case; however, dosage typically starts at 2 mg for pediatric patients and can increase to 15 mg for adults. It should be noted that Abilify is not prescribed for children less than 13 years old (PubMed Health, 2011). Researchers also placed each case into a group based on dosage level. Group 1 consisted of doses less than 20 mg. In group 2, dosage ranged from 21 to 90 mg. All doses of 91 mg or higher fell into group 3.

Results of the analysis showed that out of 286 cases, 128, or nearly half, showed no symptoms whatsoever. For those who did report symptoms, drowsiness was the most common complaint, followed by nausea/vomiting, muscle twitch, and tremors. In no case was the overdose considered life threatening, and none of the patients appeared to have experienced permanent effects. For adults, only those in dosage group 3 (91 mg+) were statistically likely to experience symptoms. In pediatric cases, symptoms presented themselves even at the group 2 level. In 176 cases of overdose, no treatment was required other than observation. When treatment was administered, activated charcoal given orally was the most common course of action.

While this was only one study of one database, the data seem to indicate that Abilify is not an especially toxic medication. However, the effects of overdose vary from person to person, and underlying conditions may play a role in an individual’s response. As always, keeping medications in a secure location and following dosage instructions to the letter are essential safety measures.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Retrieved February 19, 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000221/
2. Mayo Clinic. (n.d.). Dystonia. Retrieved February 19, 2012. Available from: http://www.mayoclinic.com/health/dystonia/DS00684
3. Young, M. C, Shah, N., Cantrell, F. L., Clark, R. F. (2009). Risk assessment of isolated aripiprazole exposures and toxicities: a retrospective study. Clinical Toxicology, 47, 580-583.

A new study involving people with bipolar suggests that setting extrinsic goals may be a predictor for manic episodes. Individuals with bipolar disorder are aware that setting high goals can cause them to get overstimulated and result in a manic episode. “The reward sensitivity model has been found to be useful in predicting the course of mania; indeed, increases in mania over time have been predicted by self-reported reward sensitivity, life events involving reward, and elevations in behavior focused on attaining reward and goals,” said Sheri L. Johnson of the Department of Psychology at the University of California at Berkeley, and lead author of a recent study examining the relationship between reward sensitivity and the development of bipolar. “People with bipolar disorder appear to value goal pursuit more than do other people.”

Of particular interest to Johnson and her colleagues was the pursuit of extrinsic goals, namely fame and financial gain. “On the whole, findings regarding high aspirations for popular fame and low aspirations for friendships and family suggest that people with bipolar disorder adopt extrinsically rather than intrinsically motivated goals,” said Johnson. “Several early studies suggest that a better understanding of goal dysregulation might be relevant for treatment planning.” For her study, Johnson examined the goals of 92 people with bipolar 1 and a control group using the Willingly Approached Set of Statistically Unlikely Pursuits (WASSUP) model, and followed their pursuit of these highly ambitious aspirations over a three month period.

“Participants with bipolar disorder endorsed higher ambitions for popular fame than did controls; moreover, heightened ambitions for popular fame and financial success predicted increases in manic symptoms in those with bipolar disorder over the next three months.” Johnson added, “We have designed a mania treatment that involves techniques for modulating high goal setting. Over the course of the intervention, participants demonstrated significant decreases in WASSUP scores and interviewer ratings of manic symptom severity.” Johnson believes that insight into how goal dysregulation affects bipolar and how to manage it will help influence effective interventions for those at risk for bipolar and manic episodes.

Reference:
Johnson, S. L., Carver, C. S., & Gotlib, I. H. (2011, November 21). Elevated Ambitions for Fame Among Persons Diagnosed With Bipolar I Disorder. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0026370