Individual differences, particularly callous and unemotional (C&U) traits, and parenting practices are some of the strongest predictors of externalizing behavior in adolescents. However, findings on the associations between C&U traits, parenting, and externalizing behaviors have been mixed, with studies often utilizing single scores to represent these multidimensional constructs. The current study used a developmental-contextual framework to examine how dimensions of C&U traits predict aggressive and non-aggressive rule-breaking behaviors through positive and negative parenting practices. The study used archival data from 174 pairs of adolescent males, ages 11-16 years old, and their mothers. Results showed that C&U traits influenced externalizing behaviors through parenting practices. Findings also showed specificities among these relationships. Particularly, the associations between Uncaring and aggressive, as well as non-aggressive rule-breaking, behaviors was mediated by negative parenting, whereas the association between Unemotional and rule-breaking behaviors was mediated by positive parenting practices. Research and clinical implications are discussed.

Aims: Study I: Identify substance use disorders (SUDs), psychiatric disorders, and psychosocial risk (PSR) in adolescence, to predict SUD after 5 years in 147 adolescents who sought treatment at a misuse-clinic. Study II: Identify alcohol risk use (ARU) and its association with psychiatric symptoms and PSR in 960 adolescents who sought treatment in general psychiatric care. Study III: Examine the effect of antisocial behavior (ASB) on the association between inattention, hyperactivity, impulsivity, and alcohol use in 3,864 adolescent students. Study IV: Examine the veracity of drug use reports comparing responses in questionnaires, in-depth interview, and hair analysis in 200 adolescent students. Results: Study I: SUDs in adolescence persisted into early adulthood. Predictors for SUD: girls who had mothers with alcohol use disorder, victimization, criminality, SUD, or SUD treatment. Study II: Prevalence of ARU was 20%. ARU increased with the number of psychiatric symptom domains. Probability of psychiatric symptoms increased with ARU. Most ARU was found in: ASB and sexual abuse. Most common in ARU: symptoms of ADHD, depression, and anxiety. Study III: ASB reduced association between inattention, hyperactivity, impulsivity, and alcohol use for boys, and hyperactivity and impulsivity for girls. Girls’ inattention continued to affect alcohol use despite the presence of ASB. Study IV: Twice as many participants reported drug use in interviews compared to questionnaires. Questionnaires and hair-analysis showed low sensitivity and high specificity. Responses from participants in less privileged socioeconomic circumstances were less reliable. Conclusions: Study I: Treatment-as-usual experienced difficulties preventing the persistence of SUD. Participants’ comorbidity and PSR must be attended to. Study II: ARU in general psychiatric care is prevalent and associated with other psychiatric symptoms, and all symptoms must be attended to simultaneously. Study III: ASB should be screened for when symptoms of ADHD are present. Inattention in girls might require special attention to prevent alcohol use. Study IV: Interviews might be an alternative to questionnaires. Hair analysis was less useful in this population, but a physical measure might function as a pipeline procedure. Responses from participants in less privileged circumstances might be interpreted with caution.

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abstract: The current study utilized data from two longitudinal samples to test mechanisms in the relation between a polygenic risk score indexing serotonin functioning and alcohol use in adolescence. Specifically, this study tested whether individuals with lower levels of serotonin functioning as indexed by a polygenic risk score were vulnerable to poorer self-regulation, and whether poorer self-regulation subsequently predicted the divergent outcomes of depressive symptoms and aggressive/antisocial behaviors. This study then examined whether depressive symptoms and aggressive/antisocial behaviors conferred risk for later alcohol use in adolescence, and whether polygenic risk and effortful control had direct effects on alcohol use that were not mediated through problem behaviors. Finally, the study examined the potential moderating role of gender in these pathways to alcohol use. Structural equation modeling was used to test hypotheses. Results from an independent genome-wide association study of 5-hydroxyindoleacetic acid in the cerebrospinal fluid were used to create serotonin (5-HT) polygenic risk scores, wherein higher scores reflected lower levels of 5-HT functioning. Data from three time points were drawn from each sample, and all paths were prospective. Findings suggested that 5-HT polygenic risk did not predict self-regulatory constructs. However, 5-HT polygenic risk did predict the divergent outcomes of depression and aggression/antisociality, such that higher levels of 5-HT polygenic risk predicted greater levels of depression and aggression/antisociality. Results most clearly supported adolescents’ aggression/antisociality as a mechanism in the relation between 5-HT polygenic risk and later alcohol use. Deficits in self-regulation also predicted depression and aggression/antisociality, and indirectly predicted alcohol use through aggression/antisociality. These pathways to alcohol use might be the most salient for boys with low levels of socioeconomic status. Results are novel contributions to the literature. The previously observed association between serotonin functioning and alcohol use might be due, in part, to the fact that individuals with lower levels of serotonin functioning are predisposed towards developing earlier aggression/antisociality. Results did not support the hypothesis that serotonin functioning predisposes individuals to deficits in self-regulatory abilities. Findings extend previous research by suggesting that serotonin functioning and self-regulation might be transdiagnostic risk factors for many types of psychopathology. / Dissertation/Thesis / Doctoral Dissertation Psychology 2017

Introduction Offenders who suffer from a severe mental illness are sentenced to forensic-psychiatric careinstead of imprisonment. A severe mental illness is a legal term determined by type anddegree of the psychiatric illness. Forensic-psychiatric care ends when signs of severe mentalillness is no longer present. Antisocial behaviors and mental illness due to substance abuse isnot regarded as severe by law but can arguably delay discharge from care. Aim To investigate whether time in treatment for offenders sentenced to compulsory forensicpsychiatriccare is prolonged by a propensity for substance abuse and antisocial behaviors. Methods Extended §7-evaluation dictums from 2017 have been reviewed. Data concerning substanceabuse and antisocial tendencies was assessed to assort offenders in two subgroups with lowestdegree contra highest degree of additional problematic behaviors. The two subgroups andtime in treatment collected through the Swedish National Forensic Psychiatric Register wascombined in a Kaplan-Meier estimator through SPSS. Results Median time in treatment for offenders with highest degree of additional problematic behavioras in substance abuse and or antisocial tendencies was 1048 days (range 1075). Since nodischarge has occurred, median time to discharge could not be estimated. Median time todischarge for offenders with lowest degree of additional problematic behavior was 760 days(range 532). Conclusions The study could not find time in treatment among severe mental ill offenders to be longer foroffenders with additional substance abuse and or antisocial characteristics of crime in relationto offenders without.

Current therapeutic treatment methods are ineffective in identifying at-risk sex offenders and reducing recidivism of known offenders, likely due to inadequate identification of specific traits of sex offenders. Previous research and prominent theories in the area of sex offender treatment, in terms of the biological foundation of substance abuse, behaviors of sex offenders, and the presence of aggression, helped to guide this research. Data about sex offenders were collected, as reported by mental health professionals who treat them and focused on three characteristics: maladaptive interpersonal behaviors, impulsivity, and antisocial behaviors, on which the research questions were formed to detect commonality. For this study, a phenomenological approach was chosen through a qualitative design and an 11-item open-ended questionnaire was developed with which 11 mental health professionals who treated sex offenders were interviewed. The audio was transcribed, the text was coded into the themes of the research questions, and the data was analyzed for commonality. The results indicate that all three traits in the research questions are common among sex offenders. The results of this research added to the framework of understanding of common behaviors among sex offenders and to positive social change by providing a clearer understanding of the three targeted behaviors. The information gathered from this qualitative research will guide larger-scale quantitative studies on the sex offender population, ultimately assisting sex offender treatment providers and forensic interviewers with more rapid identification of traits specific to sex offenders.

No description available.

L’objectif de cette recherche est d’étudier, chez l’adolescent, les mécanismes psychopathologiques et psychologiques impliqués dans la co-occurrence de comportements antisociaux et de conduites de consommation et responsables de la « pathologisation » de la consommation de substances psychoactives, par l’adoption conjointe d’une approche centrée sur la personne et centrée sur les variables et la mise en place d’un dispositif d’étude multi-échantillons. Ainsi, cette recherche comporte trois volets : 1) une étude en milieu scolaire menée auprès de 1025 collégiens âgés de 12 ans à 16 ans, 2) une étude en milieu psychiatrique menée auprès de 168 adolescents suivis ou hospitalisés pour un trouble externalisé ou internalisé, âgés de 12 ans à 18 ans, et 3) une étude en addictologie menée auprès de 43 adolescents abuseurs/dépendants à une substance psychoactive, âgés de 12 ans à 18 ans. Un protocole d’évaluation pluri-source (adolescents, parents, enseignants) a permis d’évaluer les comportements antisociaux, les conduites de consommation, les conduites à risques, les troubles et symptômes externalisés et internalisés (et les antécédents de troubles), la personnalité, le stress perçu et les stratégies de coping de ces adolescents. Ce dispositif a permis de montrer que les adolescents les plus susceptibles d’associer ces deux comportements et d’adopter des conduites de consommation à risques présentent des difficultés à la fois relationnelles (faible coopération, trouble oppositionnel avec provocation, faible transcendance), émotionnelles (symptômes dépressifs, troubles internalisés, intolérance à la frustration, stress perçu dans le domaine scolaire ou dans la relation aux parents, stratégies d’adaptation dysfonctionnelles) et comportementales (forte recherche de nouveauté, comorbidité TDAH/TOP). La pathologisation des conduites de consommation relèvent d’enjeux similaires à l’adoption de conduites de consommation à risques. Néanmoins, le risque de pathologisation serait d’autant plus important que les enjeux émotionnels et relationnels relèvent de manifestations tempéramentales (faible dépendance à la récompense sociale). En termes de prévention des conduites de consommation à l’adolescence et de leur pathologisation, il paraît primordial de bien distinguer ces différents niveaux de vulnérabilité (psychopathologique, psychologique, tempéramentaux, adaptatif). / This work aims to study, among adolescents, the psychopathological and psychological mechanisms involved in the co-occurrence of antisocial behaviors and psychoactive substance use and in the “pathologizing” of psychoactive substance use through a person-centered and a variable-centered approach and based on a multi-sample plan. This research focus on: 1) 1 025 middle and high school students aged between 12 to 16 years old, 2) 168 inpatients and outpatients adolescents aged between 12 to 18 years old, and 3) 43 psychoactive substance abusers/dependent adolescents aged between 12 and 18 years. A multi-source assessment (adolescents, parents, teachers) was used to collect information about adolescents’ antisocial behaviors, psychoactive substance use, risk-taking behaviors, past and present externalized and internalized disorders and symptoms, personality, perceived stress and coping strategies. The results show that adolescents are most likely to associate antisocial behaviors and psychoactive substances use and to have a risky psychoactive substance use when they present both relational problems (low cooperation, oppositional defiant disorder, low transcendence), emotional difficulties (depressive symptoms, internalizing disorder, intolerance to frustration, perceived stress in school and in relationships with parents, dysfunctional coping strategies) and behavioral dysregulation (high novelty seeking, ADHD/ODD comorbidity). Mechanisms involved in the pathologizing of psychoactive substance use are similar to the adoption of risky psychoactive substance use. Nevertheless, the risk of pathologizing is all the more important when emotional and relational problems are temperamental expression (low social reward dependence). In terms of prevention of risky psychoactive substance use in adolescence and of its pathologizing, it seems important to distinguish between these different levels of vulnerability (psychopathological, psychological, temperamental, adaptative).

No description available.

Depuis la désinstitutionalisation dans les milieux psychiatriques, il a été souvent mentionné qu’une augmentation des admissions dans les milieux carcéraux et de psychiatrie légale était en cours afin de prendre soin des personnes atteintes de troubles mentaux graves (TMG). Parallèlement, plusieurs auteurs ont rapporté que les individus ayant des troubles mentaux sévères sont plus à risque de perpétrer des gestes antisociaux ou de violence. À l’égard de cette problématique, nous soutenons le modèle de la spécificité clinique. Celui-ci précise que des profils psychopathologiques particuliers augmentent le risque de violence, conduisent à différents types de fonctionnement social et articulent la demande de soins. L’environnement a, de plus, un effet modulateur au niveau du fonctionnement distinctif de l’individu. Une relation bidirectionnelle se construit entre la spécificité psychopathologique et l’environnement, plus particulièrement en ce qui a trait aux relations interpersonnelles, au milieu socioéconomique, au patron d’utilisation des services de psychiatrie et à l’interaction avec le système de justice qui déterminent subséquemment le type de prise en charge ou le statut légal du patient. Afin d’appuyer ce modèle, les profils des patients atteints de TMG en fonction des statuts légaux, du milieu de soins (psychiatrie générale et psychiatrie légale) et de l’utilisation des mesures d’isolement et de contentions ont été examinés. Les patients ont été évalués par des mesures sociodémographiques (indicateurs du fonctionnement social, des relations interpersonnelles et du milieu socioéconomique), psychodiagnostiques (SCID-I et II) et de la psychopathie. De même, le dossier criminel, les dossiers médicaux hospitaliers et administratifs (MED-ECHO et RAMQ) ont été observés. Les devis étaient rétrospectifs. Par ailleurs, au niveau de l’interaction entre les services de psychiatrie et l’individu atteint d’un TMG, nous avons exploré la perception subjective des intervenants en santé mentale quant à l’agressivité et la violence. Nous avons considéré l’impact de cette perception sur la manière d’offrir des soins, plus particulièrement en ce qui a trait aux mesures coercitives (mesures d’isolement avec ou sans contentions), lors des hospitalisations. Les cinq études ont appuyé l’idée d’une spécificité clinique tant sur le plan des profils cliniques des individus que sur la manière d’offrir les services, spécialement au niveau des mesures de contrôles. Les caractéristiques de la personne et de l’environnement semblent de ce fait jouer un rôle important dans le type de services que recevra un individu souffrant de TMG. Ces travaux ouvrent sur la possibilité de mieux déterminer l’étiologie et la gestion de la violence de même que la manière dont le système s’occupe des patients à risque de violence. / Since deinstitutionalization in psychiatry, it has often been mentioned that individuals who in the past would have been cared for in psychiatric hospitals are today ending up in forensic hospitals or, worse, in prison. Meanwhile, several authors have reported that individuals with severe mental illness are more likely to commit antisocial acts or violence. In respect of this issue, we support the clinical specificity model. It specifies that psychopathological profiles increase the risk of violence and lead to different types of social functioning. The environment has also a modulating effect on the functioning of the individual distinctiveness. A bidirectional relationship is built between the specific psychopathology and the environment, particularly with regard to interpersonal relationships, socioeconomic background, the pattern of psychiatric services use and the interaction with the justice system that subsequently determine the type of care or patient's legal status. To support this hypothesis, we examined the profiles of patients with severe mental illness based on legal status and care setting (general psychiatry and forensic psychiatry) and the use of seclusion and restraint. Patients were evaluated by sociodemographic measures (indicators of social functioning, interpersonal relationships and socioeconomic background) and measures of psychodiagnostic (SCID-I and II) and psychopathy. In addition, criminal records, official provincial government physician-billing and hospitalization files (MED-ECHO and Medicare) were observed. The designs were retrospectives. Moreover, in order to explore the subjective perception of aggression and violence of mental health workers, the level of interaction that occurs between psychiatric services and the individual suffering from severe mental illness, were evaluated. We considered the impact of this perception on how to provide care, particularly with respect to coercive measures (measures of seclusion with or without restraints) during hospitalization. The five studies have supported the clinical specificity of both the clinical profiles of individuals and the way to deliver services, especially coercion. The characteristics of the individual and the environment seem to play an important role in the type of service received by an individual with severe mental illness. This work opens the possibility in subsequent studies to better determine the etiology of aggression, how to manage violence and to identify the care offered on the issue.