New Book on Psychopathy edited by Prof. Michael Fitzgerald

Psychopathy: Risk Factors, Behavioral Symptoms and Treatment Options
Psychopathy: Risk Factors, Behavioral Symptoms and Treatment Options
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Editors: Michael Fitzgerald (Department of Psychiatry, Trinity College Dublin (TCD), Dublin, Ireland)
Book Description:
Psychopathy is one of the most serious and challenging conditions that society and mental health professionals face. The consequences of the actions of persons with psychopathy on other individuals or society at large are very great. Persons with psychopathy are extremely difficult to treat and indeed some treatments in the past have been shown to cause deterioration affects. This book explores the issue of psychopathy from the point of view of the individual with psychopathy, brain aspects of the condition, cultural aspects, treatment aspects and it’s relation to autism and other empathy disorder which it can on occasion overlap with.
Offenders with high levels of psychopathy are among the most challenging persons mental health professionals have to treat. They need very careful and skilled interventions. Chromis is an innovative programme described by Tew, Bennett and Atkinson which shows promise. It is a future focused programme which pays attention to control and choice, collaboration and transparency and has a cognitive skills component, a motivation and engagement components. Marc Wilson and Samantha Harley have an interesting chapter on narcissism, psychopathy and Machiavellianism. They found a relationship between vertical individualism and all three constructs and between hierarchical and narcissism. Their conclusions suggest that hierarchical, autonomous societies may socialise members in such a way that may foster aversive personalities. Don Ambrose in his chapter on unmeritorious meritorocy focuses on a topic that severely affected almost everyone in the developed world in some way. He highlights the admiration for businessmen with psychopathic traits and the negative consequences of this. In the chapter on criminal autistic psychopathy Fitzgerald highlights the overlap between psychopathy and autism. Hans Asperger in his initial descriptions recognised the overlap between psychopathy and autism with his term autistic psychopathy. This idea faded from view over the last thirty years because there was a wish to separate autism from psychopathy. This wish did not prevent the overlap. Fitzgerald (2010) has introduced the sub group of autism spectrum disorders called criminal autistic psychopathy to cover the section of the spectrum where criminality occurs. It links with the new work on callous and unemotional traits (Fitzgerald 2003) and with mass killings, school and other location shootings where criminal autistic psychopathy is not rare.The chapter on cognitive neuroscience in child and adolescent psychopathy by Halty and Prieto point out among other issues that in the case of children with psychopathic features there is evidence of fewer references to welfare of victims when they have to justify transgressions. The chapter by Halty and Prieto on psychopathy in child and adolescent populations discuss the issue of psychopathy in children and adolescents and the importance of callous and unemotional traits as well as the influence of parenting practices in the development of child and adolescent psychopathy. Laura Nunes’s chapter on psychopathy: risk factors and behavioural symptoms focuses on treatment of options in extremely difficult area and proposes a biogram. In the chapter on Hans Asperger autistic psychopathy revisited focuses on the neglected paper of 1938 long before Leo Kanner wrote his paper on autism. Asperger worked on this topic throughout the 1930’s. It also focuses on the differential diagnosis of autism and schizophrenia, obsessive compulsive disorder and other personality disorders. Ana Calzada and colleagues give us a very important chapter on brain scanning and psychopathy. These neuroanatomic differences in violent individuals are very important in terms of aetiology diagnosis and treatment problems and important areas for future research. (Imprint: Nova)References:
Fitzgerald M. (2003) Callous-Unemotional Traits and Asperger’s Syndrome. Journal of the American Academy of Child and Adolescent Psychiatry 42, 9, 10-11.
Fitzgerald M. (2001) Autistic Psychopathy. Journal of the American Academy of Child and Adolescent Psychiatry 40, 8, 870.
Fitzgerald M. (2010) Young Violent and Dangerous to Know. Nova Science: New York.
Table of Contents:
PrefaceChapter 1. The Treatment of Offenders with High Levels of Psychopathy through Chromis and the Westgate Service: What have we Learned from the Last Eight Years?
(Jenny Tew, A.L. Bennett and R. Akinson, National Offender Management Service, Ministry of Justice, United Kingdom and The Centre for Forensic and Criminological Psychology, The University of Birmingham, Birmingham, England; The Westgate Personality Disorder Treatment Service, HMP Frankland, and National Offender Management Service, Ministry of Justice, UK)Chapter 2. Psychopathy: A Proposal for an Integrated Evaluation
(Laura M. Nunes, Fernando Pessoa University, Oporto / Portugal)Chapter 3. MRI Study in Psychopath and Non-Psychopath Offenders
(Ava Calzada-Reyes, Alfredo Alvarez-Amador, Mitchell Valdes-Sosa, Lester Melic-Garcia, Alonso Y. Aleman and Jose del Carmen Iglesias-Alonso, Department of Clinical Neurophysiology, Institute of Legal Medicine, Independence Avenue, Plaza, Havana City; Cuban Center of Neuroscience, Havana City and Department of Clinical Neurophysiology, Carlos Juan Finlay, General Hospital, Havana, Cuba)Chapter 4. Unmeritorious Meritocracy: The Ascendance of Psychopathic Plutocracy in the Globalized 21st-Century
(Don Ambrose, Rider University in Lawrenceville, New Jersey, US)

Chapter 5. Narcissism, Psychopathy and Machiavellianism: Associations between Cultural Factors and Interpersonal Dominance
(Marc Stewart Wilson and Samantha M. Hartley, School of Psychology, Victoria University of Wellington, New Zealand)

Chapter 6. Hans Asperger’s Autistic Psychopathy: Revisited
(Michael Fitzgerald, Department of Psychiatry, Trinity College Dublin (TCD), Dublin, Ireland)

Chapter 7. Criminal Autistic Psychopathy.
(Michael Fitzgerald, Department of Psychiatry, Trinity College Dublin (TCD), Dublin, Ireland)

Chapter 8. Stability of Psychopathic Traits in Youth: Long-term Trends and Comparisons with the Stability of the Five Factor Model of Personality
(Mary Ann Campbell, Rosemary Beauregard and Fred Schmidt, Psychology Department & Centre for Criminal Justice Studies, University of New Brunswick-Saint John Campus, Saint John, New Brunswick; Children’s Centre Thunder Bay, Thunder Bay, Ontario; Psychology Department, Lakehead University, Thunder Bay, Ontario, and Centre for Criminal Justice Studies, University of New Brunswick-Saint John Campus,
New Brunswick, Canada)

Chapter 9. Disordered Self in Schizophrenia and Autism Spectrum Disorders. The Autisms and the Self.
(Michael Fitzgerald and Victoria Lyons, Department of Psychiatry, Trinity College Dublin (TCD), Dublin, Ireland)

Chapter 10. Exploring Treatment Options for an Allegedly “Untreatable” Disorder, Psychopathy: An Integrative Literature Review
(Chasity Bailey, Rahul Sehgal, Adrian Coscia, Deborah Shelton, University of Connecticut, Center for Correctional Health Networks-CCHNet, School of Nursing, CT, USA, and others)

Index

Series:
Psychiatry – Theory, Applications and Treatments
   Binding: ebook
   Pub. Date: 2014
   Pages: 7×10 – (NBC-C)
   ISBN: 978-1-63463-090-0
   Status: AN

Recent Activities

Prof Michael Fitzgerald

M. McDermott, M. Duffy, A. Percy, M. Fitzgerald, C. Cole (2013) “A school Based Study of Psychological Disturbance in Children Following the Omagh Bomb” Child and Adolescent Psychiatry and Mental Health, 7/36 (peer reviewed)

Fitzgerald. M., (2014) “Overlap Between Autism and Schizophrenia: History and Current Status” Advances in Mental Health and Intellectual Disabilities, 8,1,15/23 (peer reviewed)

Not Peer Reviewed Fitzgerald , M., (2013) “Author Response: All Future Psychiatrists Should be Neuro-Psychiatrists” The Psychiatrist, 37,12,404

Appointment on Editorial Board,  Journal of Autism and Developmental Disorders 2014

Fitzgerald M., (2012) “Schizophrenia and Autism/Aspergers Syndrome: Overlap and Difference”, Clinical Neuro-Psychology, IX,4,171/176 (peer reviewed)

Skeppar P. Thorr R. Agren S. Skeppar I. Parson B., Fitzgerald M. (2013) “Neuro-developmental Disorders with Co-Morbid Affective Disorders Sometimes Produce Psychiatric Conditions Traditionally Diagnosed as Schizophrenia” Clinical Neuropsychiatry 10 3/4, 123/133(peer reviewed)

Cleary L., Looney I.K. Brady N., Fitzgerald M., (2013) “Inversion Effects in the Perception of the Moving Human Form: a Comparison of Adolescents with Autism Spectrum Disorder and Typically Developing Adolescents” Autism, DOI: 10,1177/136236131349945

Cleary L., Fitzgerald M., Brady N., Gallagher L., (2014) “Holistic Processing of Faces as Measured by the Thatcher Illusion is Intact in Autism Spectrum Disorders” Autism DOI:10.1177/1362361314526005 (peer reviewed)

Fitzgerald M., McNicholas F., (2014) “Attitudes and Practices in the Management of ADHD Among Healthcare Professionals who Responded to a European Survey”  Irish Journal of Psychological Medicine 31,31/37 (peer reviewed)

Not Peer ReviewedFitzgerald M., (2014) “Unfair Playing Field”, Psychiatric Bulletin 38,2,87

(peer reviewed) Caci H., Anderson P., Donfrancisco R., Farone S., Fitzgerald M., Doepfner M., (2014) “Daily Life Impairments Associated with Childhood/Adolescent ADHD as Recalled by Adults: Results from the European Lifetime Impairment Survey” CNS Spectrums, 1/10 DOI: http://dx.doi.org/10.1017/s1092852914000078

Not Peer Reviewed Fitzgerald M, Molneux G.,(2004) “Overlap Between Alexithymia and Aspergers Syndrome”, American Journal of Psychiatry, 161:11, 2134-2135
(peer reviewed) Caci H., Doepfner M., Asherson P., Donfrancesco R., Farone S., Herves A.,  Fitzgerald M., 214 (2013) “Daily Life Impairments Associated with Self/Reported Childhood/Adolescent Attention Deficit Hyperactivity Disorder and the Experiences of Diagnosis and Treatment: Results from the European Lifetime Impairment Survey”  European Psychiatry, 29,316/323

Malaysia: Observations on Psychiatry and Society during a visit.

When people think of Malaysia what first comes to mind are the Petronas Twin Towers of Kuala Lumper.  It has a population of about 25 million.  The British during their time there left good structures which are benefiting Malaysia today unlike the behaviour of the Dutch in Indonesia.

 

During my time there I spent most of my time in Penang and at the Penang Medical School associated with RCSI and UCD. The founder of Penang was Francis Light who is reported to have hit upon a cunning method of getting the surrounding jungle cleared to make way for the town.  He loaded a canon with Spanish Silver Dollars, fired them into the forest, and invited local labourers to hack their way through the undergrowth to get to the money. Alfred Russell Wallace who discovered the evolution of the species at the same time as Charles Darwin lived in Malaysia.  The climate is warm and balmy.  The cost of living is much cheaper than Ireland and one can have an excellent dinner for €8.  Some companies are moving out of Malaysia to China because of cheaper labour in the same way they are moving out of Ireland.  Welfare is provided through Religious Organisations rather than the State. There is massive pressure on the children at school particularly Chinese children and grinds start from the age of six onwards.  Walking around the parks one sees endless monkeys roaming free. I was also told that the hills behind Penang have interesting walks but cobra snakes tend to frequent these places.  I was told that they didn’t attack one if they weren’t disturbed.  I decided this was an experiment that I wouldn’t make.  The “Ryanair” airline of Malaysia is called Air Asia and works on the exact same model.  I observed construction workers from my hotel window working 40 storeys up without protection. It made me dizzy to watch them.  It reminded me of the Irish workers in the early days of Manhattan while working on the skyscrapers worked also without protection.  There are endless motorbikes there who weave in and out quite similar to the couriers in Dublin but much more dangerously and much faster. People on motorbikes wear their coats back to front as this helps the circulation of air.

 

The Penang Medical College is extremely successful. It is approximately ten years old now. On my first day I met the Dean Amir and the President of the College Rathlingan a Physicist.  I had a chat with Professor William Shannon from RCSI who told me about developments in general practice in Malaysia.  He pointed out that there was major need for development of professional training programmes for General Practitioners. I was told that Dean Muiris Fitzgerald has been a regular visitor particularly in relation to graduation issues.  They were looking forward to Professor Niall O’Higgins President of the Royal College of Surgeons in Ireland visit soon. Professor Noel Walsh was a distinguished Professor of Psychiatry at UCD and spent a number of years as a pioneer with the Penang Medical College where he learned to speak Malay to huge approval of the local population.  I also visited a Centre called the Lion Centre for children with autism which works along similar lines to Centres in Ireland.  They gave me a book called The Reach Way to Transformation which had a Foreword by Professor Noel Walsh.  He arranged for medical students to visit this Centre during their undergraduate training. I was told that medical education can cost up to 150,000 Euros but that there are scholarships.  I met quite a number of medical students who the previous year had been at the Royal College of Surgeons in Ireland for their earlier medical education.  I had eleven professional / parent contacts during my visit there including five lectures and meetings with parents of children with autism, meeting with professionals, visits to Inpatient Psychiatric Units, and Outpatient Child and Adult Psychiatric Services.

 

In the Child Psychiatric Outpatients I met Dr. Lai a Child Psychiatrist.  On his wall he had a poster giving 88 ways to praise a child and another poster stating that families must try to achieve marital and family harmony.  I observed custody and access discussions there which were identical to Ireland using the same language and just as acrimonious. In the Child Psychiatric Outpatients they used the Swan Scales for Attention Deficit Hyperactivity Disorder and also the Vanderbilt Attention Deficit Hyperactivity Disorder Diagnostic Teachers Rating Scale.  The rates of Attention Deficit Hyperactivity Disorder seem very common and the treatments were the same as in Ireland.  The standard of psychiatry was the same as in Ireland.  In the Adult Psychiatric Outpatients some of the conditions would be different from Ireland in that there was koro which is the feeling that the penis is being withdrawn into the abdomen, amok and latah.  It seemed easier to diagnose psychosis because as in Uganda I observed that patients were more willing to be explicit about their psychotic symptoms.  The Adult Psychiatrists were doing research work on Sertindole which is a medication for the treatment of psychosis.  There are about 10 million children under 17 in Malaysia, 14 Child Psychiatrists which works out at about one Child Psychiatrist per 800,000.  I was pleased that the interest of the services was in providing direct assistance to patients rather than sitting around in teams discussing patients. I liked the Malaysians very direct way of seeing patients and helping them out to the best of their ability without the ‘team games’ so prevalent in other countries.  Of course teams are very relevant for about 5% of referrals where one is dealing with very complex psychological, social and psychiatric situation.

 

I had an opportunity to lecture to professionals from Penang as well as from the mainland up to the Thai border and I became aware that people with multiple disabilities tended to be placed together. This was not ideal but persons with autism were beginning to be separated out for their own services.

 

I met Professor Leela Ryan who is a much appreciated Consultant Psychiatrist in the South Western Area Health Board in the Naas Hospital is now playing a major role in Psychiatry in the Penang Medical School and is a key figure there.

 

I met Professor Saroja who is head of the Psychiatric Department and during the Tsunami which hit Malaysia and drowned people she developed with her colleagues an excellent Early Intervention Programme which was used throughout Asia.

 

Because of overcrowding in some schools, schools have one group of pupils coming in the morning and a second group of pupils coming in the afternoon.  This reminded me of Makere University in Uganda where some students would attend in the middle of the night because of a lack of places etc. during the day. Many of the population were Muslim and I was very impressed by their behaviour and the kind of country they had created with brilliant Chinese businessmen and Indians.  Nevertheless I did notice some concerns in the front page of a local newspaper which had the headline “Hugging and kissing in public:  freedom or indecent behaviour?”.  Malaysia is a country which symbolises Asia and is worthwhile a visit.  There is a mix of private and public hospitals just as in Ireland and medical tourism is big business particularly from Indonesia.  The issues that they have to face particularly in relation to infections are massively different from the issues in Africa.

 

A Visit to Uganda

Uganda is very much in the news at the moment because of the national elections and the unjustifiable controversy over Irish aid to Uganda, which in my opinion is well spent and accounted for.  Uganda is a very poor country, which has been ravaged by war in the not too distant past.  You can still see burnt out tanks at the side of the road.  Security is a big issue and expensive in Uganda.  My Hotel had three ring of security – the outer ring having armed guards. The second ring checked for guns which were not allowed in the Hotel.  The third or inner ring of security protected the bedrooms. Not surprising I did not see any of the “Irish glitterati” on holiday or buying holiday homes.  Uganda is on the equator, with wonderful sunshine and low humidity during my visit.

 

I also saw birthday parties for children in Uganda and weddings, which wouldn’t be out of place in Shrewsbury Road, Dublin 4. There is a privileged class as well. There is much greater in general family support in Uganda compared to Ireland.  Rejecting families of the kind that you see in Ireland are much less common in Uganda and when they occur, they occur within the more educated classes.

 

The people dress very neatly and well.  Because most of them are not overweight obviously then can carry clothes very well.  At weddings the attire is simply magnificent.  The average wage of people in the Hotel industry is 100 dollars per month. The hours are extremely long.

 

In Uganda particularly in the less educated classes polygamy is a status symbol and so a man having three, four or more wives is not uncommon. I wonder how Family Therapists or the Mater Hospital would handle this kind of family?

 

At the time I was there families were storing up on flour / grain for fear of social political implosion and there was a lot of anxiety and confusion about the upcoming presidential election.  The leader of the opposition had been jailed. It was December 2005 the beginning of the national elections.  I saw massive gatherings of political supporters with much noise.  There is considerable fear in Africa of the growth of the “Mugabe syndrome”.

 

As you walk around you see endless people walking appearing to walk forever and then other huge numbers of men sitting around under employed. The pace of life is about one fifth that of Ireland.  In the northern area where the Civil War is raging everybody has to go into the compounds at 3 p.m. in the evening for fear of attack or abduction.

 

Children are abducted and used as basically sex slaves for commanders of the rebel army.  When these come back or rescued they often describe that they have been the “wife” of a commander.  The higher up the commander that they have been the more status they have.  When they are abducted their first task maybe to kill their parents.  Caroline Moorehead pointed out that the Lord’s Resistance Army appeared to be defeated in 2002 but then abducted a further 8,400 children.  There are about 300,000 child soldiers in the world.

 

In one tribe the men sit around all day drinking a low alcohol brew and everybody drinks from this central container while the women go out to work the fields etc.  Children have their first taste of alcohol at baptism.  It is hardly surprising alcohol problems are a major feature.  Since the Afghan war drugs are being re-routed through Africa that formally went through Europe and this has led to increased drug problems in Africa.

 

The largest Hospital has a 9 year old CT scan which has scanned over 10,000 patients.  In this Hospital there is a ratio of 1 nurse to 20 patients during the day and 1 nurse to 50 patients at night.  The largest Hospital has a 1500 bed capacity and 80 to 100 deliveries per day of babies. I read in a newspaper that 53 is “a very advanced age”.

 

I attended psychiatric inpatient assessments and I saw HIV, syphilis, and many organic psychosis.  In the psychiatric setting it is not uncommon for HIV to present as an acute manic psychosis.

 

There was a great deal of police contact in relation to inpatients. I also saw traditional family problems.  An OPD session would have 50 patients for one psychiatrist.  There was 3 to 10 patients admitted per day in the Hospital. I worked with a psychiatric clinical officer which is basically a CPN who has permission to diagnose and treat psychiatric illness. She was superb in her diagnosis, assessment, and medical treatment.  Certainly we are going to see more of these performing throughout the world in the future.  Long waiting lists particularly in Child Psychiatry in Ireland could be solved if we had child psychiatric clinical officers who had extra training i.e. child psychiatric nurses with some extra training maybe in diagnosis and assessment so that they could assess people on the waiting list and referred more complex cases for multidisciplinary or child psychiatric assessment.  There was none of these endless wasteful multidisciplinary team meetings so common in Ireland.  The psychopathology was much more severe than we would see in Ireland.

 

The quality of the Registrars is similar to Ireland. I heard of one case while I was there where a traditional healer had fractured the skull of a patient.  This traditional healer as part of his treatment was to beat the patient.  The medications they use in the public service are Chlorpromazine, tricyclics, Haloperidol, diazepam, Chlordiazepoxide and lithium.  Psychologists have Cognitive Behavioural Therapy orientation.  In the Hospital the patients were uniformed in blue, green, etc..  The junior doctors wear white coats.

 

Every time a doctor or other health professional is taken from a developing country and retained in Ireland the government as part of its development aid should repay the full cost that the developing country had invested in training this health professional.  Ireland undermines health care in developing countries by taking vital health care professionals from them.

 

Christmas is a small event. I noticed no evidence in Entebbe Airport (famous for the Israeli raid on Entebbe) but I heard Silent Night being sung on the radio in Nairobi Airport three days before Christmas but that was about it.