Andrew Bickle | Queen's University at Kingston (original) (raw)
Papers by Andrew Bickle
The journal of forensic psychiatry & psychology, Feb 19, 2024
Trials
Background Challenging behaviours, in particular aggressive behaviours, are prevalent among peopl... more Background Challenging behaviours, in particular aggressive behaviours, are prevalent among people with intellectual developmental disabilities. Predictors of challenging behaviours are numerous, including past history of aggression, poor coping skills and impulsivity. Factors like motor or rapid-response impulsivity (RRI) have neurobiological underpinnings that may be amenable to change via neuromodulation using non-invasive brain stimulation techniques like transcranial direct current stimulation (tDCS). Methods This study aims to determine the efficacy of anodal tDCS in reducing RRI and incidents of aggression in people with intellectual developmental disabilities (IDD) in residential or hospital settings. Using a single blind, randomised, sham-controlled trial design, adults with IDD, with a history of impulsivity leading to aggression, will be randomised to receive either repetitive anodal or sham tDCS applied to the left dorsolateral prefrontal cortex. Outcome measures assessi...
Phallometry is an objective method of assessing male sexual arousal. The main applications in for... more Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted of sexual offences, the evaluation of those with suspected paraphilias not subject to the criminal justice system, risk assessment and measurement of response to sex offender treatment. In some jurisdictions, phallometry is incorporated into legal decisions about release from custody or discharge from secure hospitals. This paper provides a brief overview of the international development of phallometry, considers challenges to its broader adoption and discusses future directions for research and clinical practice.
Background Challenging behaviours, in particular aggressive behaviours, are prevalent among peopl... more Background Challenging behaviours, in particular aggressive behaviours, are prevalent among people with intellectual developmental disabilities. Predictors of challenging behaviours are numerous, including past history of aggression, poor coping skills and impulsivity. Factors like motor or Rapid Response Impulsivity (RRI), have neurobiological underpinnings that may be amenable to change via neuromodulation using non-invasive brain stimulation techniques like transcranial Direct Current Stimulation (tDCS). Methods This study aims to determine the efficacy of anodal tDCS in reducing RRI and incidents of aggression in people with intellectual developmental disabilities (IDD) in residential or hospital settings. Using a single blind, randomized, sham-controlled trial design, adults with IDD, with a history of impulsivity leading to aggression, will be randomised to receive either repetitive anodal or sham tDCS applied to the left dorsolateral prefrontal cortex. Outcome measures assess...
Psychiatric Bulletin, May 1, 2008
and how they should be working and, instead of introducing flexibility, enforce rigidity. They lo... more and how they should be working and, instead of introducing flexibility, enforce rigidity. They lose person-centred holistic care by replacing skilled clinicians with tick-box policies and procedures (Drife, 2006) for people working beyond their competencies.
BJPsych International
The unique challenges of the correctional healthcare environment are well-documented. Access to c... more The unique challenges of the correctional healthcare environment are well-documented. Access to community-equivalent care, voluntary informed consent of offenders with mental disorder, violence risk, suicide risk, medication misuse, and clinical seclusion, confinement and segregation are just a few of the challenges faced by correctional psychiatric services. This paper shares experiences for dealing with the ongoing challenges for psychiatrists working in the field. It provides an overview of the current state of mental healthcare in the federal correctional system in Canada, the legislative framework and initiatives aimed at addressing the healthcare needs of federal inmates.
The Journal of Forensic Psychiatry & Psychology
In England and Wales prisoners with mental disorder of such severity as to warrant inpatient trea... more In England and Wales prisoners with mental disorder of such severity as to warrant inpatient treatment may be transferred to hospital under the Mental Health Act. UK Government guidance recommends that this process should be completed within 14 days; however, evidence suggests that in many cases it can take much longer. This retrospective service evaluation of 64 male prisoners, who were transferred under Section 47 or Section 48, aimed to evaluate transfer durations. The mean time from referral to admission was 76 days. Prisoners with a psychotic disorder were admitted more quickly. Remand prisoners were admitted more quickly than sentenced prisoners. Findings suggest that, in the UK the transfer time of prisoners under Sections 47 and 48 of the Mental Health Act continues to far exceed the 14 day target which raises concern about equivalence of care for prisoners. Our findings support arguments for fundamental amendments to the admissions process.
The Journal of Forensic Psychiatry Psychology, Oct 27, 2008
Psychiatric Bulletin, 2006
Medicine, Science and the Law, 2008
The Criminal Justice Act 2003 ('the Act') introduced significant changes to the s... more The Criminal Justice Act 2003 ('the Act') introduced significant changes to the sentencing of violent and sexual offenders. The Act brought in a statutory assessment of dangerousness which includes a statutory assumption of dangerousness ('SAD') for certain repeat offenders. Previously, expert psychiatric witnesses have commented on whether a defendant demonstrated sufficient mental instability to warrant a discretionary life sentence. Under this regime, psychiatric evidence is adduced to the assessment of dangerousness, especially for the purpose of supporting or undermining a rebuttal of the statutory assumption. This study investigated how legal referrers are instructing psychiatrists in cases where on conviction there will be an automatic assumption that the offender is dangerous. The aim was to determine whether the requirements of the new law are being outlined to expert witnesses and how much notice is being given for the production of evidence. All referrals to a medium secure unit were surveyed over two years. Fifty-one referrals concerned defendants liable to the SAD on conviction. The majority of the SAD referrals (40 referrals = 78.4%) included no request to comment on risk or dangerousness. This figure did not fall over time as the Act became established. Only a small minority (5.9%) of instructions directed the psychiatrist to the relevant statutory provisions. On average, adequate notice appeared to be given for the production of evidence (45.6 days). In the authors' view, legal referrers should make more explicit the requirements of psychiatric evidence in such cases. New legislation currently before Parliament would amend further the sentencing of such offenders, but there would remain a statutory assessment of dangerousness as the basis of sentencing violent and sexual offenders. Psychiatrists wishing to act as expert witnesses should be aware of the contents of the statutory assessment and be prepared to liaise with legal counsel to clarify instructions.
Journal of Forensic Psychiatry & Psychology, 2011
The aim of this study was to report on forensic rehabilitation inpatients' experiences a... more The aim of this study was to report on forensic rehabilitation inpatients' experiences and preferences for physical restraint, seclusion and emergency intra-muscular medication using mixed qualitative and quantitative methods. Of 252 inpatients, 79 met the study inclusion ...
The Journal of Forensic Psychiatry & Psychology, 2013
Serious adverse incidents in secure psychiatric hospitals are infrequent but significant events. ... more Serious adverse incidents in secure psychiatric hospitals are infrequent but significant events. The frequency and characteristics of escape, absconsion, homicide and suicide in English high-secure hospitals have been described, but no research has been dedicated to hostage-taking. In this study, we collected details about all hostage-taking incidents in one high-secure hospital, Rampton Hospital, over a 25-year period (1984-2009). We identified four incidents. All were perpetrated by male patients. In two cases, the victims were female staff and in the other two cases, the victims were male patients. All incidents were planned; two involved the use of a weapon. None of the incidents was driven by acute symptoms of mental illness. None resulted in serious injury or in prosecution. Three patients had a history of hostage-taking. Whilst hostage-taking is a serious event, it is extremely rare and appears to be successfully managed in a highly structured and well-staffed environment.
Advances in Psychiatric Treatment, 2004
Psychiatric Bulletin, 2005
The journal of forensic psychiatry & psychology, Feb 19, 2024
Trials
Background Challenging behaviours, in particular aggressive behaviours, are prevalent among peopl... more Background Challenging behaviours, in particular aggressive behaviours, are prevalent among people with intellectual developmental disabilities. Predictors of challenging behaviours are numerous, including past history of aggression, poor coping skills and impulsivity. Factors like motor or rapid-response impulsivity (RRI) have neurobiological underpinnings that may be amenable to change via neuromodulation using non-invasive brain stimulation techniques like transcranial direct current stimulation (tDCS). Methods This study aims to determine the efficacy of anodal tDCS in reducing RRI and incidents of aggression in people with intellectual developmental disabilities (IDD) in residential or hospital settings. Using a single blind, randomised, sham-controlled trial design, adults with IDD, with a history of impulsivity leading to aggression, will be randomised to receive either repetitive anodal or sham tDCS applied to the left dorsolateral prefrontal cortex. Outcome measures assessi...
Phallometry is an objective method of assessing male sexual arousal. The main applications in for... more Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted of sexual offences, the evaluation of those with suspected paraphilias not subject to the criminal justice system, risk assessment and measurement of response to sex offender treatment. In some jurisdictions, phallometry is incorporated into legal decisions about release from custody or discharge from secure hospitals. This paper provides a brief overview of the international development of phallometry, considers challenges to its broader adoption and discusses future directions for research and clinical practice.
Background Challenging behaviours, in particular aggressive behaviours, are prevalent among peopl... more Background Challenging behaviours, in particular aggressive behaviours, are prevalent among people with intellectual developmental disabilities. Predictors of challenging behaviours are numerous, including past history of aggression, poor coping skills and impulsivity. Factors like motor or Rapid Response Impulsivity (RRI), have neurobiological underpinnings that may be amenable to change via neuromodulation using non-invasive brain stimulation techniques like transcranial Direct Current Stimulation (tDCS). Methods This study aims to determine the efficacy of anodal tDCS in reducing RRI and incidents of aggression in people with intellectual developmental disabilities (IDD) in residential or hospital settings. Using a single blind, randomized, sham-controlled trial design, adults with IDD, with a history of impulsivity leading to aggression, will be randomised to receive either repetitive anodal or sham tDCS applied to the left dorsolateral prefrontal cortex. Outcome measures assess...
Psychiatric Bulletin, May 1, 2008
and how they should be working and, instead of introducing flexibility, enforce rigidity. They lo... more and how they should be working and, instead of introducing flexibility, enforce rigidity. They lose person-centred holistic care by replacing skilled clinicians with tick-box policies and procedures (Drife, 2006) for people working beyond their competencies.
BJPsych International
The unique challenges of the correctional healthcare environment are well-documented. Access to c... more The unique challenges of the correctional healthcare environment are well-documented. Access to community-equivalent care, voluntary informed consent of offenders with mental disorder, violence risk, suicide risk, medication misuse, and clinical seclusion, confinement and segregation are just a few of the challenges faced by correctional psychiatric services. This paper shares experiences for dealing with the ongoing challenges for psychiatrists working in the field. It provides an overview of the current state of mental healthcare in the federal correctional system in Canada, the legislative framework and initiatives aimed at addressing the healthcare needs of federal inmates.
The Journal of Forensic Psychiatry & Psychology
In England and Wales prisoners with mental disorder of such severity as to warrant inpatient trea... more In England and Wales prisoners with mental disorder of such severity as to warrant inpatient treatment may be transferred to hospital under the Mental Health Act. UK Government guidance recommends that this process should be completed within 14 days; however, evidence suggests that in many cases it can take much longer. This retrospective service evaluation of 64 male prisoners, who were transferred under Section 47 or Section 48, aimed to evaluate transfer durations. The mean time from referral to admission was 76 days. Prisoners with a psychotic disorder were admitted more quickly. Remand prisoners were admitted more quickly than sentenced prisoners. Findings suggest that, in the UK the transfer time of prisoners under Sections 47 and 48 of the Mental Health Act continues to far exceed the 14 day target which raises concern about equivalence of care for prisoners. Our findings support arguments for fundamental amendments to the admissions process.
The Journal of Forensic Psychiatry Psychology, Oct 27, 2008
Psychiatric Bulletin, 2006
Medicine, Science and the Law, 2008
The Criminal Justice Act 2003 ('the Act') introduced significant changes to the s... more The Criminal Justice Act 2003 ('the Act') introduced significant changes to the sentencing of violent and sexual offenders. The Act brought in a statutory assessment of dangerousness which includes a statutory assumption of dangerousness ('SAD') for certain repeat offenders. Previously, expert psychiatric witnesses have commented on whether a defendant demonstrated sufficient mental instability to warrant a discretionary life sentence. Under this regime, psychiatric evidence is adduced to the assessment of dangerousness, especially for the purpose of supporting or undermining a rebuttal of the statutory assumption. This study investigated how legal referrers are instructing psychiatrists in cases where on conviction there will be an automatic assumption that the offender is dangerous. The aim was to determine whether the requirements of the new law are being outlined to expert witnesses and how much notice is being given for the production of evidence. All referrals to a medium secure unit were surveyed over two years. Fifty-one referrals concerned defendants liable to the SAD on conviction. The majority of the SAD referrals (40 referrals = 78.4%) included no request to comment on risk or dangerousness. This figure did not fall over time as the Act became established. Only a small minority (5.9%) of instructions directed the psychiatrist to the relevant statutory provisions. On average, adequate notice appeared to be given for the production of evidence (45.6 days). In the authors' view, legal referrers should make more explicit the requirements of psychiatric evidence in such cases. New legislation currently before Parliament would amend further the sentencing of such offenders, but there would remain a statutory assessment of dangerousness as the basis of sentencing violent and sexual offenders. Psychiatrists wishing to act as expert witnesses should be aware of the contents of the statutory assessment and be prepared to liaise with legal counsel to clarify instructions.
Journal of Forensic Psychiatry & Psychology, 2011
The aim of this study was to report on forensic rehabilitation inpatients' experiences a... more The aim of this study was to report on forensic rehabilitation inpatients' experiences and preferences for physical restraint, seclusion and emergency intra-muscular medication using mixed qualitative and quantitative methods. Of 252 inpatients, 79 met the study inclusion ...
The Journal of Forensic Psychiatry & Psychology, 2013
Serious adverse incidents in secure psychiatric hospitals are infrequent but significant events. ... more Serious adverse incidents in secure psychiatric hospitals are infrequent but significant events. The frequency and characteristics of escape, absconsion, homicide and suicide in English high-secure hospitals have been described, but no research has been dedicated to hostage-taking. In this study, we collected details about all hostage-taking incidents in one high-secure hospital, Rampton Hospital, over a 25-year period (1984-2009). We identified four incidents. All were perpetrated by male patients. In two cases, the victims were female staff and in the other two cases, the victims were male patients. All incidents were planned; two involved the use of a weapon. None of the incidents was driven by acute symptoms of mental illness. None resulted in serious injury or in prosecution. Three patients had a history of hostage-taking. Whilst hostage-taking is a serious event, it is extremely rare and appears to be successfully managed in a highly structured and well-staffed environment.
Advances in Psychiatric Treatment, 2004
Psychiatric Bulletin, 2005