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Biomedical subjects

Paul E Mullen

Publications and source records attributed to Paul E Mullen.

At least 19 recordsLinked to original sources
PubMed2006

Identifying risk factors in stalking: a review of current research.

Stalking is a behaviour which can cause substantial damage to its victims, whether the perpetrator is violent or not. Victims face a range of risks including not only assault, but persistent or recurrent stalking and varying degrees of psychological and social damage. The responsibility for assessing and managing these risks often falls to the mental health professional, yet the emerging stalking risk assessment literature is at too early a stage to provide clinicians with empirically derived evidence upon which to base their clinical practice. This paper reviews existing research to identify those factors currently believed to be associated with increased risk of physical and sexual assault; with persistent and/or recurrent stalking; and, with psychological and social damage.

Crime↗
PubMed2006

A modest proposal for another phenomenological approach to psychopathology.

In 1912, Karl Jaspers published an article entitled "The Phenomenological Approach to Psychopathology." This and his subsequent text, General Psychopathology, was to exert a profound influence on the development of psychiatry in general and psychiatric nosology in particular. The current Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases both reflect, at least in part, that legacy. This article will argue that the descriptive psychopathology of Jaspers has been gradually transformed into a caricature which has substituted authority for enquiry and simplification for subtlety. We have been left with classificatory systems which impose reified categories increasingly at variance with clinical reality and increasingly divorced from the data generated by scientific enquiry. Returning to the phenomenological method, despite its contradictions, may open the way to clinical and research approaches which free us from the current straight jacket of orthodoxy which is impending our progress.

Delusions↗
PubMed2006

Vexatious litigants and unusually persistent complainants and petitioners: from querulous paranoia to querulous behaviour.

Querulous paranoia was once of considerable clinical and academic interest in psychiatry. Over the last 40 years, however, it has virtually disappeared from the professional landscape. This decline occurred at the very time that a proliferation of complaint organizations and agencies of accountability were drawing more and more people into asserting their individual rights through the pursuit of claims and grievances. Querulous behaviour, as a result, far from declining, is on the increase, bringing with it suffering for the querulous and disruption to the organizations through which they seek their vision of justice. This article examines querulous behaviour in the vexatious litigant and in abnormally persistent complainants and petitioners. The phenomenological and nosological issues are outlined and the risks of the emergence of threatening and violent behaviour is emphasized. Threats should not be ignored, for a variety of reasons. Approaches to managing querulous behaviour in the courts and the complaint organizations are discussed, together with the utility of individual therapy. Querulous behaviour should once more take its place among the legitimate concerns of mental health professionals. Those caught up in a querulous pursuit of their notion of justice are amenable to management that can ameliorate their suffering and reduce the disruption they create.

Cognition Disorders↗
PubMed2006

Mental disorders in female prisoners.

OBJECTIVE: The objective of the study was to investigate the rates of mental disorder among women in prison in Victoria, and to compare with community rates. DESIGN: A midnight census of all women in prison in Victoria was undertaken. Respondents were interviewed with a version of the Composite International Diagnostic Interview (CIDI), an adapted version of the Personality Diagnostic Questionnaire (PDQ-4+) and a demographics questionnaire. MAIN OUTCOME MEASURES: Twelve-month prevalence rates of ICD-10 mental disorders including depressive disorders, anxiety disorders and drug-related disorders were examined. Prevalence of personality disorders was also investigated. RESULTS: Eighty-four per cent of the female prisoners interviewed met the criteria for a mental disorder (including substance harmful use/dependence) in the year prior to interview. This rate was reduced to 66% when drug-related disorders were excluded. Forty-three per cent of subjects were identified as cases on a personality disorder screener. For all disorders, (except obsessive-compulsive disorder and alcohol harmful use) women in prison had a significantly greater likelihood of having met the 12-month diagnostic criteria when compared to women in the community. The most prevalent disorders among the female prisoners were: drug use disorder (57%), major depression (44%), Posttraumatic stress disorder (36%), and personality disorders. Almost a quarter (24%) of respondents were identified as a 'case' on the psychosis screen. CONCLUSIONS: In the present study female prisoners had significantly higher rates of the mental disorders investigated (with the exceptions of OCD and alcohol harmful use) when compared with women in the community. The pattern of disorder found among female prisoners is consistent with the abuse literature, suggesting that histories of abuse among the prison population may account for part of the discrepancy. These results highlight the need for improved assessment and treatment resources to meet the demands of this population.

Adult↗
PubMed2006

Assessing and managing the risks in the stalking situation.

Stalking is a common social problem, often driven by psychiatric disorder in its perpetrators and productive of psychological and social damage in its victims. Assessing and managing the risks in the stalking situation is a task that frequently falls on the mental health professional. The concerns of risks in the stalking situation are not confined to violence but include psychosocial damage, chronicity, and recurrence, and, for the stalker, arrest and incarceration. This article outlines a structured approach to assessment and management involving domains based on the relationship between stalker and victim, the type of motivation driving the stalking, the stalker's risk profile, the victim's risk profile, and finally, the legal and mental health context. The assessment is closely linked to management strategies to counter specific ascertained risks and future hazards. These strategies will be limited, or facilitated, according to the current legal and mental health contexts that have a critical impact on the stalking situation.

Crime↗
PubMed2005

Legislation in Victoria on sexual offenders: issues for health professionals.

New legislation passed in Victoria (the Serious Sex Offenders Monitoring Act 2005) extends the role of doctors in managing and treating sex offenders. This legislation is not based on a solid understanding of the research evidence on treatment of sex offenders or on their risk of reoffending. The legislation creates ethical and professional dilemmas for health professionals through the conflation of legal control of offenders with the medical management of disorders of sexual preference. There is a critical need for research and funding in this area, rather than ever more oppressive laws, if governments are to be serious about treating sex offenders, rather than simply incarcerating them.

Conflict of Interest↗
PubMed2005

The problem behavior model: the development of a stalkers clinic and a threateners clinic.

Traditionally, forensic mental health services have focused on the assessment and treatment of offenders with serious mental disorders. In recent years, there has been growing recognition that forensic clinicians have an important role to play for those offenders who engage in criminal acts driven by psychological or/and social problems, which may, or may not, occur in conjunction with a major mental disorder. This is especially true for specific offenses such as stalking and threatening. This article describes the innovation of the problem behavior model. This model uses a reductionist approach and the nexus between psychiatry and psychology to address the complex phenomena associated with specific problem behaviors that often culminate in offenses. The model is illustrated by describing the development of specialist clinics for the problem behaviors of stalking and threatening.

Aggression↗
PubMed2005

Association between stalking victimisation and psychiatric morbidity in a random community sample.

BACKGROUND: No studies have assessed psychopathology among victims of stalking who have not sought specialist help. AIMS: To examine the associations between stalking victimisation and psychiatric morbidity in a representative community sample. METHOD: A random community sample (n=1844) completed surveys examining the experience of harassment and current mental health. The 28-item General Health Questionnaire (GHQ-28) and the Impact of Event Scale were used to assess symptomatology in those reporting brief harassment (n=196) or protracted stalking (n=236) and a matched control group reporting no harassment (n=432). RESULTS: Rates of caseness on the GHQ-28 were higher among stalking victims (36.4%) than among controls (19.3%) and victims of brief harassment (21.9%). Psychiatric morbidity did not differ according to the recency of victimisation, with 34.1% of victims meeting caseness criteria 1 year after stalking had ended. CONCLUSIONS: In a significant minority of victims, stalking victimisation is associated with psychiatric morbidity that may persist long after it has ceased. Recognition of the immediate and long-term impacts of stalking is necessary to assist victims and help alleviate distress and long-term disability.

Adult↗
PubMed2004

The autogenic (self-generated) massacre.

Mass killings can be of a variety of types including family slayings, cult killings, and the by-product of other criminal activities. This article focuses on massacres where the perpetrators indiscriminately kill people in pursuit of a highly personal agenda arising from their own specific social situation and psychopathology. Five cases are presented of this type of autogenic (self-generated) massacre, all of whom survived and were assessed by the author. Not only do these massacres follow an almost stereotypical course, but the perpetrators tend to share common social and psychological disabilities. They are isolates, often bullied in childhood, who have rarely established themselves in effective work roles as adults. They have personalities marked by suspiciousness, obsessional traits, and grandiosity. They often harbour persecutory beliefs, which may occasionally verge on the delusional. The autogenic massacre is essentially murder suicide, in which the perpetrators intend first to kill as many people as they can and then kill themselves. The script for this particular form of suicide has established itself in western society and is continuing to spread, and to diversify.

Criminal Psychology↗
PubMed2004

Criminal offending in schizophrenia over a 25-year period marked by deinstitutionalization and increasing prevalence of comorbid substance use disorders.

OBJECTIVE: This study examined the pattern of criminal convictions in persons with schizophrenia over a 25-year period marked by both radical deinstitutionalization and increasing rates of substance abuse problems among persons with schizophrenia in the community. METHOD: The criminal records of 2,861 patients (1,689 of whom were male) who had a first admission for schizophrenia in the Australian state of Victoria in 1975, 1980, 1985, 1990, and 1995 were compared for the period from 1975 to 2000 with those of an equal number of community comparison subjects matched for age, gender, and neighborhood of residence. RESULTS: Relative to the comparison subjects, the patients with schizophrenia accumulated a greater total number of criminal convictions (8,791 versus 1,119) and were significantly more likely to have been convicted of a criminal offense (21.6% versus 7.8%) and of an offense involving violence (8.2% versus 1.8%). The proportion of patients who had a conviction increased from 14.8% of the 1975 cohort to 25.0% of the 1995 cohort, but a proportionately similar increase from 5.1% to 9.6% occurred among the comparison subjects. Rates of known substance abuse problems among the schizophrenia patients increased from 8.3% in 1975 to 26.1% in 1995. Significantly higher rates of criminal conviction were found for patients with substances abuse problems than for those without substance abuse problems (68.1% versus 11.7%). CONCLUSIONS: A significant association was demonstrated between having schizophrenia and a higher rate of criminal convictions, particularly for violent offenses. However, the rate of increase in the frequency of convictions over the 25-year study period was similar among schizophrenia patients and comparison subjects, despite a change from predominantly institutional to community care and a dramatic escalation in the frequency of substance abuse problems among persons with schizophrenia. The results do not support theories that attempt to explain the mediation of offending behaviors in schizophrenia by single factors, such as substance abuse, active symptoms, or characteristics of systems of care, but suggest that offending reflects a range of factors that are operative before, during, and after periods of active illness.

Adult↗
PubMed2004

Unusually persistent complainants.

BACKGROUND: Querulous paranoia may have disappeared from the psychiatric literature, but is it flourishing in modern complaints organisations and the courts? AIMS: To investigate the unusually persistent complainants who lay waste to their own lives and place inordinate demands and stress on complaints organisations. METHOD: Complaints officers completed questionnaires on both unusually persistent complainants and matched controls. RESULTS: Persistent complainants (distinguished by their pursuit of vindication and retribution) consumed time and resources and resorted to both direct and veiled threats. Attempts to distinguish these people from a control group on the basis of the manner in which their claims were initially managed failed. CONCLUSIONS: Persistent complainants' pursuit of vindication and retribution fits badly with complaints systems established to deliver reparation and compensation. These complainants damaged the financial and social fabric of their own lives and frightened those dealing with their claims. The study suggests methods of early detection and alternative management strategies.

Agonistic Behavior↗
PubMed2004

Impact of child sexual abuse on mental health: prospective study in males and females.

BACKGROUND: The lack of prospective studies and data on male victims leaves major questions regarding associations between child sexual abuse and subsequent psychopathology. AIMS: To examine the association between child sexual abuse in both boys and girls and subsequent treatment for mental disorder using a prospective cohort design. METHOD: Children (n=1612; 1327 female) ascertained as sexually abused at the time had their histories of mental health treatment established by data linkage and compared with the general population of the same age over a specified period. RESULTS: Both male and female victims of abuse had significantly higher rates of psychiatric treatment during the study period than general population controls (12.4% v. 3.6%). Rates were higher for childhood mental disorders, personality disorders, anxiety disorders and major affective disorders, but not for schizophrenia. Male victims were significantly more likely to have had treatment than females (22.8% v.10.2%). CONCLUSIONS: This prospective study demonstrates an association between child sexual abuse validated at the time and a subsequent increase in rates of childhood and adult mental disorders.

Adolescent↗
PubMed2004

Ten books.

Explore the source record for details and available documents.

Bibliographies as Topic↗
PubMed2004

Stalking by law: damaging victims and rewarding offenders.

The introduction of anti-stalking statutes throughout Australia and much of the Western world has brought greater protection for the victims of various forms of harassment and intrusions. However, despite these new provisions, the legal system is failing some victims of stalking. This article examines those areas of the justice system that are particularly susceptible to manipulation by stalkers and the impact of these abuses on stalking victims. It also presents ways in which the problems encountered by stalking victims may be frustrated rather than alleviated by specific aspects of the enforcement of anti-stalking laws and of the functioning of certain courts and tribunals. Approaches that prevent or discourage the perpetuation of harassment and damage to victims of stalking within the legal system are discussed.

Australia↗
PubMed2004

A research review of public figure threats, approaches, attacks, and assassinations in the United States.

The authors review extant research on threats, approaches, attacks, and assassinations of public figures in the United States. Despite the limited number of studies, data exist concerning: 1) threatening letters and approaches to celebrities; 2) attacks and assassinations of public figures, usually the President of the United States; 3) threats and approaches to legislative members of state and federal governments; and 4) threats, approaches, and attacks against federal judicial officials. Similarities and differences across the various studies are discussed. Consistent findings across the studies indicate that direct threats toward the target are unusual and are often correlated negatively with an approach or attack; a significant proportion of subjects are mentally ill and have criminal histories; many subjects evidenced a downward spiral in their lives in the months or year before their approach or attack; and if an attack occurred, it was predatory (instrumental, premeditated) rather than affective (emotional, reactive), and the weapon of choice was a firearm, usually a handgun. Operational guidance and further research recommendations are made.

Criminal Psychology↗
PubMed2002

Patients who stalk doctors: their motives and management.

The prevalence of stalking is increasing and healthcare professionals are overrepresented among stalking victims. The most common motivations for stalking are patients' developing a romantic attachment, due to delusional beliefs (as in erotomania) or misplaced expectations (often by socially inept patients), and patients' developing a resentment for some supposed injury. Strategies to prevent victimisation and minimise the impact of stalking include: taking care to preserve privacy and security, making clear to patients that the relationship will always be professional and what the boundaries are, informing colleagues and other relevant parties, transferring the patient's care to another doctor, and considering legal action.

Adaptation, Psychological↗
PubMed2002

The prevalence and nature of stalking in the Australian community.

OBJECTIVE: This study examines the extent and nature of stalking victimisation in a random community sample. METHOD: A postal survey was distributed to 3700 adult men and women selected from the electoral roll in the State of Victoria. Outcome measures included the lifetime and annual cumulative incidence of stalking, the duration and methods of harassment, rates of associated violence and responses to victimisation. RESULTS: Almost one in four respondents (23.4%;432) had been stalked, the unwanted behaviour they were subjected to being both repeated and fear-provoking. One in 10 (197) had experienced a protracted course of stalking involving multiple intrusions spanning a period of at least one month. Women were twice as likely as men to report having been stalked at some time in their lives, though the rates of victimisation in the 12 months prior to the study did not differ significantly according to gender. Younger people were significantly more likely than older respondents to report having been stalked. Victims were pursued by strangers in 42% of cases. The most common methods of harassment involved unwanted telephone calls, intrusive approaches and following. Associated threats (29%) and physical assaults (18%) frequently arose out of the stalking. Significant social and economic disruption was created by the stalking for 63% of victims. Most sought assistance to manage their predicament (69%). CONCLUSIONS: The experience of being stalked is common and appears to be increasing. Ten percent of people have been subjected at some time to an episode of protracted harassment. Assaults by stalkers are disturbingly frequent. Most victims report significant disruption to their daily functioning irrespective of exposure to associated violence.

Adolescent↗