[Forensic Addiction Treatment in Germany: an Evaluation of its Effects on Criminal Recidivism and a Response to Critical Comments].

Unlabelled: In Germany, offenders with addiction problems may be sentenced to treatment in forensic psychiatric hospitals. A considerable share of patients, in some hospitals more than 40 percent, is returned to prison. The paper presents findings of a long-term evaluation study.

Neural Mechanisms Underlying Affective Theory of Mind in Violent Antisocial Personality Disorder and/or Schizophrenia.

Among violent offenders with schizophrenia, there are 2 sub-groups, one with and one without, conduct disorder (CD) and antisocial personality disorder (ASPD), who differ as to treatment response and alterations of brain structure. The present study aimed to determine whether the 2 groups also differ in Theory of Mind and neural activations subsuming this task. Five groups of men were compared: 3 groups of violent offenders-schizophrenia plus CD/ASPD, schizophrenia with no history of antisocial behavior prior to illness onset, and CD/ASPD with no severe mental illness-and 2 groups of non-offenders, one with schizophrenia and one without (H).

Neural mechanisms underlying cognitive control of men with lifelong antisocial behavior.

Results of meta-analyses suggested subtle deficits in cognitive control among antisocial individuals. Because almost all studies focused on children with conduct problems or adult psychopaths, however, little is known about cognitive control mechanisms among the majority of persistent violent offenders who present an antisocial personality disorder (ASPD). The present study aimed to determine whether offenders with ASPD, relative to non-offenders, display dysfunction in the neural mechanisms underlying cognitive control and to assess the extent to which these dysfunctions are associated with psychopathic traits and trait impulsivity.

Structural brain alterations associated with schizophrenia preceded by conduct disorder: a common and distinct subtype of schizophrenia?

Conduct disorder (CD) prior to age 15 is a precursor of schizophrenia in a minority of cases and is associated with violent behavior through adulthood, after taking account of substance misuse. The present study used structural magnetic imaging to examine gray matter (GM) volumes among 27 men with schizophrenia preceded by CD (SZ+CD), 23 men with schizophrenia but without CD (SZ-CD), 27 men with CD only (CD), and 25 healthy (H) men. The groups with schizophrenia were similar in terms of age of onset and duration of illness, levels of psychotic symptoms, and medication.

The impact of alcohol dependence on social brain function.

The impact of alcoholism (ALC) or alcohol dependence on the neural mechanisms underlying cognitive and affective empathy (i.e. the different routes to understanding other people's minds) in schizophrenic patients and non-schizophrenic subjects is still poorly understood.

[History of treatment of schizophrenic forensic patients prior to admission: a comparison with schizophrenic general psychiatric patients].

Background: The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Prior to admission to a forensic ward, two thirds of schizophrenic patients have been admitted to a general psychiatric institution at least once. Among other factors, forensic admission is seen as a consequence of insufficient pretreatment in general psychiatry.

Disentangling structural brain alterations associated with violent behavior from those associated with substance use disorders.

Context: Studies aimed at identifying structural brain alterations associated with persistent violent behavior or psychopathy have not adequately accounted for a lifetime history of substance misuse. Thus, alterations in gray matter (GM) volume that have been reported to be correlates of violent behavior and/or psychopathy may instead be related to lifelong substance use disorders (SUDs).

Objective: To identify alterations in GM volume associated with violent behavior and those associated with lifelong SUDs.

Impulsivity-related brain volume deficits in schizophrenia-addiction comorbidity.

Despite a high prevalence of schizophrenia patients with comorbid substance abuse, little is known about possible impacts on the brain. Hence, our goal was to determine whether addicted and non-addicted schizophrenic patients suffer from different brain deficits. We were especially interested to determine if grey matter volumes were affected by impulsivity.

Functional brain correlates of heterosexual paedophilia.

Although the neuronal mechanisms underlying normal sexual motivation and function have recently been examined, the alterations in brain function in deviant sexual behaviours such as paedophilia are largely unknown. The objective of this study was to identify paedophilia-specific functional networks implicated in sexual arousal. Therefore a consecutive sample of eight paedophile forensic inpatients, exclusively attracted to females, and 12 healthy age-matched heterosexual control participants from a comparable socioeconomic stratum participated in a visual sexual stimulation procedure during functional magnetic resonance imaging.

Brain response to visual sexual stimuli in homosexual pedophiles.

Objective: The neurobiological mechanisms of deviant sexual preferences such as pedophilia are largely unknown. The objective of this study was to analyze whether brain activation patterns of homosexual pedophiles differed from those of a nonpedophile homosexual control group during visual sexual stimulation.

Method: A consecutive sample of 11 pedophile forensic inpatients exclusively attracted to boys and 12 age-matched homosexual control participants from a comparable socioeconomic stratum underwent functional magnetic resonance imaging during a visual sexual stimulation procedure that used sexually stimulating and emotionally neutral photographs.

Structural brain abnormalities in the frontostriatal system and cerebellum in pedophilia.

Even though previous neuropsychological studies and clinical case reports have suggested an association between pedophilia and frontocortical dysfunction, our knowledge about the neurobiological mechanisms underlying pedophilia is still fragmentary. Specifically, the brain morphology of such disorders has not yet been investigated using MR imaging techniques. Whole brain structural T1-weighted MR images from 18 pedophile patients (9 attracted to males, 9 attracted to females) and 24 healthy age-matched control subjects (12 hetero- and 12 homosexual) from a comparable socioeconomic stratum were processed by using optimized automated voxel-based morphometry within multiple linear regression analyses.

[Plea for forensic aftercare--results from an evaluation of forensic ambulances in Germany (area: "Rheinland")].

The reintegration of patients from forensic hospitals into society is as difficult as important. At present only a few specialized forensic ambulances can be found in Germany although experts have been demanding an extension of these institutions for years. In the following we will present results from an evaluation study of forensic ambulances in Germany (area: "Rheinland").

[On the admittance of forensic patients to general psychiatric wards].

In Germany, due to an increasing number of "hospital order sentences," the capacities of forensic hospitals are exhausted. In the late 1990s,general psychiatric hospitals admitted a remarkable number of mentally disturbed offenders. In this study,data of 140 patients treated in general psychiatric hospitals in the German lower Rhine region are presented.

[Drug-dependent offenders committed for disciplinary action. Results of a cross-sectional survey].

In comparison to the middle of the 80th, the group of patients who are addicted to legal and illegal drugs and are treated in special forensic hospitals, has significantly changed. Polyvalent dependence is the predominant diagnosis. There has been an increase in violence of index delinquency.

[Development of forensic psychiatry (section 63 StGB) in North-Rhine-Westphalia. Comparison of the current situation with introduction of the forensic psychiatry regulation (MRVG-NW) 10 years ago].

In a cross-sectional study we analysed the present situation of mentally disordered offenders treated in forensic hospitals of North Rhine-Westphalia under section 63 StGB-in comparison with the first block sampling in 1984. One of the important findings was that there has been an increase in violence in respect of the index delinquency as well as the criminal record. Those patients who were again committed to a forensic hospital showed more violent criminal offences too.

[Dangerousness prognosis in the clinical context of fulfillment of psychiatric criminal commitment].

The compilation and the reliability-based evaluation of the questionnaire including potentially prognosis-relevant clinical criteria for the release of male patients from rehabilitation and security measure (section 63 German Criminal Code) are presented. The restriction to clinical (rather than social statistical) criteria results in a concentration of the criminal aspects of treatment and/or therapy. The open and, more importantly, the "unconscious" focuses of forensic clinical action become transparent.

[Alcohol-dependent criminals: on the problem of their confinement according to paragraph 64 of the German federal law].

The article presents part of the results of a Federal German investigation of psychiatric confinement in cases of delinquency in accordance with German law. Among the 674 inmates whose case history could be included in the investigation, there was a predominance of alcohol dependence in two-thirds of them. Confinement occurred mostly only after addiction and delinquencies had been going on for a long time.