[Pharmacotherapy in sexual behavior disorders and intellectual disability]. / Farmacotherapie bij seksuele gedragsstoornissen en verstandelijke beperking.

BACKGROUND: Sexual behavior disorders in intellectual disability form several challenges, despite evolutions in treatment options and risk assessment. The use of antilibidinal pharmacotherapy in this population is controversial and research is inconclusive about the most appropriate treatment strategy. AIM: To highlight pharmacotherapeutic management of sexual behavior disorders in intellectual disability, its medical and ethical considerations. METHOD: A literature review to provide an overview of the available literature, which was elaborated based on clinical experience. RESULTS: We found a lack of scientific evidence on the efficacy of pharmacotherapy specifically for sexual behavior disorders in people with intellectual disabilities. The routine use of antilibidinal medication is contraindicated. Medical and ethical guidelines have been published as well as contraindications for initiating androgen deprivation therapy in the general population. The necessity of pharmacotherapy should be closely monitored and supplemented with psychotherapeutic care to cultivate the patient’s sexual skills, attitudes and knowledge. A distinction should be made between sexual behavior disorders of the ‘paraphilic type’ and of the ‘sexually maladjusted or naive type’. CONCLUSION: Multidisciplinary evaluation, risk assessment and an individualized approach are the cornerstones of high-quality treatment of sexual behavior disorders in persons with intellectual disability.

The Importance of Context: An ESM Study in Forensic Psychiatry.

Experience Sampling Method (ESM) is a structured diary technique assessing variations in thoughts, mood, and psychiatric symptoms in everyday life. Research has provided ample evidence for the efficacy of the use of ESM in general psychiatry but its use in forensic psychiatry has been limited. Twenty forensic psychiatric patients participated. The PsyMate™ Device emitted a signal 10 times a day on six consecutive days, at unpredictable moments. After each "beep," the patients completed ESM forms assessing current context, thoughts, positive and negative affect, and psychotic experiences. Stress was measured using the average scores of the stress related items. Compliance rate was high (85% beeps responded). Activity stress was related to more negative affect, lower positive affect, and more psychotic symptoms. This finding was restricted to moments when a team member was present; not when patients were alone or with other patients. ESM can be useful in forensic psychiatry and give insights into the relationships between symptoms and mood in different contexts. In this study activity-related stress was contextualized. These findings can be used to personalize interventions.

[What are possible applications of virtual reality for forensic psychiatry?] / Mogelijke toepassingen van virtual reality voor de forensische psychiatrie.

BACKGROUND: Virtual reality (VR) has been on the rise in recent years due to the better quality and accessibility of VR glasses and software. Despite the fact that VR is being used more often in psychiatric care, little is known about the possible applications of VR in forensic psychiatry. AIM: To investigate which possible VR-applications already exist that can also be used in forensic psychiatry and what the possible risks are. METHOD: Scientific literature was consulted in PubMed, Web of Knowledge, Embase en Cochrane Library to search for immersive VR-applications for aggression, motivation and the most prevalent psychopathologies in forensic psychiatry. RESULTS: Several relevant VR-applications were found that can be used in the diagnosis or treatment of forensic psychiatric patients. Despite the limited number of empirical studies, several authors emphasize the potential benefits of VR for this target group. CONCLUSION: Due to the low number of studies of good quality on the use of VR in psychiatric care, it is currently not yet possible to draw clear conclusions about efficiency, deployability and specific applications. However, there is enough potential within forensic psychiatry to integrate VR into various parts of the care process, such as treatment, diagnosis and risk assessment.

[Determining security need in forensic psychiatric patients: HoNOS-Secure and DUNDRUM-1]. / Bepalen benodigde beveiligingsniveau van forensisch psychiatrische patiënten: HoNOS-Secure en DUNDRUM-1.

BACKGROUND: Forensic psychiatric patients can be treated in different security levels. Clear criteria to estimate the required security level or transfer to a less secure setting are not yet available. A literature review shows that, of the few instruments that are used internationally, the DUNDRUM and the HoNOS-Secure are the most promising.
AIM: To investigate whether these instruments can be used in Flemish forensic psychiatric settings.
METHOD: DUNDRUM-1 scores were collected for 150 internees. The psychometric qualities of the scale were examined. In a subpopulation, the DUNDRUM-1 was compared with the HoNOS-Secure.
RESULTS: The psychometric properties of the DUNDRUM-1 were good and exceeded those of the HoNOS-Secure.
CONCLUSION: The DUNDRUM-1 is an instrument that can help clinicians and judges to better - and in a more transparent way - substantiate their decision-making to secure care. However, further research regarding the practical applicability is needed.

[Abolition of the internment of convicted prisoners in Belgium: clinical implications]. / Klinische implicaties van afschaffing van de ministeriële internering in België: onderzoek naar profiel van Vlaamse geïnterneerden-veroordeelden.

BACKGROUND: According to article 21 of the current Belgian law regarding the protection of society, the ministry of Justice can transfer a convicted prisoner to the Commission for the Protection of Society if that prisoner develops a severe mental illness in the course of a prison sentence. The proposed abolition of this article is raising concerns in psychiatric hospitals which are not equipped to deal with dangerous forensic patients.
AIM: To explore the profiles of convicted internees and to find out to what extent they differ from the profiles of regular internees.
METHOD: Convicted internees (n = 48) and regular internees (n = 483) treated in one of the Flemish medium security units were compared on the basis of demographic, clinical and risk factors.
RESULTS: Compared to regular internees, convicted internees suffered from more serious psychiatric problems and showed a more severe risk profile.
CONCLUSION: The abolition of article 21 presents regular psychiatric hospitals with new challenges.