The prevalence of mental disorders in incarcerated contact sexual offenders.

OBJECTIVE: Mental disorders in sexual offenders are relevant in terms of risk assessment and psychotherapeutic and pharmacological treatment. METHODS: The present cross-sectional study was conducted between 2001 and 2017 and included 1511 sexual offenders who were assessed at the Federal Evaluation Center for Sexual and Violent Offenders in the Austrian Prison System. All sexual offenders were assessed with the Structured Clinical Interview for Axis I (SCID I) and Axis II disorders (SCID II). RESULTS: N = 1250 (92.9%) sexual offenders were diagnosed with a mental disorder, whereby the great majority received multiple diagnoses. The most frequently found disorders were alcohol misuse (40.0%), paraphilic (43.3%), and personality disorders (53.6%) with a special emphasis on Cluster B personality disorders (47.8%). While sexual offenders against children were more likely to be diagnosed with paraphilic disorders, sexual offenders against adults were more likely to be diagnosed with a personality disorder. CONCLUSION: Prevalence rates of mental disorders in sexual offenders are considerable. Besides specific risk reducing treatment, the psychological and social sequelae of the mental disorder have to be addressed in interventions in order to reach an effective and sustainable risk reduction.

Effect of a pocket-size tablet-dispensing device on glycaemic control in Type 2 diabetic patients.

AIM: To evaluate whether a pocket-size tablet-dispensing device would improve adherence to therapy as judged by reduction of HbA(1c) levels in a large population of Type 2 diabetic patients. METHODS: The study design was prospective, randomized, open label with two parallel groups. Patients (2296) were recruited from general practitioners and internists and randomized to either receive a tablet dispenser (TD) or no intervention (control group, CO). Patients' characteristics and current oral therapy (including dosage) were recorded at baseline. HbA(1c) was compared between groups at baseline and after 6 months' intervention. RESULTS: Data were available in 2081 patients. Baseline characterisitcs, including age, body mass index (BMI), blood pressure and gender distribution were comparable between the two groups, as was HbA(1c)[7.9 (7.9-8.0), TD vs. 8.0 (7.9-8.0)%, CO, means (95% CI)]. After 6 months, HbA(1c) improved in both groups, but improvement was significantly greater in TD than in controls [-0.74 (0.67-0.80) vs. -0.53 (0.47-0.59)%, P < 0.0001]. Possession of a dispenser remained an independent predictor of improved control in a multiple regression model. In the subgroup analysis, the effect was significantly more pronounced (i) in patients receiving more medications and (ii) more diabetes medications per day (iii) in younger patients. CONCLUSION: In this large study population in a 'realistic' setting, a simple tablet-dispensing device led to a significant and clinically relevant improvement in HbA(1c) levels. Because patients with a more complex therapy regimen benefited more, we suggest that TD might have improved adherence to therapy.

Jailhouse Blues revisited.

BACKGROUND: Over the past decades a number of studies have appeared on suicide among persons in jail and prison remand settings, and sentenced prisoners. In these papers contradictory views concerning the relation between suicide risk and length of custody were published. METHODS: This article reports on a study that investigated all suicides (n=206) in all 29 Austrian jails and prisons between 1975 and 1996. The authors demonstrate the necessity to calculate the hazard that reflects the suicide risk in relation to time. RESULTS: The results suggest three different periods of high suicide risk: immediately after admission and 2 months thereafter for prisoners on remand; for long-term prisoners the suicide risk correlates with the length of the sentence and slightly increases with the time of custody. CONCLUSIONS: With this knowledge, suicide prevention programmes in prisons and jails could be made more effective and economic.

Depression and quality of life in multiple sclerosis.

OBJECTIVES: Health related quality of life (QoL) has gained increasing influence as a relevant evaluation criterion in multiple sclerosis. The high prevalence of psychiatric comorbidity in MS is, however, hardly ever considered in studies concerning QoL. MATERIALS AND METHODS: In 60 patients of a MS outpatient clinic, symptoms of anxiety (Zung Anxiety Scale) and depression (Zung Depression Scale), as well as the health-related quality of life were rated and set into relation to the EDSS and to the duration of illness, respectively. RESULTS: There was a highly significant correlation between depression as well as anxiety and the self-assessed quality of life. Depression was the by far strongest predictor for reduced QoL. CONCLUSION: Clinical studies, which seek to register the increasingly important evaluation criterion of health-related quality of life in MS, should consider the prevalence of depressive disorders and the decisive effect of depression on the self-assessed quality of life of affected patients.

[Did suicidal behavior have relevance for prison suicide?]. / Welche Relevanz hat die dokumentierte Suizidalität in Gefangenensuiziden?

OBJECTIVE: Suicides in correctional institutions occur more frequently than in the general population. Inmate suicide rates have been increasing in many countries during the last decades, possibly reflecting a selection of highly endangered individuals with a high prevalence of mental disorders. This study investigates all suicides in all correctional institutions of Austria during the last 25 years. METHODS: All available personal files of inmates who had committed suicide in the 29 Austrian prisons between January 1st, 1975, and December 31st, 1999, were analysed. Beside personal characteristics and circumstances of custody, information concerning psychiatric disorders and the inmate's history of suicidal behavior was included. RESULTS: 220 personal files of 250 suicides were available and included. Half of all suicides had a history of attempted suicide and 37 % had expressed suicidality. Referral to psychiatric consultants was known in 48.6 % and about 37 % received psychopharmacological treatment. Based on these frequent signs of psychiatric illness and vulnerability, possible implications of these results for psychiatric services of the correctional system to improve suicide prevention are discussed. CONCLUSIONS: Obvious signs of suicidality play an important role in vulnerability profiles for jail and prison suicides. Any signs of suicidality (st. p. attempted suicide, verbal suicide threat, self-harm) should have the consequence of further psychiatric care.

[Relationship between symptoms of depression and anxiety and the quality of life in multiple sclerosis]. / Zusammenhänge zwischen Depression, Angst und Lebensqualität bei Multipler Sklerose.

BACKGROUND: Health-related Quality of Life (QoL) is gaining increasing influence as a relevant evaluation criterium in clinical research. Several studies have investigated QoL in patients suffering from multiple sclerosis (MS) and the impact of therapeutic interventions on QoL. However, the influence of psychiatric complications, which occur frequently in MS (e.g. depression and anxiety disorders), on the autoassessment of QoL are hardly ever considered. METHODS: Symptoms of depression and anxiety were rated in 74 outpatients with definite MS. The health-related QoL was assessed and set into relation to physical disability (measured with the Expanded Disability Status Scale) and duration of the disease. The results were compared with 74 normal controls of the same age. RESULTS: A highly significant relationship between emotional state (Zerssen-scale), depression (Zung-depression-scale), anxiety (Zung anxiety scale) and Quality of Life was evident. CONCLUSIONS: Clinical trials assessing Quality of Life in MS patients should consider the frequency of psychiatric comorbidity and the influence of depression and anxiety disorders on self-rated Quality of Life.

Relationship between depression, anxiety and quality of life: a study of stroke patients compared to chronic low back pain and myocardial ischemia patients.

The prevalence of anxiety disorders and depression is assessed as between 20 and 50% following stroke. Depressive persons tend to give their overall life situation a worse rating than their relatives or physicians because of negative cognitions. Nevertheless, research concerning Quality of Life (QoL) after stroke hardly ever takes into account the methodological bias of assessing QoL only by self-rating. The aim of this study was to point out the important relationship between depression, anxiety and the autoassessment of QoL. QoL was markedly affected in the poststroke patients and in the chronic low back pain and myocardial ischemia patients, and it was rated worst by the most seriously depressed subjects. Clinical studies focusing on the ever more significant evaluation criterion 'health-related QoL' after stroke should take into account the high prevalence of anxiety and depressive symptoms and their major influence on the patients' self-evaluated QoL.

Fifty years of prison suicide in Austria: does legislation have an impact?

The absolute and relative frequency of suicides in jails and prisons in Austria over the 50 years from 1947 to 1996 is described. Important legislational changes regarding the criminal justice system are discussed with regard to possible consequences for the incidence of prisoners' suicides. Within the five decades a significant increase in the absolute numbers of jail and prison suicides was evident in spite of the considerable decrease in the total inmate population. Therefore, the suicide rate of inmates of correctional facilities increased significantly. Possible reasons for this phenomenon are discussed in relation to changes of the criminal law.

Prison suicides in Austria, 1975-1997.

Suicide prevention in custody is hampered by the lack of funds and professional staff. In order to evaluate the prison suicide phenomenon, a study was conducted evaluating all suicides that occurred in Austrian prisons between 1975 and 1997 (n = 220). In addition to evaluating the number of male versus female suicides, the preferred suicide methods were studied, as well as suicide risk of different circumstances of custody. Suicide rates of distinguishable, important subgroups of prisoners were calculated. The suicide rate for prisoners on remand was 236.0 per 100,000, and for offenders classified as mentally ill it was 205.4 per 100,000. That is about 8 times higher than the suicide rate in Austria's general population (1975-1997: 24.6 per 100,000). The suicide rate for sentenced offenders was 81.3 per 100,000, about twice the suicide rate in Austria's general male population. We recommend that psychologists or psychiatrists concentrate on the suicide prevention of high-risk offenders after screening the newly admitted offenders for their propensity to suicide.

[Styles of interpersonal conflict in patients with panic disorder, alcoholism, rheumatoid arthritis and healthy controls: a cluster analysis study]. / Umgang mit Partnerkonflikten bei Panikpatienten, Alkoholikern, Rheumatikern und Gesunden-Eine clusteranalytische Studie.

OBJECTIVE: Conflict and conflict resolution in intimate relationships are not only among the most important factors influencing relationship satisfaction but are also seen in association with clinical symptoms. Styles of conflict will be assessed in patients suffering from panic disorder with and without agoraphobia, in alcoholics and in patients suffering from rheumatoid arthritis. METHODS: 176 patients and healthy controls filled out the Styles of Conflict Inventory and questionnaires concerning severity of clinical symptoms. RESULTS: A cluster analysis revealed 5 types of conflict management. Healthy controls showed predominantely assertive and constructive styles, patients with panic disorder showed high levels of cognitive and/or behavioral aggression. Alcoholics showed high levels of repressed aggression, and patients with rheumatoid arthritis often did not exhibit any aggression during conflict. CONCLUSIONS: 5 Clusters of conflict pattern have been identified by cluster analysis. Each patient group showed considerable different patterns of conflict management.

[Assessment of custodial suicide risk--jail and prison suicides in Austria 1975-1996]. / Gefangenensuizide: Hinweise zur Abschätzung der Suizidgefahr- Suizide in Osterreichs Haftanstalten 1975-1996.

OBJECTIVE: Although incarceration is a high-risk situation for suicide all over the world, hardly any results have been published concerning the situation of custodial suicide in German-speaking countries. METHODS: We investigated the case notes of all suicides occuring in Austrian prisons between 1975 and 1996 (n= 207). Beside an evaluation of gender and preferred methods of suicide the suicide risk of different circumstances of custody was studied. Suicide rates of distinguishable, important subgroups of prisoners were calculated using the official statistical data of the Ministry of Justice. RESULTS: The suicide rate for people on remand and offenders classified as mentally ill was 231/100,000 vs. 191/100,000, that was about eight times higher than the suicide rate in Austria's general population. The suicide rate for sentenced offenders was 80/100,000, about three times as high as the suicide rate in Austria's general population (1980-1990: 26.4/100,000). The suicide risk increased with the length of the announced sentence. CONCLUSIONS: The suicide rate in custody was highest for prisoners on remand and mentally ill offenders. Female offenders had a high suicide risk, too. The common assumption that the suicide risk in jails and prisons is highest shortly after admission should be confirmed based on better methodology or be reconsidered.

Discriminating among incarcerated sexual offenders by their perception of interpersonal problems and experience-related anxiety.

Fifty-seven (57) incarcerated sex offenders were assessed for their capacity to perceive interpersonal difficulties and experience related anxiety. The findings suggest that the men who have sexually transgressed against minors view themselves as easily exploitable and nurturant, and those who have sexually aggressed against adult females demonstrated minimal regard for external negative views of them. These two groups did not differ significantly from each other along social avoidance and non assertiveness dimensions. Assertiveness was found to decrease as a consequence of multiple incarcerations in both groups. Furthermore, perception of interpersonal difficulties and experience related anxiety in our study correctly classified 72% of high and low violent sexual offenders.

[Social networks and social support in a sample of mentally ill sex offenders]. / Soziales Netzwerk und die Erfüllung sozialer Bedürfnisse bei Sexualstraftätern im Massregelvollzug.

OBJECTIVE: Characteristics of social networks and social support were investigated in a group of 35 imprisoned mentally ill sex offenders. METHODS: We compared current parameters (after an average of 3 years of psychosocial therapy) with those at the time of the offence. RESULTS: Analyses reveal a decrease in social network size but an increase in social support by the remaining or new social network members. These changes are discussed in reference to various influencing variables in a therapeutic prison facility. The impact of psychosocial interventions in relapse prevention of sexual offenders will be outlined.

The relevance of self-concepts discriminating in long-term incarcerated sex offenders.

Lack of self-esteem and assertiveness have been thought to play an important role in the etiology and maintenance of sex offending behavior and to be significantly related to the number of previous convictions or violence of the assault. We, therefore, analysed self-concepts of 53 long-term incarcerated sex offenders to research the correlation between concepts of self-esteem, assertiveness, feelings towards others and relationships and the degree of violence of the last offense and risk of reoffense. We also investigated the relationship of previous convictions and duration of incarceration with the offenders' self-concepts and the influence of psychotherapeutic intervention on the offenders' self-concepts.

[Sex offenders in legal treatment and their relatives: results of family therapy sessions]. / Sexualstraftäter im Massregelvollzug und deren Angehörige: Ergebnisse gemeinsamer Therapiesitzungen.

Members of the family of origin and spouses have been invited to take part in a cognitive-behavioral treatment programme for incarcerated sexual offenders to support the offender. Offenders arranged appointments with their spouses, mother, fathers and the therapist. A one-year follow-up reveals considerable change in denying and minimisation of responsibility, forcefullness and degree of sexual intrusiveness of both the offenders and the spouses. Both groups showed a better understanding for and a more positive attitude to the offenders' sexuality. Furthermore, both groups showed a significant increase in applying concepts of relapse prevention.

Modulation of pyrogen-induced upregulation of endothelial cell adhesion molecules (CAMs) by interleukin-4: transcriptional mechanisms and CAM-shedding.

The pyrogens interleukin 1 (IL-1), tumor necrosis factor (TNF), and bacterial lipopolysaccharides (LPS) are known to increase endothelial cell (EC) adhesiveness for leukocytes by stimulating surface expression of various adhesion molecules. IL-4, a product of activated T-cells, was shown to affect pyrogen-mediated regulation of EC adhesion molecule surface expression. In the present study, we investigated the effect of IL-4 on pyrogen-induced upregulation of the cell adhesion molecules (CAMs) ICAM-1 (intercellular cell adhesion molecule-1), ELAM-1 (endothelial leucocyte adhesion molecule-1), and VCAM-1 (vascular cell adhesion molecule-1) in cultured human umbilical vein EC (HUVEC). Surface expression of adhesion molecules was quantified by flow cytometry, HUVEC mRNA content was estimated by Northern blot analysis, and ICAM-1 antigen in conditioned media was measured by ELISA. Incubation of HUVEC with IL-1 (100 U/ml), TNF (500 U/ml), and LPS (10 micrograms/ml) caused significant increase in ICAM-1, ELAM-1, and VCAM-1 surface expression; IL-1 caused about an eightfold increase in ICAM-1 expression, about a 13-fold increase in ELAM-1 surface expression, and about a fourfold increase in VCAM-1 expression. Coincubation of pyrogens with IL-4 (500 U/ml) differentially influenced their proadhesive effects on the HUVEC surface. In the presence of IL-4, IL-1-induced ICAM-1 upregulation was reduced, ELAM-1 upregulation was not significantly influenced by IL-4, and induction of VCAM-1 was enhanced by IL-4.(ABSTRACT TRUNCATED AT 250 WORDS)

Signal transduction via Fc gamma R and Mac-1 alpha-chain in monocytes and polymorphonuclear leucocytes.

Some (VIM12, Leu-15, 5A4.C5), but not all, Mac-1-specific monoclonal antibodies (mAb) induced a clear respiratory burst in unprimed monocytes but not in unprimed polymorphonuclear leucocytes (PMN). We showed that this monocyte stimulation occurred via formation of Mac-1 mAb-Fc gamma RI or Mac-1 mAb-Fc gamma RII complexes, as human monomeric IgG1 could completely block the respiratory burst induced by the murine IgG2a subclass anti-Mac-1 mAb Leu-15 and the Fc gamma RII-specific mAb IV.3 inhibited respiratory burst formation by IgG1 subclass anti-Mac-1 mAb VIM12 and 5A4.C5, respectively. F(ab')2 fragments of mAb VIM12 did not stimulate. This association between Mac-1 and Fc gamma RII may be due to a near spatial association between these molecules in monocytes, as we observed partial inhibition of FITC-labelled anti-Fc gamma RII mAb IV.3 binding after prior incubation with mAb VIM12. If monocytes were preincubated with mAb IV.3 or aggregated IgG, there was partial inhibition of mAb VIM12 binding. The non-stimulating anti-Mac-1 mAb (JML.H11,44, OKM1, LM2/1, Mo1) did not show any significant competition with mAb IV.3 binding to Fc gamma RII. Both non-stimulating CD18-specific mAb, however, showed strong competition with mAb IV.3 binding to Fc gamma RII. On unprimed PMN, the situation was different. No Mac-1-specific mAb induced a respiratory burst and there was no competitive inhibition between anti-Mac-1 mAb and antibodies binding to Fc gamma RII. In interferon-gamma (IFN-gamma)-primed PMN, however, we observed a functional association between Mac-1 and Fc gamma RI as IgG2a subclass mAb Leu-15 induced a respiratory burst which could be inhibited by monomeric human IgG1, as observed in monocytes. However, no other anti-Mac-1 mAb was able to induce a respiratory burst in IFN-gamma-primed PMN. Therefore, a similar signal transducing capability may exist between Mac-1 and Fc gamma RI on both monocytes and PMN, despite a different relationship between Mac-1 and Fc gamma RII on these cell populations. As no Mac-1 beta-chain-specific (CD18)mAb were able to induce a respiratory burst in monocytes, despite being able to interact with Fc gamma R via their Fc regions, as detected by competition with mAb IV.3 for binding to Fc gamma RII, we conclude that intracellular signalling via Mac-1 mAb-Fc gamma RII complexes requires the alpha-chain.

Cytokine release and dynamics of leukocyte populations after CD3/TCR monoclonal antibody treatment.

Cytokine release and clinical side effects resulting from the use of OKT3 and BMA 031 monoclonal antibodies in the treatment of kidney graft recipients were evaluated and compared. The rise observed in serum levels of interferon gamma. TNF alpha, and IL-8 was similar after administration of either monoclonal antibody. Furthermore, both OKT3 and BMA 031 resulted in rapid disappearance not only of virtually all T cells, but also of substantial percentages of all major leukocyte populations from the circulation; this effect is probably due to cytokine release activating endothelial cells and thereby causing extravasation even of leukocytes not specifically recognized by the administered antibodies. Evidence has thus been obtained that BMA 031 is as potent as OKT3 in inducing unequivocal signs of T cell activation in vivo. However, while OKT3 therapy was accompanied by adverse side effects in our study as in previous ones, we saw no such reactions in any of the patients receiving BMA 031. This contrast might be due to different mechanisms of leukocyte activation possibly inducing other mediators in the case of OKT3, which then, in combination with the cytokines, could generate treatment-associated morbidity.