[Shortened Treatment Concepts in Forensic Commitment According to Section 64 of the German Penal Code: A Tailored Treatment Pathway?] / Verkürzte Therapiekonzepte im Maßregelvollzug gemäß §64 StGB: Ein maßgeschneiderter Behandlungspfad?

Die forensische Therapie gemäß §64 StGB zeichnet sich aktuell durch hohe Abbruch- bzw. Erledigungsquoten aus. Das hier vorgestellte verkürzte Therapiekonzept der Klinik für Forensische Psychiatrie des Pfalzklinikums für Patienten mit günstigen Prognosemerkmalen soll durch Förderung von Eigeninitiative, Verantwortung und Motivation sowie eine möglichst individualisierte, störungsorientierte, strafzeit- und tatangemessene Behandlung mit intensiver Erprobung unter Alltagsbedingungen zu einer Verkürzung der stationären Unterbringung führen. Empirische Belege hierfür fehlen jedoch bislang. Erstmals werden hier Pilotdaten aus dem Zeitraum April 2016 bis Mai 2021 vorgestellt. Zusammenfassend hat sich das o.g. Konzept als umsetzbar erwiesen. Die erhobenen Daten weisen darauf hin, dass die im verkürzten Therapieprogramm behandelten Patienten eine geringere Erledigungsquote als der Durchschnitt aller gemäß §64 StGB untergebrachter Patienten aufweist. Eine deutliche Verkürzung der durchschnittlichen Behandlungsdauer ließ sich demgegenüber jedoch nicht belegen. Die vorliegende Arbeit will einen ersten Beitrag zur Diskussion und Weiterentwicklung derartiger Behandlungsoptionen leisten. Mögliche Nachteile derartiger Therapieangebote bei für ungeeignet befundenen Patienten, z. B. eine Abnahme der Therapiemotivation, werden diskutiert.Forensic therapy according to section 64 of the German penal code is currently characterized by high drop-out rates. The shortened therapy concept of the Department of Forensic Psychiatry of the Pfalzklinikum focusing on patients with favorable prognostic characteristics presented here is intended to lead to a shortening of hospital stay by promoting initiative, responsibility and motivation. It is supposed to provide a treatment as individualized and disorder-oriented as possible and appropriate to the individual time of detention as well as the specific kind of offense with intensified testing under everyday conditions. However, so far empirical evidence for this concept is lacking. For the first time, pilot data for the period from April 2016 to May 2021 are presented here. The concept described herein has proven to be feasible. The collected data hint at a lower drop-out rate of patients treated according the shortened therapy concept compared to the average of all patients assigned to forensic treatment according to section 64 of the German penal code. Yet, there was no evidence for a significant shortening of hospital stay. The present work aims at making a first contribution to the discussion and further development of such treatment options. Possible disadvantages for patients who are found to be unsuitable, e. g. those with a decrease in therapeutic motivation, are discussed.

[Diagnostic Criteria of PTSD in ICD10, ICD-11 and DSM 5: Relevance for expert opinion]. / Posttraumatische Belastungsstörung in ICD 10, ICD 11 und DSM 5: Welche Bedeutung haben unterschiedlichen Kriterien für Diagnostik und gutachtliche Praxis.

The diagnostic criteria of PTSD differ in the ICD-10, ICD-11 and DSM-5 manuals. The main diagnostic criteria are presented. The psychopathological findings obtained in a structured interview are essential for the diagnosis. Three case studies are used to illustrate the expert assessment in criminal law, accident insurance and victim compensation law.

[Differential diagnostic distinction between substance-induced and primary psychoses: : Recommendations for general psychiatric and forensic practice]. / Differenzialdiagnostische Unterscheidung zwischen substanzinduzierten und primären Psychosen: : Empfehlungen für die allgemeinpsychiatrische und forensische Praxis.

Substance-induced psychotic disorders (SIPD) are frequent and account for about 25% of the first admissions to a psychiatric hospital. From a clinical point of view the differential diagnosis of SIPD vs. primary (genuine or cryptogenic) psychotic disorders is often a challenge due to the similar psychopathology. This is complicated by the fact that SIPDs associated with cannabis, hallucinogens and amphetamines have a significant risk of transition to manifest psychotic disorder (e.g. schizophrenia). In the first section of this paper two case reports from general psychiatric and forensic practice are presented. Then, in a narrative review the relevance of the differential diagnostic distinction between both disorders is examined from the perspective of general and forensic psychiatry with respect to therapy, prognosis and judicial decisions regarding the placement in forensic commitment (§ 63 vs. § 64 German Penal Code, StGB). The last section aims to develop a structured procedure for the differentiation between SIPD and primary psychotic disorders. The concepts and findings presented and discussed in this paper are intended to help psychiatrists and psychologists make a diagnosis in a general and a forensic context.

[Validity of the "Structured Inventory of Malingered Symptomatology" [SIMS] in the Assessment of Healthy Individuals and Patients with Psychiatric Disorders Outside the Forensic Context]. / Validität des "Strukturierten Fragebogens Simulierter Symptome" [SIMS] bei gesunden Probanden und Patienten mit psychiatrischen Erkrankungen außerhalb eines forensischen Kontexts.

OBJECTIVE: Assessment of the rate of false-positive results of the Structured Inventory of Malingered Symptomatology (SIMS) in healthy controls and authentic patients outside the forensic or rehabilitative context. METHODS: Beyond the SIMS scores, further variables (PANSS, Hamilton scale, MMSE) were obtained. SIMS scores of healthy individuals were compared with the SIMS scores of the different groups of patients. Additionally, correlations between the SIMS scores and other variables were investigated. RESULTS: Patients with psychotic disorders (n=30) or depressive episodes (n=32) more frequently achieved SIMS scores >16 as compared to healthy controls. In comparison, patients with amnestic disorders (n=15) had inconspicuous SIMS scores. Depressed patients with positive SIMS results were significantly more likely to be diagnosed with another psychiatric disorder and the scores of these patients on the Hamilton scale were correlated with positive results on 2 subscales of the SIMS (NI, AF). CONCLUSION: If this instrument is to applied in clinical practice in the future, further validation of the SIMS is necessary. The specificity of the SIMS seems to be context-related.

Child Sexual Abuse by Catholic Priests, Deacons, and Male Members of Religious Orders in the Authority of the German Bishops' Conference 1946-2014.

This study explores the extent of sexual abuse of minors by members of the Catholic Church in Germany. It is the first comprehensive study to examine this extent in a European country. The goals of this study are as follows: (a) to analyze whether the extent and characteristics of sexual abuse in a European country are comparable to those in the United States and Australia and (b) how discrepancies can be explained. The personnel files of 38,156 Catholic Priests, deacons, and male members of religious orders in the authority of the German Bishops' Conference were analyzed. The study period lasted from 1946 to 2014. All 27 German dioceses took part in this study. A total of 4.4% of all clerics (N = 1,670) from 1946 to 2014 were alleged to have committed sexual abuse, and 3,677 children or adolescents were identified as victims. These results are similar to those from comparable studies in the United States. Sexual abuse of minors within the authority of the Catholic Church seems to be a worldwide phenomenon.

[Stalking and crimes of passion : Discussion of a case example on ex-partner stalking]. / Stalking und Affektdelikte : Diskussion eines Fallbeispiels zum Expartnerstalking.

Forensic scientists have proposed various evaluation criteria for assessing the criminal responsibility in violent acts against relationship partners under exceptional affective circumstances. Of particular importance, apart from the offender's condition at the time of the offence, are the previous history and the background of the relationship. Although each individual case requires special weighting of the individual aspects, the clinical judgment must always be based on an overall view of the offender and the crime. This article investigates the question of the extent to which empirical findings from stalking research can contribute to the assessment of crimes of passion.

[Diagnostic Criteria of PTSD in ICD10, ICD-11 and DSM 5: Relevance for expert opinion]. / Posttraumatische Belastungsstörung in ICD 10, ICD 11 und DSM 5: Welche Bedeutung haben unterschiedlichen Kriterien für Diagnostik und gutachtliche Praxis.

The diagnostic criteria of PTSD differ in the ICD-10, ICD-11 and DSM-5 manuals. The main diagnostic criteria are presented. The psychopathological findings obtained in a structured interview are essential for the diagnosis. Three case studies are used to illustrate the expert assessment in criminal law, accident insurance and victim compensation law.

[Neuropsychiatric sequelae of the COVID-19 pandemic]. / Neuropsychiatrische Folgen der COVID-19-Pandemie.

The COVID-19 pandemic has a significant impact on mental health. On the one hand, fears about one's economic situation, own health and the health of others can lead to psychosocial consequences. On the other hand, social isolation through physical distancing can affect mental health. Finally, the infection itself can lead to psychiatric and neuropsychiatric symptoms as part of a systemic manifestation. In this paper, different mechanisms are presented, which can lead directly or indirectly to neuropsychological and psychopathological symptoms in the context of the COVID-19 pandemic.

[The expert in criminal and enforcement proceedings: Mission, qualification, delimitation of competence]. / Der Sachverständige im Straf- und Vollstreckungsverfahren. Auftrag, Qualifikation, Kompetenzabgrenzung.

Die Rolle von Sachverständigen im Erkenntnis- und Vollstreckungsverfahren wurde mit der Novellierung des Rechts der Unterbringung in einem psychiatrischen Krankenhaus erneut gestärkt. Sachverständige verfügen über ein spezifisches Fachwissen und haben insoweit eine Garantenstellung gegenüber dem Gericht. Dieses interdisziplinäre Zusammenwirken birgt Gefahren, die zu kritischem und die Fach- und Kompetenzgrenzen wahrendem Zusammenwirken führen müssen. Kompetenzüberschreitungen und Grenzverletzungen können zu Eingriffen in die Grundrechte von Betroffenen führen, die auch haftungsrechtlich relevant werden können. Im Folgenden werden die Rahmenbedingungen der interdisziplinären Zusammenarbeit und insbesondere die Bedeutung der Kompetenzentrennung in foro verdeutlicht.

[Sexual Abuse of Minors in the Area of Responsibility of the Catholic Church: Institutional Specifics]. / Sexueller Missbrauch von Minderjährigen im Verantwortungsbereich der katholischen Kirche: Institutionelle Spezifika.

INTRODUCTION: From 2014 to 2018, an interdisciplinary consortium of scientists investigated the extent and possible causes of the sexual abuse of children in the area of responsibility of the Catholic Church in Germany. The study bears the acronym MHG (Mannheim / Heidelberg/Gießen) after the locations of the participating universities. The personnel file analysis identified 1670 Catholic clerics accused of sexual abuse of minors for the period from 1946 to 2014. For the Catholic Church specific conditions that favour the sexual abuse of minors could be identified. METHOD: A comparison of criminal records of accused clerics and perpetrators from other institutional contexts has been carried out. RESULT: Sexual offenses of priests are severe and the number of persons affected per convicted person is not less than that of perpetrators in other institutions; the duration of abuse by Catholic clerics is even significantly longer. Persons affected by sexual abuse in the context of the Catholic Church are significantly more often male. The Catholic Church has tried more extensively than other institutions to cover up accusations of sexual abuse of children or young people by clerics. CONCLUSION: Prevention concepts must take greater account of the specific conditions of sexual abuse in the Catholic Church.

Effects of stigmatizing media coverage on stigma measures, self-esteem, and affectivity in persons with depression - an experimental controlled trial.

BACKGROUND: Stigmatization of people with mental illness is still a significant problem even in Western society. Media is an important vector for public messaging that may lead to stigma (and potentially counteract it). There is an ongoing debate about the impact of news with potentially stigmatizing content on people with depression. This experimental study aimed at investigating the direct effects media reporting could have on people with depression, namely, higher levels of stigma attitudes and negative affect, as well as lower levels of self-esteem and positive affect. METHODS: Experimental study; target sample size n = 180 patients; eligibility criteria: clinical diagnosis of depressive episode or dysthymia, aged 18-70 years, sufficient cognitive abilities and German language skills; exclusion criteria: acute psychotic, manic or hypomanic episode, addiction symptoms, or suicidal ideation; parallel assignment to one of three arms (each n = 60): watching a short film about a negative event relating to depression (experimental group), about a negative event without relation to depression (control group 1), or about a neutral event relating to depression (control group 2); primary outcomes: degrees of stigma attitudes (stereotype awareness, stereotype agreement, self-concurrence, and self-stigmatization); secondary outcomes: degrees of self-esteem, positive and negative affect; statistical analyses: general linear models with repeated-measures; one-way ANOVAs of the change in scores, followed by Bonferroni-adjusted pairwise comparisons; IBM SPSS Statistics 24.0. RESULTS: Significant group × time interactions in stereotype agreement (medium effect: η = 0.10) and negative affect (large effect: η = 0.26); the level of stereotype agreement increased significantly more in the experimental group than in control groups 1 and 2. The level of negative affect increased significantly more in the experimental group and in control group 1 than in control group 2. All other interaction effects were non-significant. CONCLUSION: The present study allows statements about the direct effects of potentially stigmatizing media reporting on carriers of the stigmatized attribute, i.e., depression: Even single film presentations of familiar events that contain potentially stigmatizing content have an impact on stereotype agreement and negative affect. The impact of long-term exposure and change in other stigma-measures require a deeper understanding of stigma-processes. Potential explanations and implications for practice and future research are discussed. TRIAL REGISTRATION: Deutsche Register Klinischer Studien, Trial registration: DRKS00011855 . Registered 23 June 2017, retrospectively registered; for details see Additional file 1.

[Validation of a German Adaptation of the Self-Stigma of Depression Scale (SSDS) for Measuring Self-Stigmatization of People with Depression (SSDS-D)]. / Validierung einer deutschen, adaptierten Fassung der Self-Stigma of Depression Scale (SSDS) zur Messung von Selbststigmatisierung bei Personen mit Depression (SSDS-D).

The 16-item Self-Stigma of Depression Scale (SSDS) was developed to measure anticipated self-stigma hypothetically in case of depression. It is perfect for assessing anticipated self-stigma in community samples. However, in clinical samples measuring actual experienced instead of hypothetical self-stigma may be more appropriate. Aims of this study were the adaptation and validation of the SSDS specifically for people with depression. The abbreviation SSDS-D will be used in the following (D for depression) for this adapted version. All 16 items were translated into German and changed into indicative. Factor structure, internal consistency and construct validity were tested in two independent clinical samples (NA=550; NB=180). In sample A, the original structure of four factors (representing Shame, Self-Blame, Help-Seeking Inhibition, and Social Inadequacy) could be replicated in exploratory factor analyses with the exception of one item. In sample B, confirmatory factor analyses indicated a better fit for the empirically derived than for the alternatively tested original factor structure. Internal consistencies of subscales were satisfying to very good. Even controlled for current depressive symptoms, there were significant correlations to self-esteem and other self-stigma scales as expected, supporting the construct validity of SSDS-D. The SSDS-D appears to be a valid and reliable scale covering experienced self-stigma of people with depression. It may be used in clinical samples to identify correlates, test theoretical models and the efficacy of interventions.

[Sexual Abuse of Minors: Development in Light Field Statistics and Dark Field Research Since 1953 and Implications For The Health Care System]. / Sexueller Missbrauch an Kindern ­ Entwicklungen im Hell- und Dunkelfeld seit 1953 und Implikationen für das Gesundheitswesen.

Data on sexual abuse of minors can be obtained from official Police Crime Statistics and from dark field surveys. This article deals with the longitudinal development of the offense in the last 63 years in Germany. The criminal offenses of sexual abuse of children according to § 176 StGB (German Criminal Code) in the Police Crime Statistics show a decrease of frequency in the reporting period (1953-2016). The empirical results of the dark field research are inconsistent, but partially show a decline in frequency. In this study, the importance of these findings for prevention and health policy is discussed.

[Assessment of Mental Disorders]. / Begutachtung psychischer Erkrankungen in der gesetzlichen Renten- und Unfallversicherung.

Psychiatric expertise is necessary for a variety of legal expert opinion orders. Psychiatric assessment requires high professional competence and basic knowledge in the relevant areas of law. General conditions for comprehensive psychiatric assessment procedures are outlined. The problem of aggravation and simulation is discussed.

[Legal Capacity in patients with post-stroke-aphasia]. / Beurteilung der Geschäftsfähigkeit und Testierfähigkeit bei Schlaganfallpatienten mit Aphasie.

Aphasia is a frequent cognitive disorder after stroke. Despite a high prevalence, there is comparatively little medical literature or high court jurisdiction concerning the question if aphasia impairs patients in their legal capacity.Imaging studies allow a detailed understanding of the underlying pathology of aphasia, the resulting clinical pictures and potential mechanisms of recovery. Based on functional-anatomical models of language and associated concepts of inner speech, the impact of language disorders on legal capacity is evaluated. A phase model for the assessment of patients with aphasia is proposed, accounting for different stages of potential recovery after stroke.In practice, evaluation of the prerequisites for legal capacity or incapacity in patients with aphasia requires an interdisciplinary cooperation between neurologists, psychiatrists and speech language therapists. In cases of ex-post assessment, the evaluation of legal incapacity at a specific date, however, relies on a detailed documentation of the patient's language impairment and its recovery. To overcome the current limitations standardized and test-based assessment of neuropsychiatric and language capacities after acute hospital treatment and rehabilitation treatment is desirable.