[Evidence-based expert testimonies on psychiatric disorders--risk factors for invalidity]. / Evidenzbasierte Begutachtung psychiatrischer Erkrankungen--Risikofaktoren für Leistungseinschränkungen.

Psychiatric symptoms often lead to a claim for disability pension. Surprisingly, there is very little empirical data available on which variables may predict permanent job disability. A new empirically based risk assessment instrument was developed to predict the final pension outcome. This study used prospective data over a 4-year period to examine the variables of the assessment instrument and the final outcome. Data of 223 subjects with psychiatric complaints were assessed at the time of evaluation for an invalidity pension claim. 95 (42.6%) of them were without a reduction of capability, 128 (57.4%) had a reduction of capability. Eight variables assessed at the initial psychiatric evaluation correlated significantly with the subsequent expert testimony. After applying a logistic regression (maximum likelihood estimation) we found 2 variables assessed at the initial psychiatric evaluation which correlated significantly with the expert testimony. These variables were the resumption of social activities and self-estimation of the subject's health and capability. The proportion of response variation explained by the regressors (Nagelkerkes R2) was 22%. Further research should aim to differentiate subjects with "high risks" from those with a better prognosis, with respect to future disability pensioning. One major task facing disability adjudicators is to separate those who have a legitimate disability claim from those who should be recommended for more intensive treatment modalities in order to successfully prevent permanent job disability.

[Risk factors for invalidity in psychiatric disorders--development of an empirically based assessment tool]. / Risikofaktoren für Leistungseinschränkungen bei psychiatrischen Erkrankungen--strukturierte Erfassung mit dem sozialmedizinischen Dokumentationsmodul.

The staggering amount of health-related disability associated with psychiatric disorders is increasing medical claim costs. Government-run health systems and social health insurances are under pressure in almost every developed country. The complex interrelationship of these disorders and disability pensioning poses a number of challenges and emphasises the need for specialists in psychiatric medicine. In the past, physicians did not favour standardised expert testimonies because it often limits a physician's freedom to decide. In this study an empirically based assessment instrument was developed to predict the final outcome, with respect to future disability. Further prospective clinical research should aim to differentiate subjects with "high risks" from those with a better prognosis.

[Structured psychiatric assessment of risk for violent recidivism in juvenile offenders]. / Psychiatrische Beurteilung des Gewaltrisikos im Jugendalter.

The psychiatric assessment of violence in youth represents a critical and essential part of forensic expertise and clinical practice. New methodical approaches are offered by structured risk rating scales and checklists which encompass psychopathy. The recently translated German version of Structured Assessment of Violence Risk in Youth (SAVRY), which is based on the Historical, Clinical, Risk Management Scheme (HCR 20), was evaluated in a sample of forensically assessed youth (n=83) regarding the predictive validity for criminal recidivism. Receiver operating characteristic (ROC) analyses attested medium (general delinquency), moderate (violent reoffending) and high (serious violent reoffending) effect strength, depending of the type of offence. Survival analyses showed that juveniles rated as high risk for violence were significantly faster and in a higher proportion recidivistic than those with a moderate or low risk. The results indicate the applicability of risk assessment instruments for German juveniles. Approaches for preventive, therapeutic and reintegrating measures are demonstrated, taking relapse patterns and dynamic risk aspects into consideration.

[Extent to which a claimant's loss-mitigation and cooperation obligations towards the insurer are enforceable--requirements for an expert medical opinion]. / Schadenminderungs- bzw. Mitwirkungspflichten von Anspruchstellern unter besonderer Berücksichtigung der Berufsunfähigkeits--(zusatz-) versicherung (BUZ) und der Aufgabe des ärztlichen Gutachters.

A policyholder claiming an annuity benefit on the grounds that, he is no longer able to pursue his occupation must meet certain obligations vis-à-vis the insurer, e.g. duty to mitigate the loss, duty to cooperate with the insurer. These obligations are often curtailed by the claimants' rights. Physicians and providers of expert medical opinions frequently do not share this opinion. Where medical and legal considerations intermingle and, potentially, conflict, there is great uncertainty as to whether, and to what extent, an insurer may require a claimant to undergo medical treatment. Before deciding on whether or not to grant an annuity, the insurer generally calls in medical experts to assess the policyholder's actual degree of disability and offer an opinion on whether and, if so, by what medical means that disability might be mitigated or remedied. Expert medical opinions are often decisive in such cases. The present article discusses the extent to which a claimant's loss-mitigation and cooperation obligations towards the insurer are enforceable; in this context, a number of court decisions are quoted. In addition, the authors define the requirements that an expert medical opinion must meet.

[Criteral for assessing quantitative disability in expert determination of functional physical disorders. Review of the literature]. / Kriterien zur Beurteilung der quantitativen Leistungseinschränkung bei der Begutachtung funktioneller körperlicher Störungen. Eine Literaturübersicht.

The assessment of individuals with somatoform disorders seeking payments or compensation is a major challenge for psychiatrists, insurers and the social welfare system. It is difficult to examine these disorders objectively and to quantify the impairment people experience in their work or private life. In order to develop more rational criteria for the assessment of these patients, we first reviewed the relevant literature and extracted the criteria mentioned by the respective authors. We then grouped these criteria in clinically plausible dimensions in order to develop a list of parameters that could help psychiatric experts to analyse the impairment more objectively and to help institutions in evaluating the assessments.

[Evaluation of risk assessment instruments for sex offenders]. / Rückfallprognosen bei Sexualstraftätern--Vergleich der prädiktiven Validität von Prognoseinstrumenten.

In order to evaluate risk assessment instruments for sex offenders in Germany, we compared the predictive validity of the Static-99, HCR-20, SVR-20, and PCL-R scales for 134 sex offenders. The mean follow-up time was 9 years (range 1-340 months), using the first entry into the National Register of Criminal Convictions as endpoint variable. For the estimate of predictive power, the area under the curve (AUC) of receiver operating characteristic (ROC) analysis was calculated. The AUC plots accurately identified violent or sexual recidivists and "false positives" at all scale levels. Comparing the predictive validity of these four instruments, the results favored Static-99. As for the limited sample size, differences between the assessment instruments were, however, not statistically significant. The ROC analysis for Static-99 showed that including treatment dropouts does not improve predictive accuracy (including dropouts: AUC 0.710; excluding dropouts: AUC 0.721). Kaplan-Meier survival analyses yielded highly a significant correlation to recidivism time point for two Static-99 and SVR-20 risk categories. Higher-risk categories were related to earlier recidivism. However, relying on the Static-99 and SVR-20 alone showed false positive results: for up to two out of three sex offenders, they predicted recidivism which did not occur.

[Psychiatric disorders and the prognosis for criminal recidivism]. / Psychiatrische Erkrankungen und die Prognose krimineller Rückfälligkeit.

The risk for criminal recidivism of mentally ill offenders is, unlike the general risk of delinquency, not well established. The relationship between psychiatric diagnosis and criminal recidivism was examined in the context of the Munich project on risk assessment. A total of 185 offenders had been examined on the question of culpability between 1992 and 1993. Re-offenses committed before the end of 2001 were recorded according to the Federal Registry of court sentences (Bundeszentralregister); 38.8% of the total group recidivated. High rates of recidivism were observed for individuals with substance abuse (45.5%) and with personality disorders (46.6%). The combination of the two illnesses increased the rate for recidivism to 50%. For individuals with organic, affective and neurotic disorders the rates for recidivism were below the average. Rates of recidivism for schizophrenic offenders were slightly higher, if re-offenses in the state of inculpability were included. The HCR-20 predicted recidivism equally well for offenders with and without a psychiatric diagnosis. In both groups, individuals with HCR-20 scores above the mean recidivated more often and after shorter periods of time.

[Alcohol and drugs and their relation to criminal recidivism]. / Alkohol und Drogen als Risikofaktoren für kriminelle Rückfälle.

This report assesses the influence of alcohol- and drug- induced disorders on criminal recidivism. A sample of 185 delinquents was examined for their criminal responsibility in the department of forensic psychiatry in the years 1992 and 1993. Official criminal records were obtained in December 2001. 27.3 % of the delinquents with alcohol abuse, 47.3 % with drug abuse and 47.2 % with a family history of alcohol abuse recidivated with a crime. 50 % of the individuals with an own alcohol- and drug abuse together with a family history of alcohol abuse recidivated. 62.5 % of offenders with both, own drug abuse and an alcohol abuse in their family history re-offended. The co-occurrence of both, own drug abuse and a family history of alcohol abuse is highly correlated with criminal recidivism and should be considered in treatment and aftercare programs.