[Reaction on 'Does ambulantization lead to more imprisonment of psychiatric patients?'] / Reactie op 'Leidt ambulantiseren tot meer gevangenschap van psychiatrische patiënten?'.

Reaction on 'Does ambulantization lead to more imprisonment of psychiatric patients?'

[Personalised medicine in forensic psychiatry: an example for other domains of psychiatry?] / Personalised medicine in de forensische psychiatrie: een voorbeeld voor andere domeinen in de psychiatrie?

BACKGROUND: Personalised medicine promises to provide us with a diagnostic predictive system of stratification that is based on a wide variety of tests; these can include biological, cognitive, demographic, psychopathological tests and other clearly defined tests. The purpose of forensic psychiatry is not only to take care of and treat mentally impaired patients but also to engage in risk assessment and risk management.
AIM: To explain risk assessment in forensic psychiatry as a nomothetic approach to personalised medicine, and also to demonstrate the link with offence paralleling behaviour, which is an illustration of the ideographic approach.
METHOD: A discussion of recent literature and insights into risk assessment, risk management and offence paralleling behaviour.
RESULTS: Risk assessment helps us to divide patients into groups according to the risk of recidivism. The nomothetic concept is the basis of most risk assessment instruments. One of the most important tasks in risk management in forensic psychiatry is to reduce the risk factors and strengthen the influence of protective factors. The model of offence paralleling behaviour resembles in many respects the concept of integrating risk management and treatment, but shows more precisely how hypotheses can be tested in a clinical context.
CONCLUSION: In view of the great importance to society of preventing offences, forensic psychiatry is leading the way in the application of personalised medicine in psychiatry.

Unraveling sexual associations in contact and noncontact child sex offenders using the single category - implicit association test.

Previous studies found associations between children and sex in child sex offenders (CSOs) using the Implicit Association Test (IAT). We used a modification of this task, the Single Category-Implicit Association Test (SC-IAT) to unravel child-sex associations in CSOs. Using the SC-IAT, we were able to test whether CSOs indeed hold stronger child-sex associations relative to adult-sex associations, compared to adult sex offenders and nonoffenders. Furthermore, we examined whether contact CSOs differed from noncontact CSOs in their child-sex associations. The hypothesis that CSOs would have stronger child-sex associations, relative to their adult-sex associations, than adult sex offenders and nonoffenders was confirmed. No difference between contact CSOs and noncontact CSOs was found. Although the Sex SC-IAT was able to distinguish CSOs from nonoffenders, the sensitivity and specificity of the test was poor (AUC of .65) and needs refinement. The results of this study support the existence of a child-sex association as a distinctive characteristic of CSOs. These findings are discussed in the context of theories on deviant cognitions in CSOs and risk for sexual offending.