[Use of interpreters in the context of insurance psychiatric expert assessment]. / Einsatz von Dolmetschern im Rahmen der versicherungs-psychiatrischen Begutachtung.

Limited knowledge of the German language represents a serious barrier for migrants into Switzerland to communicate successfully in a variety of health care settings, which may result not just in delayed access to treatment and poorer outcome, but also in difficulties judging eligibility for health and other social benefits. Especially when conducting disability and other occupational capacity evaluations, clinicians of all medical fields, but particularly psychiatrists, are required to obtain abundant information to allow them to perform a thorough mental health examination and to form a differentiated view of an evaluee's work capacity. Within a clinical context different translation and interpreting strategies are in use, and each strategy has its advantages and disadvantages. This mini-review describes the legal and modal aspects as well as the clinical-practical implications of the use of such interpreting services during disability evaluations.

Des connaissances linguistiques insuffisantes et des difficultés de communication constituent un défi majeur pour les migrants dans différents domaines de la santé. Elles peuvent notamment entraîner des difficultés à identifier les conditions d'octroi des prestations des assurances sociales. Pour déterminer une atteinte à la santé et évaluer la capacité de travail dans la procédure AI, les cliniciens, et en particulier les psychiatres, doivent développer une compréhension aussi différenciée que possible des données anamnestiques et du bilan psychopathologique. Différentes approches de traduction et d'interprétation sont donc utilisées dans le contexte clinique. Cette mini-review éclaire les aspects cliniques, formels et juridiques du recours à des interprètes dans les examens médicaux d'incapacité de travail (de longue durée) lorsque les compétences linguistiques des personnes expertisées sont insuffisantes.

[Unusual findings in carbon monoxide-related deaths]. / Ungewöhnliche Aspekte im Zusammenhang mit tödlich verlaufenen Kohlenmonoxidintoxikationen.

The authors present three cases of carbon monoxide poisoning (two suicides and one accident) from the autopsy material of the Institute of Legal Medicine at Basel, which are unusual with regard to the circumstances at the scene of death, the method of suicide and the post-mortem findings: Suicide of a 27-year-old male by burning charcoal in the bathroom, documentation of the suicide and previous attempted suicides on a tablet PC. Suicide of a 27-year-old male by carbon monoxide chemically, produced by dehydration of formic acid with sulphuric acid and inhalation of the gas through a breathing mask. Accidental carbon monoxide poisoning of a 34-year-old male by car exhaust fumes in an open garage. Difficult establishment of the diagnosis in the post-mortem examination due to unspecific colour of livores and varnished fingernails.

Response inhibition in pedophilia: an FMRI pilot study.

BACKGROUND: The failure to inhibit pleasurable but inappropriate urges is associated with frontal lobe pathology and has been suggested as a possible cause of pedophilic behavior. However, imaging and neuropsychological findings about frontal pathology in pedophilia are heterogeneous. In our study we therefore address inhibition behaviorally and by means of functional imaging, aiming to assess how inhibition in pedophilia is related to a differential recruitment of frontal brain areas. METHOD: Eleven pedophilic subjects and 7 nonpedophilic controls underwent fMRI while performing a go/no-go task composed of neutral letters. RESULTS: Pedophilic subjects showed a slower reaction time and less accurate visual target discrimination. fMRI voxel-level ANOVA revealed as a main effect of the go/no-go task an activation of prefrontal and parietal brain regions in the no-go condition, while the left anterior cingulate, precuneus and gyrus angularis became more activated in the go condition. In addition, a group × task interaction was found in the left precuneus and gyrus angularis. This interaction was based on an attenuated deactivation of these brain regions in the pedophilic group during performance of the no-go condition. The positive correlation between blood oxygen level-dependent imaging signal and reaction time in these brain areas indicates that attenuated deactivation is related to the behavioral findings. CONCLUSION: Slower reaction time and less accurate visual target discrimination in pedophilia was accompanied by attenuated deactivation of brain areas belonging to the default mode network. Our findings thus support the notion that behavioral differences might also derive from self-related processes and not necessarily from frontal lobe pathology.

Prevalence of mental disorders among detained asylum seekers in deportation arrest in Switzerland and validation of the Brief Jail Mental Health Screen BJMHS.

BACKGROUND: Though slowly growing, knowledge about prisoners detained for having violated an Alien Act is still marginal and most studies involve detained asylum seekers in the USA and Australia. Little is known about prevalence rates of mental health disorders in such a population. The Brief Jail Mental Health Screening BJMHS has been demonstrated in other prison populations as a valid screening for serious mental illness. AIM: The aims of this study were to describe prevalence rates for mental disorders according to ICD-10 and to validate the BJMHS for this population. METHODS: 80 inmates at a detention center for prisoners having violated the Swiss Aliens Act were surveyed using the BJMHS at their admission. The results were cross validated with the WHO Composite International Diagnostic Interview (CIDI). RESULTS: When omitting disorders caused by smoking tobacco, 76% of the prisoners suffered from at least one mental disorder according to CIDI. Whereas the rates for disorders due to psychoactive substance use as well as schizophrenic and affective disorders were comparable with other prison populations, we found a specific increased reporting of phobic (14%) and post-traumatic stress disorders (23%). The BJMHS detected serious mental illness defined as schizophrenic or affective disorders with a sensitivity of 81.0% and a specificity of 74.6%. DISCUSSION: As in other prison populations prevalence rates for mental disorders were markedly above the general population. The specific pattern with high rates of phobic as well as post-traumatic stress disorders may reflect the very often traumatic backgrounds of this population. Whereas the results for the validation of the BJMHS were even better than in other similar studies and the instrument proved to be practicable and helpful to detect serious mental illness, sensitivity for a screening tool of around 80% is still too low. Additionally the fact that other serious mental disorders are not covered emphasizes the importance of other elements in the screening process, including the need to have well-trained staff, and to have a low threshold for psychiatric examination.

Immediate processing of erotic stimuli in paedophilia and controls: a case control study.

BACKGROUND: Most neuroimaging studies investigating sexual arousal in paedophilia used erotic pictures together with a blocked fMRI design and long stimulus presentation time. While this approach allows the detection of sexual arousal, it does not enable the assessment of the immediate processing of erotically salient stimuli. Our study aimed to identify neuronal networks related to the immediate processing of erotic stimuli in heterosexual male paedophiles and healthy age-matched controls. METHODS: We presented erotic pictures of prepubescent children and adults in an event related fMRI-design to eight paedophilic subjects and age-matched controls. RESULTS: Erotic pictures of females elicited more activation in the right temporal lobe, the right parietal lobe and both occipital lobes and erotic pictures of children activated the right dorsomedial prefrontal cortex in both groups. An interaction of sex, age and group was present in the right anteriolateral oribitofrontal cortex. CONCLUSIONS: Our event related study design confirmed that erotic pictures activate some of the brain regions already known to be involved in the processing of erotic pictures when these are presented in blocks. In addition, it revealed that erotic pictures of prepubescent children activate brain regions critical for choosing response strategies in both groups, and that erotically salient stimuli selectively activate a brain region in paedophilic subjects that had previously been attributed to reward and punishment, and that had been shown to be implicated in the suppression of erotic response and deception.

[A pilot study for handling errors in psychotherapy - therapists report from practical experience]. / Eine Pilotstudie zum Umgang mit Fehlern in der Psychotherapie - Therapeuten berichten aus der Praxis.

OBJECTIVE: To assess the views of psychotherapists regarding management of treatment errors by reviewing and analyzing interviews with therapists. METHODS: A literature search was used to identify topics for the interview guide. Semi-structured interviews with 30 psychotherapists were conducted and analyzed according to qualitative content analysis, a framework approach. RESULTS: Psychotherapists report an open approach to handling treatment errors: the majority claim that they would discuss errors with their patients. Experiences with error disclosure were on the whole rather positive. Errors of colleagues would be discussed in a supervisory way or, in more serious cases, be reported. CONCLUSION: In psychotherapy, a constructive and open handling of errors seems to prevail. Therapists tend to be cautious when judging errors of colleagues.

LH-RH agonists modulate amygdala response to visual sexual stimulation: a single case fMRI study in pedophilia.

Pedophilia is characterized by a persistent sexual attraction to prepubescent children. Treatment with anti-androgen agents, such as luteinizing hormone-releasing hormone (LH-RH) agonists, reduces testosterone levels and thereby sexual drive and arousal. We used functional magnetic resonance imaging (fMRI) to compare visual erotic stimulation pre- and on-treatment with the LH-RH agonist leuprolide acetate in the case of homosexual pedophilia. The pre-treatment contrasts of the erotic pictures against the respective neutral pictures showed an activation of the right amygdala and adjacent parahippocampal gyrus that decreased significantly under treatment with leuprolide acetate. Our single case fMRI study supports the notion that anti-androgens may modify amygdala response to visual erotic stimulation, a hypothesis that should be further examined in larger studies.

Forensic and psychiatric aspects of joint suicide with carbon monoxide.

A case of joint suicide of a young woman and man who became acquainted in a suicide web forum and used this platform to make an appointment to commit suicide together is described. During their investigation, police were able to reconstruct the events by analysing the computer of the deceased women which was also found with the bodies. An indoor charcoal burning unit was used to release carbon monoxide as the method of suicide.

Criminal recidivism in offenders with personality disorders and substance use disorders over 8 years of time at risk.

Personality disorders (PD) and substance use disorders (SUD) lead to high violent criminality. The influence of co-morbidity on recidivism remains unclear. Recidivism of 379 offenders was assessed at 8 years of follow-up. Sixty-nine percent of PD+SUD, 45% of SUD- and 33% of PD- subjects showed any recidivism. However, violent recidivism was highest in the PD- group.

[Judgement and informed consent]. / Urteilsfähigkeit als Voraussetzung für Aufklärung und Einwilligung.

Every diagnostic or therapeutic medical intervention requires a legal basis. This is in most cases informed consent. The ability to give informed consent depends on correct judgement which can be influenced by many mental disorders, therefore doctors have to check the mental state of a patient before they accept his or her consent.

[Reproach of malpractice - legal procedure and possible consequences]. / Der Behandlungsfehlervorwurf - juristisches Prozedere und mögliche Konsequenzen.

Legal liability proceedings against doctors have increased considerably within the last few years. These discussions frequently start with communication problems between doctors and patients. Patients should be informed openly about unwanted incidents; this does not mean recognition of a liability obligation. Many proceedings do not get to courts when an agreement can be obtained after an independent expertise. In addition to a criminal proceeding a civil law liability can follow on proved malpractice. The important steps of legal proceeding and their consequences are represented.

Female serial killing: review and case report.

BACKGROUND: Single homicide committed by women is rare. Serial killing is very infrequent, and the perpetrators are usually white, intelligent males with sadistic tendencies. Serial killing by women has, however, also been described. AIM: To conduct a review of published literature on female serial killers and consider its usefulness in assessing a presenting case. METHOD: A literature review was conducted, after searching EMBASE, MEDLINE and PsycINFO. The presenting clinical case is described in detail in the context of the literature findings. Results The literature search revealed few relevant publications. Attempts to categorize the phenomenon of female serial killing according to patterns of and motives for the homicides have been made by some authors. The most common motive identified was material gain or similar extrinsic gratification while the 'hedonistic' sadistic or sexual serial killer seems to be extremely rare in women. There is no consistent theory of serial killing by women, but psychopathic personality traits and abusive childhood experiences have consistently been observed. The authors' case did not fit the description of a 'typical' female serial killer. DISCUSSION: In such unusual circumstances as serial killing by a woman, detailed individual case formulation is required to make sense of the psychopathology in each case. Publication of cases in scientific journals should be encouraged to advance our understanding of this phenomenon.

Paedophilia on the Internet--a study of 33 convicted offenders in the Canton of Lucerne.

BACKGROUND: The connection between the consumption of pornography and "contact-crimes" is unclear. The Internet has facilitated the mass consumption of pornography in general and specifically illegal pornography such as child-pornography. In 1999, the owners of "Landslide Production Inc.", an international provider of child-pornography in the USA were arrested and the credit-card-numbers of their clients were put at the disposal of the law enforcement agencies of the countries concerned. METHODS: Roughly 1300 Swiss citizens were subsequently arrested in the course of the nationwide action "Genesis". In the canton of Lucerne 33 men were identified. The police-files of these men were screened for psychosocial, criminological and psychosexual data. RESULTS: Most of these middle-aged men held comparatively elevated professional positions, only ten were married, eleven had never had an intimate relationship to a woman, and only thirteen of them had children. Only one of them had a relevant criminal record. The level of abuse depicted in the illegal material was high, all but one consumed pornography from other fields of sexual deviation. The personal statements of the offenders in general were hardly reliable, in three cases, however, the diagnosis of sexual deviation could be established from the files. The estimated time some of the offenders must have spent online in order to retrieve the material allows the diagnosis of Pathological Internet-Use. CONCLUSIONS: Deviant sexual fantasies seem to be widespread also among men otherwise not registered for any offences. The consumption of even particularly disgusting material may not be a specific risk factor for "contact" crimes.

The Werther effect and assisted suicide.

In the course of a large epidemiological study in the region of Basle, Switzerland, from 1992 to 1996, a considerable rise in suicides assisted by the right-to-die society EXIT was uncovered after wide press coverage of an assisted double suicide of a prominent couple in that region in March 1995. Further investigation revealed that the rise of assisted suicides for a period of 2 years after the critical event was statistically significant compared to the 2 years previous to the double suicide. This was especially true for women older than 65 years. Hence, the almost enthusiastic kind of reporting about this event was apt to induce imitation suicides or a "Werther-effect."