[Interrater reliability of the criteria-based assessment of criminal responsibility in paraphilic disorders]. / Interrater-Reliabilität der kriteriengeleiteten Beurteilung der Schuldfähigkeit bei paraphilen Störungen.

BACKGROUND: For the assessment of criminal responsibility in the context of sexual delinquency, the evaluation of the severity of a paraphilic disorder and the ability to be controlled are of particular importance. Established assessment criteria are insufficiently operationalized. AIM AND METHODS: The existing criteria were tested by experts of various professional groups with respect to the reliability. For this purpose, 14 experts assessed the criteria of 2 different sets of criteria based on 2 case vignettes (see electronic supplementary material). RESULTS AND CONCLUSION: The interrater reliability (IRR) with reference to the criteria of Briken and Müller was higher than the previously established criteria of Boetticher et al. The evaluation of the subjective importance of the criteria of both assessment scales showed that all criteria were rated as at least of average importance. It could thus be useful to initially include both sets of criteria for a greater transparency in the assessment process and to investigate this procedure in further studies.

Facial perception of infants with cleft lip and palate with/without the NAM appliance.

OBJECTIVE: This study aimed to assess adults' subjective perception of infants with a unilateral cleft lip and palate (UCLP) with and without a nasoalveolar molding (NAM) appliance compared to those of controls concerning (1) adult gaze patterns and (2) emotional valence. METHODS: This interdisciplinary study was performed by (1) the Department of Orthodontics and (2) the Department for Psychiatry and Psychotherapy, University Medical Center Goettingen, using eye tracking and a 10-point Likert scale questionnaire. Eye movements and valence rating of 30 unaffected adults (15 women, 15 men; mean age: 25.5 years, standard deviation [SD] = 7.5) were recorded while presenting them infants in three picture categories (1) infant with UCLP, (2) infant with UCLP and inserted NAM appliance and (3) infant without UCLP. Total fixation time in two main areas of interest (AOI upper/lower face) was measured according to picture category as well as participants' valence rating regarding infants' appearance. RESULTS: In pictures of infants with UCLP or UCLP and NAM appliance participants had longer fixation times on AOI lower face compared to reconstructed pictures of infants without UCLP. No significant effect of a NAM appliance on gaze patterns could be detected. The valence of pictures of infants with UCLP was rated more negative compared to pictures of unaffected infants. An inserted NAM appliance improved this rating. CONCLUSIONS: The results bolster the assumption that facial disruptions like UCLP alter adults' perception of infants. Even though the NAM appliance is not able to re-establish usual adult gaze patterns, it can help to improve adults' emotional assessment.

[Standards for treatment in forensic committment according to § 63 and § 64 of the German criminal code : Interdisciplinary task force of the DGPPN]. / Standards für die Behandlung im Maßregelvollzug nach §§ 63 und 64 StGB : Interdisziplinäre Task-Force der DGPPN.

People who have been convicted of a crime due to a severe mental disorder and continue to be dangerous as a result of this disorder may be placed in a forensic psychiatric facility for improvement and safeguarding according to § 63 and § 64 of the German Criminal Code (StGB). In Germany, approximately 9000 patients are treated in clinics for forensic psychiatry and psychotherapy on the basis of § 63 of the StGB and in withdrawal centers on the basis of § 64 StGB. The laws for treatment of patients in forensic commitment are passed by the individual States, with the result that even the basic conditions differ in the individual States. While minimum requirements have already been published for the preparation of expert opinions on liability and legal prognosis, consensus standards for the treatment in forensic psychiatry have not yet been published. Against this background, in 2014 the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) commissioned an interdisciplinary task force to develop professional standards for treatment in forensic psychiatry. Legal, ethical, structural, therapeutic and prognostic standards for forensic psychiatric treatment should be described according to the current state of science. After 3 years of work the results of the interdisciplinary working group were presented in early 2017 and approved by the board of the DGPPN. The standards for the treatment in the forensic psychiatric commitment aim to initiate a discussion in order to standardize the treatment conditions and to establish evidence-based recommendations.

[Diagnostics and treatment of sex offenders : In psychiatric forensic committment according to § 63 StGB and in outpatient prevention]. / Diagnostik und Behandlung sexueller Missbrauchstäter : Im Maßregelvollzug nach § 63 StGB und in der Präventionsambulanz.

In the following article similarities and differences concerning the treatment of sex offenders in the psychiatric forensic commitment (§ 63 German penal code) and of persons with a self-reported sexual interest in children, who were diagnosed and treated in the outpatient prevention of sexual abuse (PSM) in Göttingen are demonstrated. Diagnostic and therapeutic characteristics of outpatient prevention as well as the initial results of the evaluation of the Göttingen therapy manual are presented and differentiated from the normal treatment program in psychiatric forensic commitment.

[Assessment of criminal responsibility in paraphilic disorder. Can the severity of the disorder be assessed with items of standardized prognostic instruments?]. / Beurteilung der Schuldfähigkeit bei paraphiler Störung. Kann der Schweregrad der Störung mithilfe von Kriterien aus Prognoseinstrumenten erfasst werden?

BACKGROUND: Assessment of the severity of paraphilic disorders is an important aspect of psychiatric court reports for assessing criminal responsibility and placement in a forensic psychiatric hospital according to the German penal code (§§ 20, 21, 63 StGB). The minimum requirements for appraisal of criminal responsibility published by an interdisciplinary working group under the guidance of the German Federal Court of Justice define the standards for this procedure. OBJECTIVES AND METHODS: This paper presents a research concept that aims to assess the severity of paraphilic disorders by using items of standardized prognostic instruments. RESULTS AND CONCLUSIONS: In addition to a formal diagnosis according to the international classification of diseases (ICD) and the diagnostic and statistical manual of mental diseases (DSM) criteria, the items "deviant sexual interests" and "sexual preoccupations" from the prognosis instrument Stable 2007 are used to assess the severity of paraphilic disorders. Other criteria, such as "relationship deficits" are used to support the appraisal of the severity of the disorder. The items "sexual preoccupation", "emotional collapse" and "collapse of social support" from the prognosis instrument Acute 2007 are used to assess the capacity for self-control. In a next step the validity and reliability of this concept will be tested.

[Use of virtual reality in forensic psychiatry. A new paradigm?]. / Anwendung virtueller Realitäten in der forensischen Psychiatrie. Ein neues Paradigma?

BACKGROUND: For more than 20 years virtual realities (VR) have been successfully used in the assessment and treatment of psychiatric disorders. The most important advantages of VR are the high ecological validity of virtual environments, the entire controllability of virtual stimuli in the virtual environment and the capability to induce the sensation of being in the virtual environment instead of the physical environment. VRs provide the opportunity to face the user with stimuli and situations which are not available or too risky in reality. Despite these advantages VR-based applications have not yet been applied in forensic psychiatry. OBJECTIVES AND METHODS: On the basis of an overview of the recent state-of-the-art in VR-based applications in general psychiatry, the article demonstrates the advantages and possibilities of VR-based applications in forensic psychiatry. RESULTS AND CONCLUSIONS: Up to now only preliminary studies regarding the VR-based assessment of pedophilic interests exist. These studies demonstrate the potential of ecologically valid VR-based applications for the assessment of forensically relevant disorders. One of the most important advantages is the possibility of VR to assess the behavior of forensic inpatients in crime-related situations without endangering others. This provides completely new possibilities not only regarding the assessment but also for the treatment of forensic inpatients. Before utilizing these possibilities in the clinical practice exhaustive research and development will be necessary. Given the high potential of VR-based applications, this effort would be worth it.

[Pedophilia: etiology, diagnostics and therapy]. / Pädophilie: Ätiologie, Diagnostik und Therapie.

Child sexual abuse is one of the most destructive events for healthy child development. Following psychiatric classification systems, pedophilia must be distinguished from child sexual abuse. Approximately only one half of all child abusers fulfill the diagnostic criteria for pedophilia which is defined as a persistent or dominating sexual preference for prepubescent children characterized by persistent thoughts, fantasies, urges, sexual arousal or behavior. This article describes the diagnostic criteria and potential differential diagnoses as well as epidemiological and etiological findings. From an etiological point of view multifactorial mechanisms are currently considered to be responsible especially genetic factors, learning theoretical and neurobiological factors. Psychotherapeutic and pharmaceutical treatment options will be discussed. According to the current state of knowledge cognitive-behavioral psychotherapy is the method of choice in the treatment of pedophilia and has demonstrated positive treatment effects in meta-analyses regarding relapse prevention. Medicinal treatment of pedophilia is only indicated for severe forms of pedophilia. Important aspects of risk management in the treatment of pedophilia and aspects which must be considered in the forensic psychiatric assessment are presented.

[Legal probation after deferred retrospective preventive detention: implications for the amended regulations on preventive detention]. / Legalbewährung nach nicht angeordneter nachträglicher Sicherungsverwahrung : Implikationen für die Neuregelung der Sicherungsverwahrung.

The study examines the legal probation of offenders who are considered to be highly dangerous but due to the decision of the Federal High Court were not in retrospective preventive detention (§ 66b StGB). In view of the current discussion, in anticipation of a detailed presentation of the study results the relevant criteria "probation behavior", "personality characteristics" and "prognosis quality" are picked out. The results are evaluated with respect to knowledge of the restrictions conditioned by the study regarding the usefulness for the prognosis of reoffending. The results of this study suggest that it might be useful to describe psychological criteria for the not seriously reoffending group of probands.

[Forensic psychiatry in the era of neuroscience: present status and outlook for neurobiological research]. / Forensische Psychiatrie im Zeitalter der "neuroscience": Stand und Perspektive neurobiologischer Forschung.

Progress in neurobiological research has influenced our view of human beings and the basics of their behavior. Regarding criminal law and forensic psychiatry, established codes of practice are being challenged by neuroscientific research. This article gives an overview of neurobiological findings and methods in the context of forensic psychiatric issues. Empirical approaches to addressing important legal questions are outlined. Principles behind forensic psychiatric expert opinions are given. The effect and future of neuroscientific findings and methods in answering forensic psychiatric questions are discussed. Limitations and legal and ethical requirements are addressed.

[Unruly passengers - resistance to requests by flight attendants]. / Psychisch auffällige Flugpassagiere - Widerstand gegen die Anweisungen des Flugpersonals.

Travelling by airplane is of increasing importance in modern society. Psychiatric disorders seldom cause incidents in aircrafts. Scandal sheets and serious newspapers as well report on disturbances of a flight by psychiatric patients. Up until now psychiatric research is not engaging in unruly flight passengers suffering from psychotic symptoms. We describe a passenger who became psychotic during an international flight. In addition, we provide an overview over publications dealing with unruly passengers due to psychosis and describe similar cases.

Johann Bernhard Aloys von Gudden (1824-1886): not only the King of Bavaria's psychiatrist.

The great achievements of Bernhard von Gudden in the field of biological psychiatry are overshadowed by his two-day treatment of the Bavarian 'fairy-tale' king Ludwig II, with whom he drowned in the Lake of Starnberg in 1886. Gudden was in fact a visionary psychiatrist who blended a strong interest in neurobiology with humanitarian principles. He was far more than just a consulting psychiatrist to the Bavarian royal family.

Neuroleptic therapy influences basal ganglia activation: a functional magnetic resonance imaging study comparing controls to haloperidol- and olanzapine-treated inpatients.

Functional magnetic resonance imaging (fMRI) is a non-invasive technique for mapping the working brain. Using a fingertapping task, imaging of subcortical regions has proven to be difficult. We studied an inpatient under treatment with olanzapine and haloperidol, focusing on subcortical brain activation. We compared this patient with normal controls and with patients using haloperidol or olanzapine. Brain activation was induced by a unilateral self-paced fingertapping task. Brainvoyager software package (version 3.7) was used for data analyzing. Significant increases in blood oxygen level-dependent response were found in the contralateral motor area and the ipsilateral cerebellum in all patients. Differences with regard to the subcortical regions could be revealed in both the examinations of the same patient and the different treatment groups. Functional magnetic resonance imaging is an important method to study the interaction between basal ganglia, thalamus and the motor cortex. It is especially helpful to investigate intra-individual differences under different treatment conditions.

Oskar Panizza: Psychiatrist, antipsychiatrist, patient The man behind Emil Kraepelin's case report on 'paraphrenias'.

A contemporary of Emil Kraepelin, Oskar Panizza was a psychiatric trainee under Bernhard von Gudden at the Oberbayerische Kreisirrenanstalt München. While participating in Gudden's famous degeneration studies, Panizza became psychotic. He quit his job and became a writer, trying to cope with psychotic episodes by publishing literary works. Most of his works were confiscated and Panizza himself was locked up and persecuted. His experience of his psychotic symptoms made him critical of the psychiatric orthodoxy of the time, and he preached a kind of psychological psychiatry that anticipated important features of the Antipsychiatry movement of the 1970s. After serving a year in prison for his writings, Panizza left Germany and went to Zürich, Switzerland. In 1898 he was deported from Switzerland and went to Paris, where his book of poems, Parisiana and his money were confiscated. In 1901 he had to return to the Oberbayerische Kreisirrenanstalt where a diagnosis of paranoia was made. Then he lived in Paris for the next three years, but his psychotic symptoms worsened and he fled back to the Oberbayerische Kreisirrenanstalt, where he was examined by Prof. Gudden, Dr. Ungemach and by his former colleague Emil Kraepelin, who had become head of department. The encounters with Oskar Panizza gave Emil Kraepelin some of the ideas on which he developed his concept of 'paraphrenias' and in Lectures on Clinical Psychiatry , Kraepelin illustrated the 'systematic paraphrenias', by the life of his former colleague Oskar Panizza who died in hospital in Bayreuth in 1921.

The cost of obesity in Canada.

BACKGROUND: Almost one-third of adult Canadians are at increased risk of disability, disease and premature death because of being obese. In order to allocate limited health care resources rationally, it is necessary to elucidate the economic burden of obesity. OBJECTIVE: To estimate the direct costs related to the treatment of and research into obesity in Canada in 1997. METHODS: The prevalence of obesity (body mass index of 27 or greater) in Canada was determined using data from the National Population Health Survey, 1994-1995. Ten comorbidities of obesity were identified from the medical literature. A population attributable fraction (PAF) was calculated for each comorbidity with data from large cohort studies to determine the extent to which each comorbidity and its management costs were attributable to obesity. The direct cost of each comorbidity was determined using data from the Canadian Institute of Health Information (for direct expenditure categories) and from Health Canada (for the proportion of expenditure category attributable to the comorbidity). This prevalence-based approach identified the direct costs of hospital care, physician services, services of other health professionals, drugs, other health care and health research. For each comorbidity, the cost attributable to obesity was determined by multiplying the PAF by the total direct cost of the comorbidity. The overall impact of obesity was estimated as the sum of the PAF-weighted costs of treating the comorbidities. A sensitivity analysis was completed on both the estimated costs and the PAFs. RESULTS: The total direct cost of obesity in Canada in 1997 was estimated to be over $1.8 billion. This corresponded to 2.4% of the total health care expenditures for all diseases in Canada in 1997. The sensitivity analysis revealed that the total cost could be as high as $3.5 billion or as low as $829.4 million; this corresponded to 4.6% and 1.1% respectively of the total health care expenditures in 1997. When the contributions of the comorbidities to the total cost were considered, the 3 largest contributors were hypertension ($656.6 million), type 2 diabetes mellitus ($423.2 million) and coronary artery disease ($346.0 million). INTERPRETATION: A considerable proportion of health care dollars is devoted to the treatment and management of obesity-related comorbidities in Canada. Further research into the therapeutic benefits and cost-effectiveness of management strategies for obesity is required. It is anticipated that the prevention and treatment of obesity will have major positive effects on the overall cost of health care.

Love potions and the ointment of witches: historical aspects of the nightshade alkaloids.

BACKGROUND: Nightshade plants (Solanaceae) have been utilized as hallucinogenic drugs since antiquity in nearly every culture. The Solanaceae alkaloids, atropine and scopolamine, were the active substances in ointment of witches and medieval anesthetics, and in modern poisons. They are still currently used as hallucinogenic drugs. In poisonings, a dosage- and substance-dependent clinical picture occurs, with central and peripheral symptoms. Hallucinations are predominant in the middle dose range, which explains the drugs' earlier utilization for religious and prophetic purposes. Respiratory depression and arrest at high doses confirm the use of scopolamine as a lethal poison. Despite this, the nightshade alkaloids were utilized in clinical medicine in the 19th century. This is an overview of the cultural history of the nightshade alkaloids.

Randomized trial of measures of body fat versus body weight in the treatment of anorexia nervosa.

OBJECTIVE: To determine whether treatment goals based on body weight or body fat assessed by anthropometrics caused a larger reduction in the Eating Disorder Examination (EDE) over 3 months during the treatment of anorexia nervosa (AN). METHODS: Randomized trial comparing the use of body weight versus measures of body fat by anthropometrics, with the EDE as the outcome measure. Of 23 patients enrolled, 11 subjects who met diagnostic criteria for AN (DSM-IV) and received outpatient treatment from the Eating Disorders clinic of a university teaching hospital completed the study. RESULTS: Comparison of the 2 methods by independent t-tests, verified by Mann-Whitney and Sign tests, suggests no difference (p = 0.33). Due to the small sample size, statistical significance could not be assured. A cross-sectional survey of 48 clinic users found the majority of patients preferred to be followed by skinfold measurements and felt they were more helpful than weight. DISCUSSION: Regardless of which measurement is used, if the clinic staff firmly believe that a method is more helpful and more useful, it is likely that the patients will find it acceptable.