Outcome Evaluation of a Treatment Program for Men with Paraphilic Disorders Convicted of Sexual Offenses: 10-Year Community Follow-up.

Evidence concerning specific paraphilia treatment effectiveness is limited. We present observation data of 127 men convicted of paraphilic sexual offenses who attended inpatient and outpatient follow-up treatment in Czechia. We collected participants' sociodemographic and treatment-related information, including STATIC-99R scores, and used proportional hazards models to analyze variables' effect on recidivism risk. Within the observation period, the general recidivism and sexual recidivism rates were 33.1% and 16.5%, respectively, and the sexual contact recidivism rate was 4.7%. The total STATIC-99 score for those who re-offended was 5.65 (SD = 2.11) and for those who did not was 3.98 (SD = 2.02). Recidivism risk was 7.52 times higher for those diagnosed with exhibitionism than with pedophilia, sadomasochism, or antisocial personality disorder. General recidivism is comparable to others' findings. We attribute the lower sexual contact recidivism rate to the combined effects of psychological and pharmacological treatment, and higher numbers of non-contact offenses to limited antidepressant use.

Violence risk and personality assessment in adolescents by Structured Assessment of Violence Risk in Youth (SAVRY) and high school personality questionnaire (HSPQ): Focus on protective factors strengthening.

Background: Adolescents are most at risk of engaging in violent interaction. Targeting violence risk and protective factors is essential for correctly understanding and assessing their role in potential violence. We aimed to use the Structured Assessment of Violence Risk in Youth (SAVRY) tool within the sample of adolescents to capture violence risk and protective factors and personality variables related to risk and protective factors. We further aimed to identify which violence risk and protective factors were positively or negatively related to violence within personal history and if any personality traits are typical for violent and non-violent adolescents. Identifying broader or underlying constructs within the SAVRY tool factor analysis can enable appropriate therapeutic targeting. Methods: We used the Czech standardized version of the SAVRY tool. The study sample comprised 175 men and 226 women aged 12-18 years divided into two categories according to the presence or absence of violence in their personal history. Mann-Whitney U test was used to compare numerical variables between the two groups. SAVRY factor analysis with varimax rotation was used to determine the item factors. We administered the High School Personality Questionnaire (HSPQ) to capture adolescents' personality characteristics. Results: In our sample, there were 151 participants with violence in their personal histories and 250 non-violent participants. Non-violent adolescents had higher values for all six SAVRY protective factors. The strongest protective factor was P3, Strong attachment and bonds across gender or a history of violence. Using factor analysis, we identified three SAVRY internal factors: social conduct, assimilation, and maladaptation. The SAVRY protective factors were significantly positively related to several factors in the HSPQ questionnaire. Conclusion: The results highlight the significance of protective factors and their relationship with violence prevalence. HSPQ diagnostics could be helpful in clinically targeting personality-based violence risks and protective factors. The therapeutic focus should be on tension, peer rejection, and anxiety. It is also essential to foster positive attitudes toward authority, prosocial behavior, and attitudes toward school. These strategies can help strengthen protective factors of the SAVRY.

Use of penile plethysmography in the court: A review of practices in Canada, the United Kingdom and the United States.

Penile plethysmography (PPG) is an objective measure of male sexual arousal in response to the presentation of a series of erotic and neutral stimuli. This measure is now widely recognized as the most reliable means of objectively measuring male sexual arousal to specific stimuli. Many clinicians and researchers consider PPG to be a vital contribution to the assessment and treatment of adult men with paraphilic interests and men who have committed sex crimes. PPG contributes to the clinical assessment of paraphilic interests, appraisal of risk of recidivism, and provides an objective measurement of changes in sexual arousal in response to treatment. There is strong support for the utility of PPG within clinical and legal contexts. This article addresses ways in which PPG has been utilized in the courts as part of expert clinical opinion. History of its use, details regarding admissibility in court, and case law are explored within the legal systems of Canada, the UK and the USA. Support for the inclusion of PPG as expert evidence is provided and judicial misunderstandings on the rationale for PPG use and its clinical utility in forensic assessments are discussed.

Development of a Case Formulation Model for Individuals Who Have Viewed, Distributed, and/or Shared Child Sexual Exploitation Material.

Increases in the number of arrests of individuals who download or distribute Child Sexual Exploitation Material (CSEM) have highlighted a need to further understand the offending pathways of this offender group. This article describes the development of an aetiological model specific to CSEM offending. Individuals who had viewed, distributed, and/or shared CSEM (n = 20) were interviewed regarding their life and sexual history, relationships, substance use, offending details, and circumstances leading to their CSEM offending, resulting in seven superordinate themes: Developmental Context, Individual Propensities (risk-related and risk-protective) and Psychological Vulnerabilities, Personal Circumstances, Permission-Giving Thoughts, Internet Environment and Behaviour, Evaluation of Consequences for the Individual, and Desistance. These themes were combined into a case formulation tool specific for CSEM offending behaviour, with the aim of providing systematic guidance for assessment and treatment providers.

Transnational Child Sexual Abuse: Outcomes from a Roundtable Discussion.

The phenomenon of men who travel across international borders to engage in child sexual abuse presents significant public health, legal, diplomatic, cultural, and research challenges. Briefed in the current scope of this issue by relevant stakeholders across legislation, research, and social policy, a roundtable discussion held in London aimed to synthesise plenary discussions from multidisciplinary attendees across law enforcement, academia, non-profit, and industry sectors with direct relevance to the UK. Specifically, the roundtable discussions aimed to gather the central themes relating to attendee discussions on the key challenges, affected countries, response strategies, and knowledge gaps. Four key themes were identified from the data, relating to the definition of Transnational Child Sexual Abuse (TCSA), criminal justice, geographical considerations, and issues surrounding tourism/hospitality. The data highlighted four priorities for future development and research, namely developing offender typologies, victim-centric investigative practice, prevalence and definitions, and collaborations. These themes provide insight into the issue of transnational child sexual abuse from the perspective of different disciplines and offer a strategy to prioritise, and collaborate, in the efforts against transnational child sexual abuse.

Anacardic acid inhibits pancreatic cancer cell growth, and potentiates chemotherapeutic effect by Chmp1A - ATM - p53 signaling pathway.

BACKGROUND: Pancreatic cancer is one of the leading causes of cancer related death and its incidence has risen steadily. Although anticancer drugs have been developed based on the new molecular findings, the drugs have produced unsatisfactory results due to toxicity and resistance. Thus, a complementary therapeutic intervention is urgently needed for pancreatic cancer patients. METHODS: The aim of this study was to assess the potential therapeutic effect of Anacardic acid on pancreatic cancer in vitro and elucidate its underlying mechanisms. Human pancreatic cancer cells were treated with Anacardic acid and assessed for the cytotoxic effect using MTT and spheroid formation assays. Using the same methods, the synergy between Anacardic acid and 5-Fluorouracil or Gemcitabine was determined. To elucidate the underlying molecular mechanisms, Western blot analysis and immunocytochemistry were performed on cancer cells treated with Anacardic acid alone or in combination with 5-Fluorouracil or Gemcitabine. Chromatin Modifying Protein 1A (Chmp1A), Ataxia Telangiectasia Mutated (ATM), and p53 were the primary signaling molecules examined. In addition, Chmp1A was silenced with shRNA to examine the necessity of Chmp1A for the anticancer effect of Anacardic acid, 5-Fluorouracil, or Gemcitabine. RESULTS: Anacardic acid induced an anticancer effect in pancreatic cancer cell lines in a dose dependent manner, and increased the cytotoxicity of 5-Fluorouracil or Gemcitabine in MTT cell viability assays. In spheroid formation assays, spheroids formed were smaller in size and in number upon Anacardic acid treatment compared to control. Mechanistically, Anacardic acid exerted its anticancer activity via the activation of Chmp1A, ATM, and p53. Interestingly, 5-Fluorouracil and Gemcitabine also induced an increase in Chmp1A protein level, suggesting that Chmp1A might mediate the cytotoxic action of chemotherapeutics. Silencing experiments indicate that Chmp1A is required for the action of Anacardic acid, but not for 5-Fluorouracil or Gemcitabine. CONCLUSIONS: Our data suggests that Anacardic Acid might be a promising complementary supplement to slow the initiation or progression of pancreatic cancer.

Ethics and Issues of Secondary Prevention Efforts in Child Sexual Abuse.

This article discusses the ethical, practical, and moral issues surrounding secondary prevention efforts of child sexual abuse from a professional and practice-based perspective. Transcripts of a semistructured consultation event with n = 15 international experts on the secondary prevention of child sexual abuse were analysed using thematic qualitative analysis. The research identified four main critical areas linked to secondary prevention efforts, including, the psychology of self-reporting and disclosure; the interaction with and within existing legal, social, and professional frameworks; the scale and type of an appropriate response; and potential hurdles (i.e., within media, public, politics). The article outlines these areas, highlighting participant perspectives on risk-enhancing and mitigating factors for each domain.

A non-randomised controlled trial of the R&R2MHP cognitive skills program in high risk male offenders with severe mental illness.

BACKGROUND: The growing popularity of offending behavior programs has led to the interest of whether such programs are effective with mentally disordered offenders. This study aimed to evaluate the effectiveness of the Reasoning and Rehabilitation program adapted for offenders with severe mental illness (R&R2 MHP). METHODS: A sample of 59 adult high risk males detained in a high secure hospital completed questionnaires at baseline and post treatment to assess violent attitudes, anger, coping processes and social problem-solving. An informant measure of social and psychological functioning, including disruptive behavior, was completed by staff at the same time. The data of 30 patients who participated in the group condition were compared using intention to treat analysis with 29 controls who received treatment as usual. RESULTS: 80% of group participants completed the program. In contrast to controls, significant medium-large treatment effects were found at outcome on self-reported measures of violent attitudes, social problem-solving and coping processes. Improvements were endorsed by informant ratings of disruptive behavior, social and psychological functioning. CONCLUSIONS: The R&R2MHP had a comparatively low dropout rate and was effective in a sample of high risk mentally disordered offenders requiring detention in high security. Future research should use a randomized controlled design. TRIAL REGISTRATION: Current Controlled Trials ACTRN12613000216718.

A controlled trial of a cognitive skills program for personality-disordered offenders.

OBJECTIVE: There is a need to find effective treatments for individuals with antisocial and borderline personality disorder who are known to be difficult to engage and treat. Many of these individuals share considerable overlap with symptoms of ADHD, hence this study aimed to evaluate the Reasoning and Rehabilitation ADHD program (R&R2 ADHD) among patients with severe personality disorder. METHOD: A total of 31 males detained in a "dangerous and severe personality disorder" unit completed questionnaires at baseline and post treatment to assess social problem solving, violent attitudes, anger, ADHD symptoms, emotional control, and social functioning. A total of 16 patients participated in the group condition, and their scores were compared with 15 waiting-list controls who received treatment as usual. RESULTS: In all, 76% of group participants completed the program. In contrast to controls, they showed significant improvements in scores with mainly medium effect sizes. CONCLUSION: R&R2 ADHD was effective in a small sample of severely personality-disordered offenders.