Survey on the Prescription Patterns of Pharmacological Agents in Individuals Who Have Committed Sexual Offenses During Forensic Outpatient Treatment in Germany: How Many Discontinue Testosterone Lowering Medication Under Parole?

BACKGROUND: The number of individuals who sexually offended, and who are continued to be treated with pharmacological agents to reduce sex drive after their release from prison or forensic psychiatry, are not known. Furthermore, figures on the number of those who stop their sexdrive supressing antiandrogen treatment in the outpatient setting are unknown as well. This is of central importance though as it might be associated with an increased risk of recidivism. AIM: To assess prescription patterns as well as adherence to pharmacological treatment in outpatient clinics in Germany for individuals who have sexually offended and were released from prison or forensic psychiatric hospital. METHODS: A self-constructed online survey assessing the pharmacological treatment modalities was sent by e-mail to n = 103 forensic outpatient clinics in Germany. Thirty-three (32.0%) completed the questionnaire and reported about 834 patients. OUTCOMES: Prevalence of the use of different pharmacological agents in the treatment of individuals convicted for sexual offenses as well as the number of patients who have discontinued testosterone-lowering medication (TLM). RESULTS: Among all institutions, 22.4% (n = 187) of individuals received pharmacological treatment, with 40.1% receiving gonadotropin-releasing-hormone-agonists, 26.2% antipsychotics, 24.6% selective serotonin reuptake inhibitors, 6.4% cyproterone acetate, and 2.7% a combination of gonadotropin-releasing-hormone-agonists and cyproterone acetate. A significant positive correlation was found between the number of patients released from a forensic-psychiatric hospital and the number of patients treated with TLM. Within 1 year 8.6% (n = 16) stopped their TLM during or at the end of the supervision period, most of them against treatment providers advice. CLINICAL IMPLICATIONS: Substantial regional differences indicate uncertainties regarding the prescription of pharmacological agents for outpatients who have committed sexual offences in Germany. The discontinuiation of TLM within the first year of treatment against treatment providers advise in a substantial proportion of patients could be associated with a serious risk for reoffending. STRENGTHS & LIMITATIONS: The present survey captures prevalences of the pharmacotherapy in forensic aftercare facilities for individuals who have offended sexually, and is the first to record the number of discontinuations. This is a cross-sectional survey covering only 1 country, but includes a large number of individuals. CONCLUSION: Even though the number of treated individuals has increased in prisons, the majority of pharmacological treatment is still provided by forensic hospitals, which then translates into the outpatient setting. The number of those who stop taking such medication is a highly relevant topic for both forensic treatment providers and legal decision makers Sauter J, Rettenberger M, Briken P, et al. Survey on the Prescription Patterns of Pharmacological Agents in Individuals Who Have Committed Sexual Offenses During Forensic Outpatient Treatment in Germany: How Many Discontinue Testosterone Lowering Medication Under Parole?. J Sex Med 2022;19:1147-1155.

Interactional Effects Between Relational and Cognitive Reserves on Decline in Executive Functioning.

OBJECTIVES: The present study set out to investigate associations of cognitive reserve (as indicated by education) and relational reserve (as indicated by the family network size and indices of emotional support) to decline in executive functioning over 6 years as measured by changes in Trail Making Test (TMT) completion time in older adults and whether education and network size interacted with age and sex as covariates with respect to this longitudinal association. METHOD: We analyzed data from 897 participants tested on TMT parts A and B in two waves 6 years apart. The mean age in the first wave was 74.33 years. Participants reported information on their family networks and their level of education. RESULTS: Latent change score modeling testing for moderation effects revealed a significant interaction of network size in the first wave of data assessment with education. Specifically, for lower levels of cognitive reserve (-1 SD of education), the longitudinal association between relational reserve in the first wave and subsequent changes in executive functioning was not significant. In contrast, for higher levels of cognitive reserve (+1 SD of education), a higher relational reserve in the first wave significantly predicted a smaller subsequent increase in TMT completion time from the first to the second wave (i.e., a smaller decline in executive functioning). DISCUSSION: The present longitudinal study provides evidence for the interaction between cognitive and relational reserves. This confirms the hypothesis that reserves from different domains are intertwined and their combined effects contribute to less cognitive decline in old age.

Archaeal pseudomurein and bacterial murein cell wall biosynthesis share a common evolutionary ancestry.

Bacteria near-universally contain a cell wall sacculus of murein (peptidoglycan), the synthesis of which has been intensively studied for over 50 years. In striking contrast, archaeal species possess a variety of other cell wall types, none of them closely resembling murein. Interestingly though, one type of archaeal cell wall termed pseudomurein found in the methanogen orders Methanobacteriales and Methanopyrales is a structural analogue of murein in that it contains a glycan backbone that is cross-linked by a L-amino acid peptide. Here, we present taxonomic distribution, gene cluster and phylogenetic analyses that confirm orthologues of 13 bacterial murein biosynthesis enzymes in pseudomurein-containing methanogens, most of which are distantly related to their bacterial counterparts. We also present the first structure of an archaeal pseudomurein peptide ligase from Methanothermus fervidus DSM1088 (Mfer336) to a resolution of 2.5 Å and show that it possesses a similar overall tertiary three domain structure to bacterial MurC and MurD type murein peptide ligases. Taken together the data strongly indicate that murein and pseudomurein biosynthetic pathways share a common evolutionary history.

Testosterone-Lowering Medication and Its Association With Recidivism Risk in Individuals Convicted of Sexual Offenses.

For a particular subgroup of individuals with severe paraphilic disorders and a high risk of sexual recidivism, the combination of sex drive-reducing medications and psychotherapy is a promising treatment approach. The present quasi-experimental study aims at comparing differences in clinical characteristics and dynamic risk factors between persons receiving (+TLM, n = 38) versus not receiving (-TLM, n = 22) testosterone-lowering medications (TLMs). Individuals receiving TLM were more frequently diagnosed with paraphilic disorders. Neither the criminal history nor average risk scores differed between the two groups. In the +TLM, Stable-2007 scores showed a stronger decrease after TLM treatment was started. This accounted especially for the general and sexual self-regulation subscales. Individual variations in risk, however, were not predicted by TLM but were significantly related to treatment duration and Psychopathy Checklist-Revised (PCL-R) Factor I. Paraphilic patients with problems in self-regulatory abilities seem to profit most from pharmacological sex drive-reducing treatment. Furthermore, therapists seem to underestimate deviant sexual fantasies in medicated patients.

Targeting Misconduct in Prison by Modifying Occupational Factors in Correctional Facilities.

Misconduct in prison is a phenomenon, which by its nature is hard to observe. Little is known about its origins and its modifiability. This study presents data on the level of misconduct in prison perceived by staff members and examines its impact on occupational factors. Data from officers, which also included i.e. team climate, job satisfaction, self-efficacy, and sick days, was collected at three different correctional units in Berlin, Germany (N = 60). The study reveals higher rates of perceived misconduct in prison on regular units as compared to treatment units within the observed facilities. In addition, regression analysis provides evidence for an association of rates of misconduct in prison, sick days, and low self-efficacy. Results are discussed in terms of providing a model that supports the idea of a network entailing occupational factors and misconduct in prison and which can be utilized to target misconduct in prison with suitable interventions.

Distinct effects of cognitive versus somatic anxiety on cognitive performance in old age: the role of working memory capacity.

Objective: The adverse effects of anxiety on cognition are widely recognized. According to Attentional Control Theory, worry (i.e. facet of cognitive anxiety) is the component that is responsible for these effects, and working memory capacity (WMC) plays an important role in regulating them. Despite the increasing importance of this problem with aging, little is known about how these mechanisms interact in old age. In this study, we explored the distinct contributions of the somatic and cognitive components of anxiety to neuropsychological performance, and the potential moderating role of WMC.Method: We administered cognitive tasks testing processing speed, cognitive flexibility and working memory to 605 older adults, who also underwent depression and test anxiety assessments (data from VLV study).Results: Multiple regression analyses showed that cognitive (but not somatic) aspects of anxiety affected cognitive flexibility. The effect of cognitive anxiety on processing speed was moderated by WMC: the anxiety-performance association was lower for participants with greater WMC.Conclusion: Results confirmed the specific role of worry in the anxiety-performance relationship in old age and supported the hypothesis that working memory resources regulates its deleterious effect on cognition. The absence of a moderation effect in the more costly switching task may reflect a limitation of resources with aging.

The relation of low cognitive abilities to low well-being in old age is attenuated in individuals with greater cognitive reserve and greater social capital accumulated over the life course.

Objectives: The present study sets out to investigate the relation of cognitive abilities to well-being and its interplay with key life course proxies of cognitive reserve and social capital in a large sample of older adults.Method: Three thousand eighty older adults served as sample for the present study. Physical well-being (EuroQoL-5D questionnaire) and psychological well-being (Satisfaction with Life Scale) as well as cognitive performance in terms of verbal abilities (Mill Hill vocabulary scale), processing speed (Trail Making Test part A), and cognitive flexibility (Trail Making Test part B) were assessed. Participants reported information on education, occupation, cognitively stimulating leisure activities, the different languages regularly spoken as well as family and close friends.Results: Moderation analyses showed that the relation of cognitive performance to physical and psychological well-being was significantly attenuated in individuals with a higher cognitive level of the first job after education, a larger number of midlife and current cognitively stimulating leisure activities, a larger number of languages regularly spoken, a larger number of significant family members and friends, and more frequent contact with and more confidence in significant family members.Conclusion: Present data suggest that the relation of low cognitive abilities to low well-being in old age is attenuated in individuals with greater cognitive reserve and greater social capital accumulated over the life course.

Let's Work Together - Occupational Factors and Their Correlates to Prison Climate and Inmates' Attitudes Towards Treatment.

The role of psychosocial and structural occupational factors in mental health service provision has broadly been researched. However, less is known about the influence of employees' occupational factors on inmates in correctional treatment settings that mostly seek to apply a milieu-therapeutic approach. Therefore, the present study investigated the relationships between occupational factors (job satisfaction, self-efficacy, and the functionality of the organizational structure) and prison climate, the number of staff members' sick days as well as inmates' treatment motivation. Employees (n = 76) of three different correctional treatment units in Berlin, Germany, rated several occupational factors as well as prison climate. At the same time, treatment motivation of n = 232 inmates was assessed. Results showed that higher ratings of prison climate were associated with higher levels of team climate, job satisfaction and the functionality of the organizational structure, but not with self-efficacy and sick days. There was no significant relationship between occupational factors and the perceived safety on the treatment unit. Inmates' treatment motivation was correlated with all aggregated occupational factors and with average sick days of staff members. Outcomes of this study strongly emphasize the importance of a positive social climate in correctional treatment units for occupational factors of prison staff but also positive treatment outcomes for inmates. Also, in the light of these results, consequences for daily work routine and organizational structure of prisons are discussed.

Light-dependent growth kinetics enable scale-up of well-mixed phototrophic bioprocesses in different types of photobioreactors.

Scaling of phototrophic bioprocesses can be extremely challenging especially when reactor types in the considered scales differ. In this study, the mean integral photon flux density was used to transfer light-dependent growth kinetics of Nannochloropsis salina 40.85 and Nannochloropsis gaditana 2.99 grown with constant LED irradiation from flat-plate gas-lift photobioreactors (0.09 m2) to thin-layer cascade photobioreactors (8 m2). Even though completely different reactors were used, comparable growth rates were achieved on both scales with both strains by application of comparable mean light availabilities in the microalgae suspensions. In contrast, the light-dependent growth kinetics change significantly when irradiation varies dynamically (day-night cycles). The maximum intra-day growth rate of N. salina with dynamic climate simulation was doubled to 0.07 h-1 compared to constant irradiation, but tolerance of the microalgae against excessive irradiation was drastically reduced compared to constant irradiation. Because of that, predicting growth of N. salina in a physically simulated day-night climate would require the determination of the light-dependence of growth with dynamically varying conditions.

Cross-lagged relation of leisure activity participation to Trail Making Test performance 6 years later: Differential patterns in old age and very old age.

OBJECTIVE: We investigated cross-lagged relations between leisure activity participation and Trail Making Test (TMT) performance over 6 years and whether those reciprocal associations differed between individuals. METHOD: We analyzed data from 232 participants tested on performance in TMT Parts A and B as well as interviewed on leisure activity participation in 2 waves 6 years apart. Mean age in the Wave 1 was 73.42 years. Participants were also tested on vocabulary (Mill Hill scale) as a proxy indicator of crystallized intelligence and reported information on early and midlife cognitive reserve markers (education and occupation). Latent cross-lagged models were applied to investigate potential reciprocal activity-TMT relationships. RESULTS: The relation of leisure activity participation predicting TMT performance 6 years later was significantly larger than was the relation of TMT performance predicting later leisure activity participation. Statistically comparing different moderator groups revealed that this pattern was evident both in individuals with low education and in those with high education but, notably, emerged in only young-old adults (but not in old-old adults), in individuals with a low cognitive level of job in midlife (but not in those with a high cognitive level of job in midlife), and in individuals with high scores in vocabulary (but not in those with low scores in vocabulary). CONCLUSIONS: Late-life leisure activity participation may predict later cognitive status in terms of TMT performance, but individuals may markedly differ with respect to such effects. Implications for current cognitive reserve and neuropsychological aging research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The role of cognitive reserve accumulated in midlife for the relation between chronic diseases and cognitive decline in old age: A longitudinal follow-up across six years.

OBJECTIVES: The present study set out to investigate relations of the number of chronic diseases (as a global indicator of individuals' multimorbidity) to cognitive status and cognitive decline over six years as measured by changes in Trail Making Test (TMT) completion time in old adults and whether those relations differed by key life course markers of cognitive reserve (education, occupation, and cognitively stimulating leisure activities). METHOD: We analyzed data from 897 participants tested on TMT parts A and B in two waves six years apart. Mean age in the first wave was 74.33 years. Participants reported information on chronic diseases, education, occupation, and cognitively stimulating leisure activities. RESULTS: Latent change score modeling testing for moderation effects revealed that a larger number of chronic diseases significantly predicted stronger increase in TMT completion time (i.e., steeper cognitive performance decline). Notably, the detrimental relation of the number of chronic diseases to stronger increase in TMT completion time (i.e., cognitive performance decline) was significantly stronger in individuals with less engagement in cognitively stimulating leisure activities in midlife. DISCUSSION: Present data suggest that disease-related cognitive decline may be steeper in individuals who have accumulated less cognitive reserve in midlife. However, greater midlife activity engagement seemed to be associated with steeper cognitive decline in any case. Implications for current cognitive reserve and neuropsychological aging research are discussed.

Prison Climate and Its Role in Reducing Dynamic Risk Factors During Offender Treatment.

Although several offender treatment experts have suggested that therapeutic relationships play an important role in offender treatment, empirical finding supporting those arguments are scarce. The present study has therefore examined the relationship between prison climate, treatment motivation, and their influence on changes in risk factors in N = 215 inmates and detainees in four correctional facilities in Berlin, Germany. The inmates' perception of prison climate significantly correlated with their attitudes towards treatment. More positive climate in terms of therapeutic hold and more positive treatment attitude in terms of trust in therapy were also the best predictors of stronger decreases in dynamic risk factors measured by the Level of Service Inventory-Revised (LSI-R). Our results support the importance of treatment relationship factors within the course of offender rehabilitation.

Cognitive Reserve and Social Capital Accrued in Early and Midlife Moderate the Relation of Psychological Stress to Cognitive Performance in Old Age.

AIMS: The present study set out to investigate the relation of psychological stress to cognitive performance and its interplay with key life course markers of cognitive reserve and social capital in a large sample of older adults. METHODS: We assessed cognitive performance (verbal abilities and processing speed) and psychological stress in 2,812 older adults. The Participants reported information on education, occupation, leisure activities, family, and close friends. RESULTS: Greater psychological stress was significantly related to lower performance in verbal abilities and processing speed. Moderation analyses suggested that the relations of psychological stress to cognitive performance were reduced in individuals with higher education, a higher cognitive level of the first profession practiced after education, a larger number of midlife leisure activities, a larger number of significant family members, and a larger number of close friends. CONCLUSION: Cognitive reserve and social capital accrued in early and midlife may reduce the detrimental influences of psychological stress on cognitive functioning in old age.

Pharmacological treatment of sexual offenders in German outpatient treatment centers.

In Germany, depending on a sexual offender's culpability and the severity of the offence, he/she can be placed either in the forensic-psychiatric or the correctional system. Numbers related to the pharmacological treatment of sexual offenders for the correctional system are missing so far. In sexual offenders, the pharmacological treatment of paraphilic disorders is of special importance. The present study aimed at assessing the prevalence of pharmacological sexual offender treatment in German outpatient treatment centers supervising mainly clients from the correctional sector. An online questionnaire was sent to 112 outpatient treatment centers and 21 provided data relevant for the present study. The included institutions reported about a total of 813 sexual offenders, of whom 200 (24.6%) were treated with pharmacological agents, most frequently antipsychotics (14.8%) and selective-serotonin-reuptake-inhibitors (7.1%). Of the total sample, 26.7% of sexual offenders were diagnosed with a paraphilic - mainly with a pedophilic - disorder. Only 2% were treated with androgen-deprivation therapy. Compared with forensic-psychiatric institutions, only a minority of sexual offenders are treated with medication specifically addressing paraphilic symptomatology. However, the prevalence of paraphilic disorders found in the present study suggests that pharmacological treatment of paraphilic fantasies and behaviors could be of great importance in the correctional sector as well.

Associations of educational attainment and cognitive level of job with old age verbal ability and processing speed: The mediating role of chronic diseases.

We investigated whether the relation of educational attainment and cognitive level of job to performance in verbal ability and processing speed in old age was mediated via the number of chronic diseases. A total of 2,812 older adults participated. Psychometric tests on verbal ability and processing speed were administered. Individuals were interviewed regarding their education, midlife occupation, and chronic diseases in old age. Higher educational attainment and higher cognitive level of job were correlated with better performance in verbal ability and processing speed (.15 ≤ r ≤ .33, ps < .001). 1.4 to 7.3% of these relations was mediated via the number of chronic diseases (ß = .01, ps < .026). In conclusion, individuals with higher educational attainment and higher cognitive level of job may possibly suffer from fewer chronic diseases later in life. Possibly, this may finally be related to better performance in verbal ability and processing speed in those individuals in old age.

The Role of Leisure Activities in Mediating the Relationship between Physical Health and Well-Being: Differential Patterns in Old and Very Old Age.

BACKGROUND: Recently, Paggi et al. [Gerontology 2016;62:450-458] for the very first time showed in a cross-sectional sample of 259 adults aged 18-81 years that the relation of physical health to psychological well-being was mediated via frequency of leisure activity participation. OBJECTIVE: To extend this framework, we followed theories on successful aging and vulnerability to propose to add a differential perspective predicting that certain individuals may be more vulnerable than others and therefore may show differences in the mediation pattern. Specifically, we examined whether mediation patterns were differential in certain populations, such as in old-old (compared to young-old) adults and in individuals who carried out a low (compared to those with a high) number of activities. METHODS: We analyzed data from 3,080 individuals on physical health (number of chronic diseases, subjective health status, and subjective evaluation of change in health over the last 10 years), frequency of participation in 18 leisure activities, and physical and psychological well-being using moderated mediation models with a path model approach that allowed the simultaneous estimation of all model paths, including their significance. RESULTS: We found that the relation of physical health to physical and psychological well-being was mediated via frequency of activity participation. For physical (but not for psychological) well-being, this mediation was more pronounced in old-old (compared to young-old) adults and in individuals who carried out a low (compared to those with a high) number of activities. These moderated mediations were attributable to differential relations of physical health to frequency of activity participation and to differential relations of frequency of activity participation to physical well-being between the investigated moderator levels. CONCLUSION: Present data suggest that participation in leisure activities may play a key role in mediating the relationship between physical health and well-being, particularly in very old age. Findings are discussed with respect to theories of successful aging and differences between physical and psychological well-being.