Self-aggression, reactive aggression, and spontaneous aggression: Mediating effects of self-esteem and psychopathology.

This study examined whether the associations between self-aggression and different forms of externalized aggression (reactive and spontaneous aggression) are influenced by self-esteem and current psychopathological symptoms. For this purpose, we asked 681 participants from the general population (GP) and 282 general psychiatric patients (PPs) to answer the German versions of the Short Questionnaire for Assessing Factors of Aggression (K-FAF), the Multidimensional Self-Esteem Scale (MSWS), and the Brief Symptom Inventory 25 Forensic (BSI-25-F). Statistically, we performed descriptive and mediation analyses. Our findings indicated that in both samples the association between self-aggression and reactive aggression was mediated by self-esteem but not by current psychological problems. The association between self-aggression and spontaneous aggression was mediated by self-esteem in the GP sample and by psychopathological symptoms in the PP sample. We conclude that when examining the association between self-aggression and externalized aggression it is important to consider the various subtypes of externalized aggression and differences between populations.

The Therapeutic Relationship in Forensic and General Psychiatric Settings.

INTRODUCTION: Therapeutic relationship in forensic psychiatry is believed to be affected by the coercive setting and the role conflict of the therapists as both treaters and court-appointed experts. The aim of the study was to examine and compare the therapeutic relationship in forensic and general psychiatric settings. MATERIAL AND METHODS: 52 forensic patients and 66 general psychiatric patients filled in the Psychopathy Personality Inventory - Revised (PPI-R), the Inventory of Interpersonal Problems - German Version (IIP-D), the Questionnaire on Motivation for Psychotherapy (Fragebogen zur Erfassung der Psychotherapiemotivation (FPTM)) as well as the Working Alliance Inventory - Short Revised (WAI-SR). We applied descriptive analyses, calculated univariate t-tests as well as multivariate T-tests and performed general linear models. RESULTS: The quality of the therapeutic alliance does not differ significantly between forensic and general psychiatric patients. Moreover, patients of forensic psychiatry consider therapeutic techniques applied by their therapists as more valuable for achieving their therapeutic aims than patients of the general psychiatry. DISCUSSION: The therapeutic relationship in forensic psychiatry is as viable as in general psychiatry. This can be regarded as a result of the long-term therapy in the context of forensic psychiatry which allows more time to be spent on relationship building than in a general psychiatry setting where therapy is limited to a few weeks.

[Are Depressed People Aggressive People? Differences Between General Population and Depressive Patients]. / Sind depressive Menschen aggressive Menschen? Unterschiede zwischen Allgemeinbevölkerung und depressiven Patienten.

IntroductionThe study aimed to investigate the relationship between depression and aggression. Material and Methods681 depressive and non-depressive subjects of the general population as well as 132 depressive patients completed the Beck Depression Inventory Revised (BDI-II) as well as the Short Questionnaire for Gathering Factors of Aggressiveness (K-FAF). ResultsDepressive patients and depressive subjects of the general population did not merely report the highest levels of self-aggressiveness but also reached the highest scores on the scales of reactive and proactive aggression, indicating a high level of externalizing aggressiveness. DiscussionThe results support the neurobiological approach of the etiology of depressive disorders. Conclusions For future research of depressive disorders and aggression the investigation of the mediating roles of a low serotonin-level is recommended.

Baseline brain perfusion and brain structure in patients with major depression: a multimodal magnetic resonance imaging study.

BACKGROUND: Abnormal regional cerebral blood flow (rCBF) and grey matter volume have been frequently reported in patients with major depressive disorder (MDD). However, it is unclear to what extent structural and functional change co-occurs in patients with MDD and whether markers of neural activity, such as rCBF, can be predicted by structural change. METHODS: Using MRI, we investigated resting-state rCBF and brain structure in patients with MDD and healthy controls between July 2008 and January 2013. We acquired perfusion images obtained with continuous arterial spin labelling, used voxel-based morphometry to assess grey matter volume and integrated biological parametric mapping analyses to investigate the impact of brain atrophy on rCBF. RESULTS: We included 43 patients and 29 controls in our study. Frontotemporal grey matter volume was reduced in patients compared with controls. In patients, rCBF was reduced in the anterior cingulate and bilateral parahippocampal areas and increased in frontoparietal and striatal regions. These abnormalities were confirmed by analyses with brain volume as a covariate. In patients with MDD there were significant negative correlations between the extent of depressive symptoms and bilateral parahippocampal rCBF. We found a positive correlation between depressive symptoms and rCBF for right middle frontal cortical blood flow. LIMITATIONS: Medication use in patients has to be considered as a limitation of our study. CONCLUSION: Our data suggest that while changes of cerebral blood flow and brain volume co-occur in patients with MDD, structural change is not sufficient to explain altered neural activity in patients at rest. Abnormal brain structure and function in patients with MDD appear to reflect distinct levels of neuropathology.

FACTORIAL VALIDITY OF THE SHORT FORM OF THE CHILDHOOD TRAUMA QUESTIONNAIRE (CTQ-SF) IN GERMAN PSYCHIATRIC PATIENTS, INMATES, AND UNIVERSITY STUDENTS.

For the purpose of retrospective assessment and characterization of childhood trauma in adults, the factorial validity of the short form of the Childhood Trauma Questionnaire (CTQ-SF) in Germany was evaluated by conducting confirmatory factor analyses for three samples including 1,524 adult psychiatric patients, 224 inmates, and 295 university students. In addition, sex-specific confirmatory factor analyses were performed within each sample. Because several authors have suggested a different factor structure than that originally proposed in the manual, two competing models focusing on the Physical neglect subscale were examined. In psychiatric patients and inmates, the fit indices were reasonable to good. Among the students, factor loadings were markedly lower, and fit indices were poor. Sex-specific analyses did not indicate sex differences. Comparing the original and the alternative models revealed better fit indices of the original factor structure. The present findings indicate that the German version of the CTQ-SF has factorial validity in psychiatric patients and inmates, but not in students.

[Self-Aggression as Mediator between Depression and Aggression]. / Selbstaggression als Mediator zwischen Depression und Aggressivität.

OBJECTIVE: The aim of the present study was to examine the relationship between depression, self-aggression and externalized aggression. METHODS: In order to check a possible mediator effect of self-aggression on the relationship between depression and externalized aggression, we investigated a clinical sample of patients diagnosed with major depression (n = 134) and conducted a mediator analysis. RESULTS: Self-aggression mediated the relationship of depression and externalized aggression in terms of a total mediator effect. CONCLUSIONS: Patients with major depression tend to exhibit both, self-aggression and externalized aggression equally.

Neuropsychological profile of pedophilic child sexual offenders compared with an IQ-matched non-offender sample - Results of a pilot study.

Child sexual offenders have been found to have a lower average IQ than the general population. Several studies indicate that they also exhibit executive dysfunction, but the specificity of this dysfunction is unclear; the inconclusive results have been attributed to methodological problems and the heterogeneity of the population. Our study aimed to describe the neuropsychological profiles of convicted child sexual offenders with pedophilia (n = 15). To control for IQ-related effects on neuropsychological performance, we compared the sample with an IQ-matched control group (n = 15). Test scores in both groups were significantly lower than the norms, but we did not find significant differences between the two study groups. The findings of our pilot study indicate that the neuropsychological deficits of pedophilic sexual offenders are unspecific rather than the result of a pedophilia-specific brain dysfunction.

High Quality of Life Reduces Depression, Hopelessness, and Suicide Ideations in Patients in Forensic Psychiatry.

BACKGROUND: Suicides are more common in forensic patients than in the general population. Two reasons for this discrepancy are discussed: (1) Suicides are the consequence of maladaptation to the restrictive living conditions in forensic psychiatry, and (2) suicides are explained by the demographic, social, and psychosocial characteristics of the inmates themselves, i.e., suicides happen because the inmates belong to a particularly vulnerable group. Therefore, the present study aimed to analyze the relationship between quality of life, as an indicator of the restrictive living conditions, and hopelessness, depression, and suicide ideations in a sample of forensic patients. METHODS: We assessed quality of life with a German version of the Measuring the Quality of Prison Life questionnaire that had been adapted to forensic hospitals (MQPL-forensic) and depressive symptoms with the Beck Depression Inventory, hopelessness with the Beck Hopelessness Scale, and suicide ideations with the Beck Scale for Suicide Ideation. The study included a total of 159 patients in 12 German forensic psychiatric hospitals who had been admitted in accordance with Section 64 of the German Criminal Code. We analyzed the relationships between quality of life and depression, hopelessness, and suicide ideations on the patient and hospital levels. Hospital characteristics were generated by aggregating the MQPL-forensic variables measured at the patient level. RESULTS: In generalized estimating equation models, the MQPL-forensic total score and almost all the subscale scores were significant negative predictors of depressive symptoms, hopelessness, and suicide ideations at the patient and hospital levels. At the patient level, patients who experienced a supportive welcome at the hospital, good relationships with their therapists, respectful interactions, transparent decisions, and supportive therapeutic approaches were significantly less depressed, less hopeless, and less likely to consider suicide. At the hospital level, good relationships with therapists and respectful interactions were significant negative predictors of these variables. DISCUSSION: The results indicate that the social framework within forensic psychiatric hospitals influences the frequency of suicide ideation and the severity of depressive symptoms and hopelessness among forensic patients. Forensic-psychiatric hospitals should be aware of these significant relationships and try to improve patients' quality of life.

[Who Benefits from Forensic Psychiatric Treatment? Results of a Catamnestic Study in Swabia]. / Wer profitiert von einer Behandlung im Maßregelvollzug? Ergebnisse einer bayernweiten Katamnesestudie für den Bezirk Schwaben.

OBJECTIVE: Evaluation of treatment outcomes of forensic inpatients in the Bavarian district of Swabia (2010 - 2014). METHODS: 130 inpatients were interviewed about their social reintegration, substance use and delinquency immediately after discharge from forensic psychiatry and one year after. RESULTS: One year after discharge 67 % of the patients referred due to substance use disorder according to §â€Š64 of the German Penal Code were employed, 57 % were abstinent and 83 % did not reoffend. Patients who were detained due to severe mental illness according to §â€Š63 of the German Penal Code often received inability pensions (57 %), 14 % were integrated in sheltered workshops and 100 % did not reoffend. CONCLUSION: Forensic-psychiatric treatment contributes to rehabilitation and reduces risk factors of mentally disordered offenders.

The association of adverse childhood experiences and appetitive aggression with suicide attempts and violent crimes in male forensic psychiatry inpatients.

Although previous studies in inmates, forensic and psychiatric samples suggest the relation between childhood trauma and suicide behavior as well as between childhood trauma and violent delinquency, the understanding of possible underlying mechanisms is still fragmentary. In a naturalistic study design, we tested if suicidal attempts and violent crimes are differently associated with adverse childhood experiences and levels of appetitive aggression in male forensic psychiatry inpatients. Adverse childhood experiences and appetitive aggression styles were collected by means of self-report measures, suicide attempts were taken from the medical history and violent crimes were appraised by official court records. The data were analyzed by the means of generalized linear models. Results revealed that appetitive aggression and adverse childhood experiences were significant predictors of suicide attempts, whereas violent crimes were associated solely with appetitive aggression. Suicide attempts and violent delinquency in forensic patients seem to be both positively associated with high levels of appetitive aggression, whereas their etiological pathways might differ with regard to adverse childhood experiences. Considering these interrelations to a greater extent might improve both diagnostics and treatment of forensic patients.

[Impulsiveness Among Short-Term Prisoners with Antisocial Personality Disorder]. / Impulsivität bei Kurzzeitgefangenen mit einer antisozialen Persönlichkeitsstörung.

OBJECTIVE: The study aimed to investigate the correlation between impulsiveness and the antisocial personality disorder among short-term prisoners. METHOD: The impulsiveness was diagnosed by the Barratt Impulsiveness Scale (BIS). RESULTS: Short-term prisoners with antisocial personality disorder scored significant higher marks on the BIS total scale than those without any personality disorder. In detail, they scored higher marks on each subscale regarding attentional, motor and nonplanning impulsiveness. Moderate and high effects were calculated. CONCLUSION: It is to be considered to regard impulsivity as a conceptual component of antisociality.