1
|
Findeis H, Strauß M, Kröber HL. The TCO concept in German forensic homicide offenders with schizophrenia spectrum disorders - new findings from a file-based, retrospective cross-sectional study. Front Psychiatry 2024; 15:1404263. [PMID: 38919633 PMCID: PMC11196989 DOI: 10.3389/fpsyt.2024.1404263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction There is evidence that there is a small group of people with schizophrenia spectrum disorders who are more likely to commit homicide than those in the general population. However, there is limited knowledge about the psychopathology that leads to homicide in this group. The aim of this study was to examine two commonly used definitions of the Threat/Control-Override (TCO) concept, which aims to identify a certain risk of serious violence in patients with schizophrenia spectrum disorders. Methods This is a sub analysis of a file-based, retrospective and exploratory cross-sectional study. All forensic homicide offenders with schizophrenia spectrum disorders who were detained at the Forensic Hospital Berlin as of 31 December 2014 were examined for the occurrence of TCO according to two commonly used definitions. Results Of a total of 419 forensic patients with schizophrenia spectrum disorders, 78 committed homicide (18.6%). The forensic homicide offenders with schizophrenia spectrum disorders were characterised by being male, unemployed, single and having committed (attempted) manslaughter. Irrespective of the definition used, the entire TCO complex was present in less than a third of the sample. In both definitions, Threat symptoms were slightly less frequent than Control-Override symptoms. While Threat symptoms occurred less frequently in Stompe et al.'s definition, Control-Override symptoms were the most common. With regard to Kröber's definition of Threat and Control-Override, the situation is exactly the opposite. Discussion Regarding the entire TCO complex, Kröber's definition seems a little more open and Stompe et al.'s more strict (38.5% vs. 35.9%). Since TCO only occurs in about one third of the subjects in both definitions, neither definition appears to be conclusive. A combination with proportions from both definitions could be a contribution to a future definition of TCO. The present study provides scarcely published primary data on psychopathology in homicide offenders with schizophrenia spectrum disorders, especially on the much discussed TCO concept in two definitions. In order to determine the most useful definition of TCO, to avoid false positives and to identify clear psychopathological risk symptoms, larger samples and comparative studies with offenders and non-offenders should be conducted in the future.
Collapse
Affiliation(s)
- Hannelore Findeis
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
- Institut für Forensische Psychiatrie, Charité Berlin, Berlin, Germany
| | - Maria Strauß
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | | |
Collapse
|
2
|
Schmidt C, Anna Seeger N, Brackmann N, Guldimann A, Habermeyer E. [Forensic-Psychiatric Consultations in General Psychiatry]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023. [PMID: 37871616 DOI: 10.1055/a-2182-6606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
A subgroup of psychiatric patients are at increased risk of committing interpersonal violence, which may lead to placements in forensic-psychiatric institutions. The majority of patients treated in forensic hospitals have had contact with the general psychiatric care system years before being forensically committed due to an offence. Nevertheless, attempts to establish models related to violence prevention in general psychiatry have remained sparse. In the Canton of Zurich, the forensic psychiatric consultation liaison service provides the general psychiatric clinics with access to forensic psychiatric expertise. In this paper, we describe the consultation service's diagnostic and advisory offers and aim to characterize the patient population seen by the service. We compared the three most common diagnostic groups (schizophrenic, affective and personality disorders) regarding reason for consultation, history of violence and substance abuse. In addition, we analyzed content and kind of the recommendations made. From 2013 to 2021, 188 patients in general psychiatric clinics in Zurich have been examined after informed consent. Most patients had a positive history of violence (72.7%) and substance use (66.1%). Almost half of the patients (48.4%) had been diagnosed with schizophrenia or a related disorder.
Collapse
Affiliation(s)
- Catharina Schmidt
- Klinik für Forensische Psychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
| | - Natalia Anna Seeger
- Klinik für Forensische Psychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
| | - Nathalie Brackmann
- Klinik für Forensische Psychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
| | - Angela Guldimann
- Klinik für Forensische Psychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
| | - Elmar Habermeyer
- Klinik für Forensische Psychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
| |
Collapse
|
3
|
Rau T, Heimgartner A, Mayer S, Allroggen M. [Attitudes of Healthcare Professionals to Extremism and Treatment Options]. Psychother Psychosom Med Psychol 2023; 73:388-395. [PMID: 37399833 DOI: 10.1055/a-2085-4502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE In view of the cruelty of acts of terrorism and violent extremism, it is often inconceivable what the underlying motives are. Analyzes of the attacks in Ansbach (2016), Halle (2019) and Hanau (2020) showed a picture of different psychological conspicuities among the perpetrators, which highlights the need to involve health care professionals in the prevention of extremism. Against this background, the treatment of people with extremist attitudes appears to be crucial in order to prevent negative consequences for those affected, but also for society. METHODS Within the framework of an anonymous online survey, physicians and psychological psychotherapists were asked about previous experiences, attitudes and wishes regarding the treatment of patients with extremist attitudes. Furthermore, data on their own work was collected. RESULTS A total of 364 physicians (18%), psychological psychotherapists (72%) and participants with other job descriptions (10%) took part in the study. Only one fifth state that they felt well trained in the subject. About half of the respondents would offer a place in therapy (if they could decide on the patients themselves), likewise about half have already dealt with the topic of extremism and the majority see a need to deal with the topic more in the future and indicate a need for further training. The analyses show that physicians have so far dealt with the topic somewhat more than those with psychological psychotherapeutic training, and professionals in private practive are more likely to see a connection between extremism and psychiatric illnesses than professionals in hospitals, but would be less willing to offer patients with extremist attitudes a place in therapy. DISCUSSION Physicians and psychotherapists need further training on extremisms and should be better prepared fo the challenges of treating patients in this context. CONCLUSION In order to increase the chances of providing adequate care for mentally ill people with extremist attitutdes, health professionals should be better prepared for the topic in the future, for example through further training or opportunities for cooperation.
Collapse
Affiliation(s)
- Thea Rau
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm
| | - Anna Heimgartner
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm
| | - Sophia Mayer
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm
| | - Marc Allroggen
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm
| |
Collapse
|
4
|
Li X, Gao Y, Liu Y, Wang Y, Wu Q. Clinical Markers of Physical Violence in Patients with Bipolar Disorder in Manic States. Risk Manag Healthc Policy 2023; 16:991-1000. [PMID: 37250432 PMCID: PMC10225141 DOI: 10.2147/rmhp.s403170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Identifying patients with bipolar disorder (BD) in manic states (BD-M) who are at a high risk of physical violence is a matter of clinical concern. This retrospective institution-based study aimed to identify simple, rapid, and inexpensive clinical markers of physical violence in patients with BD-M. Patients and Methods The anonymized sociodemographic variables (sex, age, years of education, marital status) and clinical ones (weight, height, body mass index, blood pressure, the score of BRMS, number of BD episodes, psychotic symptoms, history of violence, biochemical parameters, and blood routine parameters) of 316 BD-M participants were collected, and the risk of physical violence was identified using the Brøset Violence Checklist (BVC). Difference tests, correlation analyses, and multivariate linear regression analysis were performed to identify clinical markers for the risk of physical violence. Results The participants were categorized into groups at low (49, 15.51%), medium (129, 40.82%), and high (138, 43.67%) risk of physical violence. The number of BD episodes, serum uric acid (UA), free thyroxine (FT4) levels, history of violence, and monocyte-to-lymphocyte ratio (MLR) differed significantly between groups (all P<0.05). The number of BD episodes (r=0.152), FT3 (r=0.131) and FT4 (r=0.132) levels, history of violence (r=0.206), and MLR (r=-0.132) were significantly correlated with the risk of physical violence (all P<0.05). The existence of history of violence, number of BD episodes, UA, FT4, and MLR were identified as clinical markers of the risk of physical violence in patients with BD-M (all P<0.05). Conclusion These identified markers are readily available at initial presentation and may help in the timely assessment and treatment of patients with BD-M.
Collapse
Affiliation(s)
- Xuelong Li
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei, People’s Republic of China
| | - Yakun Gao
- Affiliated Hospital of Weifang Medical College, Weifang, People’s Republic of China
| | - Yiyi Liu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei, People’s Republic of China
| | - Ying Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei, People’s Republic of China
| | - Qing Wu
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, People’s Republic of China
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Hefei, People’s Republic of China
- Anhui Mental Health Center, Hefei, People’s Republic of China
- Hefei Fourth People’s Hospital, Hefei, People’s Republic of China
| |
Collapse
|
5
|
Rau T, Mayer S, Heimgartner A, Allroggen M. [Experiences of dangerous situations in psychiatry and psychotherapy involving patients with extremist attitudes]. DER NERVENARZT 2023; 94:408-416. [PMID: 36947217 PMCID: PMC10031705 DOI: 10.1007/s00115-023-01469-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Dangerous situations in connection with the treatment of persons with suspected extremist attitudes have become increasingly relevant. A survey of physicians and psychotherapists is intended to provide information about concrete dangerous situations among these patients. MATERIALS AND METHODS By means of an anonymous online survey, which comprised 16 main questions and up to 95 additional questions, a total of 364 health professionals were asked about the general situation and about patients, as well as relatives with suspected extremist attitudes. RESULTS In all, 17.5% of the participants were physicians, 72.1% psychotherapists. 47.7% work exclusively in a hospital, 34.2% in a private practice. A total of 57.7% of the participants have already treated patients with suspected extremist attitudes (46.7% treated relatives); 27.6% were confronted with situations of self-endangerment (30.1% in the case of relatives), 49.5% with situations of danger to others (18.3% in the case of relatives), in which they often did not feel safe. Altogether, 20.3% of the professionals informed security authorities, and not quite half found this contact to be comparatively unhelpful/not at all helpful (45.5% among relatives). The majority of the participants had no contact to other agencies, such as specialized counselling centres for deradicalization. Physicians experienced the situations of endangerment more often than non-medical psychotherapists. A comparison between professionals from hospitals and private practices shows no significant differences. DISCUSSION The study was able to show that extremism and the associated dangerous situations are an important topic in the treatment of patients and that physicians and non-medical psychotherapists should be well prepared. Networking with extremism prevention agencies and good cooperation with security authorities would be important and desirable for the future.
Collapse
Affiliation(s)
- Thea Rau
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland.
| | - Sophia Mayer
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland
| | - Anna Heimgartner
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland
| | - Marc Allroggen
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland
| |
Collapse
|
6
|
Bell C, Tesli N, Gurholt TP, Rokicki J, Hjell G, Fischer-Vieler T, Melle I, Agartz I, Andreassen OA, Ringen PA, Rasmussen K, Dahl H, Friestad C, Haukvik UK. Psychopathy subdomains in violent offenders with and without a psychotic disorder. Nord J Psychiatry 2022; 77:393-402. [PMID: 36260740 DOI: 10.1080/08039488.2022.2128869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Violence in psychosis has been linked to antisocial behavior and psychopathy traits. Psychopathy comprises aspects of interpersonal, affective, lifestyle, and antisocial traits which may be differently involved in violent offending by persons with psychotic disorders. We explored psychopathy subdomains among violent offenders with and without a psychotic disorder. METHODS 46 males, with a history of severe violence, with (n = 26; age 35.85 ± 10.34 years) or without (n = 20; age 39.10 ± 11.63 years) a diagnosis of a psychotic disorder, were assessed with the Psychopathy Checklist-Revised (PCL-R). PCL-R was split into subdomains following the four-facet model. Group differences in total and subdomain scores were analyzed with a general linear model with covariates. RESULTS Total PCL-R scores did not differ between the groups (p = 0.61, Cohen's d = 0.17). The violent offenders without psychotic disorders had higher facet 2 scores than the patient group with psychotic disorders (p = 0.029, Cohen's d = 0.77). Facet 1, 3, or 4 scores did not differ between the groups. Controlling for age did not alter the results. CONCLUSION Patients with a psychotic disorder and a history of severe violence have lower affective psychopathy scores than violent offenders without psychotic disorders. This observation may point toward distinct underlying mechanisms for violence and may provide a target for focused treatment and prevention.
Collapse
Affiliation(s)
- Christina Bell
- Department of Psychiatry, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Natalia Tesli
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Tiril P Gurholt
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jaroslav Rokicki
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Gabriela Hjell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry, Østfold Hospital Trust, Graalum, Norway
| | - Thomas Fischer-Vieler
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Division of Mental health and Addiction, Drammen Hospital, Drammen, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Petter Andreas Ringen
- Department of Psychiatry, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kirsten Rasmussen
- St.Olavs Hospital, Centre for Research and Education in Forensic Psychiatry, Trondheim, Norway.,Department of Psychology and Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hilde Dahl
- St.Olavs Hospital, Centre for Research and Education in Forensic Psychiatry, Trondheim, Norway.,Department of Psychology and Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Christine Friestad
- Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,University College of Norwegian Correctional Service, Oslo, Norway
| | - Unn K Haukvik
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
7
|
Zur Amalgamierung von Psychose, rassistischer Ideologie und Verschwörungsdenken beim Terrorakt von Hanau. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2022. [DOI: 10.1007/s11757-022-00709-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ZusammenfassungVorgestellt wird eine posthume, aus der Biografie entwickelte Analyse des Motivationshintergrundes beim Attentäter von Hanau. Wesentliche Elemente sind ein primärer, in einer Liebesenttäuschung entstandener Verfolgungswahn, der später durch fremdenfeindlich-völkische Ideologien und Verschwörungsdenken ergänzt wurde. Auch hatte es misstrauische, streitgeneigte und egozentrische Persönlichkeitsauffälligkeiten schon seit der Jugend gegeben. Dagegen sind massiv ausgeprägte rassistische Elemente in den Jahren vor dem Attentat nicht ans Licht gekommen. Zur Gefährlichkeit der unerkannt und unbehandelt gebliebenen Erkrankung trug bei, dass die Persönlichkeit in ihrem Sichtbild nach außen bemerkenswert unauffällig blieb.
Collapse
|
8
|
Hirjak D, Meyer-Lindenberg A, Brandt GA, Dreßing H. [Differential diagnostic distinction between substance-induced and primary psychoses: : Recommendations for general psychiatric and forensic practice]. DER NERVENARZT 2021; 93:11-23. [PMID: 33656571 PMCID: PMC8763934 DOI: 10.1007/s00115-021-01083-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
Substanzinduzierte psychotische Störungen (SIPS) sind häufig und für ca. 25 % der ersten Einweisungen in eine psychiatrische Klinik verantwortlich. Aus klinischer Sicht ist aufgrund ähnlicher psychopathologischer Phänomene die diagnostische Unterscheidung zwischen SIPS und primären (genuinen oder kryptogenen) psychotischen Störungen oft eine Herausforderung. Dieser Umstand wird dadurch erschwert, dass SIPS im Zusammenhang mit Cannabis, Halluzinogenen und Amphetaminen ein erhebliches Risiko des Übergangs in eine primäre psychotische Störung (z. B. Schizophrenie) haben. Im ersten Abschnitt dieser Arbeit werden zunächst zwei exemplarische Fallvignetten aus der allgemeinpsychiatrischen und forensischen Praxis vorgestellt. Danach wird im Sinne einer selektiven Literaturübersicht die Relevanz der differenzialdiagnostischen Unterscheidung beider Störungsbilder aus der Sicht der allgemeinen und forensischen Psychiatrie in Bezug auf Therapie, Prognose und richterliche Entscheidung bezüglich der Unterbringung im Maßregelvollzug (§ 63 vs. § 64 StGB) beleuchtet. Der letzte Abschnitt hat das Ziel, ein strukturiertes Vorgehen zur differenzialdiagnostischen Unterscheidung zwischen SIPS und primären psychotischen Störungen zu erarbeiten. Die in dieser Arbeit dargestellten und diskutierten Konzepte und Befunde sollen klinisch tätigen Psychiatern und Psychologen die Diagnosestellung im allgemeinen und forensischen Kontext erleichtern.
Collapse
Affiliation(s)
- Dusan Hirjak
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland.
| | - Andreas Meyer-Lindenberg
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| | - Geva A Brandt
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| | - Harald Dreßing
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| |
Collapse
|
9
|
Meinert P, Behr J, Gauger U, Krebs J, Konrad N, Opitz-Welke A. Psychosis in German prisoners: Comparison of the clinical appearance of psychotic disorder of an imprisoned population with a not detained community group. BEHAVIORAL SCIENCES & THE LAW 2020; 38:482-492. [PMID: 32833256 DOI: 10.1002/bsl.2480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
Surveys confirm risk factors for the incarceration of patients with psychosis including homelessness and comorbidity. There is also agreement that severe psychosis can lead to violence. Data describing prisoners with psychosis in Germany are scarce. We aimed to compare patients with psychosis in a prison hospital and patients with psychosis in a community hospital. Demographic data were collected, as well as comorbidity in the form of substance dependence and a psychiatric assessment using the German version of the 18-item Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). In the prison hospital group more patients were homeless (17 versus 2%) and non-German (36 versus 4%). There were also more patients with substance dependence or abuse in the prison hospital group. The total scores of BPRS and PANSS were lower in the prison hospital group (BPRS, 43.8 versus 51.2; PANSS, 71.5 versus 83.7). We assume that social disintegration for mentally disturbed offenders prior to incarceration hindered effective treatment. To avoid further social disintegration and possible further deterioration of mental health status of released offenders, which may lead to reoffending after imprisonment, discharge management after release from prison should be improved.
Collapse
Affiliation(s)
- Philipp Meinert
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Brandenburg Medical School, Neuruppin, Germany
- Institute of Forensic Psychiatry, Charité University Hospital Berlin, Germany
| | - Joachim Behr
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Brandenburg Medical School, Neuruppin, Germany
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Germany
| | - Ulrich Gauger
- Institute of Forensic Psychiatry, Charité University Hospital Berlin, Germany
| | - Julia Krebs
- Institute of Forensic Psychiatry, Charité University Hospital Berlin, Germany
| | - Norbert Konrad
- Institute of Forensic Psychiatry, Charité University Hospital Berlin, Germany
| | - Annette Opitz-Welke
- Institute of Forensic Psychiatry, Charité University Hospital Berlin, Germany
| |
Collapse
|
10
|
Seidenbecher S, Steinmetz C, Möller-Leimkühler AM, Bogerts B. Terrorismus aus psychiatrischer Sicht. DER NERVENARZT 2020; 91:422-432. [DOI: 10.1007/s00115-020-00894-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Hintergrund
Terrorismus gehört zu den Extremformen von Gewalt, die bisher in der deutschsprachigen psychiatrischen Fachliteratur kaum Beachtung fanden. Nach Terroranschlägen oder Attentaten kommt jedoch regelhaft die Frage auf, ob die Mentalität der Täter noch im Bereich psychischer Normalität liegt.
Fragestellung und Methode
Ziel dieser Übersichtsarbeit ist es, das multidimensionale Ursachengefüge von Terrorismus mit besonderer Beachtung psychopathologischer Gegebenheiten bei den Tätern darzustellen. Hierzu wurde neben einer kurzen Zusammenfassung des historischen Hintergrundes eine Literatursuche in PubMed, SCOPUS, PsychInfo, und PsychARTICLES durchgeführt.
Ergebnisse
Aus psychiatrischer Sicht ist eine Unterscheidung von Einzel- und Gruppentätern essenziell, wobei erstere eine deutlich höhere Prävalenz an krankheitswertigen Psychosyndromen, insbesondere an psychotischen, anhaltenden wahnhaften, aber auch affektiven Störungen, aufweisen. Bei der Mehrzahl der untersuchten terroristischen Gruppentäter konnten keine derartigen psychiatrischen Diagnosen (nach Achse I, DSM-IV) festgestellt werden. Bei diesen Tätern spielen neben biografischen, Sozialisierungs-, gruppendynamischen sowie ideologischen Aspekten Persönlichkeitsakzentuierungen bis hin zu Persönlichkeitsstörungen (vor allem narzisstischer und paranoid-fanatischer Prägung) eine Rolle. Es wird dargelegt, warum Terrorismus ein vorwiegend männliches Phänomen ist.
Schlussfolgerungen
Es liegt ein komplex interagierendes Bedingungsgefüge aus biographischen, biologischen, psychopathologischen, soziologischen und ideologischen Komponenten vor, das bei Einzeltätern und Gruppenterroristen unterschiedlich gewichtet ist. Die Ursachen für Terrorhandlungen sind weniger in gewaltaffinen Ideologien selbst zu suchen als darin, dass Individuen mit vorbestehender hoher Gewaltaffinität, sei sie persönlichkeitsinhärent oder biografisch herleitbar, sich Ideologien anschließen, mit denen sich terroristische Gewaltakte rechtfertigen lassen. Die Möglichkeiten der Psychiatrie in Früherkennung und Prävention sind begrenzt. Auf neu entwickelte Skalen zur Beurteilung eines Risikos für extreme Gewalttaten wird hingewiesen.
Collapse
|
11
|
[Standards for treatment in forensic committment according to § 63 and § 64 of the German criminal code : Interdisciplinary task force of the DGPPN]. DER NERVENARZT 2019; 88:1-29. [PMID: 28776213 DOI: 10.1007/s00115-017-0382-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
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.
Collapse
|
12
|
Müller JL, Saimeh N, Briken P, Eucker S, Hoffmann K, Koller M, Wolf T, Dudeck M, Hartl C, Jakovljevic AK, Klein V, Knecht G, Müller-Isberner R, Muysers J, Schiltz K, Seifert D, Simon A, Steinböck H, Stuckmann W, Weissbeck W, Wiesemann C, Zeidler R. Standards für die Behandlung im Maßregelvollzug nach §§ 63 und 64 StGB. FORENSISCHE PSYCHIATRIE, PSYCHOLOGIE, KRIMINOLOGIE 2018. [DOI: 10.1007/s11757-017-0445-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|