Welche Maßregelvollzug-Patienten erhalten nach der stationären Behandlung eine Weisung für die forensische Ambulanz?

Self-Harm Among Forensic Psychiatric Inpatients With Schizophrenia Spectrum Disorders: An Explorative Analysis

The burden of self-injury among offenders undergoing inpatient treatment in forensic psychiatry is substantial. This exploratory study aims to add to the previously sparse literature on the correlates of self-injury in inpatient forensic patients with schizophrenia spectrum disorders (SSD). Employing a sample of 356 inpatients with SSD treated in a Swiss forensic psychiatry hospital, patient data on 512 potential predictor variables were retrospectively collected via file analysis. The dataset was examined using supervised machine learning to distinguish between patients who had engaged in self-injurious behavior during forensic hospitalization and those who had not. Based on a combination of ten variables, including psychiatric history, criminal history, psychopathology, and pharmacotherapy, the final machine learning model was able to discriminate between self-injury and no self-injury with a balanced accuracy of 68% and a predictive power of AUC = 71%. Results suggest that forensic psychiatric patients with SSD who self-injured were younger both at the time of onset and at the time of first entry into the federal criminal record. They exhibited more severe psychopathological symptoms at the time of admission, including higher levels of depression and anxiety and greater difficulty with abstract reasoning. Of all the predictors identified, symptoms of depression and anxiety may be the most promising treatment targets for the prevention of self-injury in inpatient forensic patients with SSD due to their modifiability and should be further substantiated in future studies.

Rising inpatient numbers in forensic security hospitals of German federal state of Baden-Württemberg: Background and explanatory approaches

In this article, we describe critical epidemiological trends in forensic psychiatric care in the German federal state of Baden-Württemberg. For some years, there has been a marked increase in the number of patients with psychoses and with a migration background in the high-security hospitals of Baden-Württemberg. We present a number of studies exploring hypotheses as to why this is the case. Taking into account a set of person-related and non-person (forensic system)-related variables, we suggest that rising treatment figures may be understood in terms of system variables rather than individual patient characteristics. Findings regarding predictors of treatment length and legal outcome, as well as characteristics of migrant patients and patients assigned to forensic aftercare, are discussed.

Forensic Outpatient Variables That May Help to Prevent Further Detention

BACKGROUND

Forensic outpatient treatment in Germany helps forensic patients back into society while managing the risk that these individuals present to public safety. Measures used to achieve this objective include ongoing psychiatric treatment and monitoring, case management, and controlling risk factors that may cause criminal behavior. In addition to the effects of treatment and control, good living conditions have been hypothesized to help prevent criminal recidivism and a number of studies have examined variables related to poor outcomes including recidivism among former prison inmates and sexual offenders. Yet, little is known about the predictive validity of certain candidate variables on the outcomes of German forensic outpatients.

METHODS

In order to investigate variables that are likely to reduce the risk of unfavorable outcomes such as subsequent confinement or back-referral to inpatient treatment, we analyzed data from a forensic outpatient data project run by the federal state of Baden-Württemberg (Forensic outpatient documentation system). Based on data provided by six forensic treatment units throughout the federal state of Baden-Württemberg since 2015, we compared 61 forensic outpatients that had either regularly ended treatment (group one, n = 25), or were referred back to a forensic hospital or prison (group two, n = 36). Information on the patients' working, living, and financial situation as well as information on their social network and relationship status, was used. The predictive validity of these factors on treatment outcome was tested with a logistic regression model.

RESULTS

There were a number of a priori differences between the groups, but pro-social leisure activities in an outpatient environment and migration status were the only significant predictors of positive vs. negative outcome.

DISCUSSION

Implications of these findings are discussed.