Moderators of Sexual Recidivism as Indicator of Treatment Effectiveness in Persons With Sexual Offense Histories: An Updated Meta-analysis

The present meta-analysis is an update of the meta-analysis by Schmucker and Lösel [Campbell Syst. Rev. 2017; 13: 1-75], which synthesized evidence on sexual recidivism as an indicator of treatment effectiveness in persons with sexual offense histories. The updated meta-analysis includes 37 samples comprising a total of 30,394 individuals with sexual offense histories, which is nearly three times the sample size reported by Schmucker and Lösel (2017: 28 samples, N = 9781). In line with Schmucker and Lösel (2017), the mean treatment effect was small with an odds ratio of 1.54 [95% CI 1.22, 1.95] (p < .001). A moderator analysis suggested three predictors of importance, i.e., risk level, treatment specialization, and author confounding. Greater treatment effectiveness was suggested in high- and medium-compared to low-risk individuals and in specialized compared to non-specialized treatments. Authors affiliated with treatment programs reported larger effectiveness than independent authors. These findings were overall in line with Schmucker and Lösel (2017), though the effects of risk level and treatment specialization were stronger in the current meta-analysis. The findings of the updated meta-analysis reinforce the evidence for the first and second principle of the Risk-Need-Responsivity model. The results may support researchers and decision-makers in interpreting the current evidence on sexual recidivism as an indicator of treatment effectiveness, and, based on that, implement and carry out informative, methodologically sound evaluations of ongoing treatment programs in persons with sexual offense histories.

Predictive and incremental validity of the Static-99, Static-99R, and STABLE-2007 for sexual recidivism: A diagnostic test accuracy network meta-analysis (DTA-NMA)

The Static-99, Static-99R, and STABLE-2007 are internationally well-established instruments for predicting static and dynamic risks of sexual recidivism in individuals convicted of sexual offenses. Previous meta-analyses assessed their predictive and incremental validity, but none has yet compared the two Static versions and the Static-STABLE combinations. Here, we implemented diagnostic test accuracy network meta-analysis (DTA-NMA) to compare all tests and identify optimal cutoffs in one comprehensive analysis. The DTA-NMA included 32 samples comprising 45,224 adult male individuals. More information was available on the Static-99 (22 samples; 34,316 individuals) and the Static-99R (13 samples; 27,243 individuals), compared to the Static-99/STABLE-2007 (three samples; 762 individuals), the Static-99R/STABLE-2007 (two samples; 2,972 individuals), and the STABLE-2007 (three samples; 816 individuals). The primary outcome was the area under the receiver operating characteristic curve (AUC). The secondary outcomes were sensitivity and specificity. Optimal cutoffs were determined using the Youden index. The AUC suggested moderate predictive validity for Static-99 and Static-99R, whereas STABLE-2007 had no predictive value. The optimal cutoff of Static-99R was suggested to have higher specificity than that of Static-99, whereas sensitivity was comparable between instruments. The notion of incremental validity for STABLE-2007 could not be confirmed. This work represents the first meta-analysis to compare Static-99, Static-99R, STABLE-2007, and their combinations in one analysis. Static-99R demonstrated the highest specificity in predicting the risk of sexual recidivism, indicating a potential advantage in detecting true nonrecidivists. The findings are discussed, considering the current recommendations for assessing the risk of sexual recidivism in the criminal justice system. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

[Forensic-Psychiatric Consultations in General Psychiatry]

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.

Differentiating Between Sexual Offending and Violent Non-sexual Offending in Men With Schizophrenia Spectrum Disorders Using Machine Learning

Forensic psychiatric populations commonly contain a subset of persons with schizophrenia spectrum disorders (SSD) who have committed sex offenses. A comprehensive delineation of the features that distinguish persons with SSD who have committed sex offenses from persons with SSD who have committed violent non-sex offenses could be relevant to the development of differentiated risk assessment, risk management and treatment approaches. This analysis included the patient records of 296 men with SSD convicted of at least one sex and/or violent offense who were admitted to the Centre for Inpatient Forensic Therapy at the University Hospital of Psychiatry Zurich between 1982 and 2016. Using supervised machine learning, data on 461 variables retrospectively collected from the records were compared with respect to their relative importance in differentiating between men who had committed sex offenses and men who had committed violent non-sex offenses. The final machine learning model was able to differentiate between the two types of offenders with a balanced accuracy of 71.5% (95% CI = [60.7, 82.1]) and an AUC of .80 (95% CI = [.67, .93]). The main distinguishing features included sexual behaviours and interests, psychopathological symptoms and characteristics of the index offense. Results suggest that when assessing and treating persons with SSD who have committed sex offenses, it appears to be relevant to not only address the core symptoms of the disorder, but to also take into account general risk factors for sexual recidivism, such as atypical sexual interests and sexual preoccupation.

[Which Treatment Setting is Suited for Forensic Inpatients Aged≥60 Years?A Systemic Literature Analysis]

In the inpatient correctional system, the question of a suitable treatment setting for older forensic inpatients (i. e. ≥60 years) arises against the background of demographic change. In this regard, the research literature was examined using four medical databases (PsycInfo, Medline, Embase, Web of Science) for relevant keywords (elderly offender/perpetrator, aged, mental disorder, forensic treatment, forensic psychiatry). Out of 744 pre-selected articles, only 5 studies made it into the final selection. The majority of the sample is composed of men with previous criminal justice experience, who may be mentally and/or physically ill. Placement and capacity problems as well as a lack of age-appropriate infrastructure are reported. Based on the study results, an empirical recommendation regarding a suitable treatment setting cannot be given.

Deep Learning in the Identification of Electroencephalogram Sources Associated with Sexual Orientation

INTRODUCTION

It is unclear if sexual orientation is a biological trait that has neurofunctional footprints. With deep learning, the power to classify biological datasets without an a priori selection of features has increased by magnitudes. The aim of this study was to correctly classify resting-state electroencephalogram (EEG) data from males with different sexual orientation using deep learning and to explore techniques to identify the learned distinguishing features.

METHODS

Three cohorts (homosexual men, heterosexual men, and a mixed sex cohort), one pretrained network on sex classification, and one newly trained network for sexual orientation classification were used to classify sex. Further, Grad-CAM methodology and source localization were used to identify the spatiotemporal patterns that were used for differentiation by the networks.

RESULTS

Using a pretrained network for classification of males and females, no differences existed between classification of homosexual and heterosexual males. The newly trained network was able, however, to correctly classify the cohorts with a total accuracy of 83%. The retrograde activation using Grad-CAM technology yielded distinctive functional EEG patterns in the Brodmann area 40 and 1 when combined with Fourier analysis and a source localization.

DISCUSSION

This study shows that electrophysiological trait markers of male sexual orientation can be identified using deep learning. These patterns are different from the differentiating signatures of males and females in a resting-state EEG.

Neuroelectric Correlates of Human Sexuality: A Review and Meta-Analysis

Many reviews on sexual arousal in humans focus on different brain imaging methods and behavioral observations. Although neurotransmission in the brain is mainly performed through electrochemical signals, there are no systematic reviews of the electrophysiological correlates of sexual arousal. We performed a systematic search on this subject and reviewed 255 studies including various electrophysiological methods. Our results show how neuroelectric signals have been used to investigate genital somatotopy as well as basic genital physiology during sexual arousal and how cortical electric signals have been recorded during orgasm. Moreover, experiments on the interactions of cognition and sexual arousal in healthy subjects and in individuals with abnormal sexual preferences were analyzed as well as case studies on sexual disturbances associated with diseases of the nervous system. In addition, 25 studies focusing on brain potentials during the interaction of cognition and sexual arousal were eligible for meta-analysis. The results showed significant effect sizes for specific brain potentials during sexual stimulation (P3: Cohen's d = 1.82, N = 300, LPP: Cohen's d = 2.30, N = 510) with high heterogeneity between the combined studies. Taken together, our review shows how neuroelectric methods can consistently differentiate sexual arousal from other emotional states.

Suicidal Offenders and Non-Offenders with Schizophrenia Spectrum Disorders: A Retrospective Evaluation of Distinguishing Factors Using Machine Learning

Patients with schizophrenia spectrum disorders (SSD) have an elevated risk of suicidality. The same has been found for people within the penitentiary system, suggesting a cumulative effect for offender patients suffering from SSD. While there appear to be overlapping characteristics, there is little research on factors distinguishing between offenders and non-offenders with SSD regarding suicidality. Our study therefore aimed at evaluating distinguishing such factors through the application of supervised machine learning (ML) algorithms on a dataset of 232 offenders and 167 non-offender patients with SSD and history of suicidality. With an AUC of 0.81, Naïve Bayes outperformed all other ML algorithms. The following factors emerged as most powerful in their interplay in distinguishing between offender and non-offender patients with a history of suicidality: Prior outpatient psychiatric treatment, regular intake of antipsychotic medication, global cognitive deficit, a prescription of antidepressants during the referenced hospitalisation and higher levels of anxiety and a lack of spontaneity and flow of conversation measured by an adapted positive and negative syndrome scale (PANSS). Interestingly, neither aggression nor overall psychopathology emerged as distinguishers between the two groups. The present findings contribute to a better understanding of suicidality in offender and non-offender patients with SSD and their differing characteristics.

Automaticity of Early Sexual Attention: An Event-Related Potential Study

A promising line of research on forensic assessment of paraphilic sexual interest focuses on behavioral measures of visual attention using sexual stimuli as distractors. The present study combined event-related potentials (ERPs) with behavioral measures to investigate whether detection of a hidden sexual preference can be improved with ERPs. Normal variants of sexual orientation were used for a proof-of-concept investigation. Accordingly, 40 heterosexual and 40 gay men participated in the study. Within each group, half of the participants were instructed to hide their sexual orientation. The results showed that a match between sexual orientation and stimulus delays responses and influences ERP before motor responses. Late ERP components showed higher potential in differentiating hidden sexual preferences than motor responses, thereby showing how ERPs can be used in combination with reaction time measures to potentially facilitate the detection of hidden sexual preferences.

Loneliness and social isolation among the older person in a Swiss secure institution: a qualitative study

BACKGROUND

A pandemic of loneliness is hitting the aging population. As COVID19 forced us to isolate ourselves, we are in a better position to understand consequences of social distancing. The recent literature showed that older incarcerated adults are particularly at risk of health-related complications due to isolation in the prison environment, reducing their social capital. Mental and physical health can be severely affected by loneliness and social isolation, especially in prison.

METHODS

Our qualitative study investigates the view of older persons deprieved of their liberty on loneliness and social isolation pertaining to their mental health. We interviewed 57 older participants, including imprisoned individuals and forensic patients, following a semi-structured interview guide. During the data management and data analysis process, we excluded 7 interviews which were of poorer quality. Thereafter, we analyzed the remainders following a thematic approach.

RESULTS

Most interviewees experience loneliness following lack of significant human relationships in prison. Making friends appears to be a challenge for all the participants, because, for one thing, they do not find people with similar interests. Also, secure institution setting aggravates isolation due to the restrictions of movement placed such as rules concerning movement between floors, hindering intimate relationship, and separation between friends. Moreover, contact with prison personnel is limited and lack social capital (e.g. trust).

CONCLUSION

To our knowledge, this study is one of the first to present incarcerated persons' perspective on loneliness, social isolation and poor social capital in the Swiss prison setting. These has been reported to cause health problems both somatic and psychological. Our participants experience these deleterious factors in detention. As prisons have the possibility to become a health-promoting environment through connectedness, friendship, and trust promotion, stakeholders need to better their social capital.

Forensic mental health professionals' perceptions of their dual loyalty conflict: findings from a qualitative study

BACKGROUND

Mental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient's well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs' decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice.

METHODS

31 MHPs working in court-mandated treatment settings were interviewed. The interviews were semi-structured and our in-depth analysis followed the thematic analysis approach.

RESULTS

We first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved.

CONCLUSIONS

Even though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system.

Associations of the MAOA uVNTR genotype and 5-HTTLPR/rs25531 haplotype with psychopathic traits

Previous studies have linked polymorphisms of the monoamine oxidase A (MAOA uVNTR) and serotonin transporter gene (5-HTTLPR) to individual differences in the expression of psychopathic traits, but findings remain inconsistent. One possible reason is that these studies have treated psychopathy as a unitary construct when there is accumulating evidence that there are variants or subtypes. We used a variable-centered and a person-centered approach by (a) examining putative genetic correlates of psychopathy across individuals and (b) comparing the frequencies of the MAOA uVNTR genotype and 5-HTTLPR/rs25531 haplotype between empirically derived subtypes of psychopathy, respectively. Notably, we included the often neglected rs25531 polymorphism, which is closely connected to the 5-HTTLPR. Based on data from male offenders and community volunteers, structural equation modeling indicated that the 5-HTTLPR/rs25531 haplotype was specifically associated with interpersonal deficits beyond the overarching psychopathy construct. Latent profile analysis revealed four clusters that were labeled non-psychopaths, sociopaths, callous-conning, and psychopaths. The low-activity variant of the 5-HTTLPR/rs25531 haplotype was significantly more frequent in the callous-conning compared to the non-psychopathic subtype. There were no effects for the MAOA uVNTR. The results illustrate that psychopathy should not be treated as a unitary construct but that there are variants with specific profiles of psychopathic traits, and that the 5-HTTLPR/rs25531 haplotype plays a role in the manifestation of interpersonal deficits from a variable-centered as well as from a person-centered view.

Bedrohungsmanagement: deeskalieren, bevor etwas passiert

In diesem Beitrag wird die Arbeit des Kantonalen Bedrohungsmanagements (KBM) Zürich vorgestellt. Personen, die durch ihre Kommunikation und/oder ihr Verhalten Hinweise auf ein mögliches Gewaltpotenzial zeigen (sog. Gefährder), sollen frühzeitig erkannt, eingeschätzt und so risikobehaftete Entwicklungen entschärft werden. Forensische Fachpersonen der Fachstelle Forensic Assessment & Risk Management (FFA) der Psychiatrischen Universitätsklinik Zürich unterstützen die polizeilichen Gewaltschützer darin, ein tragfähiges Fallverständnis im Hinblick auf die (psychisch kranken) Gefährder zu erarbeiten. Das Fallverständnis gilt es, im Rahmen von Gefährderansprachen sorgfältig zu überprüfen. In dieser Arbeit wird zudem erläutert, wie das KBM Behörden und Institutionen in der Einschätzung und im Management mit möglichen Gefährdern unterstützt. Hierbei werden potenzielle Fallstricke der Behördenmitglieder im Umgang mit Querulanten reflektiert, aber auch die Fürsorgepflicht des Arbeitgebers bzw. der betroffenen Behörden in den Fokus gerückt. Zuletzt werden auch Gefahren des Bedrohungsmanagementansatzes reflektiert, und es wird für höchstmögliche Transparenz gegenüber den potenziellen Gefährdern sowie den Bürgern und Bürgerinnen plädiert.

Different needs in patients with schizophrenia spectrum disorders who behave aggressively towards others depend on gender: a latent class analysis approach

BACKGROUND

There is limited research with inconsistent findings on differences between female and male offender patients with a schizophrenia spectrum disorder (SSD), who behave aggressively towards others. This study aimed to analyse inhomogeneities in the dataset and to explore, if gender can account for those.

METHODS

Latent class analysis was used to analyse a mixed forensic dataset consisting of 31 female and 329 male offender patients with SSD, who were accused or convicted of a criminal offence and were admitted to forensic psychiatric inpatient treatment between 1982 and 2016 in Switzerland.

RESULTS

Two homogenous subgroups were identified among SSD symptoms and offence characteristics in forensic SSD patients that can be attributed to gender. Despite an overall less severe criminal and medical history, the female-dominated class was more likely to receive longer prison terms, similarly high antipsychotic dosages, and was less likely to benefit from inpatient treatment. Earlier findings were confirmed and extended in terms of socio-demographic variables, diseases and criminal history, comorbidities (including substance use), the types of offences committed in the past and as index offence, accountability assumed in court, punishment adjudicated, antipsychotic treatment received, and the development of symptoms during psychiatric inpatient treatment.

CONCLUSIONS

Female offender patients with schizophrenia might need a more tailored approach in prevention, assessment and treatment to diminish tendencies of inequity shown in this study.

Construct Validity of the German Version of the Hare Psychopathy Checklist – Revised

Abstract. The Hare Psychopathy Checklist – Revised (PCL-R) is among the most well-established instruments for the assessment of psychopathy. The PCL-R is a 20-item observer rating instrument based on file review and a semi-structured interview. The current study aimed to investigate the validity of the German adaptation of the PCL-R, its factor structure, construct validity, and association with socially desirable responding in a sample of male offenders ( N = 118). A parcel model with four facets and two factors yielded excellent model fit. Convergent and discriminant validity were assessed based on correlational analyses, a multitrait-multimethod (MTMM) matrix, and a canonical correlation analysis (CCA) including measures of psychopathy, antisocial personality disorder (ASPD), global personality dimensions, alexithymia, and impulsivity. The MTMM matrix as well as substantial associations with self-reported psychopathic traits and observer ratings of ASPD indicated convergent validity. Correlational analyses revealed that Factor 1 of the PCL-R was associated with low neuroticism, whereas Factor 2 was associated with impulsivity as well as with low agreeableness and conscientiousness. The PCL-R total score and Factor 2 were negatively correlated with impression management. Overall, the current findings support the validity of the German adaptation of the PCL-R.

Hallucinogenic drug induced states resemble acute endogenous psychoses: results of an empirical study

Clinical evidence suggests that hallucinogenic drug-induced altered states of consciousness (ASCs) and the incipient, acute stages of endogenous psychoses share many common phenomenological features. The aim of our study was to assess hallucinogen-like phenomena in endogenous psychotic patients using standardised methods. We examined 93 endogenous psychotic patients, 50 healthy controls and a small group of drug induced psychotic patients (n = 7) with two ASC self-assessment scales (questionnaire APZ = Abnormer Psychischer Zustand = Altered State of Consciousness [Dittrich et al, 1985]; and questionnaire OAV = Abbreviation of the three subscales: Oceanic Boundlessness/Angst = Dread of Ego Dissolution/Visionary Restructuralisation [Bodmer 1989]). Patients were examined shortly after remission of their last acute psychotic episode and they answered the questionnaires referring to the early phase of this episode. Differences in the questionnaire scores were significant between psychotic patients and controls. Drug induced patients had numerically higher scores than endogenous psychotic patients, however these differences were only significant for the APZ total score and the undifferentiated items of the APZ, but not for the three APZ subscale and the OAV scores. More than 50% of the endogenous psychotic patients answered 26% of the APZ-and 43% of the OAV-items with “yes”. The OAV total score and the OSE (Ozeanische Selbstentgrenzung = oceanic boundlessness) scores of both questionnaires correlated significantly with BPRS Factor 3 (thought disturbance). Our results support the hypothesis that hallucinogen-like experiences represent common phenomena during the acute stages of endogenous psychoses. Remarkably, these phenomena include subjectively pleasant experiences of the OSE dimension. In the routine clinical assessment of endogenous psychotic patients experiences of this dimension may be more easily overlooked than the negative experiences of the AIA dimension (AIA: Angst vor der Ich-Auflösung = dread of ego dissolution).

[Depression and Violence: A Contradiction?]

Depression and Violence: A Contradiction? Abstract. Depression is one of the leading diseases worldwide. Its symptoms are of great importance for a variety of areas within internal medicine, as patients often pay a visit to their general practitioners first. Although symptoms of depression are observed in both genders, existing peculiarities of the symptoms in men are only insufficiently known or acknowledged. Therefore, we dedicate this article to the concept of male depression, which can be characterized by social withdrawal, irritability or substance abuse. Here, we present practice-related associations between depression and violent behavior, which will be illustrated by two case studies. Of particular relevance is the so-called suicidal-homicidal syndrome, which should make further psychiatric, if not forensic-psychiatric evaluation mandatory.

[Concretism as a Correlate of the Acuteness of Schizophrenic Symptomatology]

Formal thought disorders are common in people diagnosed with schizophrenia. Among them, concretism stands for deficiencies in the understanding of idiomatic expressions, metaphors and proverbs. However, little is known as to whether concretism is a correlate of the acuteness or severity of schizophrenia within patients. In this pilot study data of 28 patients was collected in the process of implementing a proverb test for screening purposes as part of an enhancement to the standard assessment of the general cognitive functioning of the patients. Our findings support the argument for such a coherence as a significant correlation between the degree of acuteness and concretism was found. However, the proverb test also correlated significantly with our standard cognitive assessment so the question as to which degree the proverb test will add further information regarding the general cognitive functioning needs to be addressed. Finally, the question as to whether there is an indication to specifically approach concretism in the treatment of patients with schizophrenia is discussed.

Aims to Reduce Coercive Measures in Forensic Inpatient Treatment: A 9-Year Observational Study

Protecting the human rights is particularly important within the forensic context because patients in forensic psychiatry are not admitted voluntarily and so the treatment itself is of a coercive nature. Coercive measures (i.e., actions against the will of the patient such as forced medication, seclusion or restraint) form an additional incision of personal rights. Although the use of coercion within forensic psychiatric institutions remains controversial, little empirical research has been conducted on the use of coercive measures within forensic settings. The study presented here can contribute to close this research gap by informing about rates of coercive measures within the present institution. National and international organizations on the prevention of torture or inhuman or degrading treatment have emphasized the need to keep the incidents of coercive measures to a minimum. Criticisms by such organizations on high rates of seclusion, restraint, and compulsory medication have led to organizational changes within the present institution which is Switzerland's largest forensic clinic with an average of 124 patients per year. After a first visit of such a committee, e.g., the detailed documentation of coercive measures became obligatory and part of special reports. Changes in the use of coercive measures are presented here. Data on coercive measures was analyzed for years 2010 to 2018. With respect to the most invasive coercive measurement, restraint, a minimum of four patients in 2017 and a maximum of 14 patients in 2010 have been subject to this form of coercive measurement. A minimum of sixteen patients in 2012 and a maximum of 40 patients in 2010 were secluded. Though total number and duration show a trend towards a reduction in severity of coercive measures on average, a few patients are not responsive to deescalating interventions. Preventive mechanisms, documentation standards, and efforts to ensure humane and adequate treatment are discussed under ethical considerations of coercive measures within court mandated treatment.

Main and interaction effects of childhood trauma and the MAOA uVNTR polymorphism on psychopathy

Psychopathy is characterized by callous affect, interpersonal manipulation, a deviant lifestyle, and antisocial behavior. Previous research has linked psychopathic traits to childhood trauma, but also to the upstream variable number tandem repeat (uVNTR) polymorphism of the monoamine oxidase A (MAOA) gene. An interaction between childhood trauma and MAOA genotype has been associated with antisocial behavior, but so far little is known about interaction effects of childhood trauma and the MAOA uVNTR on psychopathy. In order to bridge this gap, we used data of 1531 male and 1265 female twins and their siblings from a Finnish community sample to estimate structural equation models. The psychopathy and childhood trauma constructs were conceptualized as bifactor models with one general and two orthogonal group factors. Data comprised self-reports on childhood trauma and psychopathic traits as well as MAOA uVNTR genotype. In both genders, childhood trauma was associated with the general factor that represents the overarching psychopathy construct, and with the group factor that captures social deviance, but not with the group factor capturing psychopathic core personality traits. Women with a low activity variant of the MAOA uVNTR reported slightly higher levels of psychopathy than those with a high activity allele, but only with respect to the general psychopathy factor. There was no evidence for an interaction effect between MAOA uVNTR genotype and childhood trauma on psychopathy in either gender. Our results suggest that psychopathy in general and social deviance in particular are associated with childhood trauma in men and women, and that psychopathic traits are subject to variation in the MAOA uVNTR genotype in women.

Conflicting Priorities Between Risk Management and Treatment of Schizophrenia in Swiss Forensic Services-A Case Report

The Swiss Criminal Code provides measures for mentally-ill offenders focusing on their need for treatment. This may lead to the deprivation of the patient's liberty up to several years. Under certain circumstances the mentally-ill offender can be sentenced to an indefinite incarceration. This case presentation we will describe a forensic psychiatric patient diagnosed with schizophrenia who was ordered an indefinite incarceration in Switzerland after he had been sentenced to 8 years of imprisonment for a deliberate killing. Initial presentation of symptomatology included formal thought disorders and negative symptoms such as affective flattening and alogia. Due to a scarcity of adequate treatment sites in the 90s and lack of scope for risk assessment and management, the patient could only be treated within highly regiment prison environments in the past. There, the patient's treatment concept primarily focused on short-term psychiatric care instead of providing an adequate treatment plan that would have been essential for the patient's improvement of chronic symptoms. This case description aims to present some of the fundamental issues observed in the forensic mental health system, where strong efforts are made to balance risk management and the treatment of severe mental health disorders. We will put the patient's own course of treatment and his progress within the penal system into context with ethical challenges in the forensic and correctional services and will provide potential recommendations for future research in the field of forensic psychiatry.

Regression to the Mean Mimicking Changes in Sexual Arousal to Child Stimuli in Pedophiles

The sexual preference for prepubertal children (pedophilia) is generally assumed to be a lifelong condition. Müller et al. (2014) challenged the notion that pedophilia was stable. Using data from phallometric testing, they found that almost half of 40 adult pedophilic men did not show a corresponding arousal pattern at retest. Critics pointed out that regression to the mean and measurement error might account for these results. Müller et al. contested these explanations. The present study shows that regression to the mean in combination with low reliability does indeed provide an exhaustive explanation for the results. Using a statistical model and an estimate of the retest correlation derived from the data, the relative frequency of cases with an allegedly non-pedophilic arousal pattern was shown to be consistent with chance expectation. A bootstrap simulation showed that this outcome was to be expected under a wide range of retest correlations. A re-analysis of the original data from the study by Müller et al. corroborated the assumption of considerable measurement error. Therefore, the original data do not challenge the view that pedophilic sexual preference is stable.

Supporting Threat Management with Forensic Expert Knowledge: Protecting Public Officials and Private Individuals

This article describes the implementation of a Cantonal Threat Assessment and Management (CTAM) in Zurich, Switzerland. In order to support this endeavor, the Specialist Unit for Forensic Assessment and Case Management was installed. The forensic experts provide supervision and short-term assessments to public prosecutors and general psychiatrists. In close cooperation with police threat management units, forensic experts support the assessment and management of individuals who exhibit concerning and threatening behavior towards public officials or private individuals. A public official case study illustrates this joint approach. The author's experience with CTAM, its pitfalls and the potential areas of improvement are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

Sadism and Violent Reoffending in Sexual Offenders

A diagnosis of sadism in sexual offenders is commonly regarded as indicative of high risk for violent reoffending. The purpose of the current two studies was to evaluate whether sadism is indeed associated with higher rates of violent (including sexual) reoffending. In Study 1 (meta-analysis), the rate of violent and sexual recidivism was assessed across seven samples of male sex offenders (total N = 2,169) as a function of diagnoses of sexual sadism. In Study 2 (N = 768) the outcome (violent recidivism yes/no) was regressed on sadism, along with behavioral indicators of sexually sadistic offending, and scores from violence risk assessment instruments. In Study 1 (meta-analysis), the overall risk of sadists compared with nonsadists with respect to violent (including sexual contact) reoffending was slightly elevated (by a factor of 1.18), yet not significantly increased. Similarly, the risk of sexual reoffending among sadists was slightly, but not significantly, higher than among nonsadists (factor 1.38). According to Study 2, only a measure of sadistic behavior, not the clinical diagnosis, was associated with violent reoffending. This association, however, was not present once age and customary risk assessment instruments for violence risk were included in the regression. A clinical diagnosis of sexual sadism and behavioral measures of sadism are related to the risk of violent reoffending in sexual offenders. These associations, however, are weak and do not hold once variables relevant for the prediction of violence are controlled for. At the individual level, the risk for future violence in sadists can therefore be adequately described by customary risk assessment instruments.

Psychopathy, intelligence, and impulsivity in German violent offenders

Previous studies have reported numerous correlations between psychopathy and various personality traits, behavioural tendencies or clinical characteristics. The present study examined in greater depth the relationships between the components of psychopathy as measured by the Psychopathy Checklist-Revised (PCL-R) and intelligence as well as impulsivity. A total of ninety male violent offenders were recruited from a prison and a forensic-psychiatric hospital in Germany. All of the subjects were assessed using the PCL-R, the Barratt Impulsiveness Scale (BIS-11), and a short version of the German Wechsler Adult Intelligence Scale (WIP). As expected, a canonical correlation analysis showed a negative association between spatial intelligence and the Factor 2 subtotal on the PCL-R (reckless lifestyle/antisociality). In addition, our results agreed with the assumption of an association between impulsivity and the subtotal for PCL-R Factor 2. The positive relationship between verbal intelligence and the subtotal for Factor 1 of the PCL-R (insincere, manipulative conduct/affective deficits) vanished after controlling for educational level. The results indicate that there is a relationship between the spatial components of intelligence and the concept of psychopathy as described by Hare. This result supports the spatial impairment aetiological model of antisocial behaviour.

Psychopathy and Violent Reoffending in German-Speaking Countries

The Psychopathy Checklist-Revised (PCL-R) and its screening version, the PCL:SV, are clinical assessment instruments for the observer rating of psychopathic personality in offenders. Given the link between PCL-R/SV total scores and violent offending, these instruments have been incorporated into various risk assessment protocols in forensic psychology. The purpose of the present study was to examine the predictive validity of the PCL-R/SV instruments in German-speaking countries. We collated data from 11 published studies (total-N = 2,412 offenders). Based on suitable diagnostic cutscores for prototypical psychopathy, the proportions of true-positive and false-positive cases with respect to violent reoffending were compared. Overall, sensitivity was estimated at 27% and specificity at 88% for the PCL-R (or at 28% and 90% for the PCL:SV, respectively). At critical score levels, the odds for violent offense recidivism were more than two times higher than at subcritical levels for both instruments. A decision-theory analysis suggested that the implicit utility of false-positive risk assessments was about halfway between the minimal utility of false-negative assessments and the maximal utility of correct assessments. Both the PCL-R and its screening version are viable instruments for the prediction of violent offense recidivism in German-speaking countries.

Assessment of Psychopathy in Austria

The Psychopathy Checklist-Revised (PCL-R) is a clinician rating instrument for psychopathic personality disorder. Although the instrument is routinely used in forensic assessment in Austria, Germany, and Switzerland, data on its psychometric properties in German-speaking countries are lacking. Based on a national sample of adult male sexual offenders assessed at a federal evaluation unit in Austria (N = 1,046), reliability and factor structure were estimated. More specifically, measurement invariance was assessed with respect to the North American normative data of male offenders. In the sample, the PCL-R achieved similar levels of reliability as those reported in the manual for North American male offenders. According to confirmatory factor analysis, a four-factor model of psychopathy described the data well. More specifically, weak measurement invariance (i.e., equivalence of loadings, not of thresholds) held in comparison with the North American data. The present findings support the suitability of the PCL-R for assessment purposes in German-speaking countries. However, the total score is not directly comparable to North American data given that only weak measurement invariance was observed.

[Schizophrenia and violence]

As compared to the general population schizophrenic patients are at increased risk of becoming delinquent. The majority of schizophrenic patients do not commit any crime, and the risk of the general population to be a target of a violent act by a person with schizophrenia is low. The causes of delinquency in schizophrenia are complex, but certain risk characteristics (e. g. an accompanying substance abuse) have been identified. The treatability and legal prognosis of schizophrenic offenders are good, which suggests that establishing a suitable helpers network could also be used for violence prevention in patients at risk.

Preventive detention in Germany: an overview and empirical data from two federal states

Eighty years ago, preventive detention for dangerous offenders was implemented in the German Penal Code (Section 66). In 2011, about 500 individuals were incarcerated under a preventive detention order in Germany. Through semi-structured clinical interviews and/or collateral file review, the present investigators assessed the sociobiographic, criminological, and clinical characteristics of 58 men for whom preventive detention had been ordered in two German federal states. In addition, risk assessment instruments were administered. The majority of the inmates were sexual offenders. The main mental health problems were antisocial personality disorder (APD), substance abuse/disorder, and paraphilias. Most individuals had a history of poor socialization. Structured clinical judgment as well as actuarial risk assessment instruments identified all inmates as high-risk offenders. Future development of preventive detention in Germany must emphasize treatment interventions. Given the life histories and the mental health problems of the detainees assessed in the present study, the implementation of effective treatment will prove difficult.

Emotional empathy and psychopathy in offenders: an experimental study

Previous studies associated psychopathy in adults with deficits in empathy but these studies did not directly compare cognitive and emotional facets of empathy. The present study sought to establish whether psychopathy is associated with impairments in emotional empathy among adult offenders. Participants were 90 male offenders scoring low (n = 29), medium (n = 33) or high (n = 28) on the Psychopathy Checklist-Revised (PCL-R) and n = 28 male noncriminal controls. Empathy functioning was assessed through self-report and computerized decision tasks, differentiating between perspective-taking (cognitive empathy) and compassion (emotional empathy). Against expectations, level of psychopathy among the offenders was not associated with either emotional or cognitive empathy. Offenders however had lower scores for both cognitive and emotional components of empathy functioning than controls. Both facets of empathy showed small but significant positive correlations with education level and social desirability. The methods employed to assess differences in empathy functioning may not be sensitive enough to assess differences in forensic samples.

Is psychopathy elevated among criminal offenders who are under preventive detention pursuant to Section 66 of the German Penal Code?

In Germany, preventive detention can be imposed if a repeat offender shows a proclivity to commit further significant criminal acts. The courts require expert opinion to provide information about personality traits relevant for this disposition. However, currently, consensus about this topic is lacking. On the basis of a standardized examination, the relevance of Hare's concept of "psychopathy" for expert opinion is discussed in the context of preventive detention.