[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.

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.

Reduced binocular depth inversion in patients with alcoholism

Binocular depth inversion represents an illusion of visual perception, serving to invert the perception of implausible hollow objects, e.g. a hollow face into a normal face. Such inversion occurs frequently, especially when objects with a higher degree of familiarity (e.g. photographs of faces) are displayed. Cognitive factors are assumed to override the binocular disparity cues of stereopsis. The hypothesis was tested that during mild and moderate alcohol withdrawal, and severe and mild alcohol intoxication, the central nervous system is unable to correct implausible perceptual hypotheses. Measurements of binocular depth inversion in perception of three-dimensional objects were performed in 10 patients with severe alcohol intoxication, in 10 subjects with mild alcohol intoxication, in nine patients with moderate alcohol withdrawal treated with carbamazepine, in 10 patients with moderate alcohol withdrawal without any pharmacological treatment, in 11 patients with mild alcohol withdrawal and in 10 healthy volunteers. The binocular depth inversion scores were highly elevated in the severely intoxicated patients group and in the group with moderate withdrawal symptoms without carbamazepine treatment, in comparison to the healthy volunteers. The data demonstrate a strong impairment of binocular depth inversion in moderate alcohol withdrawal and during severe alcohol intoxication. This supports the view that these states may be accompanied by a disorganization of the interaction between sensory input and top-down component. The effects of carbamazepine are discussed.

[Pro-psychotic change of binocular depth inversion by sleep deprivation]

Binocular depth inversion represents an illusion of visual perception. Such inversion does not occur in all cases, especially when objects with a higher degree of familiarity (e.g. photographs of faces) are displayed. Cognitive factors are assumed to override the binocular disparity cues of stereopsis. We tested the hypothesis that during sleep deprivation the human CNS is unable to correct the implausible perceptual information. Measurements of binocular depth inversion in perception of 3D objects were taken in sleep-deprived medical staff and healthy volunteers. The binocular depth inversion scores were highly elevated in the sleep-deprived group in comparison to the healthy volunteers. The data demonstrate a strong impairment of binocular depth inversion after sleep deprivation and support the view that sleep deprivation may be accompanied by a disorganisation of the interaction between sensory input and generation of perceptual hypotheses.

Impaired binocular depth inversion in patients with alcohol withdrawal

Binocular depth inversion represents an illusion of visual perception. Such inversion does not occur in all cases, especially when objects with a higher degree of familiarity (e.g. photographs of faces) are displayed. Cognitive factors are assumed to override the binocular disparity cues of stereopsis. We tested the hypothesis that during alcohol withdrawal the human CNS is unable to correct the implausible perceptual hypothesis. Measurements of binocular depth inversion in perception of 3D objects were performed in 10 patients with mild alcohol withdrawal and in 11 healthy volunteers. The binocular depth inversion scores were highly elevated in the patients group in comparison to the healthy volunteers. The data demonstrates a strong impairment of binocular depth inversion in alcohol withdrawal and support the view that alcohol withdrawal may be accompanied by a disorganization of the interaction between sensory input and generation of perceptual hypotheses.

Visual 3D illusion: a systems-theoretical approach to psychosis

Binocular depth inversion represents an illusion of visual perception. Such an inversion does not occur in all cases, especially when objects with a higher degree of familiarity (e.g. photographs of faces) are displayed. Cognitive factors are assumed to override the binocular disparity cues of stereopsis. We tested the hypothesis that during psychotic and similar states the human CNS is unable to correct the implausible perceptual hypothesis. Measurements of binocular depth inversion in perception of 3D objects were performed in schizophrenic patients (n = 13), in patients with alcohol withdrawal (n = 10), in sleep-deprived medical staff (n = 10) and in healthy volunteers (n = 41). The binocular depth inversion scores were highly elevated in the patient group and in the sleep-deprivated medical staff in comparison with healthy volunteers. The data demonstrate that impairment of binocular depth inversion reflects a common final pathway, characterized by an impairment of adaptive systems regulating perception.