[Therapy of sex offenders].

Outcomes of reviews of the effect of interventions for sexual offenders vary and are inconclusive. The lack of consensus reflects the inherent ethic and methodological difficulties related to the evaluation of treatment effect for sexual offenders. In this overview, we examined seven reviews of treatment outcome studies for adult sexual offenders. Three of seven reviews reported a significant positive post-treatment effect on sexual re-offending risk. However, the evidence for successful treatment seems far from robust given the lack of controlled and methodological strong primary studies.

[Hypersexuality].

Sexual behaviour is a normal and healthy part of life. However, some individuals report excessive sexual appetite and/or an inability to control sexual behaviour. The literature has conceptualised this behaviour as hypersexuality (HS). The aim of this review is to address the challenges associated with diagnosing HS reliably and the lack of empirical evidence on treatment of HS. Further research is required in order to define when or if excessive sexual behaviour is a clinical disorder or symptomatic of either a medical or psychiatric disorder and how this condition should be treated effectively.

Mortality among male forensic and non-forensic psychiatric patients: matched cohort study of rates, predictors and causes-of-death.

Background: The mortality of forensic psychiatric (FP) patients compared to non-forensic psychiatric (non-FP) patients has been sparsely examined.Methods: We conducted a matched cohort study and compared Danish male FP patients (n = 490) who underwent pre-trial forensic psychiatric assessment (FPA) 1980-1992 and were subsequently sentenced to psychiatric treatment with matched (on year of birth, marital status, and municipality of residence) male non-FP patients (n = 490) and male general population controls (n = 1716). FP and non-FP patients were also matched on major psychiatric diagnostic categories. To determine mortality and identify potential predictors of mortality, we linked nationwide register data (demographics, education, employment, psychiatric admission pattern and diagnoses, cause of death) to study cohorts. Average follow-up time was 19 years from FPA assessment/sampling until death/censoring or 31 December 2010 and risk factors were studied/controlled with Cox proportional hazard analysis.Results: Overall, psychiatric patients had significantly higher mortality compared to matched general population controls (medium to large effects). Among patients, 44% (213) of FP vs. 36% (178) of matched non-FP patients died during follow-up (p = 0.02). When we used Cox regression modeling to control for potential risk factors; age, education, immigrant background, employed/studying at index, length of psychiatric inpatient stay/year, and ever being diagnosed with substance use disorder (SUD), FP patient status was no longer significantly associated with increased mortality, whereas SUD and longer inpatient time per year were independently associated with increased mortality.Discussion: This study suggests that SUD and longer inpatient time per year are independent risk factors for increased mortality in psychiatric patients.

Long-Term Violent Reoffending Following Forensic Psychiatric Treatment: Comparing Forensic Psychiatric Examinees and General Offender Controls.

Background: Long-term violent re-offending in forensic psychiatric (FP) patients vs. non-FP offenders is largely unknown. Methods: We studied rates and facets of long-term violent reoffending among 1,062 violent forensic psychiatric examinees (FPE) consecutively undergoing pre-trial, forensic psychiatric examination (FPE) in Denmark during 1980-1992. Altogether, 392 were sentenced to FP treatment (FPE+T); the remaining 670 examinees received ordinary non-FP sanctions (FPE-T). FPE+T were compared to 392 contemporary matched violent general offenders (GEN) without FPE or other psychiatric contacts and sentenced to ordinary non-FP sanctions. FPE data were linked to population-based registers with sociodemographic, psychiatric, and crime information, and we estimated relative risks controlling for birth year, sex, educational and marital status, and previous violent crime. Results: During follow-up (mean = 18.0-19.5 years), FPE+T and GEN had any violent recidivism rates of 43% vs. 29% [adjusted hazard ratio (aHR) = 1.5; 95% CI, 1.1-1.9], respectively. Corresponding findings for severe violence (21% vs. 14%; aHR = 1.3; 95% CI, 0.9-1.9) and recurrent violence (3+ violent convictions; 16% vs. 6%; adjusted odds ratio [aOR] = 2.5; 95% CI, 1.5-4.4) also suggested weakly to moderately increased risks in FPE+T, albeit non-significantly for the former. Comparing FPE+T to FPE-T suggested decreased risk of any violence (43% vs. 51%; aHR = 0.8; 95% CI, 0.6-1.1), severe (21% vs. 34%; aHR = 0.6; 95% CI, 0.4-0.8), and recurrent violence [16% vs. 22%; adjusted odds ratio (aOR) = 0.7; 95% CI, 0.5-1.0] in FP patients, though non-significantly for any violence and recurrent violence. Among all FPE examinees, violent reoffending was independently predicted by male sex, younger age, pre-index violent crime, personality disorder (vs. schizophrenia spectrum and other psychiatric disorder), substance use disorder, and 5+ hospital admissions. Conclusion: FPE examinees, untreated followed by treated, reoffend violently more often than GENs. Similar trends are suggested also for severe and recurrent violence suggesting a need for continua of services for FPE examinees, independently of medico-legal status (i.e., sentencing to treatment or not).

[Diagnosing and treating paedophilia].

In this review, we discuss paedophilia, which is a persistent and intense sexual interest in prepuberty children. Paedophilia is related to but not identical to sexual offending. Valid and reliable identification of paedophilia is complicated. In Denmark there is a need for intensifying primary and secondary preventive interventions aimed at increasing the number of individuals with paedophilia seeking treatment. Paedophilia has the same or a higher prevalence than other severe psychiatric disorders. Yet, in Denmark, this research field is delayed in comparison to research into other psychiatric disorders.

[Criminal recidivism among sexual offenders]. / Kriminelt recidiv blandt saedelighedskriminelle.

INTRODUCTION: No previous reports have been published on the rate, frequency and nature of long-term sexual recidivism for a large cohort of Danish sexual offenders who have been through a forensic psychiatric evaluation. MATERIAL AND METHODS: A retrospective follow-up study of all male sexual offenders evaluated between 1st January 1978 and 31st December 1992 at the Department of Forensic Psychiatry, Aarhus University Hospital, or at the Clinic of Forensic Psychiatry, Ministry of Justice, Copenhagen (n = 441). RESULTS: Of the followed cohort (n = 342) 30% were sentenced for a new sexual criminal offence (including severe sexual acts), 17% for severe sexual acts, 32% for nonsexual violence and 61% for general crime during follow-up (average 16.5 years). There was a low rate of repeated sexual recidivism (12%) and severe sexual recidivism (6%). Extra-familial child molesters and exhibitionists had the highest risk of sexual recidivism and repeated sexual offences. Rapists had the highest risk of severe sexual recidivism and re-offended more rapidly than the other offender subgroups. Intra-familial child molesters had a low recidivism rate. Young offenders had a higher recidivism risk than older offenders. Severely mentally ill or retarded had a statistically lower rate of sexual recidivism than less disturbed offenders. CONCLUSION: The sexual recidivism rate varies across sexual offender types. The management and prevention of sexual recidivism need to focus on treatment of sexual offenders with the highest risk of severe and repeated sexual offences.

Unguided clinical and actuarial assessment of re-offending risk: a direct comparison with sex offenders in Denmark.

Meta-analyses suggest that actuarial risk assessments outperform unguided clinical judgment for prediction of recidivism in criminal offenders. However, there is a lack of direct comparisons of the predictive accuracy of clinical judgment and actuarial risk scales for sexual offenders. We followed up 121 male sex offenders (> or =18 years) subjected to pre-trial forensic psychiatric assessment in Denmark in 1978-1992 (mean post-detainment time = 16.4 years) to compare the predictive validity of unstructured clinical judgment of recidivism risk with that of the well-established Static-99 (Hanson and Thornton, Law and Human Behavior 24:119-136, 2000) and an extension of the Static-99, the Static-2002 (Hanson and Thornton, Notes on the development of Static-2002 (Rep. No. 2003-01), Public Safety and Emergency Preparedness Canada, Ottawa, Canada, 2003). The predictive accuracy of unguided judgment did not exceed chance for any sexual, severe sexual or any violent (sexual or non-sexual) reconviction (AUCs of the ROC curve = 0.52, 95%CI = 0.41-0.63; 0.50, 95%CI = 0.34-0.67; and 0.57, 95%CI = 0.40-0.73, respectively). In contrast, all three outcomes were predicted significantly better than chance by the Static-99 (AUC = 0.62, 95%CI = 0.52-0.72; 0.72, 95%CI = 0.59-0.84; and 0.71, 95%CI = 0.56-0.86) and the Static-2002 (AUC = 0.67, 95%CI = 0.57-0.77; 0.69, 95%CI = 0.56-0.83; and 0.70, 95%CI = 0.55-0.86). Static-99 outperformed clinical judgment for sexual recidivision (chi(2) = 5.11, df = 1, p < .05). The Static-2002 was significantly more accurate for the prediction of any sexual recidivism as compared to unguided clinical judgment but its advantage fell just short of statistical significance for severe sexual recidivism (chi(2) = 3.56, df = 1, p = 0.06). When tested for recidivism within 2 years, none of the three prediction methods yielded results significantly better than chance for any outcome. This direct trial of the unguided clinical method argues against its continued use for risk assessment of sexual offenders.