[The Ontario Domestic Assault Risk Assessment (ODARA) - Validity und authorised German translation of an intimate partner violence screening tool]. / Das Ontario Domestic Assault Risk Assessment (ODARA) - Validität und autorisierte deutsche Übersetzung eines Screening-Instruments für Risikobeurteilungen bei Intimpartnergewalt.

On average one third of all women are victimised by intimate partner violence at least once in their life. Many women are affected repeatedly. To efficiently reduce the risk of repeated violence a reliable and valid risk assessment is needed. To date several risk assessment tools have been published in the field of intimate partner violence. There is a strong demand for such tools to be applicable by a wider range of practitioners (e.g., police officers, hospital and victim services' staff) to reliably assess cases of intimate partner violence and recommend further interventions. By developing the Ontario Domestic Assault Risk Assessment (ODARA) it was the authors' aim to provide a brief risk assessment tool which can be scored on the basis of only few and easily collectable information and which efficiently discriminates between low-risk and high-risk offenders of intimate partner violence. Previous replication studies found moderate to good and on average higher power of discrimination of the ODARA compared to other risk assessment tools in the field. However, for the German speaking countries robust findings are still lacking. In the present publication a scientific and authorised translation of the ODARA is provided.

[Risk assessment for domestic violence]. / Risikokalkulation bei häuslicher Gewalt.

The aim of the present study is to give a systematic overview of risk assessment instruments for the field of domestic violence. Six instruments were identified, which had been published in a peer-reviewed journal and for which validation studies exist: the Domestic Violent Screening Instrument (DVSI), the Danger Assessment (DA), the Spousal Assault Risk-Assessment (SARA), the Ontario Domestic Assault Risk-Assessment (ODARA), the Violence Risk Appraisal Guide (VRAG), and the Domestic Violence Risk Appraisal Guide (DVRAG). Their validity and practical use are discussed.

[Indicators of course of inpatient therapy in offenders with substance dependency]. / Indikatoren für den Verlauf einer stationären Behandlung bei Straftätern mit Substanzmittelabhängigkeit.

The objective of this review is to summarise the recent state of research on intake criteria for forensic psychiatry in Germany. Therefore, a systematic literature review was conducted on the legal basis of paragraph 64 of the German Penal Code for forensic psychiatry. Although the patients were very heterogeneous, relatively robust indicators were identified that may yield an unsuccessful therapy outcome. A younger age, previous delinquency, absence of an educational and vocational qualification, and personality disorders are the most robust indicators adversely affecting therapy in German forensic psychiatric institutions.

[From victim to offender: characteristics of sexually abused violent and sex offenders]. / Vom Opfer zum Täter: Merkmale sexuell missbrauchter Gewalt- und Sexualstraftäter.

INTRODUCTION: Prospective studies on victims of sexual abuse and retrospective studies on offender populations have indicated a connection between experiences of childhood sexual abuse (CSA) and delinquency in adulthood. METHOD: Using a representative sample of violent and sex offenders from the Canton of Zurich (Switzerland; N=354), the aim of this study was to identify the characteristics of offenders who have experienced CSA. Two multivariable models for CSA were generated. RESULTS: CSA was documented for 13% of the sex offenders and 5.8% of the violent offenders. Child molesters displayed the highest prevalence rate with 18.9%. Multivariable analyses identified Swiss nationality, having stayed in a foster home and violence in the nuclear family as the strongest risk factors for CSA. In a second model, only offender characteristics from adulthood were taken into account as predictors: child molesters, offenders who prostituted themselves and repeat violent and sex offenders had a significantly higher risk of belonging to the group of offenders who had experienced CSA. DISCUSSION: The results suggest that the experience of CSA leads to an elevated and chronic risk for committing child abuse.

[The Sex Offender Risk Appraisal Guide (SORAG)]. / Der Sex Offender Risk Appraisal Guide (SORAG).

In North America, the use of actuarial instruments is considered to be state of the art in the assessment of offender recidivism risk. One of these instruments is the "Sex Offender Risk Appraisal Guide" (SORAG), which was developed specifically for the use in sex offender risk assessment. The present review investigates the current state of knowledge regarding the instrument's validity specifically for its use in German-speaking countries. Overall the results speak for the instrument's good discriminatory power. However, this is not true to the same degree for all types of sex offender populations. The discriminatory power is especially good in the subpopulation of child molesters. Part of the present review is a German translation of the instrument authorised by the developers of the SORAG.

[Prison violence: prevalence, manifestation and risk factors]. / Gewalt im Strafvollzug: Prävalenz, Erscheinungsformen und Risikofaktoren.

When comparing different studies on prison violence, it must be taken into account that correctional facilities vary considerably among one another. Studies conducted in Switzerland have shown that every one inmate in four is violent at least once during incarceration. These violent acts differ in regard to manifestation and a specific characterization of violence according to type, target, implication and trigger appears to be necessary. Existing criminal prognostic instruments are not suitable for estimating the risk of violent behavior in prisons. Therefore, the development of specific models is essential. International studies have identified various risk factors. However, due to the aforementioned differences in facilities, these predictors can only partly be transferred to a Swiss setting.

[The Violence Risk Appraisal Guide (VRAG)--a tool for the risk assessment of violent offenders]. / Der Violence Risk Appraisal Guide (VRAG)--ein Instrument zur Kriminalprognose bei Gewaltstraftätern.

OBJECTIVE: Most instruments used for assessing the recidivism risk of an offender with a violent or sex offense have been developed and validated in North America. METHODS: The aim of this study is to discuss the state of validation for the Violence Risk Appraisal Guide (VRAG)--an instrument for assessing the recidivism risk of violent offenders. A systematic literature research forms the basis for the processing of the literature. In a second section, a scientific translation of the instrument to German, including the scoring rules, is presented. RESULTS: Normally, while examining the validity of the VRAG, there is a focus on the discriminatory power (displayed using the so-called Area Under the Curve [AUC]). These examinations showed a satisfactory to good discriminatory power (AUC: 0.70-- 0.86). A standardization of this instrument for populations in Europe respectively the German-speaking area has not yet taken place. Only few studies have verified whether North American standard values are also valid for Europe. The few studies on this subject question the generalizability of these standard values to other countries. CONCLUSIONS: The VRAG can be considered a valid measure for the assessment of recidivism risk in Germany and in Switzerland, although so far, standardization has been dispensed with. The application of the VRAG can provide indications for the evaluation of recidivism risk and be integrated into an individual case-oriented assessment.

[Forensic risk calculation: basic methodological aspects for the evaluation of the applicability and validity of diverse methods]. / Forensische Risikokalkulationen: Grundlegende methodische Aspekte zur Beurteilung der Anwendbarkeit und Validität verschiedener Verfahren.

Risk assessment instruments have been the subject of a number of validation studies which have mainly examined the psychometric properties known primarily from psychological test development (objectivity, reliability and validity). Hardly any attention was paid to the fact that validation of forensic risk assessment instruments is confronted with a whole row of methodical challenges. Risk assessments include a quantitative and a qualitative component in that they state the probability (quantitative) of a particular offense (qualitative) to occur. To disregard the probabilistic nature of risk calculations leads to methodically faulty assumptions on the predictive validity of an instrument and what represents a suitable statistical method to test it. For example, ROC analyses are considered to be state of the art in the validation of risk assessment instruments. This method does however not take into account the probabilistic nature of prognoses and its results can be interpreted only to a limited degree. ROC analyses for example disregard certain aspects of an instrument's calibration which might lead in an instrument's validation to high ROC values while demonstrating only low validity. Further shortcomings of validation studies are that they ignore changes of risk dispositions or that they don't differentiate between offense specific risks (e. g. any recidivism vs. violent or sexual recidivism). The paper discusses and reviews different quality criteria of risk assessment instruments in view of methodological as well as practical issues. Many of these criteria have been ignored so far in the scientific discourse even though they are essential to the evaluation of the validity and the scope of indication of an instrument.

[CERAD and NOSGER. Comparing predictive scales for dementia in a Swiss gerontopsychiatric patient population]. / CERAD und NOSGER. Der prädiktive Wert dieser Verfahren in der Demenzdiagnostik einer Schweizer gerontopsychiatrischen Patientenpopulation.

BACKGROUND: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) is an established screening instrument for the diagnosis of Alzheimer's disease. The Nurses Observation Scale for Geriatric Patients (NOSGER), actually developed for rating the frequency of behavioral disturbances, appears suitable for dementia screening as well. MATERIAL AND METHOD: In this retrospective study we analyze the neuropsychological data of 400 consecutive patients at our hospital with several psychiatric diagnoses and cognitive deficits. By means of logistic calculation in single and multivariable models, the predictive value of CERAD and NOSGER for dementia diagnosis was studied. RESULTS: All CERAD subtests were significant single predictors for dementia. The multivariable model with the highest prediction for probability of dementia diagnosis contained the subtests Verbal Fluency Test, Word List Recall, Constructional Practice Recall, and the Mini-Mental State Examination. However, NOSGER could not differentiate between demented and nondemented patients. CONCLUSION: In our gerontopsychiatric population, CERAD separates demented patients from nondemented ones with high predictive potency. The NOSGER does not reveal any predictive value for the diagnosis of dementia.

[The predictive quality of the Psychopathy Checklist-Revised (PCL-R) for violent and sex offenders in Switzerland. A validation study]. / Die prädiktive Qualität der Psychopathy Checklist-Revised (PCL-R) bei Gewalt- und Sexualstraftätern in der Schweiz. Eine Validierungsstudie.

In Switzerland, the Hare Psychopathy Checklist-Revised (PCL-R) is administered rather restrictively for risk assessment of recidivism among violent and sexual offenders. The aim of the present study was a first-time evaluation of the predictive validity of the PCL-R for violent and sexual recidivism in Switzerland. The PCL-R scores of 96 violent and sex offenders were evaluated by collecting the data in their psychiatric expert opinions. The scores were then compared to the rates of recidivism as shown in the criminal records. Consistent with previous studies in North America and Europe, the determined predictive accuracy was satisfying. This degree of precision supports the use of the PCL-R for risk assessment of sexual and violent recidivism in Switzerland, as long as the instrument does not constitute the sole criterion to determine future recidivism, but is applied only in combination with a thorough clinical evaluation. The use of precise cut-off scores did not prove to be a valid criterion for the prognosis of recidivism and can therefore not be recommended for Swiss offenders.

[Neurobiological determinism: questionable inferences on human freedom of choice and forensic criminal responsibility]. / Neurobiologischer Determinismus: Fragwürdige Schlussfolgerungen über menschliche Entscheidungsmöglichkeiten und forensische Schuldfähigkeit.

Several authors argue that criminal behavior is generally caused by neurobiological deficits. Based on this neurobiological perspective of assumed causality, the concept of free will is questioned, and the theory of neurobiological determinism of all human behavior is put forward, thus maintaining that human beings are not responsible for their actions, and consequently the principle of guilt should be given up in criminal law. In this context the controversial debate on determinism and indeterminism, which has been held for centuries, has flared up anew, especially within the science of criminal law. When critically examining the current state of research, it becomes apparent that the results do not support the existence of a universally valid neurobiological causality of criminal behavior, nor a theory of an absolute neurobiological determinism. Neither is complete determination of all phenomena in the universe--as maintained--the logical conclusion of the principle of causality, nor is it empirically confirmed. Analyzed methodically, it cannot be falsified, and thus, as a theory which cannot be empirically tested, it represents a dogma against which plausible objections can be made. The criticism of the concept of free will, and even more so of human accountability and criminal responsibility, is not put forward in a valid way. The principle of relative determinism--the evaluation of the degree of determinism of personality factors potentially reducing criminal responsibility, which includes concrete observations and analysis of behavior--thus remains a central and cogent approach to the assessment of criminal responsibility. To sum up, the theories proposed by some authors on the complete neurobiological determinism of human behavior, and the subsequent impossibility of individual responsibility and guilt, reveal both methodical misconception and a lack of empirical foundation.

[Threats as precursors of violent crimes]. / Drohungen als Vorboten schwerer Gewalttaten.

Threats are frequent events. For example, in Switzerland in 2002 they accounted for 2.8% of all registered instantaneous crimes and showed a marked increase. Only a small proportion of threats are actually executed. On the other hand, many serious, violent crimes are preceded by threats. Therefore, the question repeatedly arises as to whether the crime could have been prevented by an adequate assessment of the threat. Even if threatening behavior is not a sufficient or necessary precursor to violent crime, it is advisable to take every threat seriously and to carry out a risk assessment. There is far-reaching agreement on the necessity of threat analysis, especially since there is practical evidence that professional risk analysis can prevent criminal acts. Since the baseline rate for grievous violent crime is very low, it is not possible for threat analysis to rely on profile-oriented (static) procedures. Rather, a process-oriented approach is indicated, whereby each threat is assessed in its individual context. Investigations so far have presented findings relating to different aspect of threats that can be helpful in the evaluation of specific, individual cases. In addition to specific analysis of the characteristics of the threat, it is essential to perform a detailed analysis of the relationship between the offender and the victim and of the offender's personality. It is to be expected that more extensive research will make it possible to benefit from an as yet inadequately exploited potential to prevent violent crime.

Risk factors for the bipolar and depression spectra.

OBJECTIVE: To identify risk factors for mood disorders in a community sample studied from the ages of 20 to 35 years. METHOD: Social characteristics, a family history of mood disorders and some personality features were analysed as risk factors for bipolar and depressive disorders by means of logistic regression. RESULTS: Frequent 'ups and downs' of mood were the strongest risk factor for both bipolar and depressive disorders; a weaker risk factor for both was emotional/vegetative lability (neuroticism). An additional risk factor for bipolar disorders was a positive family history of mania, whereas for depression it was a positive family history of depression/fatigue. As a risk factor for bipolar disorders, 'ups and downs' were much stronger than a positive family history of mania. Frequent ups and downs were independent of the family history of mood disorders. CONCLUSION: The results suggest that mood regulation should be investigated as a new, very important independent risk factor for mood disorders.

[Muscle strength and gait patterns of depressed people]. / Muskelkraft und Gangcharakteristika depressiver Menschen.

BACKGROUND: Gait characteristic and muscle power are often described in the clinical literature but with little empirical support. We assessed some parameters of gait and muscle power using simple and standardized methods within a framework based principally on classic clinical observations of depression. METHOD: 20 depressed inpatients were examined with standard tests of isometric muscle power and gait parameters, which measure step length, average walking speed, maximal walking speed, and three-minute walk distance. The results were compared with those of 20 matched healthy controls. The examination procedure was repeated after a three week period of inpatient treatment and significant symptomatic improvement. RESULTS: As predicted by our hypothesis depressed patients' muscle power and gait characteristics differed clearly from normal controls. Significant improvements after 3 weeks of inpatient treatment were found above all in extension of the knee and extension of the elbow tests as well as in all measures of our gait analysis. However, all gait parameters still differed significantly from those of healthy controls. CONCLUSIONS: Using simple but reliable tests which were used for the first time in psychiatry we examined certain relationships between depression and motor function in a moderately to severely depressed inpatient sample.

Inhibition of phagocytosis and killing of bacteria by anaesthetic agents in vitro.

Polymorphonuclear leucocytes (PMNL) are an essential contribution to protection from bacterial infection. We have examined the effects of thiopentone, etomidate, ketamine and flunitrazepam on phagocytosis and killing of Staphylococcus aureus and Escherichia coli by PMNL in vitro with fluorescence microscopy. All anaesthetic agents significantly inhibited both phagocytosis and bactericidal activity. The additives in the commercial preparations may have contributed to the suppression.

The effects of midazolam, droperidol, fentanyl, and alfentanil on phagocytosis and killing of bacteria by polymorphonuclear leukocytes in vitro.

Polymorphonuclear leukocytes (PMNL) make an outstanding contribution to the defence against invading bacteria. We studied the effects of midazolam, droperidol, fentanyl, and alfentanil on phagocytosis and killing of Staphylococcus aureus and Escherichia coli by PMNL in vitro. Using a method described by Eggleton et al., PMNL were isolated from venous blood samples obtained from ten volunteers. The fluorescence microscopic method mentioned by Bellinati-Pires et al. was used to examine phagocytosis and killing. Whereas both midazolam and droperidol caused a significant inhibition of phagocytosis as well as bactericidal activity, fentanyl and alfentanil did not influence these PMNL functions. In order to find out whether midazolam and droperidol are able to intensify perioperative bacterial infections in vivo as well, additional clinical studies should be conducted.

Propofol inhibits phagocytosis and killing of Staphylococcus aureus and Escherichia coli by polymorphonuclear leukocytes in vitro.

Polymorphonuclear leukocytes (PMNL) are important components of the immunological defence system which protects the human organism from invading bacteria. Using a fluorescence microscopic method, we examined the influence of propofol and its solvent intralipid on phagocytosis and killing of Staphylococcus aureus and Escherichia coli by PMNL in vitro. Propofol inhibited (P < or = 0.001) phagocytosis of Staphylococcus aureus as well as Escherichia coli. Killing of Staphylococcus aureus (P < or = 0.001) and of Escherichia coli (P < or = 0.01) was suppressed. Intralipid, by itself, impaired phagocytosis of Escherichia coli (P < or = 0.05). Apart from that, intralipid produced no relevant effects. Additional clinical studies regarding the influence of propofol on PMNL function are recommended.