Facial perception of infants with cleft lip and palate with/without the NAM appliance.

OBJECTIVE: This study aimed to assess adults' subjective perception of infants with a unilateral cleft lip and palate (UCLP) with and without a nasoalveolar molding (NAM) appliance compared to those of controls concerning (1) adult gaze patterns and (2) emotional valence. METHODS: This interdisciplinary study was performed by (1) the Department of Orthodontics and (2) the Department for Psychiatry and Psychotherapy, University Medical Center Goettingen, using eye tracking and a 10-point Likert scale questionnaire. Eye movements and valence rating of 30 unaffected adults (15 women, 15 men; mean age: 25.5 years, standard deviation [SD] = 7.5) were recorded while presenting them infants in three picture categories (1) infant with UCLP, (2) infant with UCLP and inserted NAM appliance and (3) infant without UCLP. Total fixation time in two main areas of interest (AOI upper/lower face) was measured according to picture category as well as participants' valence rating regarding infants' appearance. RESULTS: In pictures of infants with UCLP or UCLP and NAM appliance participants had longer fixation times on AOI lower face compared to reconstructed pictures of infants without UCLP. No significant effect of a NAM appliance on gaze patterns could be detected. The valence of pictures of infants with UCLP was rated more negative compared to pictures of unaffected infants. An inserted NAM appliance improved this rating. CONCLUSIONS: The results bolster the assumption that facial disruptions like UCLP alter adults' perception of infants. Even though the NAM appliance is not able to re-establish usual adult gaze patterns, it can help to improve adults' emotional assessment.

[Use of virtual reality in forensic psychiatry. A new paradigm?]. / Anwendung virtueller Realitäten in der forensischen Psychiatrie. Ein neues Paradigma?

BACKGROUND: For more than 20 years virtual realities (VR) have been successfully used in the assessment and treatment of psychiatric disorders. The most important advantages of VR are the high ecological validity of virtual environments, the entire controllability of virtual stimuli in the virtual environment and the capability to induce the sensation of being in the virtual environment instead of the physical environment. VRs provide the opportunity to face the user with stimuli and situations which are not available or too risky in reality. Despite these advantages VR-based applications have not yet been applied in forensic psychiatry. OBJECTIVES AND METHODS: On the basis of an overview of the recent state-of-the-art in VR-based applications in general psychiatry, the article demonstrates the advantages and possibilities of VR-based applications in forensic psychiatry. RESULTS AND CONCLUSIONS: Up to now only preliminary studies regarding the VR-based assessment of pedophilic interests exist. These studies demonstrate the potential of ecologically valid VR-based applications for the assessment of forensically relevant disorders. One of the most important advantages is the possibility of VR to assess the behavior of forensic inpatients in crime-related situations without endangering others. This provides completely new possibilities not only regarding the assessment but also for the treatment of forensic inpatients. Before utilizing these possibilities in the clinical practice exhaustive research and development will be necessary. Given the high potential of VR-based applications, this effort would be worth it.

[Pedophilia: etiology, diagnostics and therapy]. / Pädophilie: Ätiologie, Diagnostik und Therapie.

Child sexual abuse is one of the most destructive events for healthy child development. Following psychiatric classification systems, pedophilia must be distinguished from child sexual abuse. Approximately only one half of all child abusers fulfill the diagnostic criteria for pedophilia which is defined as a persistent or dominating sexual preference for prepubescent children characterized by persistent thoughts, fantasies, urges, sexual arousal or behavior. This article describes the diagnostic criteria and potential differential diagnoses as well as epidemiological and etiological findings. From an etiological point of view multifactorial mechanisms are currently considered to be responsible especially genetic factors, learning theoretical and neurobiological factors. Psychotherapeutic and pharmaceutical treatment options will be discussed. According to the current state of knowledge cognitive-behavioral psychotherapy is the method of choice in the treatment of pedophilia and has demonstrated positive treatment effects in meta-analyses regarding relapse prevention. Medicinal treatment of pedophilia is only indicated for severe forms of pedophilia. Important aspects of risk management in the treatment of pedophilia and aspects which must be considered in the forensic psychiatric assessment are presented.

[Legal probation after deferred retrospective preventive detention: implications for the amended regulations on preventive detention]. / Legalbewährung nach nicht angeordneter nachträglicher Sicherungsverwahrung : Implikationen für die Neuregelung der Sicherungsverwahrung.

The study examines the legal probation of offenders who are considered to be highly dangerous but due to the decision of the Federal High Court were not in retrospective preventive detention (§ 66b StGB). In view of the current discussion, in anticipation of a detailed presentation of the study results the relevant criteria "probation behavior", "personality characteristics" and "prognosis quality" are picked out. The results are evaluated with respect to knowledge of the restrictions conditioned by the study regarding the usefulness for the prognosis of reoffending. The results of this study suggest that it might be useful to describe psychological criteria for the not seriously reoffending group of probands.