The impact of the COVID-19 pandemic on the psychosocial rehabilitation of forensic psychiatric patients in Austria.

The coronavirus disease 2019 (COVID-19) pandemic led to increased psychological distress and far-reaching restrictions of freedom. In March 2020, Austrian penal authorities enacted various safety and protection measures to mitigate the propagation of COVID-19. While infection rates in penal institutions were low, restrictive conditions of detention limited the forensic care of offenders. This retrospective longitudinal observational study aimed to evaluate the impact of the pandemic on the psychosocial rehabilitation in forensic psychiatry. Administrative and clinical data obtained from 97 males treated at an inpatient forensic mental health institution were compared before (January 2019 - mid-March 2020) and after (mid-March 2020 - May 2021) the enactment of pandemic-related restrictive measures. The study outcomes related to rehabilitative activities, social contacts, psychopathological stability, and compliance with institutional regulations. During the pandemic, a decrease in individual one-day temporary releases (64 vs. 3, p < .001) and one-day group excursions (103 vs. 10, p < .001) was observed. Likewise, visits by relatives (1440 vs. 429, p < .001) and legal guardians (286 vs. 130, p = .009) decreased. Regarding compliance with institutional regulations, illegal activities decreased from 27 to 8 after enactment of restrictive measures (p = .024). In contrast, long-term temporary releases (122 vs. 188 weeks, p = .131) and admissions to the acute ward (141 vs. 143, p = .712) remained unchanged. Overall, this study demonstrates the substantial impact of COVID-19 on the psychosocial care of forensic psychiatric patients and implies the necessity for guidelines to uphold an appropriate standard of forensic rehabilitation during future pandemics.

Neurocognition and social cognition in patients with schizophrenia spectrum disorders with and without a history of violence: results of a multinational European study.

OBJECTIVE: Neurocognitive impairment has been extensively studied in people with schizophrenia spectrum disorders and seems to be one of the major determinants of functional outcome in this clinical population. Data exploring the link between neuropsychological deficits and the risk of violence in schizophrenia has been more inconsistent. In this study, we analyse the differential predictive potential of neurocognition and social cognition to discriminate patients with schizophrenia spectrum disorders with and without a history of severe violence. METHODS: Overall, 398 (221 cases and 177 controls) patients were recruited in forensic and general psychiatric settings across five European countries and assessed using a standardized battery. RESULTS: Education and processing speed were the strongest discriminators between forensic and non-forensic patients, followed by emotion recognition. In particular, increased accuracy for anger recognition was the most distinctive feature of the forensic group. CONCLUSIONS: These results may have important clinical implications, suggesting potential enhancements of the assessment and treatment of patients with schizophrenia spectrum disorders with a history of violence, who may benefit from consideration of socio-cognitive skills commonly neglected in ordinary clinical practice.

[Working with Fathers to Prevent Child Abuse. A Pilot Evaluation of the Caring Dads Program in Germany]. / Arbeit mit Vätern zur Prävention von Kindesmisshandlung Eine Pilotevaluation des Caring Dads Programms in Deutschland.

Working with Fathers to Prevent Child Abuse. A Pilot Evaluation of the Caring Dads Program in Germany Selective and indicated prevention programs for fathers at high risk of (repeated) child maltreatment are lacking within early childhood intervention and child protection. The Canadian Caring Dads Program has been started in Germany in 2008. The aim of this study was to examine fathers who participated in a Caring Dads program in Düsseldorf, Hanover or Groß-Gerau until 2016. The study of n = 60 fathers and n = 34 mothers included the longitudinal examination of self-reported aggression, parenting behaviors and co-parenting in fathers as well as quality of life and co-parenting in mothers, the comparison of fathers participating in the program in Germany and Canada (n = 59/64) and a postal catamnesis (n = 20). Results have shown mean improvements in paternal aggression (d = .39) and parenting behaviors (d = .80, categorized: φ = .46) as well as maternal co-parenting (d = .46) and paternal behavior toward the partner (d = .47). In one-fourth to one-third of fathers at risk-levels, improvements controlled for measurement errors by the Reliable Change Index were clinically significant. German fathers reported higher motivation for change (t1/t2: d = 1.37/1.59) and verbal aggression (t1/t2: d = 1.29/1.36) compared to Canadian fathers. The catamnesis showed subjectively significant improvements in family relationships and parenting from the paternal point of view. The evaluation does not provide any evidence of culturally induced barriers of implementing Caring Dads in Germany.

Metacognitive beliefs in individuals at risk for psychosis: a systematic review and meta-analysis of sex differences.

BACKGROUND: Sex differences were found in several domains in individuals at ultra-high risk for psychosis, but no previous work has systematically reviewed and analysed possible sex differences in metacognition in this population. However, alterations in metacognitive beliefs have been shown in the at-risk mental state for psychosis population. Our aim was to qualitatively review and quantitatively analyse the existing literature for data on sex differences in metacognitive beliefs-mainly depicted by the Metacognitions Questionnaire (MCQ) and its short form (MCQ-30)-in individuals with at-risk mental states. METHODS: We performed a systematic review of the literature on metacognition in help-seeking adolescents and young adults at ultra-high risk for psychosis. We included peer-reviewed articles that included a high-risk for psychosis group assessed with operationalised criteria and instruments. For the quantitative meta-analysis, only studies comparing MCQ data in high-risk individuals were included. A fixed-effect meta-model was used and forest plots drawn for each subscale and overall score. The studies were weighted according to the inverse variance method in order to calculate pooled confidence intervals and p values. RESULTS: No article on metacognitive beliefs in individuals at increased risk for psychosis explicitly reported possible sex differences. Our meta-analysis of 234 (57% male) individuals' scores in the MCQ yielded no significant sex difference. CONCLUSIONS: Currently, no sex differences in metacognition can be described in the at-risk population; however, data are insufficient and heterogeneous with regard to thoroughly answering the question whether sex differences in clinical high-risk populations are mirrored in the metacognitive domain.

[Descriptive examination of inpatient stays of patients with emotionally unstable personality disorder in Austria between 2001 and 2016 with special consideration of age, gender and length of stay]. / Deskriptive Untersuchung der stationären Aufenthalte von Patienten mit emotional instabiler Persönlichkeitsstörung in Österreich zwischen 2001 und 2016 mit besonderer Berücksichtigung von Alter, Geschlecht und Aufenthaltsdauer.

BACKROUND: Emotionally unstable personality disorder (EUPD) has a high prevalence worldwide and especially in in-patient psychiatric settings, varying in age and gender. Due to the complex clinical picture, repeated admissions and high costs, health systems are facing great challenges. METHODS: For the calculations Statistik Austria data of inpatient stays of patients with mental and behavioral disorders with special regard to EUPD as main discharge diagnosis in Austria in the period 2001-2016 were used. Included were patients with age over 14 years, admission to a psychiatric clinic in acute care and maximum length of stay of 365 days. Age, gender and length of stay were analyzed with SPSS®, evaluated in descriptive form and related to each other. RESULTS: The prevalence of EUPD within all mental and behavioral disorders was 4.0%. Of all personality and behavioral disorders, as well as specific personality disorders, EUPD had the highest prevalence (65.3% and 79.3%). About four times more women (79.8%) than men (20.2%) received inpatient treatment. Most patients (23.1%) were admitted at the age of 20-24 years. From 40 years of age the number of admissions clearly decreased. The largest percentage of men was found to be in the age group over 45 years (27.0%) and 183-365 inpatient days (27.0%), those of women aged 15-19 (83.4%) and 0 and 14-182 inpatient days (81.4% each). The average length of stay was 13 days for women and 12 days for men. 11.3% of patients left the clinic on the day of admission, 61.2% were treated for 1-13 days, 27.2% for 14-182 days, and 0.2% for 183-365 days.

Daily variations of homocysteine concentration may influence methylation of DNA in normal healthy individuals.

The regulation of genetic expression is tightly controlled and well balanced in the organism by different epigenetic mechanisms such as DNA methylation and histone modifications. DNA methylation occurring after embryogenesis is seen mainly as an irreversible event. Even small changes in genomic DNA methylation might be of biological relevance, and several factors influencing DNA methylation have been identified so far, one being homocysteine. In this study, genomic DNA methylation was analyzed and homocysteine plasma levels were measured over a 24 h period in 30 healthy students (15 males and 15 females) exposed to a standard 24 h regime of daytime activity alternating with nighttime sleep. Plasma homocysteine concentrations were measured using HPLC detection. DNA was extracted from whole EDTA blood, and genomic DNA methylation was assessed by fluorescently labeled cytosine extension assay. Both homocysteine and DNA methylation showed 24 h variation. Homocysteine showed a significant daily rhythm with an evening peak and nocturnal nadir in all subjects (p<0.001). Males showed higher overall homocysteine levels compared to females (p=0.002). Genomic DNA methylation showed a significant rhythm with increased levels at night (p=0.021), which was inverse to plasma homocysteine levels.