ABSTRACT
A basic task of psychiatry is to identify and treat mentally disordered persons at risk of committing crimes. Psychiatry has an important function in preserving social peace, law, and order. How the psychiatric world handles this duty has changed with time. There have been very important changes from asylums to mental hospitals and from voluntary or involuntary inpatient treatment to outpatient care; but clinical psychiatry cannot give up forensic psychiatry. As a result of developments, inpatient care in mental hospitals often concentrates on crisis management, risk assessment, and risk management. On the other hand, forensic psychiatry has made great efforts in recent decades with special therapies for mentally disturbed criminals and collaborated closely with criminologists in developing instruments for risk assessment and prognosis of repeat offenses.
Subject(s)
Commitment of Mentally Ill , Criminal Psychology/organization & administration , Forensic Psychiatry/organization & administration , Mental Disorders/diagnosis , Mental Disorders/rehabilitation , Psychology, Clinical/organization & administration , Criminology/organization & administration , Dangerous Behavior , Germany , Mentally Ill Persons , Patient Care Team/organization & administration , Psychiatry/organization & administration , Psychiatry/trendsABSTRACT
Using key concepts of Janzarik's structural-dynamic model, this article describes some of the potential uses of this model in a forensic setting. We will especially take into account that aspect of Janzarik's work from the start of his research in the 1950s through to the late 1990s which particularly addressed forensic questions. Using the example of dynamic Unstetigkeit and structural derailment, the aspect of 'mental content becoming autonomous' will be considered regarding Schuldunfahigkeit. Taking the example of autopraxis, successful and disturbed balance between impulsivity and self-control in personality disorder will be clarified and concerning the concept of self-corruption the self-induced corroboration of dissocial attitudes will be explained. The author considers the user-friendly work of Janzarik to be a fundamental instrument for answering questions in forensic psychiatry.
Subject(s)
Juvenile Delinquency/psychology , Adolescent , Child , History, 20th Century , Humans , Impulsive Behavior/psychology , Models, Psychological , Personality Disorders/psychologyABSTRACT
Criminal offenders have a high rate of personality disorders (PDS), especially Antisocial Personality Disorders and psychopathy, but criminal acts are not necessarily the result of PD. Findings from psychiatric research suggest that the development of PD is influenced by genetic factors, that can result in deviant traits in temper, emotionality and cognitive style. There is general agreement that those peculiarities and vulnerabilities find their expression and structure only under a complex interplay of stimulating or impairing environmental influences. Do these genetic factors-or other factors-diminish a person's criminal responsibility? There is no difficulty in diagnosing PDs, but the challenging questions arise in forensic assessments of defendants for criminal responsibility who have a PD. This article discusses the German legal situation and special problems created by the term of "diminished" criminal responsibility. In contrast to the Anglo-American legal situation, the German criminal law obliges the court to order an indeterminate forensic - psychiatric confinement, in addition to punishment, if the offender had acted under diminished criminal responsibility and is now still considered to be dangerous. The convicted offender remains under the control of the criminal court during psychiatric hospitalization. The change from handling the personality disordered offender as a criminal to handling him as someone with a mental disorder creates a social option for extended state interventions, including indeterminate hospitalization.
Subject(s)
Criminal Law/legislation & jurisprudence , Personality Disorders/epidemiology , Antisocial Personality Disorder/diagnosis , Antisocial Personality Disorder/epidemiology , Germany/epidemiology , Humans , Psychiatric Status Rating ScalesABSTRACT
The term "sensation seeking" is part of a self-contained theory on personality psychology. It is meant to denote a disposition--peculiar to a certain personality, probably genetically founded and correlating with biological, f. e. neuroendocrine measures--to explore one's social environment in order to find new and diversified stimuli. In their work, researchers mainly refer to Zuckerman's Sensation Seeking Scale in its fifth version (SSS-V), which distinguishes between four aspects of sensation seeking based on factor analysis of the 40 SSS-V-items. There is partly an overlapping of the phenomenon with impulsiveness and extraversion. Whereas application studies show inter alia links between sensation seeking and dangerous driving or dangerous sexual practices, data on the expression of this trait in addictive persons do not point to definitely consistent links. In forensic terms, there is on a link between "boredom susceptibility"--the inability to stand uneventful, monotonous situations--and "disinhibition"--a lack of control of impulses--figuring as subscales of the SSS-V, on the one hand, and hyperkinetic attention deficit syndromes and "disactualisation weakness", as described by Janzarik, on the other. At present, there is no German-language SSS-inventory in line with basal testing theory requirements. Because of the apparently different modi of sensation seeking influenced by other cultural traditions, such a scale must be basically adapted to the life-style in Western Europe.
Subject(s)
Exploratory Behavior , Personality , Humans , Neurosecretory Systems/physiology , Personality TestsABSTRACT
Psychiatry deals with addiction but it is not concerned very much about the symptomatology of acute alcohol intoxication. This causes problems in connection with the legal system: intoxication is the most frequent cause of diminished legal responsibility in Germany, and judges want to have a system to assess the grade of intoxication as simply and reliably as possible. So they found the blood alcohol concentration (BAC) to be a safe indication. But the BAC has various effects not only on different people but also on the same person in different situations: other factors are influential, i.e. alcohol habituation and physical condition, personality, mood and situation. Therefore it is necessary to describe the typical syndromes of intoxication and their dependency on BAC.
Subject(s)
Alcoholic Intoxication/diagnosis , Crime/prevention & control , Forensic Psychiatry , Liability, Legal , Mental Competency/legislation & jurisprudence , Social Responsibility , Acute Disease , Alcoholic Intoxication/blood , Alcoholic Intoxication/complications , Alcoholic Intoxication/psychology , Crime/legislation & jurisprudence , Crime/psychology , Ethanol/blood , Germany , HumansABSTRACT
A prospective multidimensional study with 71 remitted bipolar outpatients (37 bipolars without, 34 with psychotic symptoms during acute mania) was made to assess relevant influential factors on relapse and readmission to hospital: characteristic data of previous course, psycho(patho)logical state and personality after remission, personality disorders, and ways of coping. In the course of the 5 years after the first examination, 48% of the patients were readmitted, 60% of them because of a (schizo)manic state. The study confirms the prognostic relevance of past course, e.g. number of previous episodes and mania-quotient. A further risk-factor are residual psychopathological alterations which persist after remission ("negative symptoms" of strictly bipolars, increased vulnerability for dynamic derailment for the bipolars with psychotic symptoms). Patients with "syntonic" personality in the free interval suffered less relapses. The relevance of other personality traits differed in the diagnostic subgroups of nonpsychotic and psychotic bipolars. Active coping was positively correlated with staying healthy, but the correlations were weak.
Subject(s)
Bipolar Disorder/psychology , Patient Readmission , Adaptation, Psychological , Adult , Bipolar Disorder/diagnosis , Bipolar Disorder/rehabilitation , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Length of Stay , Male , Middle Aged , Personality Assessment , Personality Disorders/diagnosis , Personality Disorders/psychology , Personality Disorders/rehabilitation , Personality Inventory , Recurrence , Rehabilitation, Vocational , Risk FactorsABSTRACT
In a longitudinal survey of 122 healthy criminal offenders aged 18 to 37 years, the relationship between intelligence measured by the Wechsler Adult Intelligence Scale (WAIS), neuropsychological scales and delinquency was investigated. The Benton Test correlates well with the WAIS and moderately with offence data, but not with recidivism in delinquency. The 122 men had normal intelligence test scores (average IQ = 102), but bad school and working records. The 34 per cent and 60 per cent respectively of offenders, who relapsed within the time span of 1.5 and 3 years respectively, showed significantly worse results in the Verbal Scale and in the Block Design of the Wechsler Intelligence Scale. Poor performance in the Information and the Block Design sub-tests of the WAIS, a low level of formal education and the belief in external control by circumstances and powerful others are predictors of a high risk of recidivism.
Subject(s)
Intelligence Tests , Juvenile Delinquency/psychology , Adolescent , Adult , Data Collection , Humans , Internal-External Control , Longitudinal Studies , Male , Neuropsychological Tests , Recurrence , Risk Factors , Statistics, NonparametricABSTRACT
Rendering an expert opinion on offenders with personality disorders is one of the most frequent tasks in forensic psychiatry. In Germany, the juridical term "severe mental deviance" for impaired responsibility, caused by severe personality disorder or sexual perversion, causes a lot of problems, because there is no obligatory psychiatric interpretation of this term. This paper gives a review of the different clinical transpositions by German forensic psychiatrists and discusses the model of "progredient psychopathological development." Based on the common elements of these solutions, the paper proposes a clinical interpretation of "severe mental deviance", which is derived from the diagnostic and clinical practice with non-delinquent patients with severe personality disorders.
Subject(s)
Expert Testimony/legislation & jurisprudence , Insanity Defense , Personality Disorders/diagnosis , Humans , Liability, Legal , Mental Competency/legislation & jurisprudence , Personality Development , Personality Disorders/classification , Risk FactorsABSTRACT
In a multidimensional model, the "Heidelberg Delinquency Study" explores biological, biographical, psychological and social factors that may be important to the development and persistence of violent crimes. After a survey of the literature in part I (22) the empirical results in the areas of neurological anamnesis, neurological findings and nonfocal neurological ("soft") signs and their correlations with other variables, e.g. criminal relapses, are reported. In our population of 129 adult offenders we found a high relevance of nonfocal neurological signs. These symptoms were associated with problems in social adjustment and conduct disorder in childhood, cognitive impairment, reduced emotional response, externalizing attributional style and a pattern of rapid delinquent relapses.
Subject(s)
Juvenile Delinquency , Adolescent , Adult , Age Factors , Cognition Disorders/psychology , Crime , Electroencephalography , Family Characteristics , Female , Germany , Humans , Intelligence Tests , Male , Mood Disorders/psychology , Neuropsychological Tests , Socioeconomic Factors , Substance-Related Disorders/psychology , ViolenceABSTRACT
Men with polytropic and persistent delinquency constitute a core group of criminal offenders. Criminological research could establish a set of social characteristics for this group, but psychiatric, neurological and neuropsychological variables with importance to the formation of delinquent recidivism are rarely investigated. In this study we give a survey of the results concerning the relevance of genetic factors for delinquent behaviour. Then we review the development of the "minimal brain disorder" conception and its changes to "hyperkinetic syndrome", "attention deficit disorder" and to specific developmental disorders, which are all associated with a higher degree of conduct disorders and delinquent behaviour. We finally discuss the stability and relevance of nonfocal neurological ("soft") signs and depict a tentative model of the relations between the influential factors. Part II of this study (66) gives an account of the results of the "Heidelberg Delinquency Study" in this area.
Subject(s)
Antisocial Personality Disorder/psychology , Attention Deficit Disorder with Hyperactivity/psychology , Brain Damage, Chronic/psychology , Criminal Psychology , Juvenile Delinquency/psychology , Neurologic Examination , Adolescent , Adult , Antisocial Personality Disorder/diagnosis , Antisocial Personality Disorder/etiology , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/etiology , Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/etiology , Child , Humans , Male , Risk FactorsABSTRACT
Subjective concepts and experience of illness and coping behaviour are important factors for the course of bipolar disorder. 81 remitted and discharged patients (bipolar manic-depressive and bipolar schizoaffective) were interviewed on these topics. The last manic episode was usually reported as pleasant, but the recollection of acute symptoms was often affected by shame. Patients with few episodes preferred social and interactional explanations for their disordered states. The medical concept of illness was accepted with advancing episodes, it correlated with resignation and feelings of powerlessness. Initially active and conflict-orientated forms of coping predominated. But after further manic episodes family members often declared themselves responsible for the prevention of relapse (without success); the patients now showed an increase of denial and externalization. The data are condensed to a concept of a gradual change of attitudes of bipolar patients (with therapeutical implications).
Subject(s)
Adaptation, Psychological , Bipolar Disorder/psychology , Sick Role , Adult , Bipolar Disorder/diagnosis , Cost of Illness , Cyclothymic Disorder/psychology , Female , Hospitalization , Humans , Male , Personality Assessment , Psychotic Disorders/psychologyABSTRACT
81 remitted patients with bipolar affective disorder were examined 20 months after the last discharge from hospital, for personality disorders and other personality deviations, which could be important for their way of coping. There was a high frequency of narcissistic, histrionic and borderline traits and, especially in the bipolar schizoaffective subgroup, of schizoid and related traits. Patients with few former episodes seemed to be "syntonic". Bipolar patients with a longer duration of illness showed an increasing resignative and subdepressive change of feelings and attitudes, whereas the schizoaffective patients in the long term showed a hypomanic alteration. The personality changes of bipolar patients occur during the "free intervals" and are mediated by social interaction, whereas the alteration of some bipolar schizo-affective seems to be caused directly by their illness.
Subject(s)
Bipolar Disorder/diagnosis , Hospitalization , Personality Disorders/diagnosis , Adult , Bipolar Disorder/drug therapy , Bipolar Disorder/psychology , Carbamazepine/therapeutic use , Cyclothymic Disorder/diagnosis , Cyclothymic Disorder/drug therapy , Cyclothymic Disorder/psychology , Depressive Disorder/diagnosis , Depressive Disorder/drug therapy , Depressive Disorder/psychology , Female , Humans , Lithium/therapeutic use , Male , Middle Aged , Personality Assessment , Personality Disorders/drug therapy , Personality Disorders/psychology , Psychiatric Status Rating ScalesABSTRACT
In an unselected group of 48 excessive gamblers who came for psychiatric help or for an expert opinion on legal responsibility, childhood developmental limitations were frequent, as well as disorders in the ability to form and maintain partner relationships in later life. However, the childhood conditions and biographies of this group were diverse, and the spectrum of their observed mental and personality disorders rather wide. Differences in age, social class and psychiatric spectrum were found between gamblers at electronic game machines (german style slot-machines) and roulette gamblers. Delinquent behaviour was relatively frequent and had usually started before the onset of excessive gambling.
Subject(s)
Expert Testimony/legislation & jurisprudence , Gambling/psychology , Adult , Female , Humans , Male , Middle Aged , Personality Development , Psychiatric Status Rating Scales/statistics & numerical data , Psychometrics , Psychopathology , Social EnvironmentABSTRACT
On the basis of a sample of 125 adult criminal offenders and 66 students, the use of the abriged BDI as a depression screening device for felons is explored. The investigation confirms the high consistency and item-total correlations of the BDI. The factorial validity is doubtful. Only the first factor may be reidentified in different samples. A high percentage of offenders had scores at or above 8 indicating moderate or severe depression. Since offenders and students do not differ in the depression scores, the validity of the cut-off scores (Beck & Beck, 1972) may be questioned. The abriged BDI does not correlate with criminal or arrest data (e.g. number of offences, sentence length and status of imprisonment), but with other self-report measures for the assessment of self-concept or anxiety. Discriminant validity in respect to related constructs (anxiety and self-concept) cannot be expected.
