Confidence analyses of self-interpretation and self-description in depressive behaviour.

The present paper represents an investigation in the procedure to validate a new questionnaire (Salzburg Subjective Behavioural Analysis, SSBA). This questionnaire is based on a new approach to the diagnosis of depressive behaviour. It is hypothesized that a patient suffering from a depressive disorder loses the ability to produce one or more modes of behaviour at a given time and simultaneously has the urge to produce one or more modes of behaviour constantly. Although the patient is capable of describing this behavioural disorder, he/she is unable to interpret it confidently. This inability of interpretation of depressive behaviour assessed with the SSBA may represent a special kind of cognitive impairment in depression that is tested in conducting an analysis of confidence. The analysis of confidence shows that the capability of interpretation in the patient group is significantly impaired. Finally, a discriminant analysis allows to differentiate between depressive behaviour and normal behaviour based on the questionnaire.

[Dissociation (conversion) - malingering - antisocial personality disorder: differential diagnostic reflection on the basis of a case study]. / Dissoziation (Konversion) - Simulation - Dissozialität: Differentialdiagnostische Überlegungen anhand eines Fallbeispiels.

In this case report we refer to the big challenge of making a diagnosis in a deliberate malingering in the field of mental disorders. We specifically describe the difficulty regarding the differentiation between a conversion disorder and malingering of a serial delinquent. For such a person avoiding criminal persecution is one of the most frequent reason to deceitfully simulate a mental illness. In this field, symptoms of conversion disorders exceed the average; furthermore, a great number of organic-neurological illnesses may appear to be very similar to a conversion disorder or in many cases a neurological disorder can actually be detected in the course of a somatic examination. A further obstacle for the differential diagnosis can be seen in the difficulty to discern it from factitious disorders. However, it is quite possible to discern the deliberate malingering of a mental disorder from a conversion disorder by means of the diligent diagnosis of a competent and experienced doctor/assessor who specialises.

Comprehensive behavioral analysis of patients with a major depressive episode.

BACKGROUND: A major depressive episode diagnosed according to DSM-IV criteria can be accompanied by symptoms that DSM-IV does not include. These symptoms are sometimes classified as comorbidities. Our study assessed altered behavioral modes during a major depressive episode; ie, if 1 or more modes of behavior operated less or even not at all ("never"), or if the operation of others was more frequent or even constant ("always"). We hypothesize that these altered behavioral modes, especially the extreme positions "never" (hypomodes) and "always" (hypermodes) might correlate with depression scores and thus represent a typical symptom of depression. MATERIAL/METHODS: We used the 35-item Salzburg Subjective Behavioral Analysis (SSBA) questionnaire to measure altered behavioral modes in 63 depressed patients and 87 non-depressed controls. Depression was assessed using the Hamilton Depression Scale. RESULTS: In our test group (n=63) we found a total of 888 extreme positions. The mean number of extreme positions per patient was 11.15±5.173 (SD). Extreme positions were found in all 35 behavioral modes. The mean Hamilton score was 22.08±7.35 (SD). The association of the incidence of extreme positions and the Hamilton score in our test group was highly significant (Spearman's Rho=0.41; p=.001). In the control group (n=87), only 11 persons were found to display extreme positions, with a total of only 25. CONCLUSIONS: Although this study has several limitations, such as the small sample or the use of a questionnaire in the validation procedure, the significant correlation of extreme positions and the Hamilton score indicate that altered modes of behavior as detected with the SSBA might be typical symptoms in a major depressive episode.

[Method and empirical results from expert opinions on 90 offenders concerning the question of complete intoxication]. / Methodik und Empirie der Begutachtung von 90 Straftätern zur Frage der vollen Berauschung.

Based on a 3-year sample of expert opinions concerning the question of complete intoxication (n = 90), methodology and results are presented. Since more than half of the offenders (n = 53) claim amnesia regarding the circumstances of the offence, this subjective amnesia is considered methodologically. If the file contains observations on the offender's behaviour, it is generally possible to assess if the offender was still able to self-reflect and act in a purposeful way. If so, complete intoxication must be negated independent of the objective degree of alcohol or drug intoxication, and the subjective amnesia claimed by the offender is implausible. In the assessment procedure of complete intoxication a decision tree is used. 37/90 offenders showed no significant memory impairment as well as no psychiatric diagnosis, thus excluding both criminal irresponsibility and complete intoxication. The assessment of subjective amnesia and total intoxication was based on the following information from the decision tree: in 51 (47 males, 4 females) of the 53 offenders claiming subjective amnesia the file contained behavioural observations at the time of the offence. Only in two cases, a considerable lack of information prevented a clear decision regarding the question of complete intoxication. Despite the fact that only in about 50% of the offenders claiming subjective amnesia evidence of alcohol or drug influence was demonstrated according to the files, the question of complete intoxication could be successfully evaluated in all but two cases according to the decision tree.

Loss of self-understanding: a behavior-oriented model of depression.

BACKGROUND: A new model of depression is proposed which is biological and explanatory on the behavioral level. It is hypothesized that a patient suffering from a depressive disorder loses the ability to produce one or more modes of behavior at a given time and simultaneously has the urge to produce one or more other modes of behavior constantly. The patient is also unable to interpret his behavioral disorder ("loss of self-understanding"). MATERIAL/METHODS: The authors developed the Salzburg Subjective Behavioral Analysis (SSBA) self-assessment questionnaire asking subjects to elaborate on changes in 35 modes of behavior and to interpret the behavioral disorder, if possible. The study was conducted using this questionnaire and the Hamilton Depression Scale on 30 inpatients with depressive disorders and this questionnaire on 30 healthy controls. RESULTS: Extreme positions in the SSBA were found in all 30 patients, compared with 2 in the 30 healthy controls. Significant correlation between the occurrence of extreme positions and the Hamilton scores was found (r=0.44, p=0.02) and correlation between the Hamilton scores and the inability of the patients to interpret the behavioral disorder was nearly significant (r=-0.35, p=0.06). CONCLUSIONS: The occurrence of extreme positions in the SSBA increased with depressive mood. In addition, the likelihood that subjects could explain their extreme positions in behavior decreased with increasing depression. The SSBA questionnaire assesses the self-evaluation of modes of behavior. As a diagnostic instrument, DSM-IV does not have criteria for modes of behavior. Thus, behavioral analysis should be considered in diagnosing depression.

[Aggression homicide and rejection homicide: a communicative classification of homicide]. / Kommunikative Qualifikation von Tötungsdelikten als Aggressionstötungen und Verwerfungstötungen.

Based on a 10-year sample of homicides (n = 50), the hypothesis was tested that it is possible to differentiate between aggression and rejection homicide. The aggression homicide results from the offender/victim relationship, which is no longer accepted for some reason. In contrast, in the rejection homicide the offender radically strives for a goal which can only be reached if the victim is eliminated. Based on forensic-psychiatric expert opinions (n = 50), the case analyses yielded 31 aggression homicides and 18 rejection homicides, one case could not be classified. Aggression homicides differed significantly from the rejection homicides with regard to their main motives. Hate in quarrel (n = 8), violent occupation of the victim (n = 7), delusions (n = 5), revenge (n = 3), self-defence (n = 2), and jealousy (n = 1) characterized the aggression homicides, whereas rejection homicides were dominated by economic motives (n = 14). Two offenders intended to get rid of the victim and one offender wanted to rescue a third person. From a forensic-psychiatric point of view, the pertinent statistical data (social data, diagnosis, criminal responsibility) are reported and the significance of the differentiation between aggression homicide and rejection homicide for medico-legal or criminological case profiling and for the prognosis of the risk potential is discussed.