[Standards for treatment in forensic committment according to § 63 and § 64 of the German criminal code : Interdisciplinary task force of the DGPPN]. / Standards für die Behandlung im Maßregelvollzug nach §§ 63 und 64 StGB : Interdisziplinäre Task-Force der DGPPN.

People who have been convicted of a crime due to a severe mental disorder and continue to be dangerous as a result of this disorder may be placed in a forensic psychiatric facility for improvement and safeguarding according to § 63 and § 64 of the German Criminal Code (StGB). In Germany, approximately 9000 patients are treated in clinics for forensic psychiatry and psychotherapy on the basis of § 63 of the StGB and in withdrawal centers on the basis of § 64 StGB. The laws for treatment of patients in forensic commitment are passed by the individual States, with the result that even the basic conditions differ in the individual States. While minimum requirements have already been published for the preparation of expert opinions on liability and legal prognosis, consensus standards for the treatment in forensic psychiatry have not yet been published. Against this background, in 2014 the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) commissioned an interdisciplinary task force to develop professional standards for treatment in forensic psychiatry. Legal, ethical, structural, therapeutic and prognostic standards for forensic psychiatric treatment should be described according to the current state of science. After 3 years of work the results of the interdisciplinary working group were presented in early 2017 and approved by the board of the DGPPN. The standards for the treatment in the forensic psychiatric commitment aim to initiate a discussion in order to standardize the treatment conditions and to establish evidence-based recommendations.

Gray matter anomalies in pedophiles with and without a history of child sexual offending.

Pedophilia is a psychiatric disorder that is inter-related with but distinct from child sexual offending (CSO). Neural alterations reportedly contribute to both pedophilia and CSO, but until now, no study has distinguished the brain structural anomalies associated with pedophilia from those specifically associated with CSO in pedophilic men. Using high-resolution T1-weighted brain images and voxel-based morphometry, we analyzed the gray matter (GM) volume of the following 219 men recruited at four acquisition sites in Germany: 58 pedophiles with a history of CSO, 60 pedophiles without any history of CSO and 101 non-pedophilic, non-offending controls to control for the effects of age, education level, verbal IQ, sexual orientation and the acquisition site. Although there were no differences in the relative GM volume of the brain specifically associated with pedophilia, statistical parametric maps revealed a highly significant and CSO-related pattern of above vs below the 'normal' GM volume in the right temporal pole, with non-offending pedophiles exhibiting larger volumes than offending pedophiles. Moreover, regression analysis revealed that the lower GM volume of the dorsomedial prefrontal or anterior cingulate cortex was associated with a higher risk of re-offending in pedophilic child molesters. We believe our data provide the first evidence that CSO in pedophilia rather than pedophilia alone is associated with GM anomalies and thus shed new light on the results of previous studies on this topic. These results indicate the need for new neurobehavioral theories on pedophilia and CSO and may be potentially useful for treatment or prevention approaches that aim to reduce the risk of (re)offending in pedophilia.

[Sexual hallucinations and dreams under anesthesia and sedation : medicolegal aspects]. / Sexualbezogene Halluzinationen und Träume unter Anästhesie und Sedierung : Medizinische und rechtliche Aspekte.

Dreams and hallucinations under sedation or anesthesia have been well known phenomena since the introduction of anesthesia. Sexual hallucinations may lead to allegations of sexual molestation or assault by medical doctors or professional nursing staff. Hallucinations under the influence of sedative or hypnotic drugs may be very vivid and as misinterpreted as being real and it is therefore often difficult to disprove the resulting false allegations. In this report the terms drug-induced dreams and hallucinations are defined and the probable mechanism described. By a historical review and case reports the medicolegal consequences are demonstrated and procedures recommended to avoid allegations of sexual assault.

Haloperidol and clozapine decrease S100B release from glial cells.

Recent meta-analyses showed consistently elevated levels of S100B in serum and cerebrospinal fluid of schizophrenic patients. This finding has been attributed to glial pathology because S100B is produced by astrocytes and oligodendrocytes. However, S100B may be likewise associated with schizophrenia-related disturbances in glial cell as well as adipocyte energy supply and glucose metabolism. The influence of antipsychotic drugs on S100B levels remains unclear, and some studies have suggested that treatment with these drugs may actually contribute to the elevated S100B levels observed in schizophrenic patients. In this study, we explored the effects of the typical antipsychotic haloperidol and the atypical prototype drug clozapine on the release of S100B by astrocytic C6 cells and oligodendrocytic OLN-93 cells. Because of the association between schizophrenia and disturbances in energy metabolism, we assessed the effects of these drugs under basal condition (BC) compared to serum and glucose deprivation (SGD). We found that treatment of C6 and OLN-93 cells with haloperidol and clozapine reduced the release of S100B from C6 and OLN-93 cells under BC and SGD in vitro at a tissue concentration corresponding to the assumed therapeutic dose range of these drugs. These data suggest that elevated levels of S100B in bodily fluids of schizophrenic patients are normalized rather than increased by the effects of antipsychotic drugs on glial cells.

Relationship between hippocampal structure and memory function in elderly humans.

With progressing age, the ability to recollect personal events declines, whereas familiarity-based memory remains relatively intact. It has been hypothesized that age-related hippocampal atrophy may contribute to this pattern because of its critical role for recollection in younger humans and after acute injury. Here, we show that hippocampal volume loss in healthy older persons correlates with gray matter loss (estimated with voxel-based morphometry) of the entire limbic system and shows no correlation with an electrophysiological (event-related potential [ERP]) index of recollection. Instead, it covaries with more substantial and less specific electrophysiological changes of stimulus processing. Age-related changes in another complementary structural measure, hippocampal diffusion, on the other hand, seemed to be more regionally selective and showed the expected correlation with the ERP index of recollection. Thus, hippocampal atrophy in older persons accompanies limbic atrophy, and its functional impact on memory is more fundamental than merely affecting recollection.

[Lipomatosis dolorosa--a frequently overlooked disease picture]. / Lipomatosis dolorosa--ein häufig übersehenes Krankheitsbild.

Dercum's disease (lipomatosis dolorosa) is a relatively unknown illness. The disorder usually affects middle-aged females. Subcutaneous fatty tissue deposits may occur in many parts of the body. The upper arms, elbows, stomach wall, buttocks, thighs, or knees are most commonly affected. Severe hyperalgesia is found on light pressure and touch. Analgesics or pain-modulating drugs usually have little or no effect. The following case report demonstrates successful symptomatic treatment of the otherwise nearly unbearable complaints: intravenous infusions of 5 mg/kg body weight of lidocaine over 30-90 min may give pain relief lasting several weeks or even months. Alternatively, patients are treated with 150-750 mg orally administered mexiletine daily. Surgical excision or liposuction of these fatty tissue deposits have shown significant reduction of pain. However, this effect reduces over time and recurrences often develop.

An electrophysiological analysis of the time course of conceptual and syntactic encoding during tacit picture naming.

A central question in psycholinguistic research is when various types of information involved in speaking (conceptual/semantic, syntactic, and phonological information) become available during the speech planning process. Competing theories attempt to distinguish between parallel and serial models. Here, we investigated the relative time courses of conceptual and syntactic encoding in a tacit picture-naming task via event-related brain potential (ERP) recordings. Participants viewed pictures and made dual-choice go/no-go decisions based on conceptual features (whether the depicted item was heavier or lighter than 500 g) and syntactic features (whether the picture's German name had feminine or masculine syntactic gender). In support of serial models of speech production, both the lateralized readiness potential, or LRP (related to response preparation), and the N200 (related to response inhibition) measures indicated that conceptual processing began approximately 80 msec earlier than syntactic processing.

Control of semantic interference in episodic memory retrieval is associated with an anterior cingulate-prefrontal activation pattern.

Prefrontal activation is a consistent finding in functional neuroimaging studies of episodic memory retrieval. In the present study we aimed at a further analysis of prefrontal neural systems involved in the executive control of context-specific properties in episodic memory retrieval using an event-related fMRI design. Nine subjects were asked to learn two 20-item word lists that consisted of concrete nouns assigned to four semantic categories. Ten items of both word lists referred to the same semantic category. Subjects were instructed to determine whether nouns displayed in random order corresponded to the first 20-item target list. The interference evoked by the retrieval of semantically related items of the second list resulted in significantly longer reaction times compared to the noninterference condition. Contrasting the interference against the noninterference retrieval condition demonstrated an activation pattern that comprised a right anterior cingulate and frontal opercular area and a left-lateralized dorsolateral prefrontal region. Trial averaged time series revealed that the PFC areas were selectively activated at the interference condition and did not respond to the familiarity of learned words. These findings suggest a functionally separable role of prefrontal cortical areas mediating processes associated with the executive control of interfering context information in episodic memory retrieval.

Neurophysiological aspects of synesthetic experience.

Synesthesia is a perceptual condition in which stimulation in one sensory modality elicits a concurrent sensation in another. The authors studied possible electrophysiological correlates of synesthetic experience in 17 subjects claiming to continuously experience chromatic-graphemical synesthesia and a matched control group. Subjects had to respond to one of four numbers and one of six letters by pressing a button. Even-related potentials (ERPs) were recorded from multiple scalp sites. Most synesthetic subjects reported strong synesthetic perceptions during the experiment. The ERPs of both groups showed a distinct P300 component when subjects encountered the assigned target number or letter. Synesthetic subjects had significantly and clearly more positive waveform over frontal and prefrontal scalp regions than control subjects for target and nontarget stimuli. This electrophysiological marker is discussed in terms of cortical inhibition in synesthetic subjects and the role of prefrontal regions in multisensory integration.

Decomposition of morphologically complex words in English: evidence from event-related brain potentials.

To explain processing differences between regular (e.g., start/started) and irregular (e.g., think/thought) word formation linguistic models posit either a single mechanism handling both morphological clusters or separate mechanisms for regular and irregular words. The purpose of the present study is to investigate how these processing differences map onto brain processes by assessing electrophysiological effects of English past tense forms, using the repetition priming paradigm. Event-related brain potentials (ERPs) were recorded from 59 scalp sites as 19 subjects read stem forms of regular and irregular verbs from a list of 1152 words; the stem forms were either preceded (5-9 intervening items) by their past tense forms (=primed condition) or by past tense forms of unrelated verbs (=unprimed condition). The difference between the ERPs to the primed and unprimed stems was taken as a measure of morphological priming. We found that the ERPs to regular verbs were clearly different from those to irregular verbs: the former were associated with an N400 reduction in the primed condition; primed irregular verb stems, however, showed no such effect. Control conditions demonstrated that the N400 modulation for regular verbs cannot be attributed to formal (i.e., phonological or orthographical) priming. These ERP effects indicate that regular verbs serve as more powerful primes for their corresponding stem forms than irregular past tense forms, suggesting that regular (but not irregular) past tense forms may be decomposed into stem plus affix.

When temporal terms belie conceptual order.

We conceive of time as a sequential order of real-world events, one event following another from past to present to future. This conception colours the way we speak of time ("we look forward to the time") and, as we show here, the way we process written statements referring to the temporal order of events, in real time. Terms such as 'before' and 'after' give us the linguistic freedom to express a series of events (real or imaginary) in any order. However, sentences that present events out of chronological order require additional discourse-level computation. Here we examine how and when these computations are carried out by contrasting brain potentials across two sentence types that differ only in their initial word ('After' X, Y versus 'Before' X, Y). At sites on the left frontal scalp, the responses to 'before' and 'after' sentences diverge within 300 ms; the size of this difference increases over the course of the sentences and is correlated with individual working-memory spans. Thus, we show that there are immediate and lasting consequences for neural processing of the discourse implications of a single word on sentence comprehension.

Effects of combined frontal and temporal lesions on learned behaviors in rhesus monkeys.

Delayed response ability, and to a lesser extent visual discrimination performance, is seriously impaired by extensive bilateral damage to the frontal lobes. Reciprocal anatomical connections between the frontal and temporal lobes suggested that massive lesions in both lobes might produce an impairment more complete than that resulting from frontal lobectomy alone. Five monkeys were given combined bilateral frontal and anterior-temporal lesions, and were found to be inferior to both frontal lobectomized monkeys and to unoperated controls on the object discrimination task. The combined lesion did not increase the deficit on delayed response over that obtained after only bilateral frontal lobectomy. Results indicate that the anterior-temporal neocortex is involved in the mediation of visual discrimination ability.