The impact of testosterone-lowering medication on recidivism in individuals convicted of sexual offenses.

INTRODUCTION: Treatment of individuals who have committed sexual offences with Testosterone-Lowering Medication (TLM) is a comparatively intrusive kind of intervention, which regularly takes place in coercive contexts. Thus, the question of efficacy, but also the question of who should be treated, when and for how long, are of great importance. METHODS: Recidivism rates of TLM-treated high-risk individuals (+TLM; n = 54) were compared with high-risk individuals treated with psychotherapy only in the same forensic outpatient clinic (-TLM; n = 79). RESULTS: Group differences suggested a higher initial risk of + TLM (e.g. higher ris-assessment, previous convictions). Despite the increased risk, after an average time at risk of six years, +TLM recidivated significantly less often and significantly later than - TLM (27.8% vs. 51.9%). Such an effect was also found for violent (1.9% vs. 15.2%), but not for sexual (5.6% vs. 10.1%) and serious recidivism (5.6% vs. 10.1%), which could be explained partly by the small number of cases. In the course of treatment, TLM proved to be a significant variable for a positive process, whereas a high risk-assessment score indicated a rather negative course. In total, n = 19 individuals had stopped their TLM treatment, of these 31.6% recidivated. CONCLUSION: The results support the efficacy of TLM, particularly in the group of high-risk offenders.

Forensic Aftercare Facilities and Their Impact on the Releasability of Persons Who Committed Sexual Offenses: A Three Group Comparison.

Partly due to a lack of release options for individuals who committed sexual offenses, forensic follow-up treatment has been strengthened latest since 2007. The current study investigates whether the foundation of a professionalized follow-up-treatment has actually improved release options for individuals who committed sexual offenses. Thus, the aim of the present study was to assess the difference in criminogenic needs and recidivism relevant characteristics (e.g., index offense, criminal history, psychiatric diagnoses and risk assessment) between three groups who had been released from forensic psychiatry at different times or under different outpatient follow-up modalities: (1) individuals released prior the foundation of professionalized follow-up-treatment, (2) individuals released after the foundation and received treatment, and (3) individuals released after the foundation but not receiving this special treatment. It was found that with the availability of professionalized forensic followup treatment, persons with higher scores in common risk assessment tools and a longer duration of implacement had been released. Indeed, this indicates an increased risk tolerance among decision makers. However, it was not those who were released after the foundation of the professionalized forensic follow-up treatment but without this specific treatment who showed the lowest initial risk, but those who were released prior to the foundation. Results are discussed in terms of possible explanations and methodological issues.

[On the Situation of Inpatient Forensic Psychotherapy in Germany - Results of a Survey in Forensic Psychiatric Institutions]. / Zur Situation stationärer forensischer Psychotherapie in Deutschland ­ Ergebnisse einer Umfrage in Maßregelvollzugseinrichtungen.

The Federal Constitutional Court has emphasized the necessity of psychotherapy for offenders. Little is known about the actual situation of this field of work. Thus, an online survey was initiated.The survey was conducted through an online portal. The heads of forensic psychiatric facilities have been asked to participate by completing a questionnaire.The elicitation provided data from 27 institutions. A large part of patients receive psychotherapeutic treatment. Psychotherapy is predominantly shaped by psychologists. The majority of institutions apply approaches derived from behavioral therapy. To a large extent, manualized and modular procedures are being used; most of them in group settings. One problem stems from personnel deficiencies, leading to psychotherapy not taking place on a regular basis or not being performed in accordance to the guidelines of treatment programs.The prior allegation - impositions of forensic measures being characterized by custodial detention - is no longer valid for a high number of forensic psychiatric services.

Prepulse inhibition of the acoustically evoked startle reflex in patients with an acute schizophrenic psychosis--a longitudinal study.

Deficits in sensorimotor gating as assessed by prepulse inhibition (PPI) of the startle reflex have been reported in schizophrenia. However, the state or trait nature of these deficits and the relationships with clinical features and psychopathological symptoms are not clear. To explore these issues, we performed a longitudinal study with schizophrenia inpatients. We examined 36 medicated schizophrenia inpatients twice in the course of an acute psychotic episode: recently after admission and after psychopathological improvement 2-3 weeks later. In addition, we examined 18 healthy control subjects twice (two weeks apart). Relative to control subjects, patients with schizophrenia had lower PPI only in the acute, but not in the improved clinical state. Larger PPI deficits were associated with more severe formal thought disorder and bizarre behavior. In the present longitudinal study, PPI deficits in schizophrenic patients appeared to be state dependent. Taking into account recent evidence from the literature we propose that reduced PPI may be a mediating vulnerability marker of schizophrenia: Impairments in sensorimotor mechanisms which subserve PPI of the startle reflex may both predispose individuals to develop psychosis, and, in addition, may covary with the presence of acute positive symptoms.

Blunted inhibition of return in schizophrenia-evidence from a longitudinal study.

Previous cross-sectional studies on covert orienting of visual attention in schizophrenia have been inconsistent. In the present longitudinal study, we examined 40 medicated acutely ill inpatients with a covert orienting of attention task (COVAT) shortly after admission, and again 12-16 weeks after the initial examination, while most patients were in (partial) remission. We administered a COVAT with nonpredictive peripheral cues and two stimulus-onset asynchronies (SOA; 100 and 800 ms). In addition, we examined 34 healthy control subjects twice (2 weeks apart). The most important finding was a lack of inhibition of return (IOR) in patients with schizophrenia, both at the first examination in an acute psychotic state and at the follow-up examination after considerable clinical improvement. The IOR deficit was unrelated to psychopathology, length of illness, number of previous psychotic episodes, and type of neuroleptic (NL) medication. Deficient IOR in patients with schizophrenia appears to be state-independent and might be viewed as a trait or vulnerability marker of the disorder. Subsequent studies with never-medicated populations and with schizotypal or high-risk subjects are needed in order to further analyze the possible role of NL medications and to clarify whether blunted IOR might represent a vulnerability marker of schizophrenia.

Semantic hyperpriming in thought-disordered patients with schizophrenia: state or trait?--a longitudinal investigation.

Enhanced semantic priming (SP) has been reported in individuals with schizophrenia who exhibit positive formal thought disorder (TD) and it has been linked to heightened automatic spreading activation in semantic networks of these patients. However, the state or trait nature of semantic hyperpriming in schizophrenia and its relation to clinical features (e.g., length of illness, symptom shifts) is not clear. To explore these issues, we administered a lexical decision task with semantically related, indirectly related or unrelated prime-target pairs to acutely ill inpatients with schizophrenia shortly after admission and again after 12-16 weeks, while most patients were already in (partial) remission (n=33). In addition, we examined 20 healthy control subjects twice (2 weeks apart). Relative to control subjects, TD patients with schizophrenia exhibited hyperpriming only in the acute psychotic state, but not during the follow-up examination, when TD and other positive symptoms had resolved. There were no associations between priming effects and length of illness or number of previous psychotic episodes. In conclusion, semantic hyperpriming in TD patients with schizophrenia appears to be clearly state-dependent and might be viewed as an episode marker of psychosis with TD.

Electromyographical differentiation between the acoustic blink and startle reflex. Implications for studies investigating startle behavior.

Recent evidence suggests that electromyographic activity in the orbicularis oculi muscle occurring in response to sudden acoustic stimuli consists of two overlapping components: the blink and the startle reflex. The aim of the present study was to identify these two components in acoustically elicited eyeblink responses and to analyze their differential modulation by weak acoustic prepulses. The prevalence, latency and amplitude characteristics of double EMG peaks in pulse-alone and prepulse-pulse trials (PP) with 30 ms and 100 ms interstimulus intervals were assessed in 16 healthy volunteers.EMG responses with two peaks were registered in 42.6 % of the pulse-alone trials and in 56.2 % of the PP30 and 48.7 % of the PP100 trials, respectively. Prepulse inhibition of the amplitude was greater for the second peak (14.2 % (P2) vs. -11.5 % (P1) in PP30 trials; 62.6 % (P2) vs. 32.3 % (P1) in PP100 trials), resulting also in higher P1/P2 amplitude ratios in prepulse-pulse trials (P1/P2: 62.9 % in pulse-alone, 92.6 % in PP30 and 100.1 % in PP100 trials). In conclusion, double peaks are a common phenomenon in human studies of acoustically elicited blink responses. It is postulated that the first peak represents the auditory blink reflex, whereas the second peak corresponds to the startle reflex, which may be more susceptible to prepulse inhibition. This complexity should be taken into account in clinical studies of the modulation of the startle reflex.