Das Absetzen antiandrogener Medikation im ambulanten Setting

In the Forensic Therapeutic Outpatient department in Berlin a total of n?=?20 individually justified, therapeutically accompanied withdrawals from antiandrogenic treatment have been implemented. The sample was compared with n?=?20 patients under antiandrogenic treatment. Patients with withdrawal have been significantly older, than patients without withdrawal. No differences were found regarding their duration of further imprisonment and standardized risk-assessment (HCR-20, LSI-R, Static-99, Stable-2007, PCL-R). Firsts results of the monitoring of the withdrawals indicate, that the symptom-checklist SCL-90-R is not appropriate for that purpose. However, post-hoc both known sexual reoffendings could be identified by the Massachusetts General Hospital Sexual Functioning Questionnaire. By means of practical experience results are getting discussed.     

Wenn ja,wie lange? – Dauer antiandrogener Behandlung von Sexualstraftätern mit paraphilen Störungen

Background

Since 2010 a total of 15 individually justified, therapeutically accompanied treatment-free intervals from antiandrogenic treatment (ADT) have been carried out in the Forensic Therapeutic Outpatient (FTA) department in Berlin.

Material and methods

This article describes the conditions under which a responsible and legally justifiable cessation of ADT can be carried out.

Results

In all 15 of the investigated stable, forensically rehabilitated patients who had been on long-term psychotherapeutic treatment, no criminally prognostic or clinically relevant destabilization has so far occurred, which would have necessitated cessation of the treatment-free interval with resumption of the antiandrogenic depot medication.

Conclusion

The short-term experiences from the clinical aftercare practice have so far shown that in a strictly structered aftercare setting with continuous clinical monitoring, it is possible to withdraw even long-standing antiandrogenic medication. This is important not least to attest the argumentation for a removal of supervision of conduct in case destabilization does occur. Further long-term longitudinal investigations will be the subject of later publications.

     

Die Durchführung antiandrogener Behandlung von Sexualstraftätern im Berliner Maßregelvollzug

In 2002, the Forensic Psychiatric Hospital in Berlin started a pilot project for combined treatment of sex-offenders with anti-androgenic LH-RH agonists and psychotherapy. On the basis of experience-based knowledge transfer and with almost six years of practical experience, this article reports results of this new approach of combined psychotherapy and drug treatment from medical and psychological viewpoints. First, a short history and general information about the combined treatment are provided. Secondly, its effects on patients’ sexual self-perception, personality disorders and aspects of prognosis are explored. Thirdly, a medical therapy scheme, possible side effects, as well as issues of patients’ rights and approvals are discussed.     

Assessing the effect of a Cognitive Behaviour Therapy (CBT)-based workshop on work-related rumination,fatigue, and sleep

This quasi-experimental longitudinal study assessed the effect of a one-day Cognitive Behaviour Therapy (CBT)-based workshop on work-related rumination, chronic fatigue, and sleep quality. We hypothesized that participants who attended the workshop would report lower levels of affective work-related rumination, chronic fatigue, and improved sleep quality, at follow-up, 6 months after workshop completion. Two hundred and twenty-seven participants took part in the study, with 102 participants attending a one-day workshop delivered in their workplace. Participants completed an online questionnaire at two time-points, with follow-up occurring 6 months after initial survey completion. Results showed that participants who took part in the CBT workshop reported significantly lower levels of affective rumination (p = .03) and chronic fatigue (p = .003), at follow-up in comparison with individuals who did not attend the workshop; however, there were no significant differences between the groups in self-reported sleep quality (p = .06). A combination of more effective recovery both at work and outside of work may explain the reductions in both affective rumination and fatigue over time. This study adds to the recovery from work literature by providing initial support for a one-day CBT-based workshop delivered in the workplace.     

II. Symposium für Empirische Forschung in der Forensischen Psychiatrie, Psychologie und Psychotherapie am 25. und 26. Oktober 2012 in Hamburg

The Second Symposium for Empirical Research in Forensic Psychiatry, Psychology and Psychotherapy was held on 25th–26th of October 2012 in Hamburg. The symposium offers young scientists in the field the opportunity to present their research studies. In total 15 papers were presented at the symposium which will be briefly described in this article. The following four topics were discussed:

1. Innovative measurement tools for violent and sexual offenders,
2. Risk assessment tools for violent and sexual offenders,
3. Physiological and neuropsychological assessment of violent and sexual offenders,
4. Treatment approaches for violent and sexual offenders.

The conference is organized annually either by the University Medical Center Hamburg-Eppendorf (Institute for Sex Research and Forensic Psychiatry), the Saarland University Medical Center (Institute for Forensic Psychology and Psychiatry) or the Asklepios Medical Center Göttingen (Ludwig-Meyer-Institute for Forensic Psychiatry and Psychotherapy). The best three research presentations are honoured with the Ludwig Meyer Award of the Asklepios Psychiatry Niedersachsen GmbH, the Eberhard Schorsch Award of the German Society for Sex Research and the Hermann Witter Award of the Southwest German Academy of Forensic Psychiatry. The proceedings of the conference are expected to be published in autumn 2013 by the Wissenschaftliche Verlagsgesellschaft Berlin.     

Predictors of Therapist Adherence and Emotional Bond in Multisystemic Therapy: Testing Ethnicity as a Moderator

This study examined the interaction between problem severity and race\ethnicity as a predictor of therapist adherence and family-therapist emotional bond. Data for this study came from a longitudinal evaluation of Multisystemic Therapy (MST) provided by licensed MST provider organizations in community settings. Outcome variables included mid-treatment levels of caregiver report of therapist adherence, changes in caregiver report of therapist adherence over the course of treatment, and overall levels of caregiver-therapist and youth-therapist emotional bond. Hypothesized predictors included race\ethnicity and levels of poly-substance use, externalizing behavior, and youth self-report of delinquency early in treatment as well as pre-treatment number of arrests. Participants were 185 adolescents (M age = 15.35, SD = 1.29) and their caregivers. Of the participating youth, 48 % self-identified as Caucasian, 20 % as African-American, 28 % as Hispanic\Latino, and 4 % as “other.” Two-level Hierarchical Linear Modeling analyses revealed that for Caucasian youth, lower rates of self-reported delinquency were associated with greater increases in caregiver report of therapist adherence over the course of MST. For Hispanic\Latino caregivers, higher externalizing behavior and poly-substance use were associated with reports of lower therapist adherence at mid-treatment and poorer overall levels of emotional bonding with therapists. In contrast, for African-American participants, higher levels of youth externalizing behavior and poly-substance use were associated with higher overall levels of caregiver and youth report of emotional bonding with therapists, respectively. Results provide evidence that race\ethnicity interacts with problem severity in predicting therapist adherence and family-therapist emotional bond within real-world practice settings and suggest possible therapeutic process differences across race.     

Parental Depressive Symptoms as a Predictor of Outcome in the Treatment of Child Depression

Child depression is an impairing condition for which psychotherapies have shown modest effects. Parental depression is a risk factor for development of child depression and might also be negatively associated with child depression treatment outcomes. To explore this possibility, we analyzed data from a study in which children were treated for depression after parental depressive symptoms had been assessed at baseline. Among children treated for depression in a randomized controlled trial, we identified 31 who had child- and parent-report pre- and post-treatment data on child symptoms and parent-report of pre-treatment parental depressive symptoms. Children were aged 8–13, 77% boys, and 52% Caucasian, 13% African-American, 6% Latino, and 29% multi-racial. Analyses focused on differences in trajectories of change (across weekly measurements), and post-treatment symptoms among children whose parents did (n = 12) versus did not (n = 19) have elevated depressive symptoms at baseline. Growth curve analyses showed markedly different trajectories of change for the two groups, by both child-report (p = 0.03) and parent-report (p = 0.03) measures: children of parents with less severe depression showed steep symptom declines, but children of parents with more severe depression showed flat trajectories with little change in symptoms over time. ANCOVAs showed lower post-treatment child symptoms for children of parents with less severe depression versus parents with more severe depression (p = 0.05 by child report, p = 0.01 by parent report). Parental depressive symptoms predict child symptom trajectories and poorer child treatment response, and may need to be addressed in treatment.     

Intelligenzgeminderte Rechtsbrecher im Maßregelvollzug

Forensic patients with intellectual disabilities have so far received little attention which is reflected in the comparatively briefly written chapters in the standard textbooks and also the low scientific interest in this patient group. There are only few therapeutic concepts and even less information on their effectiveness. This article presents the Christophorus Clinic in Münster which was the first forensic institution in Germany to specialize in these patients. The institution incorporates 54 treatment places and started operating on 3 June 2011. In addition to the known fact that a therapy concept must (further) develop over the years, during the first year of operation some aspects have arisen which have cristallized as problem areas specific for this patient group, which are discussed.     

E‐Mailed Standardized Cognitive Behavioural Treatment of Work‐Related Stress: A Randomized Controlled Trial

The aim of this study was to assess the effects of a 7‐week standardized cognitive behavioural treatment of work‐related stress conducted via e‐mail. A total of 342 people applied for treatment in reaction to a newspaper article. Initial screening reduced the sample to a heterogeneous (sub)clinical group of 239 participants. Participants were assigned randomly to a waiting list condition (n = 62), or to immediate treatment (n = 177). A follow‐up was conducted 3 years after inception of the treatment. The outcome measures used were the Depression Anxiety Stress Scales (DASS‐42) and the Emotional Exhaustion scale of the Maslach Burnout Inventory – General Survey (MBI‐GS). Fifty participants (21%) dropped out. Both groups showed statistically significant improvements. Intention‐to‐treat analysis of covariance (ANCOVAs) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition (0.001<p?0.025). In the treatment group, the effects were large to moderate (0.9 (stress)?d?0.5 (anxiety)). The between‐group effects ranged from d = 0.6 (stress) to d = 0.1 (anxiety). At follow‐up, the effects were more pronounced, but this result requires replication in view of high attrition at follow‐up. The results warrant further research on Internet‐driven standardized cognitive behavioural therapy for work‐related stress. Such research should include the direct comparison of this treatment with face‐to‐face treatment, and should address the optimal level of therapist contact in Internet‐driven treatment.     

Universalism,Vagueness and Supersubstantivalism

Sider has a favourable view of supersubstantivalism (the thesis that all material objects are identical to the regions of spacetime that they occupy). This paper argues that given supersubstantivalism, Sider's argument from vagueness for (mereological) universalism fails. I present Sider's vagueness argument (§§II–III), and explain why – given supersubstantivalism – some but not all regions must be concrete in order for the argument to work (§IV). Given this restriction on what regions can be concrete, I give a reductio of Sider's argument (§V). I conclude with some brief comments on why this is not simply an ad hominem against Sider, and why this incompatibility of supersubstantivalism with the argument from vagueness is of broader interest (§VI).     

The Study of Religions in the Third Reich: A Report on Work in Progress

Translator's Note. Possible connections between the study of religions and European fascism, if not indeed Nazism, have sparked considerable discussion and debate in the English-speaking world. Consider the celebrated cases of Mircea Eliade and Georges Dumézil.By contrast, the work of German scholars of religion during the NS period has been relatively little studied. Still, there have been exceptions. Burkhard Gladigow of Tübingen has published ‘Naturwissenschaftliche Modellvorstellungen in der Religionswissenschaft in der Zeit zwischen den Weltkriegen’.¹Recently, the study of religions during the Third Reich has become the subject of an ongoing seminar at Philipps-Universität Marburg. To date, one student has declared his intentions to write a thesis on the topic. Rainer Flasche, who convenes the seminar, has also worked on the topic extensively. The following essay is a preliminary indication of his results.Flasche, born in Hannover in 1942, studied theology, philosophy, German, and the history of religions in Marburg. He has taught history of religions there since 1971, making his habilitation in 1975. His best known work isDie Religionswissenschaft Joachim Wachs(Berlin: de Gruyter, 1978).Readers may wish especially to note what emerges as the central principle of Nazi religio-historical hermeneutics: that only those who belong to a race (gender? class?) can understand it. Thus, only Germans can understand Germanic religion. The essay may also shed some light on the study of religions in Germany after the war. A reviewer of a recent book by Isaiah Berlin has noted how Berlin's lasting confidence in the liberal tradition perhaps derives from the usefulness of that tradition in Eastern Europe, where Berlin spent his formative years. In post-war Germany, the study of religions has emphasized a positivism that remains close to the sources and shuns explicit theorizing, an emphasis in which Flasche clearly concurs. The usefulness of this strategy should not be overlooked. It allowed German scholars of the NS period, but also later under communist rule in the Democratic Republic and to some extent within the confines of state-run theology programs in the Federal Republic, to work independently of and even oppose a sanctioned ideology. The strategy was not to champion competing theories but to oppose ideological claims with ‘facts’. This stance contrasts sharply with the theoretical richness that characterized German thought about religions before 1933, but—once burned, twice cautious.A note on terminology. The development of the nation-state took markedly different courses in the German and English speaking worlds. As a result, the wordVolkand the adjectivevölkischhave no entirely satisfactory English equivalents. The connotations of ‘nation’ are too limited, because the GermanVolkwas an ideal that transcended not only the principalities that dominated German political life from 1648 to 1866 but also the remnants of German glory that remained after World War I and even the extensive empire administered by Prussia from 1866 to 1918. Therefore, I have translatedVolkas ‘people’. But English ‘popular’ has quite a different sense fromVölkisch, so forvölkischI have used the adjective ‘national’ instead. Readers should keep in mind the direct verbal link between the two in the original.     

The role of maladaptive anger in self-criticism: A quasi-experimental study on emotional processes

The present study examines the role of emotion in the self-critical process of individuals with anger problems. Self-criticism is a prevalent intra-personal feature which greatly impacts an individual’s emotion. So far, it is unclear, which emotions individuals with maladaptive anger experience when they work through their self-criticism. Using a quasi-experimental design, the present study compared n = 23 anger-prone under-graduate students to n = 22 controls on process indices of contempt, fear, shame, anger and global distress, as well as on their access to underlying need, as participants were working through personalized self-critical content. This was achieved using a single-session enactment from emotion-focused therapy, augmented with a standardized procedure for priming participants to focus on their unmet needs. Findings suggested that this work on self-criticism reduced for both groups distress, fear and shame, as well as increased assertive anger (McNemar tests significant at p = .05). More centrally, anger-prone individuals expressed more self-contempt (t(1, 44) = 3.65; p < .05), and they had more difficulty in accessing their underlying need (χ² = 5.35; p < .05), when compared to controls. These results have implications for clinical work with anger-prone individuals, and clarify key features in the use of enactment interventions when working towards emotional resolution. The present study also demonstrates the use of personalized stimuli in the context of clinically relevant quasi-experimental research on emotional processes.     

Work-anxiety-coping intervention improves work-coping perception while a recreational intervention leads to deterioration: Results from a randomized controlled trial

Work-anxieties are costly and need early intervention. The perception of being able to cope with work is a basic requirement for work ability. This randomized controlled trial investigates whether a cognitive behavioural, work-anxiety-coping group (WAG) intervention leads to better work-coping perception than an unspecific recreational group (RG). Heterogeneous people in medical rehabilitation, who were due to return to work, were interviewed concerning their work-anxieties, and either randomly assigned to a WAG (n = 85) or a RG (n = 95). The participants (with an average of 50 years old [range 23–64]; 51% women; 70% workers or employees, 25% academics, 5% unskilled) followed the group intervention for four or six sessions. The perceived work-coping was assessed by self-rating (Inventory for Job-Coping and Return Intention JoCoRi) after each group session. Although participants had a slight temporary decrease in work-coping after group session two (from M₁ = 2.47 to M₂ = 2.28, d_Cohen = ?.22), the WAG led to the improvement of perceived work-coping over the intervention course (from M₁ = 2.47 to M₆ = 2.65, d_Cohen = .18). In contrast, participants from the RG reported lower work-coping after six group sessions (from M₁ = 2.26 to M₆ = 2.02, d_Cohen = ?.18). It is considered that people with work-anxieties need training in work-coping. By focusing on recreation only, this may lead to deterioration of work-coping. Indeed, intervention designers should be aware of temporary deterioration (side effects) when confronting participants with work-coping.     

“Dear Employer,Let Me Introduce Myself” – Flow,Satisfaction with Work–Life Balance and Millennials’ Creativity

With creativity being recognised as a key driver of organizational success, organizations emphasize the need for their employees to be creative and to work long hours. This article takes a step toward understanding the factors contributing to the creativity of millennials, a generation pursuing meaningful work and cherishing a work–life balance. In Study 1 (n = 238), the relationships between creativity, flow, satisfaction with work–life balance and job crafting were explored; in Study 2 (n = 120) the focus was on examining flow as the mediator in the relationship between satisfaction with work–life balance and creativity. In experimental Study 3 (n = 90), the findings from Study 2 were replicated. Overall, the results of the three studies established flow as the mediating variable and demonstrated the beneficial role of satisfaction with the work–life balance and job crafting in the process leading to creativity.     

Effect of a participative work conference on psychosocial work environment and well-being

The aim of this study was to investigate the effect of a participative work conference based on democratic dialogue on the employee's psychosocial work environment (job control, work climate, clarity of work goals, flow of information, and support from supervisor) and well-being (emotional exhaustion and stress symptoms). The study group was male-dominated (80%) and was mostly employed in manual tasks (86%) in a municipal public works department. Pre- and postmeasurements were carried out through a questionnaire with a 2-year interval. In addition, the experiences of participating in the intervention and the perceived changes due to the intervention were examined through thematic group interviews. The intervention group (n = 253 from Department A) participated in two-and-a-half-day participative work conferences. Two control groups were applied: (1) n = 107 from Department A; (2) n = 165 from Department B. The intervention had a positive effect on the work climate and flow of information in the intervention group compared with Control group 2 after controlling for age, gender, type of work, basic education, and participation in other interventions. The intervention did not, however, have an effect on individual well-being. According to the interviews, the work climate became more open and participative regardless of some negative experiences in participating in the conferences.     

The relationships of change in work climate with changes in burnout and depression: a 2-year longitudinal study of Chinese mental health care workers

Mental health care workers face heavy emotional demand and are prone to work burnout. Work burnout has been associated with poor mental health and work climate, which refers to individual perceptions about work setting. The purpose of this study was to examine whether intra-individual changes in work climate were associated with intra-individual changes in burnout and depression over two years. The present sample included Chinese mental health care workers (N = 312; mean age = 38.6, SD = 9.9) working in a psychosocial rehabilitation institution. The participants completed questionnaires on work climate, work burnout and depression at seven time points across two years. Parallel process latent growth modeling was used to analyze the associations of change between work climate and burnout and depression. Work climate displayed a logarithmic decreasing trend while burnout and depression displayed logarithmic increasing trends over two years. Baseline levels of work climate were negatively and moderately associated with baseline levels of burnout and depression (r = ?.44 to ?.60, p < .01). Changes in work climate were negatively and moderately associated with change in burnout (r = ?.43, p < .01) and change in depression (r = ?.31, p < .05). Change in burnout was positively and strongly associated (r = .58, p < .01) with change in depression. The current results support temporal relationships among changes in work climate, burnout and depression across time. Practical implications for future preventive work in burnout interventions were discussed within this population.     

Forensic-psychologic-psychiatric assessment from the viewpoint of perpetrators--data from a survey

In this contribution, various aspects of the expert/culprit-relationship and of the communication behavior styles between the included persons within the scope of forensic-psychological-psychiatric expertise, are discussed. A survey is given on results gained with a questionnaire study (n = 93 culprits; Department of Forensic Psychiatry, Charité Berlin) of the most important expectations, of the social-relevant attitudes towards the assessment and physicians before the forensic investigation as well as of the experiences of own feelings, stress and of the culprit's reflections on the physician/proband relationship after the assessment. A good partnership relation between experts and culprits presupposes that the expert not only possesses a high profession but also the necessary interpersonal-social competence.     

Preventing Maltreatment with a Community-Based Implementation of Parent–Child Interaction Therapy

The purpose of this study was to examine rates of child abuse and neglect reports following a community implementation of Parent–Child Interaction Therapy (PCIT), an evidence-supported intervention for the prevention of maltreatment. Among a group of families receiving PCIT, predictors of reports were examined including family demographics, course of treatment, changes in clinical measures, and caregiver report for prior maltreatment victimization and perpetration. Participants (n = 120) included families at-risk for future maltreatment with and without prior maltreatment history. Agency case records were linked with state administrative records of child welfare reports. Time to follow-up ranged from 13 to 40 months. Bivariate and multivariate survival analyses were used to model risk for a later report. During the follow-up period, 12.5 % of families had a report for physical abuse or neglect. Reports of prior victimization as a child and prior perpetration as an adult were strong predictors of a report of perpetration after PCIT. Dosage of PCIT and change in clinical measures did not increase risk for a later report. PCIT can be an effective intervention for preventing maltreatment. Family history of child welfare involvement is a prominent factor in assessing risk for future involvement.     

Religious and Spiritual Beliefs of Physicians

The aim of this study is to describe religious and spiritual beliefs of physicians and examine their influence on the decision to pursue medicine and daily medical practice. An anonymous survey was e-mailed to physicians at a large, multidisciplinary tertiary referral center with satellite clinics. Data were collected from January 2014 through February 2014. There were 2097 respondents (69.1 % men), and number of practicing years ranged from ≤1 to ≥30. Primary care physicians or medical specialists represented 74.1 %, 23.6 % were in surgical specialties, and 2.3 % were psychiatrists. The majority of physicians believe in God (65.2 %), and 51.2 % reported themselves as religious, 24.8 % spiritual, 12.4 % agnostic, and 11.6 % atheist. This self-designation was largely independent of specialty except for psychiatrists, who were more likely report agnosticism (P = 0.003). In total, 29.0 % reported that religious or spiritual beliefs influenced their decision to become a physician. Frequent prayer was reported by 44.7 % of physicians, but only 20.7 % reported having prayed with patients. Most physicians consider themselves religious or spiritual, but the rates of agnosticism and atheism are higher than the general population. Psychiatrists are the least religious group. Despite the influence of religion on physicians’ lives and medical practice, the majority have not incorporated prayer into patient encounters.     

Formal Employment and Health-Related Quality of Life among People Living with HIV in South Africa

This study examined the link between formal employment and characteristics of the workplace (especially awareness of workplace HIV policies and HIV status disclosure to work colleagues) and health-related quality of life (HRQoL) among people living with HIV (PLHIV). The study analysed medical treatment and employment history since first being diagnosed as HIV-positive among 554 adults, 55 % females, who had been on HIV treatment for at least 2 years in South Africa. Additional cross-sectional data on HRQoL were collected using the Medical Outcomes Study 36-Item Short Form (SF-36) (QualityMetric Incorporated). Two hundred and forty four (44 %) of the study participants (39 % and 49 % among males and females, respectively) were formally employed at the study interview. Formally employed study participants reported higher HRQoL than those not formally employed, as reflected in mean scores in the physical and mental component summaries of the SF-36 instrument. HRQoL was unrelated to study participants’ CD4 count, viral load and duration since HIV diagnosis. Among the formally employed study participants, 27.9 % reported awareness of workplace HIV policies in their organisations, while 50.8 % said they had disclosed their HIV status to work colleagues. The awareness of workplace HIV policies was associated with higher mental component summary scores after controlling for study participants’ socio-demographic characteristics, but had no significant association with the physical component summary scores. The disclosure of HIV status to work colleagues was associated with neither mental nor physical component summary scores. The finding of a positive association between formal employment and HRQoL among PLHIV suggest the need for facilitative interventions for employment entry and continuation among PLHIV for their wellbeing.