The 33rd Sir Frederick Bartlett Lecture Cognitive neuropsychiatry and delusional belief

Cognitive neuropsychiatry is a new field of cognitive psychology which seeks to learn more about the normal operation of high-level aspects of cognition such as belief formation, reasoning, decision making, theory of mind, and pragmatics by studying people in whom such processes are abnormal. So far, the high-level cognitive process most widely studied in cognitive neuropsychiatry has been belief formation, investigated by examining people with delusional beliefs. This paper describes some of the forms of delusional belief that have been examined from this perspective and offers a general two-deficit cognitive-neuropsychiatric account of delusional belief.     

Cognitive neuropsychiatry and delusional belief

Cognitive neuropsychiatry is a new field of cognitive psychology which seeks to learn more about the normal operation of high-level aspects of cognition such as belief formation, reasoning, decision making, theory of mind, and pragmatics by studying people in whom such processes are abnormal. So far, the high-level cognitive process most widely studied in cognitive neuropsychiatry has been belief formation, investigated by examining people with delusional beliefs. This paper describes some of the forms of delusional belief that have been examined from this perspective and offers a general two-deficit cognitive-neuropsychiatric account of delusional belief.     

Action,affordances, and anorexia: body representation and basic cognition

We evaluate a growing trend towards anti-representationalism in cognitive science in the context of recent research into the development and maintenance of anorexia nervosa in cognitive neuropsychiatry. We argue two things: first, that this research relies on an explanatorily robust concept of representation—the concept of a long-term body schema; second, that this body representation underlies our most basic environmental interactions and affordance perception—the psychological phenomena supposed to be most hospitable to a non-representationalist treatment.     

Body image and the parietal lobes

In this review, the history of the concept of the body image in neuropsychiatry is presented. Links between the parietal cortex and the body image are discussed and the possible role of the parietal lobe in psychiatric disorders noted. The link between parietal lobe function and some neurophilosophical concepts are introduced.     

Self‐Reported Current Practices in Child Forensic Interviewing: Training,Tools, and Pre‐Interview Preparation

In child sexual abuse investigations, forensic interviewers within the Child Advocacy Center (CAC) model serve as neutral fact‐finders for a team of professionals tasked with investigating and intervening in cases of alleged child sexual abuse. Although empirical evidence has led to the development of best‐practice techniques and protocols, there is currently no universally adopted protocol in the field. The present research gathered detailed information from a national sample of real‐world child forensic interviewers about their training and current practices, with a specific focus on assessing the information interviewers typically review prior to conducting child forensic interviews. Most notably, the survey revealed a lack of uniformity in interviewing protocols adopted and pre‐interview preparation practices. Although rare, some interviewers reported using an allegation‐blind interviewing approach, highlighting the need for future research on this and other under‐studied techniques. Copyright © 2017 John Wiley & Sons, Ltd.     

Beitrag der Neurowissenschaften zur forensischen Psychiatrie

Forensic psychiatry is a subspecialty dedicated to the interface between psychiatry and law. It uses paradigms and knowledge from general psychiatry for diagnostics, assessment, therapy and research under consideration of the special requirements of legal aspects and framework conditions; therefore, scientific development in forensic psychiatry is substantially dependent on scientific progress in psychiatry and thus nowadays also in neurosciences. Neurobiological hypotheses on the neuronal foundations of psychiatric diseases have been established, for example the dopamine hypothesis for schizophrenia, in a manner that led to important therapeutic advances in the treatment and long-term quality of life for affected persons. Analogous advances should not be withheld from forensic psychiatric patients, who are doubly affected by the disease and the accompanying limitations in their rights to freedom, which is why research in this field must be driven forwards. Clear advances in knowledge of the neurobiological foundations of forensic psychiatric illnesses have, for example, already been made in the field of pedophilia and psychopathy. Based on studies of investigation populations, such neuroscientific knowledge on the neurobiological principles of forensic psychiatric diseases, however, requires a carefully concerted communication with respect to dissemination in the media as well as in the interpretation of individual cases, for example in court. This is of great importance in order to prevent simplifying misconceptions and to avoid a subsequent loss of trust in the scientific process. Therefore, training of the new generation of forensic psychiatrists in the understanding and communication of scientific methods of modern forensic psychiatric neuroscience is of great importance for the societal impact and further advancement of the discipline.     

The practice of forensic psychology. A look toward the future in light of the past

In a 1987 American Psychologist article, Tom Grisso summarized the state of forensic psychological assessment, noted its limitations and potential, and offered suggestions for researchers and practitioners interested in contributing to its future. Since that time, there have been many important developments in the field of forensic psychology, as well as in clinical psychology more generally, some of which were anticipated and recommended by Grisso, and some of which were not. Forensic psychology is now at a crossroads, and the specialty must make an effort to respond to current challenges if it is to aid in the administration of justice by assisting legal decision makers. The need to distinguish between and identify levels of forensic knowledge and practice, establish guidelines for practice, educate legal consumers, and devote more attention to treatment issues in forensic contexts is highlighted.     

Standards nichtstrafrechtlicher psychiatrischer Begutachtung

The introduction of the certificate for forensic psychiatry of the German Association of Psychiatry, Psychotherapy, Psychosomatics (DGPPN) in 2000 was a significant contribution to raising awareness of the formal and substantive requirements for forensic psychiatric evaluations and to develop a systematic quality improvement in forensic psychiatric expert services. By the special dominance of the certification in the field of penal law assessment, this proved to be problematic for many predominantly non-penal experts. This led to a requirement to develop a qualification for the non-penal expert opinions. In particular the increasing specialization of the psychiatric disciplines and the diversity of the legal issues and framework require a continuing education in the field of non-penal psychiatric assessments. Substantive and formal requirements are discussed and a continuous process of quality improvement and assurance is outlined. Last but not least a plea is made for close interdisciplinary exchange with the jurisprudence and the courts in the context of quality circles.     

Forensische Psychiatrie zwischen Therapie und Sicherung

The therapeutic tasks of forensic psychiatry range between the field of tension of “improvement” and “security” of entrusted persons. With respect to these aspects a paradoxical position of politics and society can be seen: whereas, regulatory security aspects are emphasized and detention measures are required with respect to the treatment measures according to §63 and §64 of the penal code (StGB) and any relaxation of rules is critically viewed, under pressure from the European jurisprudence preventive detention has been declared as a therapeutic measure. The superordinate priority of these measures is to prevent recidivism. This article firstly summarizes the empirical evidence concerning the efficacy of forensic psychiatric treatment of relevant disorders. From this it becomes obvious that the data are unreliable due to relevant risk aspects; therefore, the comparison of safety and therapeutic interests remains a challenging undertaking. A working approach that can successfully encompass both aspects is long-term case management, which is in a position to do justice to both the inpatient interaction and dynamic aspects of the treatment process beyond detention. Because the effectiveness of aftercare has been confirmed, we propose the implementation of forensic outpatient treatment as an alternative to forensic inpatient treatment.     

Umgang mit gefährlichen Straftätern in England und Wales

Forensic psychiatric institutions exist in all western European countries. Their organisation depends on a number of factors including the legal framework and societal attitudes towards mentally disordered offenders. This article describes and critically comments on the forensic psychiatric system in England and Wales, its legal framework and approaches to dealing with dangerous offenders. England and Wales have a long forensic psychiatric tradition with the first high security hospital, Broadmoor hospital, having been established in 1863. Evidence-based treatment approaches in forensic hospitals as well as in prisons, training of forensic psychiatrists and research in the field of forensic psychiatry have gained international recognition. However, there are some worrying aspects in the system of forensic psychiatric care and the criminal justice system more generally, in particular the high and still increasing number of prisoners in comparison with other European countries, the low age of criminal responsibility, long sentences, increasing length of stay in forensic care and the increasingly risk averse culture. A number of differences to the German system can be found; one such difference relates to the role of criminal responsibility which is irrelevant for decisions regarding commitment in England and Wales. Only the mental state and need for treatment at the time of trial (or later assessment in prison) determine whether an offender is admitted to psychiatric care or receives a prison sentence. A number of new initiatives have been launched in recent years resulting in an increasing number of individuals being detained in forensic psychiatric and criminal justice institutions, in particular the initiative for the detention and treatment of individuals with so-called dangerous and severe personality disorders, the sexual offenders register and the new sentence of indeterminate imprisonment for public protection. These initiatives have been the subject of a number of complaints to the European Court of Human Rights. Nevertheless, the trend towards a more and more risk averse culture continues.     

Ambulante Behandlung von Sexualstraftätern

Treatment of sexual offenders is still a controversial issue for both forensic clinical practice and research. The methods to evaluate efficacy and effectiveness in the field of forensic psychiatry and psychotherapy show many distinctive characteristics. Especially outpatient treatment of sexual offenders takes place in a conflict of interest. This article aims to illustrate several potentials and difficulties in the field of sexual offender treatment using the example of the Hamburg Institute for Sex Research and Forensic Psychiatry at the University Medical Center Hamburg-Eppendorf (UKE).     

Review of the contemporary literature on how children report sexual abuse to others: findings, methodological issues, and implications for forensic interviewers

Methods used during forensic interviews with children are driven by beliefs about how children recall and report child sexual abuse (CSA) to others. Summit (1983) proposed a theory (Child Sexual Abuse Accommodation Syndrome) contending that, due to the specific traumatic characteristics of CSA, children will often delay disclosing abuse or altogether fail to disclose during childhood, deny abuse when asked, and often recant abuse allegations. His theory has had a tremendous impact on the field of CSA forensic evaluations, despite its dearth of empirical support. In this paper, we review and critique the contemporary literature from two main sources: retrospective accounts from adults reporting CSA experiences and studies of children undergoing forensic evaluation for CSA. We conclude that data support the notion that children often delay abuse disclosure, but that among valid abuse cases undergoing forensic evaluation, denial and recantation are not common. Methodological issues and implications for forensic interviewers are discussed.     

A survey of psychological test use patterns among forensic psychologists

Clinical psychologists are frequently called on to testify in court regarding mental health issues in civil or criminal cases. One of the legal criteria by which admissibility of testimony is determined includes whether the testimony is based on methods that have gained "general acceptance" in their field. In this study, we sought to evaluate the psychological tests used in forensic assessments by members of the American Psychology-Law Society Division of the American Psychological Association, and by diplomates in the American Board of Forensic Psychology. We present test results from this survey, based on 152 respondents, for forensic evaluations conducted with adults using multiscale inventories, single-scale tests, unstructured personality tests, cognitive and/or intellectual tests, neuropsychological tests, risk assessment and psychopathy instruments, sex offender risk assessment instruments, competency or sanity-related instruments, and instruments used to evaluate malingering. In addition, we provide findings for psychological testing involving child-related forensic issues.     

Communicating the Risk of Violent and Offending Behavior: Review and Introduction to this Special Issue

How to communicate risk of recidivism in correctional and forensic contexts has been a subject of scholarly discussion for two decades. This emerging literature, however, is sparse compared with studies on the assessment of risk for violent and offending behavior. In this special issue of Behavioral Sciences and the Law, we have gathered together empirical and review papers exemplifying promising directions and methodologies. We begin with a review of the state of the field, and lessons that can be drawn from research into medical risk assessment and risk communication, finding that many of the same principles apply to the forensic context. How risks are framed, and how numerate assessors are, affects how risk information is understood and applied. We discuss the existing research bearing on these issues, as well as the conceptual, practical, empirical, and legal implications of communicating risk using numerical or categorical risk terms. Along with the seven articles in this volume, we suggest directions for future research on measuring and communicating change, understanding and managing the statistical literacy of those who use and communicate risk assessments, and developing a theoretical framework for forensic risk communication research. We hope this volume will help integrate and invigorate research into forensic risk communication. Copyright © 2015 John Wiley & Sons, Ltd.     

Height vertigo, fear of heights, acrophobia

Height vertigo (acrophobia) is a very frequent phenomenon being of interest for its physiological and psychological background, though usually only of limited significance in neuropsychiatry and otology. The different aspects as to its nature and origin are discussed. If acrophobia has developed into a conditioned reaction of avoidance with pressure of suffering, or acrophobia in persons, who have to work at heights, behavior therapeutic measures with systematic desensibilisation, starting from an imaginative training, are indicated.     

Conclusions from shifts in morbidity patterns of hospitalized children with neuropsychiatric diseases

The decrease of neurological illnesses and the corresponding increase of psychogenic disturbances by patients belonging to clinical departments of neuropsychiatry of child and youth are described. This conversion leads to a frequently longer staying of the patients within the clinics. Furthermore, changes of the behaviours of the whole team for treatment may be observed.     

Forensic and correctional applications of the personality assessment inventory

The relative utility of psychological tests for addressing legal issues is an area of considerable debate in the field. Regardless of the merits of psychological testing, it is apparent that such instruments are used widely both to address specific psycholegal issues and to evaluate offender populations more generally. One instrument gaining prominence in terms of its use in both forensic and correctional settings is the Personality Assessment Inventory (PAI; Morey, 1991), which was developed to assess various constructs relevant to clinical settings (e.g. psychopathology, response distortion, and personality traits). This paper reviews the psychometric properties of the PAI specifically in reference to its ability to assess factors relevant to forensic decision-making, as well as its utility to provide clinically relevant information about offender populations more generally.     

Field validity of the Psychopathy Checklist-Revised in sex offender risk assessment

Several studies have concluded that scores from Hare's (2003) Psychopathy Checklist-Revised (PCL-R) predict reoffense among sexual offenders, but most of those studies examined the predictive validity of scores from trained research staff, not clinicians in the field scoring the measure as part of actual forensic assessments. Therefore, we examined the field validity of PCL-R scores that forensic evaluators assigned to 333 male sexual offenders who underwent evaluations during a civil commitment selection process. Overall, no PCL-R score was a significant predictor of sexually violent recidivism. Facet 4 was the only PCL-R score with an area under the curve (AUC) greater than .50 (AUC = .53, p = .85) and the only PCL-R score that approached statistical significance for predicting the combined category of violent or sexually violent offending (AUC = .63, p = .08). However, scores from a subset of evaluators revealed stronger predictive effects, indicating that predictive validity was higher for scores from some evaluators than others. Overall, these results suggest that the stronger predictive validity values in controlled research studies may not apply to all evaluators when the PCL-R is administered in the field.