Krankheitsverhalten als Überlebensstrategie

Somatoforme St?rungen stellen in den westlichen Industriegesellschaften ein erhebliches Problem für Behandlung, Begutachtung und Sozialversicherungswesen dar. Anders als bei sch?rfer umschriebenen psychiatrischen Krankheitsbildern, deren klinisches Erscheinungsbild gut bekannt und deren St?rungswert unbestritten ist, erfolgt hier die Symptompr?sentation durch verbale, mimische und gestische Darstellung. Insofern k?nnen sowohl Form als auch Schweregrad der Beschwerden durch willentliche Einflu?nahme gestaltet werden, was die M?glichkeit der Zweckgerichtetheit aufgrund sekund?rer Motivbildung zumindest mit einschlie?t.     

Regionale Psychiatrieberichterstattung

In diesem Beitrag werden zun?chst die Motivation, das Konzept und die Datenquellen der 2006 eingeführten Vorarlberger Psychiatrieberichterstattung dargestellt. Dann erfolgt, mit Hilfe definierter Kennzahlen, anhand der Ergebnisse für das Berichtsjahr 2008 ein überblick über die in die Berichterstattung einbezogenen Hilfsangebote und ihre Nutzer. Die Kennzahlen beschreiben den Umfang der Hilfen, das dafür eingesetzte Fachpersonal und die betreuten Patienten. Beispielhaft werden sodann M?glichkeiten der empirischen überprüfung des Zielgruppenbezugs und der regionalen Bedarfsgerechtigkeit der Hilfen erl?utert. Der Beitrag schlie?t mit einigen Bemerkungen zu den geplanten n?chsten Schritten auf dem Weg zu einer kontinuierlichen Qualit?tsentwicklung der regionalen psychiatrischen Versorgung, die das gesamte Netzwerk der Hilfen einbezieht und dabei auch die Notwendigkeit und Wirksamkeit der therapeutischen Ma?nahmen im Einzelfall in den Blick nimmt.     

Leben ohne Gewalt organisieren

Several runs of a cognitive-behavioral group-based training program for violent offenders in a youth detention center were evaluated. The training aims at reducing disposition towards violence, promoting responsibility and strengthening personal and social resources. The 49 participants were compared to 47 non-participating violent offenders. For the participants a reduction of several facets of aggression and an increase of responsibility for the offence was observed in a pre-post-comparison. However, treatment effects appear to decrease with longer observation time. Competencies such as empathy were not affected by the training. Furthermore, participants showed no difference to non-participants regarding officially recorded violent recidivism.     

Kritische Anmerkungen zur Einweisung von Jugendlichen und Heranwachsenden in den Maßregelvollzug

In this paper the preconditions for placing adolescents and young adults in forensic psychiatric institutions are analyzed. According to the law such placements are only justifiable in exceptional cases. Even from a psychiatric point of view it is difficult to delineate a severe and most notably lasting mental disorder at a young age and distinguish it from a lack of maturity, although only the first would justify an indefinite placement in an institution. Nevertheless both broadly pathologizing certain behaviors and loosely interpreting preconditions for placements in institutions encourage commitment to institutions.     

Die Entwicklung der Gesetzgebung zur Sicherungsverwahrung und die damit verbundenen Auswirkungen auf ihre Klientel

Initially, the article gives a short overview over the expansions of preventive detention the legislator has made in recent years. Secondly, prosecution statistics as well as statistics on enforcement of sentences are analyzed focusing on the effects the change in legislation has on the number and structure of preventive detainees. Hereafter, the author presents the central results of an own study titled ‘Reconviction of Dangerous Recidivists’. These results further the conclusion that there is a considerable amount of persons falsely classified as dangerous amongst today’s preventive detainees.     

Sexueller Sadismus und Sexualkriminalität

The categorization of sadism has turned out to be a versatile phenomenon, which covers a spectrum from harmless symbolic rituals to extremely violent acts where strong impulses or prolonged fantasies and rituals are involved. As the phenomenon is versatile its causes and appearances vary as well, although so-called BDSM (bondage & discipline & dominance & submission & sadism & masochism) practitioners and persons with severe sadism in a forensic context share only few common preferences. Based on own clinical experiences with sadism in forensic patients the authors support the proposed revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) especially the diagnostic disjuncture of sadism and masochism. Sexual sadism appears more frequently in forensic contexts in combination with sadistic, antisocial and borderline personality disorders but rarely with masochism. Masochism is otherwise reported to be more prevalent in patients of general psychiatry, however, combined with depression or dependent personality traits rather than with sadism. Moreover, the authors believe that if use of the diagnostic term sadism is perpetuated the establishment of the proposed new diagnosis “paraphilic coercive disorder” is unnecessary. The diagnostic term is also important for treatment and assessment. Despite the lack of reliable long-term studies with larger samples, it is reasonable to assume that medication, sometimes even anti-androgenic treatment, can be indicated in patients with severe sadism.     

Patienten mit einer wahnhaften Depression in der Maßregel nach § 63 StGB

Delinquency of depressed patients numerically plays a minor role in criminal or civil law. Compared with the high prevalence of affective disorders in the general population, the frequency of patients in forensic psychiatric hospitals with the respective disorder as a main diagnosis is low. The spectrum of possible crimes committed by depressed subjects essentially comprises disease-characteristic offences, amongst which cases of extended suicide or attempted suicide are the foremost and most tragic offences. Based on 2 case reports notions of extended suicide as well as questions of forensic assessment are discussed.