Schizophrene Patienten der forensischen Psychiatrie im Vergleich zu schizophrenen Patienten der Allgemeinpsychiatrie

Background

The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Some researchers assume that these forensic patients form a group of patients with very complex mental disorders, a number of risk factors and insufficient pretreatment in general psychiatry. This study aimed to identify differences regarding the history of treatment of forensic and general psychiatric patients diagnosed with schizophrenia.

Method

The matched samples included 72 male patients from forensic wards and 72 male patients from general psychiatric institutions diagnosed with schizophrenia. The history of psychiatric treatment was reconstructed by interviewing the patients as well as outpatient psychiatrists and patients’ legal custodians and by analyzing patient medical records.

Results

In contrast to the general psychiatric patients, prior to admission forensic patients were less integrated into psychiatric care and showed a lower rate of treatment compliance. They also showed a higher rate of previous compulsory treatment because of aggressive behavior towards other persons as well as higher rates of treatment difficulties and violent behavior during previous inpatient treatment. Furthermore, forensic patients had a higher number of previous criminal convictions and had been convicted more often for violent offences. With regard to other relevant risk factors (e.g. comorbid substance abuse disorder, age, education, conduct disorder, antisocial personality disorder, previous exposure to violent and abusive behavior) the two patient groups were, however, comparable.

Conclusions

Regarding schizophrenic patients with comorbid substance abuse disorders, previous violent delinquency and violent behavior during previous inpatient treatment, an intensive outpatient aftercare should be arranged before they are discharged from general psychiatric institutions.     

The Influence of Major Life Events and Personality Traits on the Stability of Affective Well-Being

The current study examines the influence of major life events compared to personality traits on the stability of affective well-being (AWB). It is shown how the decomposition of autocovariances can be used to estimate the degree of stability that is due to life events and personality traits. The approach is illustrated by an analysis of data from a nationally representative Australian sample with four consecutive waves of measurement. The autocovariances of positive and negative mood served as indicators of the stability of AWB. Big five personality traits as well as 21 major life events were used as predictor variables in a path analysis. In comparison to previous studies, this allowed to directly compare the effects of multiple events to the influence of personality traits in a longitudinal design. Results indicated medium stability coefficients for AWB. Ca. 10 % of the autocovariances could be accounted for by life events and about 20 % by personality traits. Both types of predictors together accounted for about 30 %. Among personality traits, emotional stability followed by extraversion had the highest effects. Among life events “financial worsening” and “serious personal injury/illness” had the highest effects. Additionally, life events were significantly correlated with personality traits as well as with other life events. In a next step, it might be interesting to compare the influence of Big Five personality traits and stable life circumstances on the stability of the cognitive well-being component, using a similar statistical procedure. Also, as the number of variables in large panel studies is limited, results should be complemented by more in-depth studies, favourably using multi-method approaches.     

Vergleich zweier diagnostischer Ans?tze zur Erfassung der Sexualfantasien p?dophiler M?nner

Two diagnostic approaches to measure sexual fantasies, the Wilson Sexual Fantasy Questionnaire (WSFQ; Wilson 1988, Sex Marital Ther 3:45) as a quantitative self-report measure and the qualitative content analysis categories for the fantasy content, have been examined regarding their quality and capability for identifying pedophilic fantasies. For this purpose 33 men from the general community were selected and compared with 24 adult men from the project ??Kein Täter werden?? (avoid being a perpetrator) at the Institute of Sexology and Sexual Medicine, Charité Clinical Center, Berlin, all fulfilling diagnostic criteria of pedophilia according to DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision) (American Psychiatric Association 2000, Washington). The examination revealed that the reliability of the WSFQ scales (Cronbach??s ??) varied between moderate and good. The interrater reliability coefficients of content analysis categories ranged between moderate and predominantly good and very good. The WSFQ identified a generalized impersonal character only as a main feature of pedophilic fantasies and proved to have limited capability for identification of specific contents of sexual fantasies of persons with these diagnoses. In contrast, content analysis categories allowed identification of a set of specific features of the fantasized partners, pedophilic men and the sexual contacts in addition to the age and prepubertal body of a preferential partner which might be traced back to the preference for prepubertal age. Replication studies are necessary for evaluation of the current findings on the basis of a representative sample of men with pedophilia. These findings might be of primary use for the diagnosis of pedophilia.     

The impact of past behaviour normality on regret: replication and extension of three experiments of the exceptionality effect

Norm theory (Kahneman, D., & Miller, D. T. (1986). Norm theory: Comparing reality to its alternatives. Psychological Review, 93, 136–153) described a tendency for people to associate stronger regret with a negative outcome when it is a result of an exception (abnormal behaviour) compared to when it is a result of routine (normal behaviour). In two pre-registered studies, we conducted a replication and extension of three classic experiments on past behaviour exception/routine contrasts (N?=?684). We successfully replicated Kahneman and Miller’s (1986) experiments with the classic hitchhiker-scenario (Part 1) and car accident-scenario (Part 2). In both cases, participants examined negative outcomes and tended to indicate a protagonist who deviated from own past behaviour as more regretful than another who followed routine. Pre-registered extensions also showed effects for ratings of social norms, negative affect, and perceived luck. We did not find support for the Miller, D. T., and McFarland, C. [(1986). Counterfactual thinking and victim compensation: A test of norm theory. Personality and Social Psychology Bulletin, 12, 513–519] experiment robbery scenario (Part 3) using a compensation measure, in that compensation to a victim of a robbery was not significantly different comparing exceptional and routine circumstances. However, a pre-registered extension showed that robbery under exceptional circumstances was perceived as more regretful than robbery under routine circumstances. We discuss implications for current and future research.     

Omission and commission in judgment and decision making: Understanding and linking action‐inaction effects using the concept of normality

Research on action and inaction in judgment and decision making now spans over 35 years, with ever‐growing interest. Accumulating evidence suggests that action and inaction are perceived and evaluated differently, affecting a wide array of psychological factors from emotions to morality. These asymmetries have been shown to have real impact on choice behavior in both personal and interpersonal contexts, with implications for individuals and society. We review impactful action‐inaction related phenomena, with a summary and comparison of key findings and insights, reinterpreting these effects and mapping links between effects using norm theory's (Kahneman & Miller, 1986) concept of normality. Together, these aim to contribute towards an integrated understanding of the human psyche regarding action and inaction.