Manuela Dudeck

Die Prävalenz psychischer Erkrankungen bei Gefängnisinsassen mit Kurzzeitstrafe

OBJECTIVE The aim of the study was to determine the prevalence of mental disorders among prisoners with a short prison term. METHODS We investigated 102 participants with the Structured Clinical Interview for DSM Disorders (SCID I and II) and the Symptom Check List (SCL-90). RESULTS We found a lifetime-prevalence of mental disorders (axis I) of 83 %. 80 % of the participants showed at least one personality disorder. CONCLUSIONS These results indicate that short-term prisoners are a population which is highly troubled in a psychiatric sense and shows a need of treatment in prison.

Trauma and Current Posttraumatic Stress Symptoms in Elderly German Women Who Experienced Wartime Rapes in 1945

The aim of this study was to determine the persistent trauma impact and significant posttraumatic stress symptoms in a sample of very elderly German women who survived the mass rapes committed by soldiers at the end of World War II. A total of 27 women were recruited, interviewed, and then administered a modified Posttraumatic Diagnostic Scale. They all reported a very severe degree of trauma exposure in 1945; 19% reported significant current posttraumatic stress symptoms indicating a possible posttraumatic stress disorder at the time of the study, and 30% fulfilled the criteria of a current partial posttraumatic stress disorder. The results highlight the necessity for prevention and treatment programs for women exposed to wartime rapes in current conflict settings worldwide, and the need to identify and treat posttraumatic conditions in the elderly generation of all countries exposed to World War II trauma.

Borderline Personality Disorder in Four Different Age Groups: A Cross-Sectional Study of Community Residents in Germany

Studies examining the natural course of borderline personality disorder (BPD) over the life span have yielded declining prevalence rates in older age groups. However, there is evidence that different BPD symptoms have different longitudinal patterns, with impulsivity decreasing with advancing age and negative affect remaining stable into late adulthood. However, since all studies dealt with treated, clinical samples of BPD patients, it is not yet known whether this represents the natural course of BPD symptoms or just mirrors difference in treatability of these symptoms. The authors addressed this issue by investigating a nonclinical population and compared prevalence of BPD, impulsivity, and depressivity in various age groups from adolescence to late adulthood (N = 2,488); all individuals were assessed by standardized clinical interviews. Syndromal and subsyndromal BPD rates sharply decreased between adolescents and young adults and remained stable thereafter. Whereas the same course was found for impulsivity, depressivity increased between young, middle-aged, and older adults. The present results support the hypothesis that age-related decreases in BPD diagnosis might be attributable to declining levels of impulsivity, whereas the persistence of a subsyndromal BPD might be attributable to an enduring negative affect.

Forensic inpatient male sexual offenders: The impact of personality disorder and childhood sexual abuse

Abstract Given the great epidemiological, social, and psychological importance of sexual offences, and their deleterious consequences for victims, it seems vital to focus on potential risk factors for becoming a sexual offender. Our study aims to contribute to a better understanding of specific risk factors for sexual offenders by including a number of potentially important variables: biographical, clinical, and forensic. The sample consisted of 51 male inpatients at two maximum security forensic hospitals in Germany. The 19 sexual offenders were compared to the 32 non-sexual offenders. Personality disorder diagnoses and childhood maltreatment were assessed by experts; current psychopathology and interpersonal problems were measured using self-report questionnaires. Narcissistic personality disorders were significantly more frequent in sexual offenders than in the comparison group. Moreover, sexual offenders had been sexually abused as children significantly more often than the non-sexual offenders. Our findings indicate that sexual victimization in childhood might be an important risk factor for sexual offending in later life. Therapeutic interventions for offenders focusing on their childhood sexual abuse might improve their psychosocial well-being and functioning, and their criminal prognosis.

Quality of life and sense of coherence in former German child soldiers of World War II

OBJECTIVE The aim of the study was to determine the quality of life and the sense of coherence in a sample of former German child soldiers of World War II. METHODS 103 participants were recruited by the press, then administered a Short-Form-Health-Survey (SF-12), a sense-of-coherence scale (SOC) and 2 qualitative questions on possible resources in the combat situation. RESULTS The quality of life was not lowered compared to a comparison group of the same age. The sense of coherence was significantly higher than that of the comparison group. CONCLUSIONS The participants belonged to a comparably unobtrusive group of veterans. A possible protective variable might be the high sense of coherence.

Lebensbedingungen im europäischen Langstrafenvollzug

Da der Strafvollzug als Teil der Strafvollstreckung einer der Bereiche ist, die von der polizeilichen und justiziellen Zusammenarbeit in Strafsachen in der EU erfasst werden, wird die Union sich in absehbarer Zeit mit den Problemen ihrer Gefangenen auseinandersetzen müssen. Ebenso wie bei der Strafverfolgung führen auch hier die nationalen Besonderheiten der Mitgliedstaaten zu Schwierigkeiten. Zwar hielt die Europäische Kommission in ihrer Mitteilung an den Rat und das Euro päische Parlament vom 19.5.2005 (KOM (2005) 195 endg) fest, dass eine strafrechtliche Verurteilung, die in einem Mitgliedstaat ergangen ist, auch in jedem anderen Mitgliedstaat vollstreckt werden können muss. Allerdings konzen trieren sich die Bemühungen im Rahmen der justiziellen Zusammenarbeit in Strafsachen bisher auf das materielle Strafrecht und das Strafprozessrecht, der Strafvollzug war bisher nur Gegenstand einer Empfehlung des Europäischen Parlaments an den Rat (P5_ TA(2004)0142 vom 9.3.2004).

Anhaltender sexueller Missbrauch in der Kindheit und Langzeitfolgen für die Entwicklung

ZusammenfassungHintergrundDie psychischen Langzeitfolgen der sexuellen Traumatisierungen in der Kindheit sind mit vielschichtigen Symptomen assoziiert, werden jedoch noch häufig nicht erkannt oder fehldiagnostiziert. Diagnostisch werden sie verstärkt unter dem Konzept der komplexen posttraumatischen Belastungsstörung (PTBS) subsumiert.Ziel der ArbeitUnter Einbeziehung eines prototypischen Falls wird eine Übersicht über dieses vielschichtige Krankheitsbild in unterschiedlichen Altersstufen gegeben, und die evidenzbasierten Therapieoptionen werden aufgezeigt.Material und MethodenEs erfolgen die Darstellung eines prototypischen Falls, die narrative Übersicht über die aktuelle Literatur und eine vergleichende Analyse der diagnostischen Kriterien in den unterschiedlichen Klassifikationssystemen.Ergebnisse und DiskussionDie Symptome einer komplexen Traumatisierung im Erwachsenenalter können auch während der längeren und multiplen stationären Behandlungen im multidisziplinären Setting einer Universitätsklinik verkannt werden. Für die Praxis erscheint die Erhebung einer spezifischen Traumaanamnese bei multiplen Beschwerden, wechselnden Diagnosen und gescheiterten Therapieansätzen in der Vergangenheit notwendig, da die richtige Bewertung und Einordnung von großer Bedeutung für das weitere psychotherapeutische Vorgehen ist, das eine weitere Chronifizierung der Beschwerden verhindern kann.AbstractBackgroundThe psychological long-term effects of sexual abuse in childhood are typically associated with diverse symptoms. To date, these symptoms may be best conceptualized as complex posttraumatic stress disorder (PTSD).ObjectivesBased on a prototypal case, we overview multiple facets of complex PTSD during child- and adulthood, as well as associated diagnostic challenges particularly regarding symptom overlap with borderline personality disorder and current evidence-based psychotherapeutic options. With the present work, we aim to sensitize clinicians to trauma-related disorders.MethodsCase report, narrative review of the current literature, and comparable analysis of the diagnostic criteria in the different classification systems.Results and conclusionsAlthough epidemiological studies report high rates of childhood sexual abuse, the symptoms of a subsequently developing complex PTSD are still frequently unidentified or falsely diagnosed by practitioners. Therefore, the specific trauma history should be reviewed if multiple, diverse, or varying symptoms and diagnoses are on hand. Trauma- and confrontation-oriented psychotherapeutic approaches might prevent further chronic manifestations of the symptoms.

FACTORIAL VALIDITY OF THE SHORT FORM OF THE CHILDHOOD TRAUMA QUESTIONNAIRE (CTQ-SF) IN GERMAN PSYCHIATRIC PATIENTS, INMATES, AND UNIVERSITY STUDENTS.

For the purpose of retrospective assessment and characterization of childhood trauma in adults, the factorial validity of the short form of the Childhood Trauma Questionnaire (CTQ–SF) in Germany was evaluated by conducting confirmatory factor analyses for three samples including 1,524 adult psychiatric patients, 224 inmates, and 295 university students. In addition, sex-specific confirmatory factor analyses were performed within each sample. Because several authors have suggested a different factor structure than that originally proposed in the manual, two competing models focusing on the Physical neglect subscale were examined. In psychiatric patients and inmates, the fit indices were reasonable to good. Among the students, factor loadings were markedly lower, and fit indices were poor. Sex-specific analyses did not indicate sex differences. Comparing the original and the alternative models revealed better fit indices of the original factor structure. The present findings indicate that the German version of the CTQ–SF has factorial validity in psychiatric patients and inmates, but not in students.

Psychopharmacologic treatment of in-patients with schizophrenia: comparing forensic and general psychiatry

Abstract Patients with schizophrenia constitute a substantial proportion of patients hospitalized in forensic psychiatry. Antipsychotic medication is an essential part of evidence-based treatment and can significantly improve both the medical and legal prognosis. In this study, we compared psychopathological features, psychopharmacological treatment, and the neurologic and metabolic side effects of treatment in demographically comparable in-patients with schizophrenia being treated in either forensic or general psychiatry. Megalomanic ideations, animosity, affect flattening, weak will, social passivity, apathy, uncooperative behavior, and poor impulse control were more pronounced in the forensic psychiatry sample. Nevertheless, patients in the forensic setting were prescribed less antipsychotic medication than the general psychiatry patients. Polypharmacy was pronounced in both samples. There were no significant differences in prescription rates of depot antipsychotics, movement disorders, or metabolic parameters. Our preliminary findings suggest a number of differences in the symptomatology and antipsychotic drug treatment of forensic and general adult psychiatry patients with schizophrenia. These differences deserve reexamination with more sophisticated designs.

Different yet similar? Prisoners versus psychiatric patients – A comparison of their mental health

BACKGROUND Previous research indicates that prisoners have severe psychological distress. To assess their distress level and potential need for treatment, the present study compared the subjective psychological distress of long- and short-term prisoners with that of psychiatric and forensic patients. METHODS Long- (n=98) and short-term prisoners (n=94) and forensic (n=102) and psychiatric (n=199) patients completed the German versions of the Symptom Checklist Revised (SCL-90-R) and Brief Symptom Inventory (BSI). RESULTS In general, long-term prisoners showed the same level of mental distress as psychiatric patients and more than that reported by forensic patients. Short-term prisoners reported the least level of distress. Long- but not short-term prisoners showed clinically significant results on the scales for depression, paranoid ideation, and psychosis. CONCLUSIONS The improvements in psychiatric treatment for inmates demanded by many stakeholders need to differentiate between long- and short-term prisoners. Because depression seems to cause the most psychological distress among inmates, suicide prevention seems to be an important issue in prisons.