Stefanie Otte

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.

The association of adverse childhood experiences and appetitive aggression with suicide attempts and violent crimes in male forensic psychiatry inpatients

Although previous studies in inmates, forensic and psychiatric samples suggest the relation between childhood trauma and suicide behavior as well as between childhood trauma and violent delinquency, the understanding of possible underlying mechanisms is still fragmentary. In a naturalistic study design, we tested if suicidal attempts and violent crimes are differently associated with adverse childhood experiences and levels of appetitive aggression in male forensic psychiatry inpatients. Adverse childhood experiences and appetitive aggression styles were collected by means of self-report measures, suicide attempts were taken from the medical history and violent crimes were appraised by official court records. The data were analyzed by the means of generalized linear models. Results revealed that appetitive aggression and adverse childhood experiences were significant predictors of suicide attempts, whereas violent crimes were associated solely with appetitive aggression. Suicide attempts and violent delinquency in forensic patients seem to be both positively associated with high levels of appetitive aggression, whereas their etiological pathways might differ with regard to adverse childhood experiences. Considering these interrelations to a greater extent might improve both diagnostics and treatment of forensic patients.

Konvergente Validität von SKID-II und TCI: Kategoriale vs. dimensionale Diagnostik von Persönlichkeitsstörungen am Beispiel von Gefangenen mit Kurzzeitstrafe

In order to objectify the diagnostics of personality disorders, questionnaires and structured interviews are used. Nevertheless, due to different methodological approaches even those instruments arrive at different results very often. Therefore, this study aimed to check the convergent validity of two frequently used instruments - the Structured Clinical Interview for DSM IV Axis II Disorders (SCID-II) and the Temperament and Character Inventory (TCI) - the first one representing the categorical and the latter one the dimensional approach for diagnosing personality disorders. The diagnostic concordances were statistically described with Cohens Kappa, Yules Y, and correlations. The results indicate that there are striking differences in diagnoses and that the SCID-II rather tends to diagnose a personality disorder earlier than the TCI.

Impulsiveness among short-term prisoners with antisocial personality disorder

OBJECTIVE The study aimed to investigate the correlation between impulsiveness and the antisocial personality disorder among short-term prisoners. METHOD The impulsiveness was diagnosed by the Barratt Impulsiveness Scale (BIS). RESULTS Short-term prisoners with antisocial personality disorder scored significant higher marks on the BIS total scale than those without any personality disorder. In detail, they scored higher marks on each subscale regarding attentional, motor and nonplanning impulsiveness. Moderate and high effects were calculated. CONCLUSION It is to be considered to regard impulsivity as a conceptual component of antisociality.

Psychopathy, the Big Five and empathy as predictors of violence in a forensic sample of substance abusers

Abstract It is widely recognized that substance abuse increases the general risk of delinquency and violent offenses in particular. Substance-related disorders are the primary cause of offenders being sentenced to mandatory treatment in forensic psychiatry. However, instead of a mono-causal link between addiction and violence, additional risk factors must be assumed. The current study examined the relations between psychopathy, empathy and general personality traits and their role in statistically predicting violent crimes of substance-abusing offenders. The sample consisted of 164 male and female forensic inpatients with substance-related disorders. They were administered the German versions of the Psychopathic Personality Inventory (PPI-R), the NEO Personality Inventory (NEO-PI-R) and the Interpersonal Reactivity Index (SPF). The psychopathy factor Impulsive Antisociality (IA) emerged as a positive statistical predictor of violent offenses, while Fearless Dominance (FD) served as a negative predictor. The Big Five factors and empathy domains failed to statistically predict violence, despite showing significant correlations with the psychopathy factors. Hence, substance-abusing violent offenders display a distinct pattern of personality characteristics with IA being associated with high Neuroticism, low Agreeableness and low Conscientiousness, as well as high Personal Distress and low Perspective Taking. IA therefore reflects a maladaptive trait that is overrepresented in forensic settings.

Psychometric validation of the Brief Symptom Inventory 25 Forensic (BSI-25-F)

ABSTRACT The Brief Symptom Inventory 25 Forensic (BSI-25-F) is a screening instrument for measuring the psychophysical distress of prisoners and forensic patients. The aim of the study was to validate the instrument. For this purpose, 165 forensic patients, 312 general psychiatric patients, and 1359 people from the general population completed the BSI-25-F. In addition, the data of the long-term prisoners who were studied when the instrument was originally developed were used for comparison. The item analyses revealed acceptable to very good item characteristics within the target samples of the prisoners and the forensic patients for the majority of the items. Reliability tests also showed acceptable to good values for the target samples. The differential validity but not the factorial validity could be proved. To conclude, the new BSI-25-F represents an economic, practicable, and reliable screening instrument for identifying prisoners who are in a need of treatment.

Die therapeutische Beziehung im forensischen und allgemeinpsychiatrischen Setting

INTRODUCTION Therapeutic relationship in forensic psychiatry is believed to be affected by the coercive setting and the role conflict of the therapists as both treaters and court-appointed experts. The aim of the study was to examine and compare the therapeutic relationship in forensic and general psychiatric settings. MATERIAL AND METHODS 52 forensic patients and 66 general psychiatric patients filled in the Psychopathy Personality Inventory - Revised (PPI-R), the Inventory of Interpersonal Problems - German Version (IIP-D), the Questionnaire on Motivation for Psychotherapy (Fragebogen zur Erfassung der Psychotherapiemotivation (FPTM)) as well as the Working Alliance Inventory - Short Revised (WAI-SR). We applied descriptive analyses, calculated univariate t-tests as well as multivariate T-tests and performed general linear models. RESULTS The quality of the therapeutic alliance does not differ significantly between forensic and general psychiatric patients. Moreover, patients of forensic psychiatry consider therapeutic techniques applied by their therapists as more valuable for achieving their therapeutic aims than patients of the general psychiatry. DISCUSSION The therapeutic relationship in forensic psychiatry is as viable as in general psychiatry. This can be regarded as a result of the long-term therapy in the context of forensic psychiatry which allows more time to be spent on relationship building than in a general psychiatry setting where therapy is limited to a few weeks.