Der Einfluss des richterlichen Auftrags auf die Qualität der Arbeit von Sachverständigen im Rahmen der Prognosebegutachtung

Im Jahr 2006 wurden von einer Arbeitsgruppe (nicht verbindliche) Mindestanforderungen für Prognosegutachten formuliert, die bereits im Gutachtenauftrag Berücksichtigung finden sollen. Insbesondere sollen die Sachverständigen sich an folgenden vier prognostischen Fragestellungen orientieren: (1) der Wahrscheinlichkeit erneuter Straftaten, (2) der Art, Häufigkeit und des Schweregrades erneuter Straftaten, (3) möglicher risikoreduzierender Maßnahmen und (4) möglicher risikoerhöhender Umstände. In einer empirischen Studie werden N = 787 Prognosegutachten von Gewalt- und Sexualstraftätern, die zwischen 1999 und 2016 erstellt worden sind, hinsichtlich der richterlichen Auftragsstellung und deren Beantwortung analysiert. Einen Teil der Stichprobe bilden n = 412 externe Prognosegutachten der JVA Freiburg und n = 375 Prognosegutachten der Abteilung für Forensische Psychiatrie der Klinik und Poliklinik für Psychiatrie und Psychotherapie der Ludwig-Maximilians-Universität München. Es wurden n = 407 (Freiburg: 253, München: 154) vor 2006 erstellt und n = 380 (Freiburg: 159, München: 221) nach 2006. Es zeigt sich, dass ab 2006 die Münchner Abteilung eine statistisch signifikant häufigere Beantwortung der Fragestellungen (1), (2) und (4) verzeichnet, wohingegen keine Veränderung bei den externen Prognosegutachten der JVA Freiburg festzustellen ist. Es wird argumentiert, dass in universitären Einrichtungen eher wissenschaftliche Empfehlungen aufgegriffen werden als in der allgemeinen Gutachterpraxis. Zudem wird die Bedeutung der Bezugnahme auf die prognostischen Fragestellungen bereits im richterlichen Gutachtenauftrag betont, da statistisch gezeigt werden kann, dass diese zu einer konkreteren Beantwortung durch die Sachverständigen führt

Neuroanatomical correlates of aggressiveness: a case-control voxel- and surface-based morphometric study

Aggression occurs across the population ranging on a symptom continuum. Most previous studies have used magnetic resonance imaging in clinical/forensic samples, which is associated with several confounding factors. The present study examined structural brain characteristics in two healthy samples differing only in their propensity for aggressive behavior. Voxel- and surface-based morphometry (SBM) analyses were performed on 29 male martial artists and 32 age-matched male controls. Martial artists had significantly increased mean gray matter volume in two frontal (left superior frontal gyrus and bilateral anterior cingulate cortex) and one parietal (bilateral posterior cingulate gyrus and precuneus) brain clusters compared to controls (whole brain: p < 0.001, cluster level: family-wise error (FWE)-corrected). SBM analyses revealed a trend for greater gyrification indices in martial artists compared to controls in the left lateral orbital frontal cortex and the left pars orbitalis (whole brain: p < 0.001, cluster level: FWE-corrected). The results indicate brain structural differences between martial artists and controls in frontal and parietal brain areas critical for emotion processing/inhibition of emotions as well as empathic processes. The present study highlights the importance of studying healthy subjects with a propensity for aggressive behavior in future structural MRI research on aggression

S100B Serum Levels in Schizophrenia Are Presumably Related to Visceral Obesity and Insulin Resistance

Elevated blood levels of S100B in schizophrenia have so far been mainly attributed to glial pathology, as S100B is produced by astro- and oligodendroglial cells and is thought to act as a neurotrophic factor with effects on synaptogenesis, dopaminergic and glutamatergic neutrotransmission. However, adipocytes are another important source of S100B since the concentration of S100B in adipose tissue is as high as in nervous tissue. Insulin is downregulating S100B in adipocytes, astrocyte cultures and rat brain. As reviewed in this paper, our recent studies suggest that overweight, visceral obesity, and peripheral/cerebral insulin resistance may be pivotal for at least part of the elevated S100B serum levels in schizophrenia. In the context of this recently identified framework of metabolic disturbances accompanying S100B elevation in schizophrenia, it rather has to be attributed to systemic alterations in glucose metabolism than to be considered a surrogate marker for astrocyte-specific pathologies

Glutamatergic and Resting-State Functional Connectivity Correlates of Severity in Major Depression – The Role of Pregenual Anterior Cingulate Cortex and Anterior Insula

Glutamatergic mechanisms and resting-state functional connectivity alterations have been recently described as factors contributing to major depressive disorder (MDD). Furthermore, the pregenual anterior cingulate cortex (pgACC) seems to play an important role for major depressive symptoms such as anhedonia and impaired emotion processing. We investigated 22 MDD patients and 22 healthy subjects using a combined magnetic resonance spectroscopy (MRS) and resting-state functional magnetic resonance imaging (fMRI) approach. Severity of depression was rated using the 21-item Hamilton depression scale (HAMD) and patients were divided into severely and mildly depressed subgroups according to HAMD scores. Because of their hypothesized role in depression we investigated the functional connectivity between pgACC and left anterior insular cortex (AI). The sum of Glutamate and Glutamine (Glx) in the pgACC, but not in left AI, predicted the resting-state functional connectivity between the two regions exclusively in depressed patients. Furthermore, functional connectivity between these regions was significantly altered in the subgroup of severely depressed patients (HAMD > 15) compared to healthy subjects and mildly depressed patients. Similarly the Glx ratios, relative to Creatine, in the pgACC were lowest in severely depressed patients. These findings support the involvement of glutamatergic mechanisms in severe MDD which are related to the functional connectivity between pgACC and AI and depression severity

Patterns of risk—Using machine learning and structural neuroimaging to identify pedophilic offenders

BackgroundChild sexual abuse (CSA) has become a focal point for lawmakers, law enforcement, and mental health professionals. With high prevalence rates around the world and far-reaching, often chronic, individual, and societal implications, CSA and its leading risk factor, pedophilia, have been well investigated. This has led to a wide range of clinical tools and actuarial instruments for diagnosis and risk assessment regarding CSA. However, the neurobiological underpinnings of pedosexual behavior, specifically regarding hands-on pedophilic offenders (PO), remain elusive. Such biomarkers for PO individuals could potentially improve the early detection of high-risk PO individuals and enhance efforts to prevent future CSA.AimTo use machine learning and MRI data to identify PO individuals.MethodsFrom a single-center male cohort of 14 PO individuals and 15 matched healthy control (HC) individuals, we acquired diffusion tensor imaging data (anisotropy, diffusivity, and fiber tracking) in literature-based regions of interest (prefrontal cortex, anterior cingulate cortex, amygdala, and corpus callosum). We trained a linear support vector machine to discriminate between PO and HC individuals using these WM microstructure data. Post hoc, we investigated the PO model decision scores with respect to sociodemographic (age, education, and IQ) and forensic characteristics (psychopathy, sexual deviance, and future risk of sexual violence) in the PO subpopulation. We assessed model specificity in an external cohort of 53 HC individuals.ResultsThe classifier discriminated PO from HC individuals with a balanced accuracy of 75.5% (sensitivity = 64.3%, specificity = 86.7%, P5000 = 0.018) and an out-of-sample specificity to correctly identify HC individuals of 94.3%. The predictive brain pattern contained bilateral fractional anisotropy in the anterior cingulate cortex, diffusivity in the left amygdala, and structural prefrontal cortex-amygdala connectivity in both hemispheres. This brain pattern was associated with the number of previous child victims, the current stance on sexuality, and the professionally assessed risk of future sexual violent reoffending.ConclusionAberrant white matter microstructure in the prefronto-temporo-limbic circuit could be a potential neurobiological correlate for PO individuals at high-risk of reoffending with CSA. Although preliminary and exploratory at this point, our findings highlight the general potential of MRI-based biomarkers and particularly WM microstructure patterns for future CSA risk assessment and preventive efforts

Two Sides of One Coin: A Comparison of Clinical and Neurobiological Characteristics of Convicted and Non-Convicted Pedophilic Child Sexual Offenders

High prevalence of child sexual offending stand in contradiction to low conviction rates (one-tenth at most) of child sexual offenders (CSOs). Little is known about possible differences between convicted and non-convicted pedophilic CSOs and why only some become known to the judicial system. This investigation takes a closer look at the two sides of "child sexual offending" by focusing on clinical and neurobiological characteristics of convicted and non-convicted pedophilic CSOs as presented in the Neural Mechanisms Underlying Pedophilia and sexual offending against children (NeMUP)*-study. Seventy-nine male pedophilic CSOs were examined, 48 of them convicted. All participants received a thorough clinical examination including the structured clinical interview (SCID), intelligence, empathy, impulsivity, and criminal history. Sixty-one participants (38 convicted) underwent an inhibition performance task (Go/No-go paradigm) combined with functional magnetic resonance imaging (fMRI). Convicted and non-convicted pedophilic CSOs revealed similar clinical characteristics, inhibition performances, and neuronal activation. However, convicted subjects' age preference was lower (i.e., higher interest in prepubescent children) and they had committed a significantly higher number of sexual offenses against children compared to non-convicted subjects. In conclusion, sexual age preference may represent one of the major driving forces for elevated rates of sexual offenses against children in this sample, and careful clinical assessment thereof should be incorporated in every preventive approach

Sexualisierte Gewalt gegen Kinder und elektronische Medien. Die Sichtweise der forensischen Psychiatrie

Pädosexuelle Internetpornographie und Kindsmissbrauch im Internet werden immer häufiger aufgedeckt. Über die dadurch verursachten Schäden bei den Opfern wissen wir relativ wenig; die Täter bleiben wegen der Anonymität und der grenzüberschreitenden Aktivität im Internet oft unentdeckt. Das Phänomen gewinnt nicht nur für Polizei und Justiz zunehmende Bedeutung sondern auch für die forensische Psychiatrie. Schuldfähigkeitsbegutachtungen, Risikoeinschätzungen, Behandlungs- und Präventionsmöglichkeiten gehören auch bei diesen Tätern zu den wesentlichen Aufgaben, aber auch die vorbeugende Betreuung bei jenen, die sich selber in der Gefahr sehen, derartige Straftaten zu begehen. Um diese Ziele zu erreichen, ist es erforderlich, das aktuelle Wissen über die Verbreitung der Delinquenz, die Motivationen und das Bedingungsgefüge für Tatbegehungen, die Umstände, unter denen die Delinquenz von statten geht, und die Methoden der Prävention zu kennen. Der Artikel versucht den aktuellen Wissenstand zusammen zu fassen und daraus Schlussfolgerungen für die Schuldfähigkeitsbeurteilung, die Risikoerfassung und die Behandlung und Prävention bei identifizierten Tätern, aber auch bei jenen, die vorsorgend eine Therapie suchen, abzuleiten. </p

Behandlung und Therapieerfolg in der forensischen Psychiatrie

In dieser Ausgabe werden drei wichtige Artikel zur psychiatrischen Behandlung von Straftätern publiziert. Vor dem Hintergrund, dass die Anzahl der forensisch-psychiatrischen Behandlungsplätze für Personen, die im Kontext einer psychiatrischen Erkrankung eine Straftat begangen haben, in Deutschland seit vielen Jahren stetig anwächst, ist es sehr wichtig, dass die Entwicklung dieses Bereiches, nämlich der forensischen Psychiatrie, stetig durch wissenschaftliche Forschung überprüft und geleitet wird. Die drei Artikel in dieser Ausgabe adressieren zum einen die wissenschaftliche Situation hinsichtlich belegter Wirkfaktoren in der Behandlung von Straftätern und zum anderen Faktoren, die die Erfolgswahrscheinlichkeit einer Behandlung von suchtkranken Straftätern vorhersagen.</jats:p