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In Germany, offenders with addiction problems may be sentenced to treatment in forensic psychiatric hospitals. A considerable share of patients, in some hospitals more than 40 percent, is returned to prison. The paper presents findings of a long-term evaluation study., Method: 16 hospitals participated and provided data on patients' background and course of treatment. The Federal Office of Justice reported on patients' conduct after discharge in terms of new entries in the federal criminal register (FCR). A matched sample of controls - prisoners with addiction problems - was recruited referring to a schema of criminological characteristics., Findings: The former patients' social adjustment was significantly better than the former prisoners': the total risk reduction (less new FCR-entries) amounted over 20 percent (effect-size bcohen > 0.45). This comparison included all patients returned to prison., Discussion: The treatments reveal - in total - a significant and substantial effect in favor of patients' later adjustment, though a too large subgroup of patients is returned to prison., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Among violent offenders with schizophrenia, there are 2 sub-groups, one with and one without, conduct disorder (CD) and antisocial personality disorder (ASPD), who differ as to treatment response and alterations of brain structure. The present study aimed to determine whether the 2 groups also differ in Theory of Mind and neural activations subsuming this task. Five groups of men were compared: 3 groups of violent offenders-schizophrenia plus CD/ASPD, schizophrenia with no history of antisocial behavior prior to illness onset, and CD/ASPD with no severe mental illness-and 2 groups of non-offenders, one with schizophrenia and one without (H). Participants completed diagnostic interviews, the Psychopathy Checklist Screening Version Interview, the Interpersonal Reactivity Index, authorized access to clinical and criminal files, and underwent functional magnetic resonance imaging while completing an adapted version of the Reading-the-Mind-in-the-Eyes Task (RMET). Relative to H, nonviolent and violent men with schizophrenia and not CD/ASPD performed more poorly on the RMET, while violent offenders with CD/ASPD, both those with and without schizophrenia, performed similarly. The 2 groups of violent offenders with CD/ASPD, both those with and without schizophrenia, relative to the other groups, displayed higher levels of activation in a network of prefrontal and temporal-parietal regions and reduced activation in the amygdala. Relative to men without CD/ASPD, both groups of violent offenders with CD/ASPD displayed a distinct pattern of neural responses during emotional/mental state attribution pointing to distinct and comparatively successful processing of social information., (© The Author 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Results of meta-analyses suggested subtle deficits in cognitive control among antisocial individuals. Because almost all studies focused on children with conduct problems or adult psychopaths, however, little is known about cognitive control mechanisms among the majority of persistent violent offenders who present an antisocial personality disorder (ASPD). The present study aimed to determine whether offenders with ASPD, relative to non-offenders, display dysfunction in the neural mechanisms underlying cognitive control and to assess the extent to which these dysfunctions are associated with psychopathic traits and trait impulsivity. Participants comprised 21 violent offenders and 23 non-offenders who underwent event-related functional magnetic resonance imaging while performing a non-verbal Stroop task. The offenders, relative to the non-offenders, exhibited reduced response time interference and a different pattern of conflict- and error-related activity in brain areas involved in cognitive control, attention, language, and emotion processing, that is, the anterior cingulate, dorsolateral prefrontal, superior temporal and postcentral cortices, putamen, thalamus, and amygdala. Moreover, between-group differences in behavioural and neural responses revealed associations with core features of psychopathy and attentional impulsivity. Thus, the results of the present study confirmed the hypothesis that offenders with ASPD display alterations in the neural mechanisms underlying cognitive control and that those alterations relate, at least in part, to personality characteristics., (Copyright © 2014. Published by Elsevier Ireland Ltd.)

Conduct disorder (CD) prior to age 15 is a precursor of schizophrenia in a minority of cases and is associated with violent behavior through adulthood, after taking account of substance misuse. The present study used structural magnetic imaging to examine gray matter (GM) volumes among 27 men with schizophrenia preceded by CD (SZ+CD), 23 men with schizophrenia but without CD (SZ-CD), 27 men with CD only (CD), and 25 healthy (H) men. The groups with schizophrenia were similar in terms of age of onset and duration of illness, levels of psychotic symptoms, and medication. The 2 groups with CD were similar as to number of CD symptoms, lifelong aggressive behavior, and number of criminal convictions. Men with SZ+CD, relative to those with SZ-CD, displayed (1) increased GM volumes in the hypothalamus, the left putamen, the right cuneus/precuneus, and the right inferior parietal cortex after controlling for age, alcohol, and drug misuse and (2) decreased GM volumes in the inferior frontal region. Men with SZ+CD (relative to the SZ-CD group) and CD (relative to the H group) displayed increased GM volumes of the hypothalamus and the inferior and superior parietal lobes, which were not associated with substance misuse. Aggressive behavior, both prior to age 15 and lifetime tendency, was positively correlated with the GM volume of the hypothalamus. Thus, among males, SZ+CD represents a distinct subtype of schizophrenia. Although differences in behavior emerge in childhood and remain stable through adulthood, further research is needed to determine whether the differences in GM volumes result from abnormal neural development distinct from that of other males developing schizophrenia.

The impact of alcoholism (ALC) or alcohol dependence on the neural mechanisms underlying cognitive and affective empathy (i.e. the different routes to understanding other people's minds) in schizophrenic patients and non-schizophrenic subjects is still poorly understood. We therefore aimed at determining the extent to which the ability to infer other people's mental states and underlying neural mechanisms were affected by ALC. We examined 48 men, who suffered either from ALC, schizophrenia, both disorders or none of these disorders, using functional magnetic resonance imaging while performing on a mind reading task that involves both cognitive and affective aspects of empathy. Using voxel-based morphometry, we additionally examined whether between-group differences in functional activity were associated with deficits in brain structural integrity. During mental state attribution, all clinical groups as compared with healthy controls exhibited poor performance as well as reduced right-hemispheric insular function with the highest error rate and insular dysfunction seen in the schizophrenic patients without ALC. Accordingly, both behavioral performance and insular functioning revealed schizophrenia × ALC interaction effects. In addition, schizophrenic patients relative to non-schizophrenic subjects (regardless of ALC) exhibited deficits in structural integrity and task-related recruitment of the left ventrolateral prefrontal cortex (vlPFC). Our data suggest that ALC-related impairment in the ability to infer other people's mental states is limited to insular dysfunction and thus deficits in affective empathy. By contrast, mentalizing in schizophrenia (regardless of ALC) may be associated with insular dysfunction as well as a combination of structural and functional deficits in the left vlPFC., (© 2012 The Authors, Addiction Biology © 2012 Society for the Study of Addiction.)

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. Prior to admission to a forensic ward, two thirds of schizophrenic patients have been admitted to a general psychiatric institution at least once. Among other factors, forensic admission is seen as a consequence of insufficient pretreatment in general psychiatry. This study aims to identify differences regarding the history of treatment of forensic and general psychiatric patients diagnosed with schizophrenia., Method: The matched samples include 72 male patients from forensic wards and 72 male patients from general psychiatry diagnosed with schizophrenia. The history of psychiatric treatment was reconstructed by interviewing the patients as well as the outpatient psychiatrists and by analyzing these patients' medical records., Results: Both groups showed similar risk factors, however, forensic patients had a higher number of previous convictions and were convicted more often for violent offences. Furthermore, the data indicate that forensic patients are less integrated into psychiatric care and showed a lower rate of treatment compliance prior to admission to a forensic ward., Conclusions: The results provide support for the arrangement of an intensive outpatient aftercare, especially for schizophrenic patients with comorbid substance abuse disorders and previous convictions for violent offences.

Context: Studies aimed at identifying structural brain alterations associated with persistent violent behavior or psychopathy have not adequately accounted for a lifetime history of substance misuse. Thus, alterations in gray matter (GM) volume that have been reported to be correlates of violent behavior and/or psychopathy may instead be related to lifelong substance use disorders (SUDs)., Objective: To identify alterations in GM volume associated with violent behavior and those associated with lifelong SUDs., Design: Cross-sectional study., Setting: Participants were recruited from penitentiaries, forensic hospitals, psychiatric outpatient services, and communities in Germany. Structural magnetic resonance imaging was performed at a university hospital., Participants: Four groups of men were compared: 12 men with SUDs who exhibited violent behavior (hereafter referred to as violent offenders), 12 violent offenders without SUDs, 13 men with SUDs who did not exhibit violent behavior (hereafter referred to as nonoffenders), and 14 nonoffenders without SUDs., Main Outcome Measures: Voxel-based morphometry was used to analyze high-resolution magnetic resonance imaging scans. Assessments of mental disorders, psychopathy (using the Psychopathy Checklist-Screening Version), aggressive behavior, and impulsivity were conducted by trained clinicians., Results: Compared with nonoffenders, violent offenders presented with a larger GM volume in the amygdala bilaterally, the left nucleus accumbens, and the right caudate head and with less GM volume in the left insula. Men with SUDs exhibited a smaller GM volume in the orbitofrontal cortex, ventromedial prefrontal cortex, and premotor cortex than did men without SUDs. Regression analyses indicated that the alterations in GM volume that distinguished the violent offenders from nonoffenders were associated with psychopathy scores and scores for lifelong aggressive behavior. The GM volumes of the orbitofrontal cortex and prefrontal cortex that distinguished the men with SUDs from the men without SUDs were correlated with scores for response inhibition., Conclusions: These findings suggest that a greater GM volume in the mesolimbic reward system may be associated with violent behavior and that reduced GM volumes in the prefrontal cortex, orbitofrontal cortex, and premotor area characterize men with SUDs.

Despite a high prevalence of schizophrenia patients with comorbid substance abuse, little is known about possible impacts on the brain. Hence, our goal was to determine whether addicted and non-addicted schizophrenic patients suffer from different brain deficits. We were especially interested to determine if grey matter volumes were affected by impulsivity. We hypothesized that (comorbid) substance abuse would be associated with enhanced impulsivity and that this enhanced impulsivity would be related to grey matter volume deficits in prefrontal areas. We employed a voxel-based morphometry approach as well as neuropsychological assessment of executive functions and trait impulsivity in 51 participants (age range 23-55). The schizophrenia group comprised 24 patients (12 patients with paranoid schizophrenia and 12 with additional comorbid substance use disorders). The comparison group comprised 27 non-schizophrenic individuals, matched by age and education (14 healthy individuals and 13 patients with substance use disorders). Total grey matter volume deficits were found in all patient groups as compared with healthy controls but were largest (~8%) in both addicted groups. While grey matter volume losses in lateral orbitofrontal and temporal regions were affected by schizophrenia, volume decreases of the medial orbitofrontal, anterior cingulate and frontopolar cortex were associated with addiction. Compared with non-addicted schizophrenics, comorbid patients showed significant volume decreases in anterior cingulate, frontopolar and superior parietal regions. Additionally, they showed an increased non-planning impulsivity that was negatively related to grey matter volumes in the same regions, except for parietal ones. The present study indicates severe grey matter volume and functional executive deficits in schizophrenia, which were only partially exacerbated by comorbid addiction. However, the relationship between non-planning impulsivity and anterior cingulate and frontopolar grey matter volumes points to a specific structure-function relationship that seems to be impaired in schizophrenia-addiction comorbidity.

Although the neuronal mechanisms underlying normal sexual motivation and function have recently been examined, the alterations in brain function in deviant sexual behaviours such as paedophilia are largely unknown. The objective of this study was to identify paedophilia-specific functional networks implicated in sexual arousal. Therefore a consecutive sample of eight paedophile forensic inpatients, exclusively attracted to females, and 12 healthy age-matched heterosexual control participants from a comparable socioeconomic stratum participated in a visual sexual stimulation procedure during functional magnetic resonance imaging. The visual stimuli were sexually stimulating photographs and emotionally neutral photographs. Immediately after the imaging session subjective responses pertaining to sexual desire were recorded. Principally, the brain response of heterosexual paedophiles to heteropaedophilic stimuli was comparable to that of heterosexual males to heterosexual stimuli, including different limbic structures (amygdala, cingulate gyrus, and hippocampus), the substantia nigra, caudate nucleus, as well as the anterior cingulate cortex, different thalamic nuclei, and associative cortices. However, responses to visual sexual stimulation were found in the orbitofrontal cortex in healthy heterosexual males, but not in paedophiles, in whom abnormal activity in the dorsolateral prefrontal cortex was observed. Thus, in line with clinical observations and neuropsychological studies, it seems that central processing of sexual stimuli in heterosexual paedophiles may be altered by a disturbance in the prefrontal networks, which, as has already been hypothesized, may be associated with stimulus-controlled behaviours, such as sexual compulsive behaviours. Moreover, these findings may suggest a dysfunction (in the functional and effective connectivity) at the cognitive stage of sexual arousal processing.

Objective: The neurobiological mechanisms of deviant sexual preferences such as pedophilia are largely unknown. The objective of this study was to analyze whether brain activation patterns of homosexual pedophiles differed from those of a nonpedophile homosexual control group during visual sexual stimulation., Method: A consecutive sample of 11 pedophile forensic inpatients exclusively attracted to boys and 12 age-matched homosexual control participants from a comparable socioeconomic stratum underwent functional magnetic resonance imaging during a visual sexual stimulation procedure that used sexually stimulating and emotionally neutral photographs. Sexual arousal was assessed according to a subjective rating scale., Results: In contrast to sexually neutral pictures, in both groups sexually arousing pictures having both homosexual and pedophile content activated brain areas known to be involved in processing visual stimuli containing emotional content, including the occipitotemporal and prefrontal cortices. However, during presentation of the respective sexual stimuli, the thalamus, globus pallidus and striatum, which correspond to the key areas of the brain involved in sexual arousal and behaviour, showed significant activation in pedophiles, but not in control subjects., Conclusions: Central processing of visual sexual stimuli in homosexual pedophiles seems to be comparable to that in nonpedophile control subjects. However, compared with homosexual control subjects, activation patterns in pedophiles refer more strongly to subcortical regions, which have previously been discussed in the context of processing reward signals and also play an important role in addictive and stimulus-controlled behaviour. Thus future studies should further elucidate the specificity of these brain regions for the processing of sexual stimuli in pedophilia and should address the generally weaker activation pattern in homosexual men.

Even though previous neuropsychological studies and clinical case reports have suggested an association between pedophilia and frontocortical dysfunction, our knowledge about the neurobiological mechanisms underlying pedophilia is still fragmentary. Specifically, the brain morphology of such disorders has not yet been investigated using MR imaging techniques. Whole brain structural T1-weighted MR images from 18 pedophile patients (9 attracted to males, 9 attracted to females) and 24 healthy age-matched control subjects (12 hetero- and 12 homosexual) from a comparable socioeconomic stratum were processed by using optimized automated voxel-based morphometry within multiple linear regression analyses. Compared to the homosexual and heterosexual control subjects, pedophiles showed decreased gray matter volume in the ventral striatum (also extending into the nucl. accumbens), the orbitofrontal cortex and the cerebellum. These observations further indicate an association between frontostriatal morphometric abnormalities and pedophilia. In this respect these findings may support the hypothesis that there is a shared etiopathological mechanism in all obsessive-compulsive spectrum disorders.

The neuroendocrine response to sexual activity in humans is characterized by a pronounced orgasm-dependent increase of plasma levels of prolactin. In contrast to the well-known inhibitory effects of chronic hyperprolactinemia on sexual drive and function, the impact of acute prolactin alterations on human sexual physiology is unknown. Therefore, this study was designed to investigate the effects of acute manipulation of plasma prolactin on sexual behavior. Ten healthy males participated in a single-blind, placebo-controlled, balanced cross-over design. Prolactin levels were pharmacologically increased to high levels (protirelin, 50 micro g i.v.) or reduced to low physiological concentrations (cabergoline, 0.5 mg p.o.). Sexual arousal and orgasm were then induced by an erotic film and masturbation. In addition to continuous neuroendocrine and cardiovascular recordings, the quality and intensity of the acute sexual drive, arousal, orgasm and refractory period were assessed by extensive psychometric measures. Administration of cabergoline decreased prolactin levels and significantly enhanced all parameters of sexual drive (P<0.05), function (P<0.01) and positive perception of the refractory period (P<0.01). Administration of protirelin increased prolactin concentrations and produced small, but not significant reductions of sexual parameters. The sexual effects observed from cabergoline were completely abrogated by coadministration of protirelin. Although different pharmacological sites of action of prolactin-altering drugs have to be considered, these data demonstrate that acute changes in prolactin plasma levels may be one factor modulating sexual drive and function. Therefore, besides a neuroendocrine reproductive reflex, a post-orgasmic prolactin increase may represent one factor modulating central nervous system centers controlling sexual drive and behavior. These findings may offer a new pharmacological approach for the treatment of sexual disorders.

Background: Several pharmacotherapeutic approaches have confirmed the influence of neuroendocrine parameters on sexual desire, function, and fantasies in men; however, the relevance of acute neuroendocrine changes in mediating heightened sexual drive remains unknown. We recently demonstrated that plasma prolactin substantially increases following orgasm in healthy men, suggesting a feedback mechanism for peripheral prolactin in the control of acute sexual arousal. Because prolactin appears to play a regulatory role in acute sexual drive, we initiated this study to see whether sexual offenders with a high sexual drive have a different neuroendocrine response to sexual arousal. This study compares the prolactin response to orgasm of sexual offenders with high sexual drive and that of healthy subjects with average sexual drive., Methods: From a subject pool of 150 inpatients held because of sexual crimes, we recruited 10 volunteers, based on their high sexual drive according to an intensive, semistructured clinical interview. We defined sexual drive by a short refractory period and strong sexualization, or a high frequency of sexual stimulation. We analyzed the acute psychoneuroendocrine response to sexual arousal and orgasm continuously before, during, and after masturbation-induced orgasm in patients and control subjects., Results: Sexual offenders demonstrated higher sexual desire (P < 0.001) and function (P < 0.001) and a more positively perceived refractory period (P < 0.05). Both groups displayed a prolonged, significant increase in prolactin plasma levels after orgasm (P < 0.001). Sexual offenders did not differ from control subjects in neuroendocrine response to sexual arousal and orgasm., Conclusions: These data demonstrate that sexual offenders with a high sexual drive do not differ from control subjects in the postorgasmic neuroendocrine response, particularly in prolactin release. This study confirms that factors other than peripheral hormones influence deviant sexual behaviour.

In Germany, due to an increasing number of "hospital order sentences," the capacities of forensic hospitals are exhausted. In the late 1990s,general psychiatric hospitals admitted a remarkable number of mentally disturbed offenders. In this study,data of 140 patients treated in general psychiatric hospitals in the German lower Rhine region are presented. These patients clearly differ from those treated in forensic hospitals. Approximately 60% of them suffer from schizophrenic psychosis. Only a few reveal a long antisocial background, a severe personality disorder, or a sexual offence as an index crime. Though the staff in the general psychiatric units often complain about the circumstances of patients' admittance to the hospitals, in about half of the cases they do not agree with a transferring of their patients to a forensic hospital. The results of this study are discussed in regard to general questions of organizing forensic psychiatric treatment.

In several studies we have recently demonstrated that orgasm induces prolactin secretion in healthy males and females. This suggests that prolactin may form a feedback regulator of the refractory period following orgasm. To examine this position we investigated the prolactin response of a healthy multi-orgasmic male subject. Blood was drawn continuously during masturbation-induced orgasm. The prolactin response of the case-subject was compared with that of nine healthy adult men with a normal refractory period. The case-subject showed no prolactin response to three orgasms. Data from this multi-orgasmic subject support the hypothesized role of plasma prolactin in contributing to sexual-satiation mechanisms.

The psychoneuroendocrine responses to sexual arousal have not been clearly established in humans. However, we have demonstrated previously that masturbation-induced orgasm stimulates cardiovascular activity and induces increases in catecholamines and prolactin in blood of both males and females. We presently investigated the role of orgasm in producing these effects. Therefore, in this study parallel analysis of prolactin, adrenaline, noradrenaline, and cortisol concentrations, together with cardiovascular variables of systolic/diastolic blood pressure and heart rate were undertaken during film-induced sexual arousal in nine healthy adult men and nine healthy adult women. Blood was drawn continuously via an indwelling cannula and connected tubing system passed through a mini-pump. In parallel, the cardiovascular parameters were recorded continuously via a computerised finger-cuff sensor. Subjective sexual arousal increased significantly in both men and women during the erotic film, with sexual arousal eliciting an increase in blood pressure in both males and females, and plasma noradrenaline in females only. In contrast, adrenaline, cortisol and prolactin levels were unaffected by sexual arousal. These data further consolidate the role of sympathetic activation in sexual arousal processes. Furthermore, they demonstrate that increases in plasma prolactin during sexual stimulation are orgasm-dependent, suggesting that prolactin may regulate a negative-feedback sexual-satiation mechanism.

In comparison to the middle of the 80th, the group of patients who are addicted to legal and illegal drugs and are treated in special forensic hospitals, has significantly changed. Polyvalent dependence is the predominant diagnosis. There has been an increase in violence of index delinquency. In the middle of the 80th, most of the patients were committed because of criminal offences against the BtMG (German law to sentence drug abusers). Today, robbery turns out to be the "classical" index delinquency. The problem of defining "false admission" to a forensic hospital has to be considered in a multidimensional way.

In a cross-sectional study we analysed the present situation of mentally disordered offenders treated in forensic hospitals of North Rhine-Westphalia under section 63 StGB-in comparison with the first block sampling in 1984. One of the important findings was that there has been an increase in violence in respect of the index delinquency as well as the criminal record. Those patients who were again committed to a forensic hospital showed more violent criminal offences too. The average duration of hospitalisation has been reduced from 6.1 to 4.8 years.

The compilation and the reliability-based evaluation of the questionnaire including potentially prognosis-relevant clinical criteria for the release of male patients from rehabilitation and security measure (section 63 German Criminal Code) are presented. The restriction to clinical (rather than social statistical) criteria results in a concentration of the criminal aspects of treatment and/or therapy. The open and, more importantly, the "unconscious" focuses of forensic clinical action become transparent. However, the prognostic constructs of clinicians prove to be somewhat lacking in criteria and rather inconsistent. Until it is validated as a prognostic instrument and integrated in a multidimensional inventory of prognoses, this questionnaire can contribute towards conceptual transparency and help create a better link between treatment and release criteria.

The article presents part of the results of a Federal German investigation of psychiatric confinement in cases of delinquency in accordance with German law. Among the 674 inmates whose case history could be included in the investigation, there was a predominance of alcohol dependence in two-thirds of them. Confinement occurred mostly only after addiction and delinquencies had been going on for a long time. In more than one-half of the patients no attempt had previously been made to treat and manage their alcohol addiction. Every fourth patient is confined without first consulting a psychiatric expert. Basing on sociobiographic characteristics it is possible to form two contrasting groups of patients: a smaller group where addiction has set in early and delinquency at a late stage, and a larger one with early onset of delinquency developing parallel to the abuse of alcohol. This leads to conclusions with regard to the development of specific treatment guidelines.

The purpose of this study was to investigate the difference between offender female patients (OFS) and non-offender female patients (NOFS) with schizophrenia spectrum disorder (SSD).The patients in this study were admitted to the university psychiatry in Zurich Switzerland between 1982 and 2016. Demography, psychopathology, comorbidity, and treatment differences were analyzed using binary statistics to compare 31 OFS and 29 matching NOFS with SSD. The Fisher's exact test was used for categorical data variables in small size samples and the Mann-Whitney-U-Test for nonparametric test variables, adjusted with the Benjamini and Hochberg method.The results indicate that the NOFS were cognitively more impaired, they were more likely to have had antipsychotic drugs prescribed (NOFS; 100%, OFS: 71%, OR 1.41, 95% CI 1.13-1.77, p=0.022) and their medication compliance was higher (NOFS: 84.6%, OFS: 4.5%, OR 0.09, 95% CI 0.00-0.08, p=0.000). In contrast, the OFS had completed compulsory school less often and the were observed to be more often homeless and socially isolated (OFS: 72.4%, NOFS: 34.6%, OR 4.96, 95% CI 1.58-15.6, p=0.026), self-disorders (OFS: 51.6%, NOFS: 11.1%, OR 8.53, 95% CI 2.12-34.32, p=0.011), delusions (OFS: 96.8%, NOFS: 63%, OR 17.65, 95% CI 2.08-149.99, p=0.014) and substance use disorder (51.6%, OR 0.27, 95% CI 0.09-0.85, p=0.039). Clinicians treating female offender patients with SSD should focus more on the treatment for substance use disorder, medication and early recognition of the illness for preventative purposes., (© 2024. The Author(s).)

Rationale: Cabergoline (CAB) is an ergot derivative typically prescribed for the treatment of hyperprolactinemia. It suppresses the release of prolactin through agonist actions on dopamine (DA) D2 receptors; however, it possesses binding affinity for other DA and 5-HT receptors. Side effects that exacerbate valvular heart disease can occur with high doses., Objective: The present study examined the acute, subchronic, and chronic dose-response effects of CAB and a derivative dimethylcabergoline (DMC) which acts as an antagonist instead of agonist at 5-HT 2B receptors, on appetitive and consummatory sexual behaviors of male rats., Methods: CAB (0, 0.03, 0.15, or 0.3 mg/kg/ml) was administered daily to sexually experienced male rats (N = 10/dose) by oral gavage for a total of 68 days. Sexual behavior was tested every 4 days during this period for a total of 16 trials. On the 17 th trial, rats were administered their dose of CAB, and 4 h after were overdosed with sodium pentobarbital, perfused intracardially, and their brains processed for Fos immunohistochemistry. DMC (0, 0.03, 0.15, 0.3 mg/kg/ml) was administered daily to sexually experienced male rats (N = 10/dose) by oral gavage for a total of 36 days. Sexual behavior was tested every 4 days for a total of 9 trials., Results: CAB increased anticipatory level changes, intromissions, and ejaculations significantly across all timepoints, with the medium and high doses being most potent. The medium and high doses also increased Fos protein significantly within the medial preoptic area, whereas in the nucleus accumbens shell, the low and medium doses decreased Fos protein but the high dose increased it significantly from control. Similar to CAB, the medium and high doses of DMC increased the number of ejaculations significantly. Rats in all drug dose groups appeared healthy for the duration of the experiments., Conclusions: Both CAB and DMC facilitate ejaculations, and CAB further facilitates measures of anticipatory sexual motivation and intromissions. These data suggest that both could be used as treatments for sexual arousal disorders and ejaculation/orgasm disorders with little or no untoward side effects at low doses., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This study sought to examine neuropsychological functioning in men with pedophilic disorder (PD), in order to assess whether findings from prior neuropsychological studies are replicated in a diverse sample including men with non-contact sexual offenses. It was hypothesized that when non-contact offenders are included in the study, a slowed processing speed will emerge as the only finding unique to men with PD. A comprehensive neuropsychological battery was administered to 58 men convicted of a sexual offense, 20 of whom were classified as having PD. The sample included men with contact sexual offenses (n = 33), non-contact sexual offenses (n = 5), and child sexual abuse material (CSAM) offenses (n = 20). Test performance was compared by PD status. Participants with PD performed significantly better on verbal memory and visual discrimination than those without PD. Men with PD made more errors on a set-shifting task but no significant differences were seen in domains of attention, intellectual functioning, visual learning and memory, visuospatial ability, or language ability. Effect sizes were generally small, although some medium effects were seen (visual discrimination and verbal learning and memory). Scores in both groups (with and without PD) were generally in the average range across tasks. Within the subgroup of CSAM offenders, minimal differences emerged between those with and without PD, although those with PD were slower on visuomotor set-shifting but made fewer errors (d = - 0.89). CSAM offenders with PD were in the high average range on many tasks of intellectual functioning; however, a potential trend was identified such that CSAM offenders without PD had lower scores on a task of verbal learning and memory, with medium effect sizes observed. As few differences in neuropsychological functioning emerged when comparing offenders with and without PD, differences demonstrated in prior research may be better attributed to contact offending status rather than sexual interest., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: There has been a substantial change in the law on the provision of secure health services for offender-patients in Italy, a country currently with the lowest general psychiatry bed availability per head of the population in Europe, raising questions about possible differences in offender-patient admissions between European countries., Aims: In this multicentre case-control study, our aim was to compare the socio-demographic, clinical and criminological characteristics of a sample of Italian forensic in-patients with schizophrenia or similar psychosis with patients in a similar diagnostic range in specialist in-patient services elsewhere in Europe., Methods: Secure hospital unit in-patients with psychosis were recruited across five European countries (Italy, Austria, Germany, Poland and England). Consenting patients were interviewed by researchers and assessed using a multidimensional standardised process. Within country similarities between Austria, Germany, Poland and England were confirmed., Results: Overall, 39 Italian participants had had fewer years of education than the 182 patients in the other countries and were less likely to have ever had skilled or professional employment. The Italian patients had been older at first contact with any mental health services than the other Europeans. Diagnosed comorbidity rates were similar, but the Italian group reported higher levels of disability. Although the other European forensic patients were more likely to be undergoing treatment at the time of their index offence, they were also more likely to have been poorly compliant with treatment. The rate of suicide-related behaviours was significantly lower among the Italian patients than among the others., Conclusions: Notwithstanding similar diagnoses, important differences emerged between patients in Italian forensic mental health resident services and those in four other European countries, some possibly reflecting less access to earlier relevant services in Italy. Others, including lower disability ratings among the Italian patients and a lower rate of suicide-related behaviours, may indicate that the Italian reforms carry benefits. This is worthy of further evaluation., (© 2023 The Authors. Criminal Behaviour and Mental Health published by John Wiley & Sons Ltd.)

Sexual delinquency is a global problem where those with paraphilic disorders, such as paedophiles, are more likely to commit and reoffend. Androgen deprivation therapy (ADT) has been suggested as a solution. The objective of this narrative review is to present current information on its risks, benefits and limitations as a treatment for paraphilias. The importance of testosterone in sexual function, the effect of its deficiency by age or by pharmacological treatment (anti-androgens, GnRH agonists and GnRH antagonists) and the effect of testosterone replacement therapy will be reviewed. The relationship between androgens, brain, sexual behaviour and pathophysiology of paraphilic disorders will also be explored. ADT reduces sexual urges, but has adverse effects and, because its reversible nature, it does not ensure less recidivism. Likewise, the research quality of ADT drugs is limited and not enough to support their use. Child sex offenders, and not paraphilic subjects who have not committed assaults, show signs of elevated prenatal exposure to androgens and a higher methylation state of the androgen receptor gene. Sexual behaviour is regulated by subcortical (hypothalamus, brainstem and spinal cord) and cortical structures of the brain, in addition to brain circuits (dopaminergic, serotonergic). Those with paraphilic disorders show abnormalities at these levels that could relate to the risk of sexual offences. In conclusion, androgens represent a significant part of the pathophysiology of paraphilias and therefore, ADT seems promising. Nonetheless, more studies are needed to make definite conclusions about the efficacy of long-term ADT in paraphilic patients., (© 2022 Wiley-VCH GmbH.)

Background: While there is an established link between untreated psychosis and aggression, an enhanced understanding of the role of social cognition is still needed., Aims: To examine social cognitive functioning among patients in a specialist forensic mental health service who had been deemed not criminally responsible for acts of violence due to a psychotic disorder. It was hypothesised, first, that such patients would show reduced social cognitive functioning compared with healthy, nonviolent comparison participants and, second, that those who continued to be aggressive while inpatients would demonstrate significant reductions compared to the now nonaggressive group., Methods: The study samples were of 10 recently aggressive and 15 not-recently aggressive patients and 20 healthy, nonviolent comparison participants. Each completed the Toronto Empathy Questionnaire (TEQ), the Reading the Mind in the Eyes Test-Revised (RMET) and the Interpersonal Perception Task-15 (IPT-15)., Results: There was no significance between group differences on the RMET and TEQ. The patient group as a whole, however, showed significant interpersonal misperceptions, with specific misperceptions on IPT-15 deception and kinship subscales, while at the same time lacking self-awareness of their errors. Misperceptions on the IPT-15 competition subscale were unique to recently aggressive patients., Conclusions: Select aspects of reduced social cognitive functioning were found among not criminally responsible patients with psychosis who had committed violent acts and who continued to act aggressively while forensic inpatients. These findings enhance our understanding of the role of social cognition in predisposing toward violence and the potential importance of incorporating interventions which improve social cognition directly. We suggest also the potential for future research using virtual reality technologies in treatment., (© 2022 John Wiley & Sons Ltd.)

The neurodevelopmental theory of pedohebephilia states that sexual interests in children arise from early neurodevelopmental perturbations, as, for example, evidenced by increased non-right-handedness, more childhood head injuries, and reduced intelligence and height. As corroborating evidence largely rests on samples of convicted men, we conducted online surveys among German-speaking (Study 1, N = 199) and English-speaking men (Study 2, N = 632), specifically targeting community members with pedohebephilic or teleiophilic interests. Although we detected theoretically meaningful sexual interest patterns in an embedded viewing time task, we could not detect expected neurodevelopmental differences between teleiophilic and pedohebephilic men in either of the two studies. Strikingly, pedohebephilic men who reported convictions for sexual offenses emerged as shorter and less intelligent than pedohebephilic men without convictions in Study 2. While elucidating possible third variable confounds, results have to be interpreted cautiously because of the methodological problems inherent to non-matched case control designs., (© 2022. The Author(s).)

Brain mechanisms of sexual attraction toward reproductive partners develop from a systematic interrelationship between biology (nature) and learning (nurture). However, the causes of attraction toward non-reproductive partners are poorly understood. Here, we explored the role of Pavlovian learning under dopaminergic agonism on the development of sexual preference and brain activation for young male rats. During conditioning, adult sexually naïve males received either Saline (Saline-Paired) or the D2-receptor agonist quinpirole (QNP-Paired) and cohabited in contingency, or out of contingency (QNP-Unpaired) during 24 h with an almond-scented prepubertal juvenile male (PD25). Conditioning occurred every 4 days for three trials. Social and sexual responses were assessed four days after the last conditioning trial in a drug-free test, and males chose freely between a scented young male (PD37) and a novel receptive female. Four days later, males were exposed to the conditioned odor only and brain Fos-IR and serum testosterone were analyzed. Saline-Paired and QNP-Unpaired males displayed more non-contact erections (NCEs) and genital investigations for females, whereas QNP-Paired males expressed more NCEs and genital investigations for young males. In the QNP-Paired group, exposure to the young male-paired odor evoked more Fos-IR in limbic, hypothalamic and cortical areas, but no differences in serum testosterone were observed. Cohabitation with juvenile males during enhanced D2 agonism results in atypical appetitive sexual responses and a higher pattern of brain response for the young male-paired odor, with no changes in serum testosterone. We discuss the potential implications for the development of pedophilic disorder and perhaps other paraphilias., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Increased risk-taking is a central component of bipolar disorder (BIP) and is implicated in schizophrenia (SCZ). Risky behaviours, including smoking and alcohol use, are overrepresented in both disorders and associated with poor health outcomes. Positive genetic correlations are reported but an improved understanding of the shared genetic architecture between risk phenotypes and psychiatric disorders may provide insights into underlying neurobiological mechanisms. We aimed to characterise the genetic overlap between risk phenotypes and SCZ, and BIP by estimating the total number of shared variants using the bivariate causal mixture model and identifying shared genomic loci using the conjunctional false discovery rate method. Summary statistics from genome wide association studies of SCZ, BIP, risk-taking and risky behaviours were acquired (n = 82,315-466,751). Genomic loci were functionally annotated using FUMA. Of 8.6-8.7 K variants predicted to influence BIP, 6.6 K and 7.4 K were predicted to influence risk-taking and risky behaviours, respectively. Similarly, of 10.2-10.3 K variants influencing SCZ, 9.6 and 8.8 K were predicted to influence risk-taking and risky behaviours, respectively. We identified 192 loci jointly associated with SCZ and risk phenotypes and 206 associated with BIP and risk phenotypes, of which 68 were common to both risk-taking and risky behaviours and 124 were novel to SCZ or BIP. Functional annotation implicated differential expression in multiple cortical and sub-cortical regions. In conclusion, we report extensive polygenic overlap between risk phenotypes and BIP and SCZ, identify specific loci contributing to this shared risk and highlight biologically plausible mechanisms that may underlie risk-taking in severe psychiatric disorders., (© 2021. The Author(s).)

Reward processing is a fundamental human activity. The basal ganglia are recognized for their role in reward processes; however, specific roles of the different nuclei (e.g., nucleus accumbens, caudate, putamen and globus pallidus) remain unclear. Using quantitative meta-analyses we assessed whole-brain and basal ganglia specific contributions to money, erotic, and food reward processing. We analyzed data from 190 fMRI studies which reported stereotaxic coordinates of whole-brain, within-group results from healthy adult participants. Results showed concordance in overlapping and distinct cortical and sub-cortical brain regions as a function of reward type. Common to all reward types was concordance in basal ganglia nuclei, with distinct differences in hemispheric dominance and spatial extent in response to the different reward types. Food reward processing favored the right hemisphere; erotic rewards favored the right lateral globus pallidus and left caudate body. Money rewards engaged the basal ganglia bilaterally including its most anterior part, nucleus accumbens. We conclude by proposing a model of common reward processing in the basal ganglia and separate models for money, erotic, and food rewards.

Various studies have shown that women with psychopathy tend to commit crimes that are less violent than those of psychopathic men. The present study was designed to address the influence of psychopathy on the crimes committed by female offenders. A national sample of female offenders found NGRI or of diminished responsibility and at risk for criminal recidivism (OPG patients) was compared with a sample of female offenders who were convicted and imprisoned. Results of this comparison between the two groups of female offenders indicate that psychopathy is a transversal psychopathological dimension which may or may not be associated with other mental disorders. In both samples, the most commonly reported offenses among women with high PCL-R scores were minor offenses, not particularly violent, but they appear to be related to typical psychopathic features such as superficial charm, pathological lying, and manipulation., (© 2019 American Academy of Forensic Sciences.)