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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.)

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.

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.