Search

Abstract: For the timeframe of February 1st, 2003 until December 31st, 2005, all forensic medical experts at the Medico-Legal Center of the Institute of Legal Medicine in Hamburg, Germany, completed a standardized questionnaire for every consenting surviving violence victim (n =2733) age 14 and older. Central to the quantitative analysis of the data collected was the extraction of specific injury characteristics from the sample population. A correlation was demonstrated between injury typologies and four possible perpetrator–victim constellations, each of which was subcategorized into sexual and non-sexual assaults. [Copyright &y& Elsevier]

The aim of the study is the descriptive evaluation of the recidivism trajectories of 321 discharged patients sentenced to forensic treatment acc. to art 63 of the German penal code. The data were taken from the Essen prospective long-term study. Reoffending was aggregated in periods of three years. In the course of the average 16.5-year follow-up period ("time-at-risk"), about one third reoffended (35.2 %). Differentiated by main diagnoses, discharged patients with personality disorders in particular had high overall recidivism rates (57.8 %). For patients discharged for reasons of proportionality (n = 8; 2.5 %), recidivism occurred in 4 cases and serious offending in 3 cases. The results underscore the effectiveness of forensic psychiatric and highlight the need for additional consideration regarding appropriate treatment measures and outpatient follow-up care for personality disordered offenders., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Only few studies have reported on males as victims of intimate partner violence (IPV) so far. The aim of the present study is to analyse frequency and case characteristics of physical violence against male IPV victims examined in a clinical-forensic medical examination centre for victims of violence in Germany over an 11-year period, contributing to a better understanding of IPV in men. Male victims represented 6.2% of IPV cases (n = 167) with a median age of 40 years. Cases were reported to the police in 78.4% before medicolegal examination. In 60.5% of the cases, the perpetrator was the current partner, and 82% occurred in a domestic environment with a predominance of female offenders. In more than half of the cases (57.5%), the victims consulted the examination centre without prior healthcare utilisation. About one-third of the victims reported previous IPV (31.7%). The findings point to the relevance of men as victims of IPV, case group-specific risk factors, injury-dependent behaviour related to healthcare utilisation, the need to establish or strengthen specialised support services for affected men and underscore the importance of clinical-forensic services in documenting and assessing violence-related injuries., (© 2021. The Author(s).)

In Germany, the increasing focus on child abuse led to remarkable changes in recent years. The latest child protection laws (Kinderschutzgesetz, 2012) and the new medical guideline (AWMF S3+ Kinderschutzleitlinie, 2019) provide effective means for child protection services. Sound knowledge of the clinical manifestations, the parties involved, and the legal situation are required in order to provide effective child protection interventions. This article presents an update of the epidemiology, the legal situation, and the clinical manifestations concerning child abuse. With this information it foremost adresses medical professionals seeing children regularly without having a child protection team at disposal., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma: nein. Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma (Nicht-Sponsor der Veranstaltung): nein. Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

People who have been convicted of a crime due to a severe mental disorder and continue to be dangerous as a result of this disorder may be placed in a forensic psychiatric facility for improvement and safeguarding according to § 63 and § 64 of the German Criminal Code (StGB). In Germany, approximately 9000 patients are treated in clinics for forensic psychiatry and psychotherapy on the basis of § 63 of the StGB and in withdrawal centers on the basis of § 64 StGB. The laws for treatment of patients in forensic commitment are passed by the individual States, with the result that even the basic conditions differ in the individual States. While minimum requirements have already been published for the preparation of expert opinions on liability and legal prognosis, consensus standards for the treatment in forensic psychiatry have not yet been published. Against this background, in 2014 the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) commissioned an interdisciplinary task force to develop professional standards for treatment in forensic psychiatry. Legal, ethical, structural, therapeutic and prognostic standards for forensic psychiatric treatment should be described according to the current state of science. After 3 years of work the results of the interdisciplinary working group were presented in early 2017 and approved by the board of the DGPPN. The standards for the treatment in the forensic psychiatric commitment aim to initiate a discussion in order to standardize the treatment conditions and to establish evidence-based recommendations.

Background: The quality and success of the aftercare treatment of forensic patients (§ 63 StGB, Penal Code) are not only of concern to therapists and law courts dealing with the question of potentially dangerous behavior; apart from politicians and the general public it is also a matter of interest for workers in general and community psychiatry., Methods: In an evaluation of forensic patients who were discharged from confinement (§§ 67d 2, 6 and 67b StGB) into aftercare treatment between 2002 and 2006 in North Rhine-Westphalia, it was possible to collect data on recidivism from a total of 225 patients after an average follow-up period of 4.4 years. Apart from gathering statistics concerning case history, diagnosis, offence committed and resulting confinement, a dynamic analysis of how they coped in differing day to day situations was carried out with 115 of the discharged patients., Results: The frequency of offence recidivism by patients who were professionally accompanied throughout the aftercare period was significantly lower in comparison to earlier studies (without specialist supervision), particularly the number of sexual offences and violent crimes (7 from 225 - 3.1 %) were noticeably reduced. By comparing patients who reoffended with those showing socially acceptable behavior it was possible to determine specific features of protection and risk characteristics., Conclusions: Low offence recidivism indicated a high degree of aftercare effectiveness but there is room for improvement and further development in the existing system. The postdischarge prognosis factors and the typical pitfalls found in the study should be adequately taken into account in order to improve risk management in the aftercare setting and therefore subsequently ameliorate the chances of discharge for long neglected problematic patient groups, in particular patients with personality disorders involved in sexual offences.

Richard Strauß is one of the most important composers of the first half of the 20th century. In this article, his life is represented with special emphasis on the points of contact with urology and on the field of conflict of the time. We give a detailed description of the composer's urological illness, which finally lead to his death. The last works of the master, composed at the beginning and during his last illness, are appreciated as touching creations of his parting. Finally, we compare the treatment of the prominent patient with the contemporary level of urology.

A qualitative interview based study on ways of addressing and managing domestic violence (DV) by general practitioners (GPs) is presented. Problem centred semi-structured topic-guided interviews were conducted with 10 male and nine female GPs. Transcribed passages were analysed with the deductive approach of qualitative content analysis. Female doctors gave broader definitions of DV. Addressing of DV by a patient was perceived as a demand to act by all doctors. Documentation of injuries was considered to be important. Time constraints, feelings of being ashamed and helpless were described as barriers in addressing DV. Female doctors reported being anxious about losing their professional distance in cases of female victims. While female participants tend to take an 'acting' role in managing cases of DV by being responsible for treatment and finding a solution in collaboration with the patient, male doctors preferred an 'organising' role, assisting patients finding further help. Definitions of DV and differences in addressing the issue seemed to be strongly affected by personal professional experience. Definitions of DV, personal barriers in addressing the subject and understanding of the own role in management and treatment of DV cases differed between male and female doctors. Pre-existing definitions of DV, personal experience and gender aspects have to be taken into account when planning educational programmes for GPs on the issue of DV., (Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Sexual violence is a global problem that particularly affects women and children. A retrospective analysis of 390 clinical-forensic examinations and 120 autopsies regarding injuries of the female genitalia in cases of sexual violence was performed. In the majority of cases no injuries of the female genitalia were found. Autopsy cases showed significantly more (and more serious) injuries of the genitalia than clinical forensic examinations (43 % vs. 25 %; p = 0.0004). Predominantly found were injuries of the external anogenital area, mostly tears or soft tissue lesions. In the current literature, data regarding the rate of injuries in victims of sexual violence vary strongly and their comparability is limited. Regarding the reconstruction of an offence, a forensic examination with an appropriate documentation of the injuries is evidently crucial.

Up to 22 % of all child maltreatment cases involve non-accidental burns or scalds. In the time period of 2000 until 2007, 20 children with non-accidental burns and scalds in conjunction with other mechanisms of injury were examined at children's hospitals in Hamburg and at the Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, by experts in forensic medicine. The fact that these children presented with additional injuries due to blunt and sharp force and sometimes had signs of neglect emphasize the urgent need for a multidisciplinary cooperation between pediatricians and forensic medical experts to ensure the early identification and prevention of child maltreatment. A new approach for Germany, enforcing mandatory child well-being examinations is discussed.

The aim of our study was to determine the development of the number of patients with schizophrenia in detention (section 63 German Penal Code) in North Rhine-Westphalia and the characterization of these patients. Patients with schizophrenia are examined, by using a standardized questionnaire answered by the attending psychiatrist or psychologist (n = 531). During the last 12 years the number of patients with schizophrenia in forensic-psychiatric hospitals has increased three times, whereas the number of patients with other diagnoses heightened only twofold. The patients with schizophrenia showed high rates of psychiatric comorbidities (substance disorders 73.9 %, personality disorders 17.2 %), previous inpatient treatments (78.3 % with a mean of 7.5 stays) and previous convictions (63.4 %). Almost half of these convictions (46.6 %) were violent offences (e. g. assault, homicide). Possible explanations for this development are discussed.

During a three year period, 418 victims of intimate partner violence (IPV) were examined and their injuries documented at the Center for Victims of Violence (CVV) in Hamburg, Germany. All victims were questioned if their acute injuries were attributable to recurring acts of violence by the same intimate partner. The victims' experiences with recurring IPV were analyzed and associated risk factors as well as findings of acute physical injuries were integrated into the assesment. Overall, women were significantly more often victims of recurring episodes of IPV than men. In 35.4% of cases, victims of recurring IPV sustained injuries to three or more body regions. However, women who were victimized during a single act of violence, presented with the same distribution of injuries in only 21.1% of cases (p = 0.01). The results emphasize the fact that IPV often manifests itself in a spiraling escalation of physical violence. Furthermore, blunt force trauma to the head was diagnosed significantly more often (p = 0.05). The risk of sustaining a head injury was equally high for women who experienced a first-time violent episode by their ex-partner as it was for married women or women living in a non-marital partnership during recurring episodes of IPV. In an effort to reduce the increased risk for victims of IPV, health care personnel are highly encouraged to partake in forensic medicine based continuing education. This preventative measure may prepare clinicians to recognize IPV earlier as well as to treat and advise clients appropriately.

The prediction of dangerousness in mentally disordered offenders is still as well complex as insufficiently empirically proven. So far more or less valid criteria for predicting recidivism have been determined concerning historical and clinical aspects. Whereas biological, neurological and neuropsychological variables that could be of importance for the development of chronic delinquent behavior have mostly been neglected. This article deals with the relevance of neurological soft signs (NSS) for the prediction of dangerousness in mentally ill offenders as one possible factor in a multidimensional model. 155 patients were examined after a minimum time at risk of 2 years (mean 4 years). The results showed that on the one hand there is no relevant and valid connection between neurological soft signs and recidivism for the general heterogeneous group of forensic patients. On the other hand similar results arose for the subgroup of patients with a personality disorder without intellectual deficits as for the homogeneous group of offenders in prisons. Therefore a significant meaning of NSS for certain subgroups can be presumed.

Background: The assessment of recidivism in sexual offenders is an urgent topic for forensic psychiatry in Germany. The call for useful predictive measures is therefore getting louder., Aims: The present study analyses which criteria are employed by therapists in forensic hospitals to assess the dangerousness of sexual offenders. Of particular interest is whether the criteria listed in presently known prediction scores as decisive are actually used in decision-making in current forensic psychiatric practice., Method: Data are collected in a prospective prediction study funded by the German Research Association., Results: The results reveal that therapists employ mainly clinical and less historical criteria, thus indicating substantial differences from currently known prediction scores and results of other studies., Conclusions: That therapists base their prediction of dangerousness primarily on clinical variables reveals a substantial error that has to be remedied. Further research on the extent of relevance of clinical variables is needed.

The prediction of dangerousness in mentally disordered offenders -- and here mainly the issue of safety -- is still of primary interest for forensic experts and the public. The effectiveness of treatment and therefore of the whole German forensic system is generally measured by recidivism rates of this clientele. This article presents topical recidivism rates of 255 mentally ill offenders after a minimum time at risk of 2 years (mean 4 years). Data are collected in the Essener prospective multicenter study funded by the German research association which began in 1997 and in which 23 forensic hospitals in Germany took part. Main objective of the study is the determination of valid criteria for predicting recidivism of mentally disordered offenders. Currently the rates for general recidivism are 21.6 % and for severe reoffences 7.5 % which are in comparison to other recent studies relatively low.

This article presents first results of a prospective prediction study with participation of twenty-three forensic institutions from seven states of FRG. Main objective of this study is the determination of valid criteria for predicting recidivism of mentally disordered offenders. This evaluation (n = 188) investigates which patients are presently released from forensic institutions. In comparison to previous studies the releases per annum have decreased significantly. In the last two years there has been an increase in release of schizophrenic patients and a decrease in release of patients with a personality disorder and sexual offenders. In addition it has been analyzed which criteria therapists use to predict dangerousness from a clinical point of view.

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.