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Introduction: Deviant sexual interest for children (pedophilia, hebephilia) is associated with a higher risk of sexual offending against children (CSA) and consuming child sexual abuse images (CSAI). There is a general shortage of therapeutic programs for individuals who feel sexually attracted to juvenile bodies and are concerned about their sexual behaviour. Efforts to establish regional centres throughout Germany offering preventive support led to the prevention network "Don't become an offender" ("Kein Täter werden"). Objectives: To identify dynamic risk factors (DRFs) and evaluate a treatment programme aiming to reduce CSA and CSAI among potential or existing pedosexual offenders (who have not been legally charged). In addition, changes in the course of therapy are examined to provide information about the accessibility and motivation of the target group and its therapeutic responsiveness. Methods: Participants undergo standardized diagnostic and treatment procedures. Therapy comprises an outpatient psychotherapy program (group therapy) over the course of approx. 48 weekly sessions, optional individual and partner/relative including sessions, as well as additional pharmaceutical treatment. Assessments are carried out through self- and other-reported psychometric test batteries pre-, during and post-treatment up to a 3.5 year follow-up. The test battery includes clinical questionnaires (WHO-5, CTQ-SF), personality questionnaires (ISK-K, NEO-FFI), sexuality questionnaires (EKK-R, KV-M, MSI, HBI-19) and risk assessment procedures (VRAG-R, STATIC-99, VRS:SO). Main outcome measures are self- and externally-reported DRF changes well as offending behaviour characteristics. Results: By September 20, 2023, N=12 individuals were enrolled in the treatment program. All individuals had a deviant sexual preference (exclusive/non-exclusive pedo-/hebephilia). Nine individuals reported past and/or current use of CSAI. Of these, two individuals reported at least one CSA in the past. Three had no previous use of CSAI or CSA history. In the first treatment group (N=6), preliminary results show reduction in dynamic risk factors (e.g., Cognitive Bias, Sexual Compulsivity, Impulsivity) after the first 12 weeks of treatment. The evaluation of additional clinical data is pending. Conclusions: To date, therapy for individuals with pedophilia or hebephilia has been insufficient – particularly when not offending. Ongoing evaluation of the therapy program should provide further insight into responsiveness and therapeutic motivation of this target group. In particular, the impact of therapy on changing dynamic risk factors for CSA and CSAI remains to be examined. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Background The direct execution as well as the visual perception of violence can have a hedonistic aspect and elicit positive arousal. ( Elbert et al., 2010 ) So far, neurobiological correlates of this “appetitive” form of aggression have not been investigated in healthy subjects. Using functional magnetic resonance imaging (fMRI), we tested if subjects who act violently (martial artists) showed greater brain responses to violent images compared to controls in the subcortical reward-associated areas of the mesolimbic dopaminergic system. ( Urban et al., 2012 ). Methods Sixteen male martial artists and 26 male controls took part in the study. As a measure of aggressiveness, we used the FAF questionnaire (“Fragebogen zur Erfassung von Aggressivitätsfaktoren”). During our event-related fMRI paradigm, 54 violent and 54 neutral pictures were shown in a randomized order. After their presentation, a square or circle was briefly projected on the pictures and the subjects then decided which shape had been shown by pressing a button. Independent of their response, a reward randomly followed their answer in 50% of trials. A first-level general linear model (GLM) analysis was run, obtaining the contrast values for violent > neutral pictures. Average contrast values were then extracted from the bilateral nucleus accumbens, amygdala and orbitofrontal cortex (OFC). These values were entered in a GLM to investigate main effects and interactions of the group factor and FAF scores, using age as a covariate. Results Across all participants, higher aggressiveness scores were associated with less activation of the bilateral OFC while watching violent pictures in contrast to neutral ones (left OFC: F df=1 = 4.201, p = .048; right OFC: F df=1 = 4.097, p = .050). On average, martial artists had a higher activation in the left amygdala while watching violent pictures in contrast to controls ( F df=1 = 13.333, p = .001). Furthermore, the more aggressive martial artists were, the smaller their activation in the left amygdala in this condition ( F df=1 = 7.998, p = .008). Discussion Activations in the OFC have been linked to emotional regulation. ( Philipps et al., 2008 ) While watching violent pictures, more aggressive people might show a reduced frontal inhibition of subcortical areas involved in emotion generation. The amygdala is activated by presentation of affective and motivationally triggering stimuli ( Rosell and Siever, 2015 ), e.g. watching a fight between two people. There might be different mechanisms in both groups to deal with aggression. [ABSTRACT FROM AUTHOR]

Theoretical background Perception and practice of violence have, aside from reactive components, also hedonistic aspects that are associated with positive arousal (appetitive aggression). Earlier studies have predominantly investigated the etiology of aggressive behavior in forensic and psychiatric patients. The present study examined structural brain abnormalities in healthy people inclined to violence (martial artists) compared to healthy controls not showing violent behavior. Methods Aggressiveness was assessed in 21 male healthy martial artists and 26 age-matched male healthy controls using the Freiburg personality inventory (FPI-R) and the aggressivity factors questionnaire (FAF). Participants then underwent structural T1-weighted MRI scanning. Differences in local gray matter (GM) were analyzed using voxel-based morphometry (VBM). A whole-brain analysis of the main effects of group and aggressivity (FAF) as well as their interaction was computed, using a threshold of p < .001, followed by a cluster-level p FWE < .05 to account for multiple comparisons. All analyses were controlled for age and total intracranial volume. Results There was no significant main effect of group or aggressiveness in predicting GM concentration. Nevertheless, an interaction effect between group and aggressiveness was evident in a cluster comprising the left temporal pole and left inferior temporal gyrus ( F -test, whole-brain: p < .001, cluster-level: p FWE = .017; Fig. 1 ). Post-hoc analysis revealed a significant negative partial correlation between aggressiveness and mean GM concentration within the cluster in martial artists ( r = −.71, p = .001) and a significant positive one in healthy controls ( r = .54, p = .007) ( Fig. 2 ). Discussion Martial artists and controls displayed opposite correlations between aggressiveness and temporal GM: while they were positively correlated in controls, they correlated inversely in martial artists. Earlier studies reported decreased regional GM volumes in this region within diverse aggressive psychiatric populations, for example patients affected by psychopathy (Ermer et al., 2013) or impulsive-aggressive personality disorder ( Dolan et al., 2002 ). The temporal pole and inferior temporal gyrus are relevant for emotional regulation and aggression control ( Dolan et al., 2002 ) and display alterations in antisocial or violent behavior ( Wong et al., 1997 ). The increased GM concentration of these areas in aggressive healthy controls might reflect a stronger top-down inhibition of their aggressivity. Martial artists, on the other hand, might be able to release their aggressivity in fights, thus showing reduced need for regulation and lower GM concentration in this region. [ABSTRACT FROM AUTHOR]

The potential influence of astrocytes on neuronal circuitry and psychotic symptoms in schizophrenia have recently been highlighted. Human postmortem studies have observed reduced astrocyte numbers in schizophrenia, but whether this pathology is present at disease onset or accumulates progressively with further psychotic episodes remains unclear. Therefore, we analysed serum levels of the astrocyte-derived proteins glial fibrillary acidic protein (GFAP) and fatty acid-binding protein 7 (FABP7) in acutely ill first-episode (n = 60) and relapsed (n = 34) schizophrenia patients compared to 94 matched controls. Measurements were taken before and 6 weeks after antipsychotic treatment. We found significantly lower levels of GFAP (p < 0.001) and FABP7 (p < 0.001) in patients compared to controls, with no significant differences between first-episode and relapsed patients or changes after treatment. FABP7 negatively correlated with age in controls (r = -0.319, p = 0.002), but not in patients (r = -0.251, p = 0.015). In contrast, GFAP showed no correlation with age. Our findings suggest that lowered GFAP and FABP7 may serve as trait markers of astrocyte pathology in schizophrenia, even prior to antipsychotic treatment. The absent correlation between FABP7 and age in schizophrenia patients, in contrast to controls, may be related to premature brain aging in schizophrenia. Long-term studies are needed to explore the relationship between chronic disease and astrocyte pathology in schizophrenia., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Electroencephalography (EEG) is a noninvasive, cost-effective, and robust tool, which directly measures in vivo neuronal mass activity with high temporal resolution. Combined with state-of-the-art machine learning (ML) techniques, EEG recordings could potentially yield in silico biomarkers of severe mental disorders., Hypothesis: Pathological and physiological aging processes influence the electrophysiological signatures of schizophrenia (SCZ) and major depressive disorder (MDD)., Study Design: From a single-center cohort (N = 735, 51.6% male) comprising healthy control individuals (HC, N = 245) and inpatients suffering from SCZ (N = 250) or MDD (N = 240), we acquired resting-state 19 channel-EEG recordings. Using repeated nested cross-validation, support vector machine models were trained to (1) classify patients with SCZ or MDD and HC individuals and (2) predict age in HC individuals. The age model was applied to patient groups to calculate Electrophysiological Age Gap Estimation (EphysAGE) as the difference between predicted and chronological age. The links between EphysAGE, diagnosis, and medication were then further explored., Study Results: The classification models robustly discriminated SCZ from HC (balanced accuracy, BAC = 72.7%, P < .001), MDD from HC (BAC = 67.0%, P < .001), and SCZ from MDD individuals (BAC = 63.2%, P < .001). Notably, central alpha (8-11 Hz) power decrease was the most consistently predictive feature for SCZ and MDD. Higher EphysAGE was associated with an increased likelihood of being misclassified as SCZ in HC and MDD (ρHC = 0.23, P < .001; ρMDD = 0.17, P = .01)., Conclusions: ML models can extract electrophysiological signatures of MDD and SCZ for potential clinical use. However, the impact of aging processes on diagnostic separability calls for timely application of such models, possibly in early recognition settings., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.)

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., (© 2023. The Author(s).)

Background: Fifty years after its introduction, the American Psychiatric Association's (APA) Goldwater Rule remains contentious, prohibiting member-psychiatrists from providing mental health commentary on individuals they have not treated and where they lack consent. Whilst its resonance extends beyond the United States, there is limited awareness about the Goldwater Rule's applicability elsewhere, notably within Europe., Methods: In 2022, we investigated whether the European Psychiatric Association's (EPA) forty-four National Psychiatric Association Members (NPAs) had similar guidelines to the Goldwater Rule or comparable ethical positions around media and public commentary. We initially searched NPA websites and subsequently contacted NPAs via email and phone. Findings were coded to four categories: "NPA-level rules or position", "No NPA-level rules orposition but noted country-level rules", "No NPA-level rules or position and did not note country-level rules", and "No response"., Results: n=27 NPAs had relevant web materials or replied to our correspondence (61.3% of total NPAs). From these 27, based on our interpretation, n=6 (22.2%) had rules or positions, n=6 (22.2%) indicated that country-level rules existed, and n=15 (55.5%) did not have applicable NPA-level or country-level regulations., Conclusions: A sizeable proportion of NPAs included in our study have not yet formally developed or considered ethical issues addressed by the Goldwater Rule and psychiatric commentary on an individual's psychopathology. Accordingly, the EPA could consider broader discussions about this, accounting for national traditions and sociocultural aspects of clinical practice. These could integrate the advantages and disadvantages of the APA's rubric towards an evolved ethical debate.

One of the most commonly replicated results in the research area of recidivism risk assessment is the superiority of structured and standardized prediction methods in comparison to unstructured, subjective, intuitive, or impressionistic clinical judgments. However, the quality of evidence supporting this conclusion is partly still controversially discussed because studies including direct comparisons of the predictive accuracy of unstructured and structured risk assessment methods have been relatively rarely conducted. Therefore, we examined in the present study retrospectively N = 416 expert witness reports written about individuals convicted of violent and/or sexual offenses in Germany between 1999 and 2015. The predictive accuracy of different methodological approaches of risk assessment (subjective clinical [i.e., unstructured clinical judgment; UCJ], structured professional judgment [SPJ], actuarial risk assessment instruments [ARAIs], and combinations of ARAIs-/SPJ-based risk assessments) was compared by analyzing the actual reoffenses according to the Federal Central Register (average follow-up period M = 7.08 years). In accordance with previously published results, the results indicated a higher predictive accuracy for structured compared to unstructured risk assessment approaches for the prediction of general, violent, and sexual recidivism. Taken together, the findings underline the limited accuracy of UCJs and provided further support for the use of structured and standardized risk assessment procedures in the area of crime and delinquency. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Aggression can have a hedonistic aspect in predisposed individuals labeled as appetitive aggression. The present study investigates the neurobiological correlates of this appetitive type of aggression in non-clinical samples from community. Applying functional magnet resonance imaging (fMRI), we tested whether 20 martial artists compared to 26 controls had a higher activation in the nucleus accumbens (NAcc), a central part of the dopaminergic, mesolimbic reward system. Subjects had to watch violent vs. neutral pictures representing appetitive aggression. The affinity towards hedonistic violence was assessed by the Appetitive and Facilitative Aggression Scale (AFAS). Furthermore, the subjects rated all the pictures with regard to how pleasant and violent they were. The martial artists reported a higher AFAS-score and a more positive perception of violent pictures. On the neural level, across all subjects, there was a significant positive correlation between the AFAS-score and the activation in the left NAcc and an inverse association with the activation of the right NAcc when watching violent compared to neutral pictures. This lateralization effect indicates a different processing of hedonistic aspects of aggression in the two hemispheres., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: GABAergic interneuron dysfunction has been implicated in the pathophysiology of schizophrenia. Expression of glutamic acid decarboxylase (GAD), a key enzyme in GABA synthesis, may also be altered. Here, we have simultaneously evaluated GAD-immunoreactive (GAD-ir) neuropil and cell profiles in schizophrenia-relevant brain regions, and analysed disease-course related differences., Methods: GAD65/67 immunoreactivity was quantified in specific brain regions for profiles of fibres and cell bodies of interneurons by automated digital image analysis in post-mortem brains of 16 schizophrenia patients from paranoid (n = 10) and residual (n = 6) diagnostic subgroups and 16 matched controls. Regions of interest were superior temporal gyrus (STG) layers III and V, mediodorsal (MD) and laterodorsal (LD) thalamus, and hippocampal CA1 and dentate gyrus (DG) regions., Results: A reduction in GAD-ir neuropil profiles (p < 0.001), particularly in STG layer V (p = 0.012) and MD (p = 0.001), paralleled decreased GAD-ir cell profiles (p = 0.029) in schizophrenia patients compared to controls. Paranoid schizophrenia patients had lower GAD-ir neuron cell profiles in STG layers III (p = 0.007) and V (p = 0.001), MD (p = 0.002), CA1 (p = 0.001) and DG (p = 0.043) than residual patients. There was no difference in GAD-ir neuropil profiles between paranoid and residual subgroups (p = 0.369)., Conclusions: These results support the hypothesis of GABAergic dysfunction in schizophrenia. They show a more prominent reduction of GAD-ir interneurons in paranoid versus residual patients, suggestive of more pronounced GABAergic dysfunction in the former. Fully automated analyses of histological sections represent a step towards user-independent assessment of brain structure., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Psychiatric disorders are the most frequent cause for premature retirement; however, trying to verify claims of performance deficits due to psychiatric disorders without the actual existence of the latter in sociomedical assessments is problematic. For this reason, differentiation between actual psychiatric disorders with real presence of symptoms and simulated or aggravated symptoms is of importance in sociomedical assessments. In recent years, symptom validity tests (SVT) have been increasingly utilized in psychiatric/psychological assessments; however, knowledge of the validity of these tests and the relation to symptom severity is still lacking., Objective: This study aimed to compare the validity of different SVTs depending on symptom severity (Structured Inventory of Malingered Symptomatology (SIMS), Word Memory Test (WMT), Symptom Checklist-90-R (SCL-90‑R), Minnesota Multiphasic Personality Inventory‑2 (MMPI-2))., Material and Methods: Clinically treated inpatient psychiatric patients (n = 30) were compared with subjects of sociomedical assessments (n = 29) regarding their tendency to simulate or aggravate symptoms., Results: It could be shown that the WMT and the SIMS both failed in the differentiation between psychiatric patients and subjects of sociomedical assessments, regarding description of symptoms or (un)restricted performance motivation. Furthermore, 20% of psychiatric patients were classified as false positive in WMT. The results of the SIMS were significantly related to the severity of psychiatric symptoms in SCL-90‑R, therefore the severity of symptoms was assessed rather than the response distortion., Conclusion: The results underline the importance of further research on SVTs in sociomedical assessments, especially regarding symptom severity and response distortion., (© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

The Habenula is increasingly being investigated in addiction. Reduced volumes of other relevant brain regions in addiction, such as nucleus accumbens, globus pallidus and hypothalamus have been reported. Reduced volumes of the habenula as well as reduced neuronal cell count in the habenula have also been reported in mood disorders and an overlap between mood disorders and addiction is clinically widely recognized. Thus, our aim was to investigate possible volume and neuronal cell count differences in heroin addicts compared to healthy controls. Volumes of the medial (MHB) and lateral habenula (LHB) in heroin addicts (n = 12) and healthy controls (n = 12) were assessed by morphometry of 20 µm serial whole brain sections. Total brain volume was larger in the heroin group (mean 1466.6 ± 58.5 cm 3 vs. mean 1331.5 ± 98.8 cm 3 ), possibly because the heroin group was about 15 years younger (p = 0.001). Despite larger mean whole brain volume, the mean relative volume of the MHB was smaller than in healthy non-addicted controls (6.94 ± 2.38 × 10 -6 vs.10.64 ± 3.22 × 10 -6 ; p = 0.004). A similar finding was observed regarding relative volumes of the LHB (46.62 ± 10.90 × 10 -6 vs. 63.05 ± 16.42 × 10 -6 p = 0.009). In parallel, neuronal cell numbers were reduced in the MHB of heroin-addicted subjects (395,966 ± 184,178 vs. 644,149 ± 131,140; p < 0.001). These findings were not significantly confounded by age and duration of autolysis. Our results provide further evidence for brain-structural deficits in heroin addiction.

Objectives: Paedophilic disorder is characterised by sexual attraction towards children. Classification of a counterpart as sexually attractive likely occurs rapidly, and involves both conscious and unconscious attentional and cognitive processes. Magnetoencephalography (MEG) is an imaging method especially well-suited to examine visual and attentional processes triggered by sexual images within the range of milliseconds., Methods: We investigated brain responses to sexual images depicting adults (frequent) and children (infrequent stimulus) in seventeen paedophilic patients with a history of child sexual offending (P + CSO) and twenty healthy controls (HC) during a passive visual oddball paradigm. Event-related fields (ERF) were measured to extract the magnetic visual mismatch negativity (vMMNm), and how it relates to the processing of different classes of sexual stimuli., Results: P + CSO exhibited significantly longer vMMNm latencies (100-180 ms post-stimulus) than HC. Moreover, P + CSO showed widespread increased amplitudes in response to child images starting from P3a and P3b components and lasting up to 400 ms post-stimulus presentation localised in frontal and temporal brain regions., Conclusions: This study uncovers the first MEG differences in automatic change detection between P + CSO and HC during the presentation of subliminal sexual images of adults and children, contributing towards a better understanding of the neurobiological processes of P + CSO.

Hashimoto's thyroiditis has been associated with major depression (MD) and schizophrenia (Sz) in epidemiological studies. However, diagnostically relevant antibodies (Abs) against thyroid peroxidase (TPO) and thyroglobulin (Tg) do not act directly on neurons. We hypothesized that an increased prevalence of anti-brain-Abs in thyroid-Ab-carriers could be linked with MD and Sz even without clinically manifest Hashimoto's thyroiditis. Serum samples from 638 acutely-ill patients with MD, Sz or matched controls were systematically screened for TPO- and Tg-Abs, other endocrine-Abs and a spectrum of specific anti-brain-Abs (directed against neuronal cell surface, synaptic, other neuronal or glial proteins). Analyses were based on indirect immunofluorescence in biochip mosaics of frozen tissue sections and transfected HEK293 cells expressing respective recombinant target antigens. Psychopathology was assessed on admission and after 6 weeks treatment by HAMD-21 (in MD) or PANSS (in Sz). Seroprevalence of TPO- and/or Tg-Abs was comparable in ill and healthy individuals (MD ~10%, Sz ~7%, controls ~9%) but thyroid-Abs were associated with neuronal cell surface/synaptic-Abs (p = 0.005), particularly in schizophrenia. Thyroid Ab-positive MD patients showed higher HAMD-21 scores (particularly somatic symptoms) at baseline (p = 0.026) and better reduction of symptoms after 6 weeks (p = 0.049) than thyroid-Ab-negative patients. This was unrelated to antidepressant drug dosage, thyroid hormonal-, inflammation- and anti-brain-Ab-status. No link with PANSS scores was observed in Sz. In conclusion, the co-occurrence of thyroid-Abs and neuronal surface/synaptic-Abs may be associated with Sz. Future cerebrospinal fluid research may be promising to clarify if thyroid-Ab-associated neuronal-Abs reach the brain in Sz patients. Thyroid-Ab-related differences regarding disease-severity and -course in MD are currently unexplained, but may be caused by un-identified anti-brain-Abs or a direct action of TPO-Abs on astrocytes., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Teegen and Prof. Stoecker are full-time employees of and hold stock in Euroimmun AG. All other authors report no conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)