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[Validity of risk calculations in offenders -- criticism of a basic methodological assumption, and future perspectives].

Catalogs of multidimensional criteria have become established in continental Europe. In contrast, due to the limited reliability of clinical prognoses, procedures such as "Actuarial Risk Assessments" have been established in Anglo-Saxon countries as a means of assessing prognoses. The basic assumptions of "Actuarial Risk Assessments" (principally a statistical methodology) show a remarkable discrepancy compared with the fundamental ideas of the European experts (clinical assessment procedures), although this has not to date been discussed in depth in the literature. Apart from this discrepancy, however, certain basic assumptions are internationally regarded as generally accepted methodological cornerstones of prognostic theory. Thus, such a generally unchallenged "essential" methodological principle as the "Two by Two Table" has been mentioned for many years in a dichotomous sense in numerous textbooks or basic lecture on prognostic theory. Far-reaching conclusions concerning the validity of prognostic statements are made on the basis of this methodological axiom. Thus, the putative error rate for prognostic assessments is derived from so-called "false positive prognoses", and, among other things, the unjustified committal of offenders wrongly judged to be dangerous is criticised. Surprisingly, there is no discussion in the considerable literature currently available, that it is methodologically highly questionable to use the Two by Two Table that is adequate for dichotomous decision-making, without using further differentiation with respect to probability factors, as is undoubtedly the case for risk calculations. The article discusses the above mentioned problems and gives possible approaches for solutions.

Actuarial Analysis↗

[Stigmatization of mentally ill patients by the society].

In our society, people with mental illness are exposed to various forms of discrimination. In principle, individual and structural discrimination plus discrimination due so self-stigmatisation can be distinguished. All three forms of discrimination will be illustrated based on results from our own studies. Next, negative consequences of discrimination for those afflicted will be described such as lack of self-confidence and reduced subjective well-being as well as social disadvantages and disadvantages with regard to treatment and rehabilitation. Finally, using the association "Irrsinnig menschlich" ("Madly human") in Leipzig as an example, approaches to reduce discrimination of mentally ill people will be presented.

Alcoholism↗

[COMSKILLS: assessing community living skills in offender groups].

OBJECTIVE: An international network study involving parallel, complementary interventions in three EU countries and an associate country (Germany, United Kingdom, The Netherlands and Norway) is reported. The aim is to develop a unified approach to the assessment of social risk and related behaviours in offender groups. METHOD: The Behavioural Status Index (BEST-Index) and a set of cross-validating instruments (PCL-R, HCR-20; SCL-90-R; BDHI-D) were applied to a sample of n = 231 mentally ill offenders. RESULTS: Selected results using a sub-sample of n = 89 German offenders are reported and discussed. CONCLUSIONS: The BEST-Index shows convergent validity with respect to a social risk criterion and it helps to determine an objective data base for the improvement of carer assessments, related care planning, and delivery.

Adult↗

[The Hinckley case and some sequelae for psychiatry].

After John Warnock Hinckley jr. had fired shots at President Reagan and had severely injured three others, he was considered not guilty by reason of insanity and brought to a psychiatric hospital. The case caused an unprecedented public interest because the psychiatric testimonies were contradictory (schizophrenia vs. personality disorder). According to the known facts it is very unlikely that a German psychiatrist would have diagnosed Hinckley as schizophrenic. One of the sequels of the sentence was a lowering of the reputation of psychiatrists for their inability to arrive at clear diagnosis. Another sequel was to increase the funds for research in biological psychiatry. Still another sequel was an insanity defense reform bill. The scientific debate and public discussions continue.

Commitment of Persons with Psychiatric Disorders↗

[Does the evaluation of affect crimes deal with a psychopathologic problem?].

The reformulation of the sections 20, 21 StGB (concerning the defense of insanity in the German law) brought a renewed interest in the controversy about the disease concept and the assessment of responsibility in forensic psychiatry. Although the opinions of Kurt Schneider are still very influential, there are competing conceptions based on positions of normal psychology, social psychology or motivational psychology. The controversial issues are discussed and an integrating approach is proposed, though the psychopathological analysis is still regarded as the most important aspect. The question, whether one of the categories of the sections 20, 21 StGB is qualified and whether the intensity of the psychological disturbance indicates a reduced responsibility, must be answered regarding the empirical knowledge of mentally ill, abnormal and sane individuals. Instead of the former concept of disease, which was based on a known or postulated somatic pathology, a psychopathological system of reference for each category of the sections 20, 21 StGB has to be developed for the assessment of the disfunction during the offense. As an example, two catalogues of positive and negative criteria are proposed for the detection of a "profound disturbance of consciousness" in crimes of passion.

Dangerous Behavior↗

["Running amok"--content analytic study of 196 news presentations from industrialized countries].

We performed a content analysis study based on 196 reports in the German press published during the last decade on acts of violence designated as "going berserk" or "running amok (amuck)" and meeting defined criteria. With less than one person per one million men per year running berserk or amok, this is a very rare act of violence, albeit a very dangerous one involving 1.3 deaths and 1.7 injuries per case. Offenders differ from the normal population in regards to the small percentage of women (5%) and high unemployment (40%), and from other violent offenders in that they are normally occupationally well-qualified. Severe psychiatric disorders are overrepresented. A total of 108 cases were classified according to specific syndromes either by specialists or experts on the spot, or on the basis of a description of the signs and symptoms. Of the syndrome-related acts, the most dangerous offences were committed by 10 delusionally ill and 2 psychopathic individuals. 30 less dangerous offenders suffered from paranoid-hallucinatory syndromes. 28 crimes committed in a state of intoxication and 11 "crimes of passion" were the least dangerous. Another 25 persons with an extensive incidence of suicide in the family, without any apparent pre-existing psychiatric disorder, may have gone berserk in the course of a depressive syndrome. Although psychotically ill individuals tend to overreact more often following a minimal slight, under delusions or with no apparent reason at all, on the whole the causes for both the psychotic and other offenders are of a serious nature. Object loss and private disputes on the one hand and social conflicts on the other were of approximately equal significance. The relationship between the offender and his victim is more essential for the course of the occurrence than motives or the type of the psychopathological syndrome. If only family members are attacked, the offenders have usually been inconspicuous, elderly individuals, two thirds of whom can not be allocated to a given syndrome and may be depressive. They kill deliberately and on-target, do not merely injure their victims--hardly ever, in fact--and then commit suicide practically without exception. If strangers are the target of violence, the crimes are generally committed by younger, passive-aggressive, psychopathic, paranoid or intoxicated offenders. They kill only about half of their victims, but injure many, also causing a great deal of damage. They rarely commit suicide.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

[Endangerment and dangerousness of psychiatry].

Psychiatry is more influenced by the "Zeitgeist" than other medical disciplines. One important reason is the lack of biological data despite large efforts. In this situation ideological factors may become more relevant than they deserve. Temptations of a "pure" doctrine are dangerous. New developments (methadone substitution, active euthanasia) add to the possible dangerousness of psychiatry. Psychiatrists will have to be careful to avoid this dangerousness and the endangering of their discipline.

Dangerous Behavior↗

Visual search of driving situations: danger and experience.

Previous research on visual search in driving suffers from a number of problems: small sample sizes, a concentration on mundane situations, and a failure to link results to more general psychological theory. The study reported in this paper addresses these issues by recording the eye movements of a large sample of drivers while they watched films of dangerous driving situations and comparing the findings with those from more general studies on scene perception. Stimuli were classified according to the types of road shown and the degree of danger present in the scenes. Two groups of subjects took part, fifty-one young novice drivers who had just gained a full driving licence and twenty-six older more experienced drivers. Dangerous situations were characterised by a narrowing of visual search, shown by an increase in fixation durations, a decrease in saccade angular distances, and a reduction in the variance of fixation locations. These effects are similar to the concept of 'attention focusing' in traumatic situations as it is described in the literature on eyewitness memory. When road types are compared, the least visually complex rural roads attracted the longest fixation durations and the shortest angular saccade distances, while the most visually complex urban roads attracted the greatest spread of search but the shortest fixation durations. Differences between the groups of subjects were also present. Novices had longer fixation durations than experienced drivers, particularly in dangerous situations. Experienced drivers also fixated lower down and had less vertical variance in fixation locations than novices.

Adolescent↗

Probabilistic assessment of "dangerous" climate change and emissions pathways.

Climate policy decisions driving future greenhouse gas mitigation efforts will strongly influence the success of compliance with Article 2 of the United Nations Framework Convention on Climate Change, the prevention of "dangerous anthropogenic interference (DAI) with the climate system." However, success will be measured in very different ways by different stakeholders, suggesting a spectrum of possible definitions for DAI. The likelihood of avoiding a given threshold for DAI depends in part on uncertainty in the climate system, notably, the range of uncertainty in climate sensitivity. We combine a set of probabilistic global average temperature metrics for DAI with probability distributions of future climate change produced from a combination of several published climate sensitivity distributions and a range of proposed concentration stabilization profiles differing in both stabilization level and approach trajectory, including overshoot profiles. These analyses present a "likelihood framework" to differentiate future emissions pathways with regard to their potential for preventing DAI. Our analysis of overshoot profiles in comparison with non-overshoot profiles demonstrates that overshoot of a given stabilization target can significantly increase the likelihood of exceeding "dangerous" climate impact thresholds, even though equilibrium warming in our model is identical for non-overshoot concentration stabilization profiles having the same target.

Climate↗

The gravely inadequate definition of a "mentally ill person" in the Mental Health Act (New South Wales) 1983.

The definition, given in Section 5 of the new Act, of a "mentally ill person" is examined. It is argued that this "definition" is cumbersome, logically incoherent, and impractical. It is predicted that if given effect it will have very unwelcome consequences. Various sources of inherent misunderstanding and uncertainty are noted. Arguments are presented for allowing severe mental illness itself rather than its consequences to be the ground for involuntary hospitalization in certain circumstances. Various suggestions are proposed for the Section's amendment. These fall into two categories, depending upon alternative assumptions: (1) minor improvements, upon the pessimistic assumption that the main structure and content of the definition will be retained; (2) more radical amendment, involving the abandonment of the entire present structure of the section, and the adoption of a working definition of "mental illness" with clear safeguards against error and abuse. The nature and requirements of such a definition are discussed.

Commitment of Persons with Psychiatric Disorders↗

Mental health law: institutionalised discrimination.

The aim of the paper is to propose that special mental health laws be replaced by generic protection and prevention legislation. The arguments used for the detention and compulsory treatment of persons with mental illnesses are analysed, and found not to justify protection and prevention rules which apply only to persons with mental illnesses. Two separate systems of legal intervention should be established to deal with (1) all persons in need of compulsory care and (2) all persons who require to be detained for the prevention of harm to others.

Attitude↗

Mental health law: an idea whose time has passed.

In this paper I argue that specific mental health law should not exist and should be replaced by modern guardianship law which is non-discriminatory and which intervenes according to need rather than diagnostic classification. Substituted consent provided by a guardian protects the patient and the treatment provider. Custody to prevent danger to others should remain with courts rather than informal proceedings where individual rights to freedom are less carefully protected. Special mental health law stigmatises people with mental illness and degrades their treatment. It also diminishes the standing of the psychiatric profession which advocates the continuation of such laws.

Attitude↗

The interactionist nature of drinking and driving: a structural model.

A structural model is described that examines the contributions of personal and situational determinants (interactionist theory) for the elicitation of previous self-reported drink-driving offending. Responses of 1011 UK driver's licence holders to 57 questions concerning demographics, driving experience/exposure, deterrence issues, attitudinal factors and situation specific drink-driving behaviour were subjected to a series of multiple regression analyses. Seven variables (five personal and two situational) accounting for 46% of the sample variance were shown to be significantly predictive of undetected offending behaviour. Of these age and safe driving consumption estimates were found to be best described in terms of their direct effects on offending behaviour. The relationships between general alcohol consumption and exposure to secondary level enforcement (breath test) with drink-driving behaviour have both direct and indirect effects. Two attitudinal factors referring to a belief of deterrence if random breath testing were introduced into the UK, and arranging alternative transport on a drinking occasion, as well as exposure to a drink-driving charge, show approximately proportional direct and spurious links with offending. Findings are discussed i n terms of the utility of an interactionist approach for the study of drink-driving behaviour, previous attempts at modelling drink-driving behaviour, and the implications that such results have for counter-measure development.

Adolescent↗