PubMed Health⌕ Search

Biomedical subjects

N Nedopil

Publications and source records attributed to N Nedopil.

At least 19 recordsLinked to original sources
PubMed2006

[Evaluation of risk assessment instruments for sex offenders].

In order to evaluate risk assessment instruments for sex offenders in Germany, we compared the predictive validity of the Static-99, HCR-20, SVR-20, and PCL-R scales for 134 sex offenders. The mean follow-up time was 9 years (range 1-340 months), using the first entry into the National Register of Criminal Convictions as endpoint variable. For the estimate of predictive power, the area under the curve (AUC) of receiver operating characteristic (ROC) analysis was calculated. The AUC plots accurately identified violent or sexual recidivists and "false positives" at all scale levels. Comparing the predictive validity of these four instruments, the results favored Static-99. As for the limited sample size, differences between the assessment instruments were, however, not statistically significant. The ROC analysis for Static-99 showed that including treatment dropouts does not improve predictive accuracy (including dropouts: AUC 0.710; excluding dropouts: AUC 0.721). Kaplan-Meier survival analyses yielded highly a significant correlation to recidivism time point for two Static-99 and SVR-20 risk categories. Higher-risk categories were related to earlier recidivism. However, relying on the Static-99 and SVR-20 alone showed false positive results: for up to two out of three sex offenders, they predicted recidivism which did not occur.

Forensic Psychiatry↗
PubMed2006

[Misdemeanor in frontotemporal dementia].

The nature and prevalence of misdemeanor in patients with dementia due to frontotemporal lobar degeneration has been described in a few case reports and in two small U.S. studies. Our clinical impression suggests that antisocial and aggressive behaviour are relatively frequent in this patient population. The objective of the present study was to verify this observation. For this purpose we developed a standardized questionnaire on misdemeanor in Frontotemporal Dementia. Using this instrument caregivers of 30 patients with Frontotemporal Dementia (FTD), 11 patients with Semantic dementia (SD) and 33 patients with Alzheimer-type dementia (AD) were interviewed. The interview included questions about theft, burglary, damaging other peoples' belongings, verbal or physical offence, bodily harm, drug abuse and use of weapons. Questions about the frequency of criminal behaviour, the amount of damages and consequences if applicable completed the questionnaire. Misdemeanor was found in half of the patients with FTD (15 out of 30) and in 7 out of 11 patients with SD, but only in one out of 33 patients with AD. The most frequent type of inappropriate behaviour was theft (13 patients), particularly shoplifting. 8 patients with FTD, 1 patient with SD and 1 patient with AD entered someone else's house without permission. 10 patients with FTD and 3 patients with SD but none of the patients with AD had physically threatened spouses, relatives or strangers. In one case another person was hurt.

Adult↗
PubMed2005

[Psychiatric disorders and the prognosis for criminal recidivism].

The risk for criminal recidivism of mentally ill offenders is, unlike the general risk of delinquency, not well established. The relationship between psychiatric diagnosis and criminal recidivism was examined in the context of the Munich project on risk assessment. A total of 185 offenders had been examined on the question of culpability between 1992 and 1993. Re-offenses committed before the end of 2001 were recorded according to the Federal Registry of court sentences (Bundeszentralregister); 38.8% of the total group recidivated. High rates of recidivism were observed for individuals with substance abuse (45.5%) and with personality disorders (46.6%). The combination of the two illnesses increased the rate for recidivism to 50%. For individuals with organic, affective and neurotic disorders the rates for recidivism were below the average. Rates of recidivism for schizophrenic offenders were slightly higher, if re-offenses in the state of inculpability were included. The HCR-20 predicted recidivism equally well for offenders with and without a psychiatric diagnosis. In both groups, individuals with HCR-20 scores above the mean recidivated more often and after shorter periods of time.

Crime↗
PubMed2003

[Criteral for assessing quantitative disability in expert determination of functional physical disorders. Review of the literature].

The assessment of individuals with somatoform disorders seeking payments or compensation is a major challenge for psychiatrists, insurers and the social welfare system. It is difficult to examine these disorders objectively and to quantify the impairment people experience in their work or private life. In order to develop more rational criteria for the assessment of these patients, we first reviewed the relevant literature and extracted the criteria mentioned by the respective authors. We then grouped these criteria in clinically plausible dimensions in order to develop a list of parameters that could help psychiatric experts to analyse the impairment more objectively and to help institutions in evaluating the assessments.

Activities of Daily Living↗
PubMed2003

[Alcohol and drugs and their relation to criminal recidivism].

This report assesses the influence of alcohol- and drug- induced disorders on criminal recidivism. A sample of 185 delinquents was examined for their criminal responsibility in the department of forensic psychiatry in the years 1992 and 1993. Official criminal records were obtained in December 2001. 27.3 % of the delinquents with alcohol abuse, 47.3 % with drug abuse and 47.2 % with a family history of alcohol abuse recidivated with a crime. 50 % of the individuals with an own alcohol- and drug abuse together with a family history of alcohol abuse recidivated. 62.5 % of offenders with both, own drug abuse and an alcohol abuse in their family history re-offended. The co-occurrence of both, own drug abuse and a family history of alcohol abuse is highly correlated with criminal recidivism and should be considered in treatment and aftercare programs.

Adult↗
PubMed2001

[Quantitative detection of dyssocial and psychopathic personalities in criminal expert assessment. Retrospective study of the value of the German version of the Hare Psychopathy Checklist].

In 1980, the Hare Psychopathy Checklist (PCL), an operationalised rating scale for the quantitative assessment of "psychopathy" as seen in the Anglo-American literature, was developed by R.D. Hare in Canada. It proved to be the most valid prognostic instrument for assessing relapse of criminals in English-speaking countries. This study was aimed at verifying the applicability of a German version of the revised PCL (PCL-R) on carefully selected subjects from the Forensic Psychiatric Department of the Psychiatric University Hospital in Munich. Two groups with an equal number of different forensic-psychiatric reports were evaluated retrospectively using the PCL-R. The results confirm the applicability of the PCL-R for the assessment of psychopathy in our sample population. One can expect that the positive experiences with the PCL-R abroad can be transferred to German conditions. The results are encouraging as to the practicability of the PCL-R as a prognostic instrument in routine forensic assessment.

Adult↗
PubMed2000

[Ethics of physician-patient relationship].

Ethical questions pertaining to the examination and treatment of patients have gained considerable importance during the last decades, also in psychiatry and psychotherapy. Interest in these questions, however, is moderate among students and beginning therapists. Ethical and legal problems often arise during practical work and are frequently solved without much consideration of the current ethical opinions and legal issues involved. This article tries to elaborate on the current ethical positions from an historical perspective and to come to a hierarchy of values, which could guide the therapeutic decisions. Nonmaleficence and autonomy are considered to be on top of that hierarchy, paternalism which was a guideline until the early sixties has lost its importance. The article discusses the consequences of this change of values in different practical fields, e.g. consent to long-term treatment with uncertain outcome, confidentiality in the face of dangers to third parties, suicidal patients.

Confidentiality↗
PubMed1999

Competence to give informed consent to clinical studies. Statement by the taskforce on "ethical and legal questions" of the Association for Neuropsychopharmacology and Pharmacopsychiatry ("Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie [AGNP]").

Over the last 50 years, patient autonomy has become an increasingly important part of the principles of medical ethics, or rather of the ethics of the doctor-patient relationship. While the principle of charity and the associated paternalism became less important, the patient's active consent became more and more relevant (Sass, 1989; Bayer, 1998; Nedopil, 1998). This development was inevitably also accompanied by a demand for more detailed information prior to medical interventions (Appelbaum and Grisso, 1988; Weisstub, 1990; Kreussler, 1997; Ulsenheimer, 1995; Laufs, 1997; Sommer, 1997) and for complete information on medical procedures subsequent to interventions (e. g. Bender, 1997). Determination of a person's competence to give informed consent is a central problem in the assessment of his expression of consent to a medical intervention. The capacity to adequately express consent can be impaired at certain stages of life and during some illnesses. Patients in borderline situations, children, mentally ill patients and old people with dementia may either be limited in their capacity to give informed consent, or be completely unable to do so. This results in special ethical problems when such groups are included in research projects.

Clinical Trials as Topic↗
PubMed1995

[Forensic psychiatric expert evaluation of so-called drug-induced psychoses].

A considerable number of schizophrenic persons also abuse illegal drugs. This comorbidity raises problems of diagnosis which become particularly important when concerning forensic questions. The hypothesis of a distinct psychopathological syndrome of drug induced psychosis is widely criticized in the literature. A case report is presented to demonstrate the problems of differential diagnoses and the difficulties for psychiatric expertizing arising from these problems.

Adult↗
PubMed1995

[Compliance with psychiatric legal ordinance section 63 STGB. Legal principles--current status--treatment concepts--perspectives].

According to German law, delinquents who are considered either not fully responsible or not responsible at all for their actions because of a mental disorder receive no punishment or a lesser degree of punishment in criminal trials. They may, however, be sentenced to psychiatric treatment either in a psychiatric hospital or in an addiction centre, if the risk of them committing such offenses in the future is considered to be high. This article reviews the current situation of mentally ill offenders in hospitals and explores possible developments in forensic psychiatry. It outlines the legal framework, and the current and developing treatment strategies, and finally raises the question of whether these developments will lead to further specialization of forensic psychiatry or to a reintegration of forensic knowledge into general psychiatry.

Commitment of Persons with Psychiatric Disorders↗
PubMed1989

[Psychopathologic differentiation of aggressive criminals as an aid in expert assessment].

Psychiatric assessment and treatment of aggressive mentally ill offenders is one of the most difficult tasks in forensic psychiatry. Whereas psychiatric literature mostly refers to a uniform definition of aggression, different forms of aggression have been shown in animal experiments. In this study it was tested, whether a psychopathological differentiation of aggression was possible in men. In 124 individuals accused of homicide a preliminary dichotomic differentiation into undercontrolled and overcontrolled types of violent offenders (Megargee 1984) was examined. 60% of the population could be assigned to one of the two types. Undercontrolled individuals reacted violently when overburdened by situational conflicts. This form of aggression was called asthenic aggression. It was significantly more frequent in the mentally ill and led more often to the conclusion of diminished responsibility. In the undercontrolled offender aggression served mostly to achieve immediate goals. This form of violence was called sthenic aggression.

Adult↗