Forensic Outpatient Clinic Research Articles

Assessing Compliance with Driver Behavior Improvement Training (DBET): A Study on ADATC Data

Objective: This study aims to focus on the follow-up processes of 128 people who applied to Driver Behavior Improvement Training (DBET) and were referred to the Alcohol and Drug Addiction Treatment Center (ADATC) with a prediagnosis of alcohol use disorder (AUD). By providing access to critical information such as sociodemographic characteristics, follow-up times, number of admissions, and AUD detection rates, data review will help to plan health services more effectively and develop a comprehensive understanding of support processes for individuals with a prediagnosis of AUD. Material and Method: We retrospectively analyzed the data of 128 individuals who applied to the ADATC forensic outpatient clinic between October 2021 and October 2023 and received a preliminary diagnosis of AUD from the DBET. Results: The mean age was 41.85±8.79 years, and the median number of referrals was 9. The follow-up period was 237.09±171.35 days; of the participants, 96.9% were male, 78.1% were primary school graduates, 43% were followed for less than six months, and 57% for more than six months. The rate of individuals with positive results was 64.8%, and the rate of individuals with long-term positive results was 41.4%. No significant differences were found between the participants in the 'positive' and 'continuation' status regarding age, number of applications, follow-up periods, gender, and educational level (p>0.05). However, in the subgroup analysis of follow-up periods, a significant difference was observed in the follow-up rate for more than six months between participants with positive results compared to those with a follow-up time of <6 months (p<0.05). Conclusion: It indicates that individuals with a positive outcome succeed more when followed up for longer. The study contributes to the understanding of the follow-up processes of individuals presenting with a prediagnosis of AUD and the development of a comprehensive understanding of providing adequate support.

Lost diagnoses? A multi-year trajectory of patients with childhood ADHD in the criminal justice system in Switzerland.

Attention-deficit/hyperactivity disorder (ADHD) is prevalent amongst offenders, increasing risks for aggressive and delinquent behaviors. Since ADHD and its symptoms can persist into adulthood, accurately diagnosing and maintaining diagnoses in offenders is crucial to ensure appropriate treatment and reduce recidivism. This study employed a retrospective longitudinal design to investigate ADHD amongst adult offenders with a confirmed diagnosis of ADHD during childhood or adolescence at a Swiss forensic outpatient clinic between 2008 and 2021. N = 181 patient files were reviewed, including forensic expert witness assessments and treatment reports. We charted the adulthood trajectory of patients with a confirmed childhood/adolescence ADHD diagnosis, examining the course of their diagnoses. Of 181 patients, evidence indicated that 12 (7%) had an ADHD diagnosis in childhood/adolescence. In 1 (8%) of these 12 cases, the diagnosis was maintained throughout the observation period. For 4 patients (33%), a diagnosis was given in the first forensic psychiatric expert witness assessment in adulthood but subsequently dropped. In another 4 cases (33%), the diagnosis was dropped in adulthood but later re-assigned, whereas in 3 cases (25%), the diagnosis was discontinued throughout the observation period. In 50% of cases with a diagnostic change, the discontinuation of an adult ADHD diagnosis coincided with a newly diagnosed personality disorder (or vice versa). Our findings highlighted considerable inconsistencies in the assignment of adult ADHD diagnoses amongst offenders. Whilst ADHD remission in adulthood occurs, the diagnostic variability in our results warrants detailed scrutiny. One possibility is that ADHD has similar fluctuations to conditions like depression, as argued elsewhere. Equally, diagnoses may become "lost", meaning they are not given even when applicable and replaced by other diagnoses. Additionally, residual symptoms may remain but beyond the diagnostic threshold. This is significant because untreated ADHD can increase re-offending risks and adverse health outcomes.

The impact of testosterone-lowering medication on recidivism in individuals convicted of sexual offenses.

Treatment of individuals who have committed sexual offences with Testosterone-Lowering Medication (TLM) is a comparatively intrusive kind of intervention, which regularly takes place in coercive contexts. Thus, the question of efficacy, but also the question of who should be treated, when and for how long, are of great importance. Recidivism rates of TLM-treated high-risk individuals (+TLM; n = 54) were compared with high-risk individuals treated with psychotherapy only in the same forensic outpatient clinic (-TLM; n = 79). Group differences suggested a higher initial risk of + TLM (e.g. higher ris-assessment, previous convictions). Despite the increased risk, after an average time at risk of six years, +TLM recidivated significantly less often and significantly later than - TLM (27.8% vs. 51.9%). Such an effect was also found for violent (1.9% vs. 15.2%), but not for sexual (5.6% vs. 10.1%) and serious recidivism (5.6% vs. 10.1%), which could be explained partly by the small number of cases. In the course of treatment, TLM proved to be a significant variable for a positive process, whereas a high risk-assessment score indicated a rather negative course. In total, n = 19 individuals had stopped their TLM treatment, of these 31.6% recidivated. The results support the efficacy of TLM, particularly in the group of high-risk offenders.

Effectiveness of forensic outpatients' psychiatric treatment and recidivism rates: A comparison study

It was previously shown that forensic outpatient psychiatric treatment lowers recidivism and improves mental health. However, there is no data specifically from Switzerland, a fact that has been repeatedly criticized by local policymakers in the course of healthcare planning. The present study aimed to describe two groups of mentally ill offenders referred to a Swiss forensic outpatient clinic, namely those accepted for treatment and those who were left untreated because their treatment was rejected. The recidivism rates of the two groups were then compared, to determine whether differences in recidivism rates between the two groups might be related to socio-demographic characteristics and mental health. Finally, improvements regarding general functional level and severity of psychopathology were evaluated over the course of time. A total of n = 131 mentally ill offenders were studied. After an average time at risk of 42.6 months, our preliminary results show that 18% of those accepted for treatment relapsed into delinquent activities, while 38% of the rejected offenders did so. We found no sociodemographic variable that differentiated between reoffenders in the two samples. Likewise, the prevalence of personality disorders was similar in the two groups. Regarding comorbidity, the combination of any substance abuse disorder and any personality disorder was more prevalent in the treated sample. Over the course of therapy, the treated group showed improvements regarding their general functional level and the severity of their psychopathology. This is the first study to explore the effects of therapeutic outpatient treatment of mentally ill offenders on Swiss recidivism rates.

The balance between clinical and administrative leadership in forensic psychiatry

Marylin Dakers-Hayward is the Clinical Director of the Forensic Psychiatry Program at St. Joseph’s Healthcare Hamilton. This program has 5 units; one secure, one undesignated, two general and one assessment, for a total of 114 beds. The program also has a forensic outpatient clinic which includes forensic outpatient rehabilitation program, aggression clinic, and sexual behaviour clinic.

Dating violence in adolescent forensic cases with history of sexual abuse

Objective: Dating violence defined as physical, sexual or psychological/emotional violence within a dating relationship. Consequences identified from longitudinal studies include cigarette smoking, marijuana and other illicit substance use, antisocial behavior, depression, and suicide ideation and attempts. We aimed to examine the concept of dating violence within a group of adolescent forensic sexual abuse cases. Methods: The files of girls aged 12-18 years who had been referred to child psychiatry forensic outpatient clinic between September 2010 and December 2012 were examined retrospectively. The group with the presence of dating violence was compared to the group without dating violence with regard to characteristics of abuse and psychiatric findings from the clinical interview. Results: The mean age of our sample was 15.20±1.67 years. Almost 75% of the cases had been abused by someone they were familiar with. Among them dating partners were the first on the list (52.3%). In both groups the most common psychiatric diagnoses were post-traumatic stress disorder and acute stress disorder, followed by major depression. Those girls, who were subjected to dating violence, had significantly more suicidal acts after the trauma. Sexual abuse with penetration was significantly higher in the dating violence group. Conclusion: The term “dating violence”, has long been known in western countries and has been regarded as a serious public health problem. It is a relatively new term in Turkey. Due to its serious consequences, such as increased suicidal attempts, the awareness about dating violence should become an issue of great importance. Keywords:

Analysis of morphological characteristics and expression levels of extracellular matrix proteins in skin wounds to determine wound age in living subjects in forensic medicine

ObjectiveWound age determination in living subjects is important in routine diagnostics in forensic medicine. Macroscopical description of a wound to determine wound age however is inadequate. The aim of this study was to assess whether it would be feasible to determine wound age via analysis of morphological characteristics and extracellular matrix proteins in skin biopsies of living subjects referred to a forensic outpatient clinic. MethodsSkin biopsies (n=101), representing the border area of the wound, were taken from skin injuries of known wound age (range: 4.5h–25days) in living subjects. All biopsies were analyzed for 3 morphological features (ulceration, parakeratosis and hemorrhage) and 3 extracellular matrix markers (collagen III, collagen IV and α-SMA). For quantification, biopsies were subdivided in 4 different timeframes: 0.2–2 days, 2–4 days, 4–10 days and 10–25 days old wounds. Subsequently, a probability scoring system was developed. ResultsFor hemorrhage, collagen III, collagen IV and α-SMA expression no relation with wound age was found. Ulceration was only found in wounds of 0.2–2, 2–4 and 4–10 days old, implying that the probability that a wound was more than 10 days old in case of ulceration is equal to 0%. Also parakeratosis was almost exclusively found in wounds of 0.2–2, 2–4 and 4–10 days old, except for one case with a wound age of 15 days old. The probability scoring system of all analyzed markers, as depicted above, however can be used to calculate individual wound age probabilities in biopsies of skin wounds of living subjects. ConclusionsWe have developed a probability scoring system, analysing morphological characteristics and extracellular matrix proteins in superficial skin biopsies of wounds in living subjects that can be applied in forensic medicine for wound age determination.

Evaluating the concurrent validity of the HCR-20 scales

The Historical, Clinical and Risk Management (HCR-20) violence risk assessment scheme was constructed to be applicable to a variety of populations, including civil and forensic psychiatric patients and correctional offenders. Research has demonstrated that the HCR-20 is strongly linked to forensic hospital readmissions and to increased risk for future violence. However, few studies have examined the psychometric properties of the HCR-20; of particular interest, the HCR-20 clinical and risk management (RM) items have had little cross-validation with other measures using independent samples. The present study is an archival examination of offenders who have been assessed at a forensic outpatient clinic and for whom the HCR-20 was used as part of the assessment. Concurrent validity was explored by correlating the Historical, Clinical and RM scales and its items with theoretically relevant constructs as measured by other psychometric measures, including the personality assessment inventory. A series of analyses to investigate the validity of the HCR-20 are reported using a small community forensic sample originally assessed at the presentence stage in the legal process. This research provides a much needed investigation of the concurrent validity for the scales and items of the HCR-20.

An evaluation of behavioural and personality differences between native and non‐native male adolescents in the Netherlands ordered into treatment in a forensic psychiatric outpatient clinic, and their non‐violent peers

In a previous study of the dynamic criminogenic needs of violent outpatients we did not differentiate between native and non-native adolescents, but differences between personality traits and problem behaviours may require adaptations to any treatment programme. To compare, in the Netherlands, native and non-native adolescents with and without a violence history on personality traits and problem behaviours. Forty-eight native and 71 non-native violent male adolescents were recruited from consecutive referrals to a forensic outpatient clinic after a violent offence and compared with randomly selected male youths in secondary vocational schools, but without a violent history, 82 of whom were from Dutch and 79 from non-Dutch descent. Each took part in an individual interview to complete a range of personality and behavioural rating scales. Native and non-native adolescent outpatients did not differ from each other on any measure. Overall, the outpatients scored higher than the students on hostility but not aggressive behaviour, but there were differences within the student group according to descent, with the native students having higher agreeableness scores and lower hostility and aggressive behaviour scores than the students of non-Dutch descent. Our study suggested that any differences in behavioural or personality traits seen in the general adolescent population according to descent are not reflected in a violent offender group of similar age. It therefore seems unlikely to be necessary to run different treatment programmes for native and non-native adolescent offenders.

Correlates of Battering Among 997 Men: Family History, Adjustment, and Attitudinal Differences

In order to identify the characteristics associated with physical abuse of female partners, a detailed questionnaire was administered to 997 men who were recruited from either a forensic out-patient clinic (780) or from a community based employment center (217). This questionnaire sampled family and personal history, criminal behavior, psychopathology, and attitudes towards violence. Based upon self-report, the sample was divided into 184 non-abusive men, 517 moderately abusive men, and 296 severely abusive men. The full sample (997) was randomly divided into two subsamples and then, using a cross-validation design, group differences were identified in both subsamples on 46 of the 93 variables examined in this study. All significant effects were linear, such that the average scores of the severely abusive men were worse than the scores of the abusive men who, in turn, scored worse than the non-abusive men. In general, both groups of abusive men reported high rates of violence during childhood (both as victims and perpetrators), antisocial personality disorder, subjective distress, marital maladjustment, attitudes tolerant of spouse assault, and a range of impulsive behaviors (impulsive violence, substance abuse, motor vehicle accidents). The factors that correlated with abuse in the total sample also correlated with abuse in the community sample.