No abstract

The long term predictive validity of four current risk assessment instruments was assessed in Germany on three different groups of subjects. The groups consisted of 73 sex offenders released from a prison-based special therapeutic unit (therapeutic sample), 15 individuals who did not complete this treatment (drop-outs), and another 46 subjects who were assessed in a psychiatric hospital having been accused of a sexual offence (assessment sample). The results of the three samples were then compared. The outcome was obtained by examining the national conviction registry. The mean follow-up time was 9 years (range: 1 -340 months). The highest rate of recidivism was observed in the dropout group, with only one individual not reoffending. The assessment group had slightly fewer reoffences compared to the treatment group, which had been selected as a high risk population. The treatment sample exceeded the assessment sample, especially concerning sexual reoffences, but less so concerning violent reoffences. Of all the assessment instruments and using the total sample, the Static-99 was the most efficient predictor of all, violent non-sexual and non-contact sexual recidivism. For the prediction of contact sexual recidivism the AUC of the HCR-20 and the SVR-20 was slightly better, but very similar to the Static-99. These differences between assessment instruments were, however, not statistically significant. The AUC for the Static-99 was smaller in the treatment group, but larger than for other assessment instruments. The Static-99 risk categories correlated significantly with the Kaplan -Meier survival functions.

A clear and structured approach to evidence-based and gender-specific risk assessment of violence in female offenders is high on political and mental health agendas. However, most data on the factors involved in risk-assessment instruments are based on data of male offenders. The aim of the present study was to validate the use of the Psychopathy Checklist Revised (PCL-R), the HCR-20 and the Violence Risk Appraisal Guide (VRAG) for the prediction of recidivism in German female offenders. This study is part of the Munich Prognosis Project (MPP). It focuses on a subsample of female delinquents (n = 80) who had been referred for forensic-psychiatric evaluation prior to sentencing. The mean time at risk was 8 years (SD = 5 years; range: 1-18 years). During this time, 31% (n = 25) of the female offenders were reconvicted, 5% (n = 4) for violent and 26% (n = 21) for non-violent re-offenses. The predictive validity of the PCL-R for general recidivism was calculated. Analysis with receiver-operating characteristics revealed that the PCL-R total score, the PCL-R antisocial lifestyle factor, the PCL-R lifestyle factor and the PCL-R impulsive and irresponsible behavioral style factor had a moderate predictive validity for general recidivism (area under the curve, AUC = 0.66, p = 0.02). The VRAG has also demonstrated predictive validity (AUC = 0.72, p = 0.02), whereas the HCR-20 showed no predictive validity. These results appear to provide the first evidence that the PCL-R total score and the antisocial lifestyle factor are predictive for general female recidivism, as has been shown consistently for male recidivists. The implications of these findings for crime prevention, prognosis in women, and future research are discussed.

No abstract

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.

The validity of the VRAG was replicated with a German sample. The VRAG yielded good predictive accuracy, despite differences in sample and outcome variables compared with its original sample.

Bupropion, a selective norepinephrine and dopamine reuptake inhibitor, has been suggested for the treatment of bipolar depression, not only because of its efficacy, but also because of a probably lower risk of inducing switches to hypomania or mania. Most studies on bupropion treatment in bipolar patients have been performed in moderately ill out-patients. In contrast, we report on a sample of difficult-to-treat, predominantly severely ill, co-morbid, psychotic or therapy-refractory bipolar depressive in-patients. In this open and prospective study, 13 patients were treated with bupropion as an add-on strategy mainly to other antidepressants and to various mood stabilizers. Our data support the idea that bupropion is a first-line antidepressant in the treatment of severe bipolar depression. Eight of 13 patients showed a >50% reduction of Montgomery-Asberg Depression Scale ratings within 4 weeks. Co-medication with drugs commonly used in treatment-resistant bipolar disorder including venlafaxine, clozapine, lithium, topiramate and sodium valproate was safe in our small sample. While adhering to the suggestion of Goren and Levin not to exceed a daily dose of 450 mg of bupropion when treating bipolar depressed patients, we did not observe any switch from depression to hypomania or mania.

Bayesian reasoning has already been applied in the area of assessing recidivism risk. Based on single predictors for re-offending, various authors have pointed out that Bayesian analysis was suited to the problem because the base rate of recidivism could be accounted for in terms of a prior probability. The present paper extends this argument towards the multivariate case. The result is a case-specific probabilistic assessment that allows judges and juries to reach informed decisions. The present paper illustrates the method through the combination of offender's age with data from a structured professional risk assessment instrument, the Psychopathy Checklist-Revised (PCL-R), for a sample of N = 393 German convicts. The combination of these two criteria emerged as optimal from all available subsets of predictors (including the History Clinical Risk-20 and its components). The effect size for the Bayesian combination measure with regard to violent offense recidivism was large and significantly higher than the predictive value for each of its constituents. The study design was retrospective, average time at risk was 6.5 years.