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Bak J.,Mental Health Center Sct Hans | Zoffmann V.,Steno Diabetes Center | Sestoft D.M.,Clinic of Forensic Psychiatry | Almvik R.,Norwegian University of Science and Technology | Brandt-Christensen M.,Mental Health Center Sct Hans
Perspectives in Psychiatric Care | Year: 2014

Purpose: To examine how potential mechanical restraint preventive factors in hospitals are associated with the frequency of mechanical restraint episodes. Design and Methods: This study employed a retrospective association design, and linear regression was used to assess the associations. Findings: Three mechanical restraint preventive factors were significantly associated with low rates of mechanical restraint use: mandatory review (exp[B] = .36, p < .01), patient involvement (exp[B] = .42, p < .01), and no crowding (exp[B] = .54, p < .01). Practice Implications: None of the three mechanical restraint preventive factors presented any adverse effects; therefore, units should seriously consider implementing these measures. © 2013 Wiley Periodicals, Inc. Source

Poeppl T.B.,University of Regensburg | Nitschke J.,Clinic of Forensic Psychiatry | Santtila P.,Abo Akademi University | Schecklmann M.,University of Regensburg | And 5 more authors.
Journal of Psychiatric Research | Year: 2013

Studies applying structural neuroimaging to pedophiles are scarce and have shown conflicting results. Although first findings suggested reduced volume of the amygdala, pronounced gray matter decreases in frontal regions were observed in another group of pedophilic offenders. When compared to non-sexual offenders instead of community controls, pedophiles revealed deficiencies in white matter only. The present study sought to test the hypotheses of structurally compromised prefrontal and limbic networks and whether structural brain abnormalities are related to phenotypic characteristics in pedophiles. We compared gray matter volume of male pedophilic offenders and non-sexual offenders from high-security forensic hospitals using voxel-based morphometry in cross-sectional and correlational whole-brain analyses. The significance threshold was set to p < .05, corrected for multiple comparisons. Compared to controls, pedophiles exhibited a volume reduction of the right amygdala (small volume corrected). Within the pedophilic group, pedosexual interest and sexual recidivism were correlated with gray matter decrease in the left dorsolateral prefrontal cortex (r = -.64) and insular cortex (r = -.45). Lower age of victims was strongly associated with gray matter reductions in the orbitofrontal cortex (r = .98) and angular gyri bilaterally (r = .70 and r = .93). Our findings of specifically impaired neural networks being related to certain phenotypic characteristics might account for the heterogeneous results in previous neuroimaging studies of pedophilia. The neuroanatomical abnormalities in pedophilia seem to be of a dimensional rather than a categorical nature, supporting the notion of a multifaceted disorder. © 2013 Elsevier Ltd. Source

Hvidhjelm J.,Mental Health Center Sct Hans | Sestoft D.,Clinic of Forensic Psychiatry | Skovgaard L.T.,Copenhagen University | Bjorner J.B.,Copenhagen University | Bjorner J.B.,Helmholtz Center Munich
Nordic Journal of Psychiatry | Year: 2014

Background: Violence and aggressive behavior within psychiatric facilities are serious work environment problems, which have negative consequences for both patients and staff. It is therefore of great importance to reduce both the number and the severity of these violent incidents to improve quality of care. Aims: To evaluate the specificity and sensitivity of the Broset Violence Checklist (BVC) as a predictor of violent incidents for Danish forensic psychiatry patients. Method: A total of 156 patients were assessed three times daily with the BVC for 24 months. All aggressive or violent incidents were recorded using the Staff Observation Aggression Scale-Revised (SOAS-R). SOAS-R scores of 9 or more defined violent incidents. Data were analyzed using standard logistic regression models as well as models incorporating a random person effect. We used receiver operating curve (ROC) analysis to evaluate different BVC thresholds. Results: Of a total of 139,579 BVC registrations we found 1999 scores above 0 and 419 violent incidents. The BVC score was a strong predictor of violence. For the standard cut-off point of 3, specificity was 0.997 and sensitivity was 0.656. For the general risk of violence seen in this study, the risk of violence given a BVC score > 3 (positive predictive value) was 37.2%, and the risk of violence given a BVC score < 3 (negative predictive value) was 0.1%. Conclusion: The BVC showed satisfactory specificity and sensitivity as a predictor of the short-term risk of violence against staff and others by patients in a forensic setting. © 2014 Informa Healthcare. Source

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