RESUMEN
Although intensive, assertive treatment options in child and adoledcent psychiatry have been successfully evaluated and established in several countries, this development is just beginning in Austria. As part of the so called home-treatment, care is provided by a multiprofessional team to patients with severe mental disorders, who would otherwise be treated in an inpatiet setting at their own home. This opens up the opportunity for a better generalizability of therapeutic progress and an intensive work with the family system. Alternative models for inpatient care like home-treatment, show the potential for intensive therapeutic options independent of building structures. Further development of this therapeutic option based on evaluated model projects is desirable within the Austrian health care system.
Asunto(s)
Trastornos Mentales , Niño , Humanos , Austria , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , HospitalizaciónRESUMEN
OBJECTIVE: Within the European Alliance Against Depression (EAAD), community mental health services inform in their service region in Lower Austria (pop. 1.600.000) about symptoms of depression, about treatment options and service characteristics. Social distance can be overcome preferably by public mental health projects involving users and relatives. Therefore, community mental health services in Lower Austria routinely inform the public about depression, treatment options and services together with service users and relatives. This paper presents an evaluation of workshops for police officers. METHODS: During the year 2010, 38 workshops for the police were conducted. All officers were asked to fill in the Gotland Scale of Male Depression, and to rate social distance and stereotypes regarding a case vignette of a fictitious depressive person. One week after the workshop, social distance and stereotypes were again rated. RESULTS: 852 police officers took part in the workshops, 703 were screened by the Gotland Scale of Male Depression. 9 % showed depressive symptoms. The officers were content with the workshops, they felt better informed afterwards and thought they could better help affected persons. The interpretation of the case vignette was more often "mentally ill" or "insane". CONCLUSIONS: Personal experience with depression was more strongly related to present depressive symptoms than age or years on duty. Personal contact with a person that had been affected by depression before, and the slogan "depression can affect anybody" may have increased feelings of anxiety in officers that had taken part in the workshops.
Asunto(s)
Concienciación , Cuidadores/educación , Servicios Comunitarios de Salud Mental , Trastorno Depresivo/diagnóstico , Educación , Educación en Salud , Policia/educación , Adulto , Austria , Cuidadores/psicología , Estudios Transversales , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Policia/estadística & datos numéricos , Distancia Psicológica , Factores de Riesgo , EstereotipoRESUMEN
BACKGROUND: Psychiatric services increasingly use internet technologies to enhance and support usual therapies, which are based on direct personal contact. METHODS: An anonymous e-mail-request of a young girl obviously requiring psychiatric support and treatment is illustrated, characterized by the intention of the service to establish personal contact. CONCLUSIONS: Chances and limitations of psychiatric interventions using the internet are discussed.
Asunto(s)
Servicios Comunitarios de Salud Mental , Internet , Terapia Asistida por Computador , Adolescente , Terapia Combinada , Correo Electrónico , Femenino , Alemania , Necesidades y Demandas de Servicios de Salud , Investigación sobre Servicios de Salud , Humanos , Educación del Paciente como Asunto , Satisfacción del Paciente , Relaciones Médico-Paciente , PsicoterapiaRESUMEN
OBJECTIVE: Community mental health teams (CMHT) provide support for severely disabled, chronic mentally ill patients. In this study, referrals to CMHT by a psychiatric hospital in Lower Austria were analysed, as were the first few weeks of care for referred patients. METHODS: Referrals to CMHT of a catchment area (pop 250.000) were analysed for 2002- 2006. RESULTS: In the first 6 months of each year, 124 to 189 patients were referred to CMHT. Between 2002 and 2006, the percentage of affective disorders (ICD-10: F3: 40.0 %), and substance use disorders (F1: 38.9 %) within the referrals diminished, as compared to patients suffering from schizophrenia (F2 initially 25.4 % of referrals vs. 49.7 %) and personality disorders (F6 initially 6.4 % of referrals vs. 22.4 %). In 30.7 % vs. 56.6 % of patients, CMHT workers managed to establish contact to patients after discharge from hospital. They actively sought contact with 39.9 to 74.6 % of referred patients (by means of telephone calls, letters, home visits, etc.). In 26.5 to 46.9 % of the referrals, continuous care was planned. CONCLUSIONS: This study emphasizes the advantage of specific referrals to CMHT, if care for severely disabled individuals is needed and should be provided. Furthermore, a description of outreach activities, which are intended to maintain contact with patients characterized by poor compliance, is presented. These activities are not yet part of routine care in German speaking countries.
Asunto(s)
Servicios Comunitarios de Salud Mental/normas , Hospitales Psiquiátricos/normas , Trastornos Mentales/rehabilitación , Garantía de la Calidad de Atención de Salud/normas , Derivación y Consulta/normas , Austria , Enfermedad Crónica , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Relaciones Comunidad-Institución/normas , Continuidad de la Atención al Paciente/normas , Continuidad de la Atención al Paciente/estadística & datos numéricos , Estudios Transversales , Diagnóstico Dual (Psiquiatría) , Investigación sobre Servicios de Salud/estadística & datos numéricos , Hospitales Psiquiátricos/estadística & datos numéricos , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Admisión del Paciente , Relaciones Profesional-Paciente , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/rehabilitaciónRESUMEN
The "Viennese Instrument for Suicidality in Correctional Institutions" (VISCI) presented here is based on the results of a large case-control study and on research on literature examining suicide prevention in general and in the prison population in particular. The aim of this study was to validate the properties of the VISCI to differentiate between suicides and nonsuicides. The sensitivity and specificity of the VISCI was tested in the files of 55 correctional suicides, and 110 controls. VISCI differentiated well between suicides and nonsuicides. The routine administration of the VISCI may help to direct the existing professional attention to inmates with the highest need.
Asunto(s)
Tamizaje Masivo , Prisioneros/psicología , Pruebas Psicológicas , Prevención del Suicidio , Austria , Estudios de Casos y Controles , Humanos , Análisis por Apareamiento , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Suicidio/psicologíaRESUMEN
OBJECTIVES: In the last decades, long-time patients were systematically discharged from psychiatric hospitals in order to integrate this disadvantaged population into the community. This procedures where adequately evaluated and are regarded to be completed in the western world today. However, few evidence has been presented regarding the further course of integration following discharge from mental hospitals: was integration into community really successful or were patients permanently placed in sheltered housing staffed 24 hours 7 days a week. This review focuses on the question whether papers describing large de-institutionalisation projects mention the level of institutional support in the years following discharge from hospital. Furthermore we tried to find out which parameters are dealt with when describing successful community integration. METHODS: "Pubmed" was searched for studies on de-institutionalisation projects published between 1997 and 2007. RESULTS: The discharge from the mental hospital wards was in all studies described as successful, positive effects like an increased quality of life were found. However, studies describing the years following discharge mentioned that patients continuously stayed in sheltered housing with care offered 24 hours a day. CONCLUSION: Reviewing the available data about the level of support regarding accommodation of former long time patients, the danger of "trans-institutionalisation" has to be pointed out. Evidence is lacking concerning support models tailored to the individual needs of the patients. Similarly, possible side effects of long-term stays in sheltered housing staffed 24 hours a day have not yet been established. Therefore, we see a need for further evaluation of different models of supported housing for former long-term hospitalised patients, as well as for new chronic mentally ill patients.
Asunto(s)
Servicios Comunitarios de Salud Mental/tendencias , Desinstitucionalización/tendencias , Hogares para Grupos/tendencias , Esquizofrenia/rehabilitación , Enfermedad Crónica , Alemania , Humanos , Cuidados a Largo Plazo/tendencias , Evaluación de Necesidades/tendencias , Ajuste Social , Apoyo SocialRESUMEN
AIM: Pupillometry is a non-invasive measurement technique based on the pupillary response to specific sensoric, mental and emotional variables. After topical application of a cholinergic antagonist (tropicamide) an increased pupillary dilatation response in Alzheimers s disease patients was described ("receptor test"). The aim of the present study was to evaluate the usefulness of the 0.01% tropicamide receptor test in differentiating types of dementia. METHOD: 425 patients (159 men, 266 women, mean age 75 years) of the Memory Clinic of the SMZ Ost Vienna, Austria were included in the study. 195 patients suffered from a dementia in Alzheimer's disease with late onset (ICD-10: F00.1), 42 from dementia in Alzheimer's disease with early onset (F00.0), 71 from vascular dementia (F01), 34 from Lewy-Body dementia (F03) and 83 from mixed dementia (F00.2). All patients were investigated by means of a computer-assisted pupillometer. The pupillary diameter of the left eye was measured 4 times (baseline=0 minutes, after 20, 40 and 60 minutes). 4 minutes after baseline one drop of 0.01% tropicamide solution was installed onto the left eye of the patients. RESULTS: At baseline the pupillary diameter was largest in Lewy-Body dementia, smallest in vascular dementia. Significant differences were observed between vascular dementia and early-onset dementia in Alzheimer's disease as well as between Lewy-Body dementia and all other dementia syndromes (except dementia in Alzheimer's disease with early onset). The 0.01% tropicamide receptor test made it possible to differentiate early-onset dementia in Alzheimer's disease from vascular and mixed dementia. CONCLUSION: Utilizing pupillometry in combination with the 0.01% tropicamide receptor test allows to discriminate between different dementia types of, as demonstrated in our study.
Asunto(s)
Demencia/diagnóstico , Antagonistas Muscarínicos , Reflejo Pupilar/efectos de los fármacos , Tropicamida , Anciano , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/fisiopatología , Demencia/clasificación , Demencia/fisiopatología , Demencia Vascular/diagnóstico , Demencia Vascular/fisiopatología , Femenino , Humanos , Enfermedad por Cuerpos de Lewy/diagnóstico , Enfermedad por Cuerpos de Lewy/fisiopatología , Masculino , Pruebas Neuropsicológicas , Soluciones Oftálmicas , Valor Predictivo de las Pruebas , Reflejo Pupilar/fisiología , Procesamiento de Señales Asistido por ComputadorRESUMEN
OBJECTIVE: Although mental health reforms in the 20th century were characterized by deinstitutionalization, previous research suggested a new era of reinstitutionalization in six European countries between 1990 and 2002. This study aimed to establish whether there has been a trend in Europe toward more institutionalized care since 2002. METHODS: Primary data sources were used to collect data on conventional inpatient beds, involuntary hospital admissions, forensic beds, places in residential care and supervised and supported housing, and the prison population in nine countries: Austria, Denmark, England, Germany, Republic of Ireland, Italy, the Netherlands, Spain, and Switzerland. RESULTS: Between 2002 and 2006 the number of conventional psychiatric inpatient beds tended to fall and changes in involuntary admissions were inconsistent. The number of forensic beds, places in supervised and supported housing, and the prison population increased in most, but not all, of the countries studied. CONCLUSIONS: The findings suggest an ongoing although not consistent trend toward increasing provision of institutionalized mental health care across Europe.
Asunto(s)
Hospitales Psiquiátricos/organización & administración , Servicios de Salud Mental/organización & administración , Europa (Continente)/epidemiología , Humanos , Institucionalización/estadística & datos numéricosRESUMEN
OBJECTIVES: Unemployment has a strong negative impact on quality of life and on the further course of the disease of mentally disordered individuals. Therefore, vocational rehabilitation programmes are necessary to help people with mental disorders to obtain work. There is increasing scientific evidence concerning positive predictors for vocational integration. This paper intends to give an overview about established predictors for successful integration. METHODS: "Pubmed" was searched for studies on psychiatric vocational rehabilitation programmes published between 1997 and 2007, which had the focus on predictors of successful outcome. RESULTS: Some of the most important predictors are a better history of work integration and better work performance measured during psychiatric vocational rehabilitation. Successful vocational integration is harder if negative symptoms or cognitive deficits are present. The impact of sociodemographic factors, diagnosis, motivation to work and social skills is discussed controversially. CONCLUSION: Future research should be directed to design vocational rehabilitation programmes, which address the specific needs of psychiatric patients.
Asunto(s)
Trastornos Mentales/rehabilitación , Rehabilitación Vocacional , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Trastornos del Conocimiento/rehabilitación , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Pronóstico , Esquizofrenia/rehabilitación , Ajuste Social , Educación VocacionalRESUMEN
OBJECTIVE: The assessment and estimation of suicidal risk constitutes a serious and difficult task for any mental health professional. If we add to this the challenges that may be presented by a specific population at higher risk with little possibilities for thorough psychiatric evaluation, the task appears even more complicated. METHOD: The "Viennese Instrument for Suicidality in Correctional Institutions" ("VISCI") presented here is based on the results of a case control study including all suicides in all Austrian jails and prisons between 1975 and 1999 and on research on literature examining suicide prevention in general and prison population in particular. RESULTS: Sensitivity and specificity of VISCI are presented. CONCLUSIONS: As suicide rates in custody are higher than in the general population, and these rates have been increasing within the last 20 years, the screening of offenders newly admitted to prison for their propensity to suicide is necessary to give a better estimation of the suicide risk and hopefully to stop further increase of suicide rates in jails and prisons.
Asunto(s)
Tamizaje Masivo , Determinación de la Personalidad/estadística & datos numéricos , Prisioneros/psicología , Intento de Suicidio/psicología , Suicidio/psicología , Adulto , Austria , Estudios de Casos y Controles , Comorbilidad , Crimen/psicología , Crimen/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Persona de Mediana Edad , Prisioneros/estadística & datos numéricos , Prisiones/estadística & datos numéricos , Medición de Riesgo/estadística & datos numéricos , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Suicidio/estadística & datos numéricos , Intento de Suicidio/prevención & control , Intento de Suicidio/estadística & datos numéricos , Violencia/prevención & control , Violencia/psicología , Violencia/estadística & datos numéricos , Prevención del SuicidioRESUMEN
OBJECTIVE: The subject of religion and spirituality has attracted little attention in psychiatric research so far. The aim of the study was to give an overview of the attitudes of patients as well as psychiatrists towards regarding the importance of religion and spirituality in the treatment of mental illness. Furthermore we tried to give a description of established ideas involving both dimensions into the treatment of psychiatric patients. METHODS: We performed a search for relevant literature using the electronic databases Medline, PubMed, Psyndex and Embase. In addition we used the internet search engines Scopus and Google Scholar. RESULTS: Patients mention religion twice as often as an important factor in their lives as compared to psychiatrists. Consecutively, particular emphasis should be paid to the integration of both dimensions into clinical treatment. Additionally, the education of mental health professionals, consultation and the enrollment of religious or spiritual needs of patients when taking their medical history are essential factors. Religious coping and positive and negative components in matters of mental health are highlighted. CONCLUSIONS: More attention should be paid to the "religiosity gap" between patients and their psychiatrists. The entirety of a human being includes a physical, emotional, social as well as a spiritual dimension. Mental health professionals ignoring one of these aspects may delay recovery.
Asunto(s)
Actitud del Personal de Salud , Trastornos Mentales/terapia , Psiquiatría , Religión y Psicología , Espiritualidad , Humanos , Anamnesis , Trastornos Mentales/psicología , Cuidado Pastoral , Grupo de Atención al Paciente , Satisfacción del PacienteRESUMEN
In 2000 the Department of Mental Health of the World Health Organization (WHO) published a guide named Preventing Suicide. A Resource for Prison Officers as part of the WHO worldwide initiative for the prevention of suicide. In 2007 there are new epidemiological data on prison suicide, a more detailed discussion of risk factors accounting for the generally higher rate of suicide in correctional settings in comparison to the general population, and several strategies for developing screening instruments. As a first step, this paper presents an update of the WHO guide by the Task Force on Suicide in Prisons, created by the International Association for Suicide Prevention. A second paper, by the same Task Force, will present some international comparisons of suicide prevention services in correctional facilities.
Asunto(s)
Cooperación Internacional , Prisiones , Prevención del Suicidio , Humanos , Prisioneros/psicología , Intento de Suicidio/prevención & controlRESUMEN
The International Association for Suicide Prevention created a Task Force on Suicide in Prisons to better disseminate the information in this domain. One of its objectives was to summarize suicide-prevention activities in the prison systems. This study of the Task Force uncovered many differences between countries, although mental health professionals remain central in all suicide prevention activities. Inmate peer-support and correctional officers also play critical roles in suicide prevention but there is great variation in the involvement of outside community workers. These differences could be explained by the availability of resources, by the structure of the correctional and community services, but mainly by the different paradigms about suicide prevention. While there is a common and traditional paradigm that suicide prevention services are mainly offered to individuals by mental health services, correctional systems differ in the way they include (or not) other partners of suicide prevention: correctional officers, other employees, peer inmates, chaplains/priests, and community workers. Circumstances, history, and national cultures may explain such diversity but they might also depend on the basic way we think about suicide prevention at both individual and environmental levels.
Asunto(s)
Cooperación Internacional , Prisiones , Prevención del Suicidio , Australia , Austria , Canadá , Alemania , Humanos , Italia , Países Bajos , Reino Unido , Estados UnidosRESUMEN
OBJECTIVE: International surveys found an increase of mentally disordered individuals in correctional institutions. As a consequence, suicides and suicide rates in jails and prisons are increasing. Mental health services and criminal justice authorities have identified this problem, but there is a lack of knowledge concerning risk factors for inmate suicides and practicable prevention. METHOD: A literature research was conducted through "medline" searching for studies addressing the problem of jail and/or prison suicide. Subsequently, results of relevant surveys were compared and depicted in several tables. RESULTS: Suicide rates in correctional facilities significantly exceed those in the general male population. Suicide rates in custody have been increasing within the last decades. Pre-trial prisoners have the highest suicide risk within the total prison population. Long-term sentences, single-cell use, mental illness, substance abuse and a history of suicidality are associated with an increased suicide risk. DISCUSSION: The impact of suicide prevention strategies and future directions of research in this high-risk setting are highlighted.
Asunto(s)
Comparación Transcultural , Prisioneros/estadística & datos numéricos , Prisiones/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Alemania , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prisioneros/psicología , Factores de Riesgo , Suicidio/psicología , Prevención del SuicidioRESUMEN
The aim of this double-blind, placebo-controlled study was to evaluate the efficacy of intravenous magnesium sulphate (MgSO(4)) on the need for chlormethiazole in pure or polysubstance opiate detoxification. Forty-one inpatients suffering from pure and polysubstance opiate dependence were treated with morphine sulphate pentahydrate in a gradual detoxification program. Morphine reduction took about 11 days. Additionally, 5% MgSO(4) was administered intravenously to the intervention group (Mg group, n=22) over 24 h by perfusor (150-200 mg MgSO(4)/h; plasma level of 2.36+/-0.29 mmol/l), whereas NaCl 0.9% was intravenously administered in the placebo group (n=19). In case of withdrawal symptoms (irritability, restlessness, and insomnia), patients received chlormethiazole p.o. Our hypothesis that the need for chlormethiazole would be decreased by adjunctive administration of Mg was not confirmed in our study population (2180 mg/day in the Mg group vs. 2360 mg/day in the placebo group). There was neither a difference in the quantity of chlormethiazole required nor a difference in the severity of withdrawal symptoms measured with the Wang scale between the two comparison groups. We observed that calcium plasma levels decreased and phosphate plasma levels increased significantly during intravenous therapy with Mg. Despite promising pilot studies, the administration of Mg did not enable a dose reduction of tranquilizing medication (chlormethiazole) in pure and polysubstance opiate detoxification.
Asunto(s)
Acatisia Inducida por Medicamentos/tratamiento farmacológico , Clormetiazol/uso terapéutico , Genio Irritable , Sulfato de Magnesio/uso terapéutico , Trastornos del Humor/tratamiento farmacológico , Morfina/uso terapéutico , Narcóticos/farmacocinética , Narcóticos/uso terapéutico , Fármacos Neuroprotectores/uso terapéutico , Trastornos Relacionados con Opioides/terapia , Adolescente , Adulto , Clormetiazol/administración & dosificación , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Inactivación Metabólica , Inyecciones Intravenosas , Sulfato de Magnesio/administración & dosificación , Masculino , Trastornos del Humor/diagnóstico , Morfina/administración & dosificación , Narcóticos/administración & dosificación , Narcóticos/efectos adversos , Fármacos Neuroprotectores/administración & dosificación , Trastornos Relacionados con Opioides/diagnóstico , Índice de Severidad de la Enfermedad , Síndrome de Abstinencia a Sustancias/diagnóstico , Síndrome de Abstinencia a Sustancias/etiologíaRESUMEN
BACKGROUND: Few risk factors and indicators of vulnerability for suicide in custody are known so far. AIMS: A case-control study was conducted to investigate the relevance of criminal history, psychiatric morbidity and social integration to suicide in prison. METHOD: For every suicide that occurred in an Austrian correctional institution between 1975 and 1999, two controls matched for correctional institution, gender, nationality, age, custodial status and time of admission were selected. Psychiatric characteristics, previous suicidal behaviour, criminal history and indicators of social integration were compared. RESULTS: Of 250 recorded suicides, 220 personal files were available and matched to 440 controls. The most important predictors for suicide in custody were a history of suicidality (status following attempted suicide and suicide threat), psychiatric diagnosis, psychotropic medication, a highly violent index offence and single- cell accommodation. CONCLUSIONS: A significant finding is the importance of suicidal behaviour as an indicator of risk of suicide in correctional institutions, which until now has been a matter of debate. This study demonstrates the need for staff to take suicidal behaviour as seriously in custodial settings as in any other circumstances.
Asunto(s)
Trastornos Mentales/epidemiología , Prisioneros/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Adolescente , Adulto , Anciano , Austria/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Factores de RiesgoRESUMEN
An unequal distribution of suicides over months and seasons has been a consistent finding in epidemiological surveys on suicide. Jails and prisons are a high-risk setting for suicide all over the world. The high prevalence of both outward and self-directed violence in prison populations indicates dysfunctional central serotonin (5-HT) neurotransmission and, therefore, could account for an unequal distribution of suicides over months and seasons due to underlying bioclimatic factors. Within a total survey of suicides in the Austrian penitentiary system, the weekly, monthly and seasonal distribution of custodial suicides between 1947 and 1999 was studied. After an explorative comparison of suicide distribution over weekdays, months and seasons of the year by chi2-tests, a harmonic Poisson regression model was performed to detect seasonality of suicides. No unequal distribution of suicides was evident over the 53-year period. A limitation of this study was its sample size of 412, a low number compared with population-based samples, where a spring suicide peak was consistently found. An explanation for lacking seasonality could be that bioclimatic factors are less relevant in urban, industrialized areas, where jails and prisons usually are located. One of the core characteristics of penal institutions is the limited possibility for communication and social interaction. This social isolation is independent of seasonal changes. If the individual's possibilities for social interactions are limited, the influence of seasonal changes in social activities may be less relevant. This could explain the absence of seasonal changes in custodial suicide incidence.
Asunto(s)
Prisioneros/estadística & datos numéricos , Prisiones/estadística & datos numéricos , Estaciones del Año , Suicidio/estadística & datos numéricos , Austria/epidemiología , Causalidad , Causas de Muerte , Estudios Transversales , Humanos , Periodicidad , Distribución de Poisson , Prisioneros/psicología , Análisis de Regresión , Estudios Retrospectivos , Riesgo , Suicidio/psicología , Suicidio/tendenciasRESUMEN
Following clinical observations in this study a comparison was undertaken between nonsexualized rapists, sexualized rapists, and pedophilic child molesters in terms of psychometric measures, criminological data, and DSM-IV diagnoses following the authors' hypotheses that nonsexualized and sexualized rapists differ in respect of psychiatric comorbidity and criminal history and sexualized rapists and pedophilic child molesters are more similar as regards to psychiatric comorbidity (anxiety, depression, and aggression) and criminal history variables than nonsexualized and sexualized rapists are. Preliminary findings confirmed the hypotheses: the authors found significant differences between paraphilic and sexualized sex offenders on one hand--regardless whether they had offended against minors or adults--and a group of sex offenders exhibiting a history of high lifestyle impulsivity on the other hand. From a psychiatric clinical point of view, paraphilic or sexualized rapists could be shown to resemble more the pedophilic child molesters. Therapeutic approaches should take these findings into account.
Asunto(s)
Conducta Impulsiva/diagnóstico , Estilo de Vida , Trastornos Parafílicos/diagnóstico , Pedofilia/psicología , Violación/psicología , Delitos Sexuales/psicología , Adulto , Niño , Abuso Sexual Infantil/prevención & control , Abuso Sexual Infantil/psicología , Comorbilidad , Humanos , Conducta Impulsiva/psicología , Entrevista Psicológica , Masculino , Trastornos Parafílicos/psicología , Pedofilia/prevención & control , Inventario de Personalidad/estadística & datos numéricos , Psicometría , Violación/prevención & control , Factores de Riesgo , Delitos Sexuales/prevención & controlRESUMEN
PURPOSE: Suicide rates in correctional institutions have been increasing during the last decades. There has been little interest in whether suicidal ideation and intent has been documented by non-medical prison staff (reports of attempted suicide, suicide threats, self-harm), and whether these signs of suicidality had the consequence of adequate intervention efforts. METHODS: The personal files of inmates who committed suicide in the 29 Austrian jails and prisons during the last 25 years (1975-1999) were included. We analysed personal characteristics, criminological data, circumstances of custody and information about psychiatric disorders and treatment. RESULTS: Of a total of 250 suicides, 220 personal files were available and included. Suicide attempts were known in 50% of all suicides and 37% had expressed suicidality. In >20%, non-medical staff had documented signs of suicidality, but no further preventive action (e.g. referral to psychiatric care) had taken place. CONCLUSION: Signs of suicidality play an important role in vulnerability profiles for jail and prison suicides and should have the minimal consequence of further psychiatric care.