http://manuscript.elsevier.com/S0149763422000781/pdf/S0149763422000781.pdf

Neurostructural traces of early life adversities: A meta-analysis exploring age- and adversity-specific effects

Stalking began to be criminalized on the heels of news stories in the late 1980s in the United States of America (USA). Unfortunately, little is known about how states have responded to stalking, e...

Stalking State Statutes: A Critical Content Analysis and Reflection on Social Science Research

Several studies have highlighted that particular social and professional categories are at higher risk of being victim of stalking. Physicians and healthcare workers in general are at risk of being harassed while practising their profession, especially by their patients; this risk has been shown to be higher for psychiatrists and psychotherapists. According to a recent study, 21% of psychiatrists has been a victim of stalking; length of stalking behaviour on healthcare workers varies from a few weeks to several years. Aim of the present work is to gain a better understanding and a highlight on the frequency with which stalking occurs toward social and healthcare workers of public health facilities in Sardinia. After a review of literature, an anonymous questionnaire, prepared ad-hoc, has been administered to a sample of 265 healthcare workers in Sardinia: out of the 210 who have answered, we have taken into consideration 187 healthcare workers, have excluded 23 operators (psychiatric rehabilitators, professional educators, social workers) and chosen to analyze victimization suffered by psychiatrists, psychologists, nurses, social healthcare workers. In our sample the subjects who reported harassments comparable to the crime of stalking are represented by 30 healthcare workers out of the total sample of 187 (16%). Females are the most frequently represented with a ratio of 23/30 (77%) compared to males 7/30 (23%). The risk of being a victim of harassment was higher for the group of psychiatrists and psychologists than for nurses. Among the victims, 18 were psychiatrists (60%), 3 psychologists (10%), and 9 nurses (30%). Healthcare professionals are at high risk of victimization. The main tool available to the services is the team approach to multi-problematic cases, avoiding isolation of the dyad designated operator-patient. The feeling of impotence and isolation that is frequent in the victims of stalking, as shown also in our sample, is highlighted by several studies in which 10% of the victims interviewed claims to have thoughts of suicide as a way out.

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Stalking of social healthcare workers: Preliminary results of a study conducted in Sardinia, Italy

Mental healthcare users and patients were described as a particularly vulnerable group in the debate on the burdens of the COVID-19 pandemic. Just what this means and what normative conclusions can be derived from it depend to a large extent on the underlying concept of vulnerability. While a traditional understanding locates vulnerability in the characteristics of social groups, a situational and dynamic approach considers how social structures produce vulnerable social positions. The situation of users and patients in different psychosocial settings during the COVID-19 pandemic has not yet been comprehensively considered and ethically analyzed under the aspect of situational vulnerability.We present the results of a retrospective qualitative analysis of a survey of ethical challenges in different mental healthcare facilities of a large regional mental healthcare provider in Germany. We evaluate them ethically using a dynamic and situational understanding of vulnerability.Difficulties in implementing infection prevention measures, restrictions of mental health services in favor of infection prevention, social isolation, negative health effects on mental healthcare users and patients, and challenges in implementing regulations on state and provider levels within the local specificities emerged across different mental healthcare settings as ethically salient topics.Applying a situational and dynamic understanding of vulnerability allows the identification of specific factors and conditions that have contributed to an increased context-dependent vulnerability for mental healthcare users and patients. These factors and conditions should be considered on the level of state and local regulations to reduce and address vulnerability. 

/pdf/situational-vulnerability-within-mental-healthcare-a-2ein4rt4.pdf

Situational vulnerability within mental healthcare – a qualitative analysis of ethical challenges during the COVID-19 pandemic

Background Anxiety and depressive disorders share common features of mood dysfunctions. This has stimulated interest in transdiagnostic dimensional research as proposed by the Research Domain Criteria (RDoC) approach by the National Institute of Mental Health (NIMH) aiming to improve the understanding of underlying disease mechanisms. The purpose of this study was to investigate the processing of RDoC domains in relation to disease severity in order to identify latent disorder-specific as well as transdiagnostic indicators of disease severity in patients with anxiety and depressive disorders. Methods Within the German research network for mental disorders, 895 participants (n = 476 female, n = 602 anxiety disorder, n = 257 depressive disorder) were recruited for the Phenotypic, Diagnostic and Clinical Domain Assessment Network Germany (PD-CAN) and included in this cross-sectional study. We performed incremental regression models to investigate the association of four RDoC domains on disease severity in patients with affective disorders: Positive (PVS) and Negative Valance System (NVS), Cognitive Systems (CS) and Social Processes (SP). Results The results confirmed a transdiagnostic relationship for all four domains, as we found significant main effects on disease severity within domain-specific models (PVS: β = −0.35; NVS: β = 0.39; CS: β = −0.12; SP: β = −0.32). We also found three significant interaction effects with main diagnosis showing a disease-specific association. Limitations The cross-sectional study design prevents causal conclusions. Further limitations include possible outliers and heteroskedasticity in all regression models which we appropriately controlled for. Conclusion Our key results show that symptom burden in anxiety and depressive disorders is associated with latent RDoC indicators in transdiagnostic and disease-specific ways.

https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1161097/pdf

The associations of Positive and Negative Valence Systems, Cognitive Systems and Social Processes on disease severity in anxiety and depressive disorders

Background Currently, there are clear indications that due to their exposed occupational position psychiatrists and psychotherapists are at a higher risk than the general public to become the victim of stalking by patients. Objectives This study investigated the frequency of stalking and its psychosocial impact among psychiatrists and psychotherapists in the Federal Republic of Germany. Methods Analysis of an online survey among members of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) from 23 September 2015 until 22 October 2015. Results Of the respondents 26.5% reported having been the victim of stalking. In more than a third of the reported cases the stalking was described as severely or very severely debilitating. The majority of the perpetrators suffered from psychotic or personality disorders. Male victims were significantly more frequently stalked by a female perpetrator. Approximately 1 in 10 stalking victims continued the treatment of the perpetrator. The majority of the stalking victims did not obtain substantial support from their employer. Conslusion The phenomenon of stalking within therapeutic relationships needs to be incorporated into the medical and psychotherapeutic professional training, e. g. by implementing specialized training courses and the systematic integration of this topic into clinical supervision. The institutional dealing with stalking by patients needs to optimized, e. g. by promptly transferring treatment of patients who stalk to other professionals and, where required, providing assistance in reporting stalking incidents to the police.

[Stalking of psychiatrists and psychotherapists : Results of an online survey].

/pdf/covid-19-challenges-for-forensic-therapy-and-quality-of-3tzzpafgo0.pdf

[COVID-19: challenges for forensic therapy and quality of treatment in institutions for forensic commitment].

Soziale Prozesse und ihre Storungen, z. B. bei Autismusspektrumstorungen und psychotischen Storungen, sind seit jeher zentral fur das Fach Psychiatrie. Die letzten Jahrzehnte haben zu beeindruckenden Fortschritten in unserem Verstandnis der zugrunde liegenden neurobiologischen Grundlagen gefuhrt, aber auch in der Art und Weise, wie wir soziale Prozesse untersuchen und analysieren. Seit ihrer Einfuhrung bieten die Research Domain Criteria ein leistungsstarkes Rahmenwerk fur die Operationalisierung und Unterteilung komplexer sozialer Prozesse in einer Weise, die sowohl neurobiologisch orientierte als auch klinische Ansatze zulasst. In diesem Artikel fassen wir die wichtigsten Erkenntnisse fur jedes der vier grundlegenden Konstrukte der Domane sozialer Prozesse zusammen und diskutieren sie: (a) Zugehorigkeit und Bindung, (b) soziale Kommunikation, (c) Wahrnehmung und Verstandnis des Selbst und (d) Wahrnehmung und Verstandnis anderer. Dabei heben wir insbesondere die klinische Relevanz der Erkenntnisse hervor, die auf dem Gebiet der sozialen Neurowissenschaften gewonnen wurden, und diskutieren die daraus resultierende zunehmende Bedeutung transdiagnostischer Konzepte in der angewandten Forschung. Schlieslich stellen wir drei innovative Forschungsmethoden vor, die auf den sich beschleunigenden technologischen Fortschritten des letzten Jahrzehnts aufbauen und es zunehmend ermoglichen, komplexe soziale Interaktionen auch unter realistischeren und alltagsnaheren Bedingungen zu untersuchen.

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[The domain "social processes" in the system of research domain criteria: current state and perspectives].

Die forensische Therapie gemäß §64 StGB zeichnet sich aktuell durch hohe Abbruch- bzw. Erledigungsquoten aus. Das hier vorgestellte verkürzte Therapiekonzept der Klinik für Forensische Psychiatrie des Pfalzklinikums für Patienten mit günstigen Prognosemerkmalen soll durch Förderung von Eigeninitiative, Verantwortung und Motivation sowie eine möglichst individualisierte, störungsorientierte, strafzeit- und tatangemessene Behandlung mit intensiver Erprobung unter Alltagsbedingungen zu einer Verkürzung der stationären Unterbringung führen. Empirische Belege hierfür fehlen jedoch bislang. Erstmals werden hier Pilotdaten aus dem Zeitraum April 2016 bis Mai 2021 vorgestellt. Zusammenfassend hat sich das o.g. Konzept als umsetzbar erwiesen. Die erhobenen Daten weisen darauf hin, dass die im verkürzten Therapieprogramm behandelten Patienten eine geringere Erledigungsquote als der Durchschnitt aller gemäß §64 StGB untergebrachter Patienten aufweist. Eine deutliche Verkürzung der durchschnittlichen Behandlungsdauer ließ sich demgegenüber jedoch nicht belegen. Die vorliegende Arbeit will einen ersten Beitrag zur Diskussion und Weiterentwicklung derartiger Behandlungsoptionen leisten. Mögliche Nachteile derartiger Therapieangebote bei für ungeeignet befundenen Patienten, z. B. eine Abnahme der Therapiemotivation, werden diskutiert.Forensic therapy according to section 64 of the German penal code is currently characterized by high drop-out rates. The shortened therapy concept of the Department of Forensic Psychiatry of the Pfalzklinikum focusing on patients with favorable prognostic characteristics presented here is intended to lead to a shortening of hospital stay by promoting initiative, responsibility and motivation. It is supposed to provide a treatment as individualized and disorder-oriented as possible and appropriate to the individual time of detention as well as the specific kind of offense with intensified testing under everyday conditions. However, so far empirical evidence for this concept is lacking. For the first time, pilot data for the period from April 2016 to May 2021 are presented here. The concept described herein has proven to be feasible. The collected data hint at a lower drop-out rate of patients treated according the shortened therapy concept compared to the average of all patients assigned to forensic treatment according to section 64 of the German penal code. Yet, there was no evidence for a significant shortening of hospital stay. The present work aims at making a first contribution to the discussion and further development of such treatment options. Possible disadvantages for patients who are found to be unsuitable, e. g. those with a decrease in therapeutic motivation, are discussed.

[Shortened Treatment Concepts in Forensic Commitment According to Section 64 of the German Penal Code: A Tailored Treatment Pathway?]

Hintergrund
Es existieren deutliche Hinweise, dass Psychiater und Psychotherapeuten im Rahmen ihrer exponierten beruflich Position einem hoheren Risiko als die Allgemeinbevolkerung ausgesetzt sind, Opfer von Stalking durch Patienten zu werden.

Peter Praus

Papers

[Stalking of psychiatrists and psychotherapists : Results of an online survey].

[COVID-19: challenges for forensic therapy and quality of treatment in institutions for forensic commitment].

[The domain "social processes" in the system of research domain criteria: current state and perspectives].

[Shortened Treatment Concepts in Forensic Commitment According to Section 64 of the German Penal Code: A Tailored Treatment Pathway?]

Stalking von Psychiatern und Psychotherapeuten