Peer support, i.e. the involvement of individuals with similar experiences of illness and life circumstances as the patients themselves, remains rare in forensic psychiatry in Germany. Administrative obstacles and preconceptions from professionals of other disciplines often hinder its implementation. At the Hospital of Forensic Psychiatry of Rostock University Medical Center, two focus groups with staff and semi-structured interviews with external clinic directors and peer support workers were conducted in preparation for introducing peer support. The aim was to gather perspectives on the benefits, challenges, expectations, and experiences associated with this approach. An inductive thematic analysis of the data identified key themes such as preparation, trust, lived-experience and professionalism. Findings revealed that the unique professional role of peersupport workers-offering expertise based on personal experience-often leads other professionals to question their reliability, resilience, and professional competence. However, participants also recognized the potential of peersupport to reduce stigma toward forensic patients and to ultimately improve the quality of care provided.

Participatory research or patient and public involvement refer to the process of actively involving people with lived experience into the research process to improve its relevance, quality, and impact. In the PART project we aim to establish a sustainable structure to include underrepresented patient groups with neurodegenerative diseases into a patient advisory board for research. As one of our milestones, we conducted a systematic literature review with the aim of examining the impact of participatory research on people involved, such as those with cognitive impairment, caregivers, and researchers. To explore the benefits, limitations and barriers of participatory research in the field of neurodegenerative diseases. We conducted a systematic literature review covering the databases PubMed, PsycINFO, CINAHL, Embase, Scopus, ClinicalTrials.gov, and Google Scholar, and added hand searches. The search strategy consisted of the terms “patients” AND “dementia” AND “participation” AND “impact” AND “research”. Based on the selection of relevant articles published between 2000 and 2022, we performed a quality assessment using the Mixed Methods Appraisal Tool (MMAT). The entire search yielded 1,994 articles, of which 1,169 remained after the removal of duplicates and were integrated into the screening process. Following a two-step screening process and subsequent validation of a subset of 20% of the articles by a second reviewer, a set of 30 articles were selected for inclusion in the review. Current findings indicate that participatory research in the field of neurodegenerative diseases provides various advantages, such as empowering people with lived experience and enhancing researchers' understanding of those affected. Challenges included the extra time and effort required, as well as the difficulty of establishing a balanced relationship between researchers and co-researchers. The number and quality of scientific articles regarding participatory research in the field of neurodegenerative diseases has been growing over the past two decades. The terminology used in reporting was frequently ambiguous, the description of participatory methods was often insufficient, and the impacts were frequently disregarded. Further research is required to address these issues and to investigate the impact of peer research in dementia studies.

Background: This article presents an international comparative review of involuntary psychiatric care, Community Treatment Orders (CTOs), and forensic mental health services, with operational implications for Italy. Italy has a community-based model inspired by the “Basaglia Law” (Law No. 180/1978), emphasizing deinstitutionalization and continuity of care. Nevertheless, risk governance gaps persist for high-complexity patients, imposing a disproportionate legal and clinical burden on mental health professionals. This group includes individuals who refuse treatment despite meeting criteria for compulsory admission, patients at elevated risk with substantial management complexity, and offenders with a current or suspected psychiatric disorder. Methods: We conducted a comparative legal and policy review across seven jurisdictions (Italy, England and Wales (UK), France, Germany, Spain, the United States, and Canada) to map frameworks for involuntary treatment, forensic services, CTOs (or equivalents), and community-based risk management. We also extracted procedural safeguards, duration and renewal limits, and interfaces with forensic services. Results: CTOs are available in five of the seven jurisdictions (England and Wales, France, Spain, the United States, and Canada) but are absent in Italy and Germany. We propose a three-pillar framework: (1) enforceable outpatient measures, including CTOs; (2) Forensic Psychiatry Units within Local Health Authorities; and (3) oversight boards with judicial, clinical, and social representatives. These components aim to redistribute responsibility, ensure continuity of care, and provide proportional oversight within a least restrictive, graduated system. Conclusions: When narrowly targeted, time limited, and paired with robust safeguards and service-quality standards, CTOs can support adherence and continuity for patients who repeatedly disengage from care. For Italy, integrating this instrument within the three-pillar framework and under independent oversight could strengthen patient rights and public safety, reduce revolving-door admissions, and improve outcomes.

OBJECTIVE:The current systematic review summarizes reviews on effects of formalized peer support work in clinical psychiatric settings in order to obtain an up-to-date picture of the current state of evidence. METHODS:Search in five electronic databases for relevant literature reviews regarding effects of peer support work in psychiatric settings. Database searches were complemented by a hand search. RESULTS:16 reviews were found. They evaluate effects of peer support on clinical or psychosocial outcomes. No consistent effects are found for clinical outcomes. Small positive tendencies occur for psychosocial outcomes. CONCLUSIONS:The authors of the reviews consistently mentioned the low quality of the primary studies. Therefore, the present results can rather be interpreted as a preliminary tendency. Further studies are necessary for evaluation of peer support in a more differentiated way.

BackgroundOffenders who pose a risk of harm and whose convictions are linked to substance use can be mandated to undergo treatment in forensic psychiatric hospitals under Section 64 StGB of the German Penal Code (Strafsgesetzbuch; StGB), if there are reasonable prospects that treatment might be successful. Relapses during treatment is a common occurrence in patients with substance use disorders but little is known about the frequencies of such events in a forensic setting.PurposeThis study aimed to determine the prevalence of relapse among patients who undergo treatment under § 64 StGB, identify substances involved and possible predictive factors.MethodWe utilized data over the span of two years from 108 patients who were admitted to the Clinic of Forensic Psychiatry in Rostock, Germany, between 2019 and 2021.We used descriptive statistics and multiple regression analysis. A relapse was defined as a positive laboratory test for illicit drugs or alcohol, admission of relapsing or a declined test (i. e. the patient did not consent to the test).ResultsWe found that 65.7% of the patients relapsed within the initial two-year period of stay. Cannabinoids were the most commonly consumed substances. Factors such as age, education level, comorbidity, number of previous convictions, duration of stay and type of substance used did not significantly affect relapse rates. Results are limited by a small sample size.ConclusionA high relapse rate is still a reality of forensic addiction treatment. Static factors alone might only have a small predictive value for substance relapses and are not sufficient to fully predict individual risk. Therefore our findings show a need to focus on dynamic factors that affect consumption relapse rates. Considering the findings of this research, future studies should investigate dynamic factors of the patient’s substance use behavior during treatment as a whole (e.g. reason for relapsing, choice of drug etc.), identify and investigate other factors affecting relapse rate and uncover possible treatment interventions that might reduce relapse rates, dropout rates and criminal recidivism.

In order to ensure the feasibility of a nationwide annual survey of patients in forensic psychiatry, a pilot study was conducted to collect data from the entire § 63 StGB patient population of Mecklenburg-Western Pomerania. Staff of the participating hospitals completed an online questionnaire on biographical, clinical and legal data that were analyzed descriptively. The data collection process was monitored and critically reviewed.Data on 145 patients (mean age 42 years) was collected. Schizophrenia was most frequently diagnosed, about half of the patients had a comorbid substance use disorder. Length of stay was longer compared to the German average. Notable is the low proportion of evidence-based treatment programs.The pilot showed that a nationwide survey of forensic-psychiatric patients is feasible and challenges can be overcome. The focus should be on therapies offered and their impact on otcomes.

Zusammenfassung Hintergrund Bei nach §64 StGB untergebrachten suchtkranken Straftätern kann die Unterbringung vorzeitig beendet werden. Es liegt eine umfangreiche Literatur zu Prädiktoren einer vorzeitigen Beendigung vor Therapiebeginn vor. Zielsetzung Ziel dieser Arbeit ist es, Prädiktoren einer vorzeitigen Erledigung während des Therapieverlaufs darzustellen. Methodik Es wurde eine systematische Literaturrecherche durchgeführt und 16 Publikationen eingeschlossen. Ergebnisse Sowohl Patienten als auch Therapeuten sehen vor allem Impulsivität/Aggressivität, Suchtmittelrückfälle und eine mangelnde Patient-Therapeuten-Beziehung als negative Prädiktoren. Beide Gruppen schreiben dem Vorhandensein von Motivation und einem positiven sozialen Netzwerk förderlichen Einfluss auf das Outcome zu. Schlussfolgerung Für ein erfolgreiches Beenden der Unterbringung sind eine tragfähige Patienten-Therapeuten-Beziehung, Motivationsarbeit und das Aufarbeiten von Vorfällen essentiell.

IntroductionThe impact of cognitive functions on treatment outcomes in forensic psychiatric patients with substance use disorders is not well understood. This study investigates whether neuropsychological deficits, such as in attention, executive functions, and social-emotional cognition, are associated with impulsivity and criminal history.Methods109 male patients with substance use disorders at the Clinic for Forensic Psychiatry in Rostock were screened using inclusion and exclusion criteria, with 30 consenting to participate. The tests included the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess cognitive functions in the areas of attention, psychomotor speed, social and emotional perception, and executive functions, with a particular focus on decision making, planning and problem solving. The Barratt Impulsiveness Scale (BIS-11) was used to measure impulsiveness.ResultsParticipants displayed significantly higher impulsivity levels on the BIS-11 compared to the general population and showed marked deficits in attention, psychomotor speed, and executive functions. There was a minimal correlation between impulsivity and cognitive performance, suggesting that impulsivity does not directly predict cognitive impairments. Notably, extensive criminal histories correlated with poorer cognitive performance, particularly in tasks requiring planning and problem-solving.DiscussionWe found mixed support for the hypothesized associations between neuropsychological functions and criminal histories among patients with substance use disorders. While tasks related to planning and sustained attention showed clearer links, broader cognitive functions displayed inconsistent correlations. These findings emphasize the complexity of the relationship between cognitive deficits, impulsivity, and criminal history, highlighting the necessity for tailored assessments and rehabilitation strategies to enhance outcomes. Future research should focus on larger, longitudinal studies to validate these findings and refine therapeutic approaches.

BACKGROUND:The treatment of addicted offenders detained under § 64 of the German Criminal Code can be terminated prematurely. There is an extensive literature on predictors of such premature termination concerned with factors established before treatment. OBJECTIVE:The aim of this paper is to present predictors of premature termination that become apparent during the course of therapy. METHODS:We conducted a systematic literature search and included 16 publications. RESULTS:Patients and therapists rated impulsivity/aggressiveness, substance use relapses and a lack of patient-therapist relationship as negative predictors. Both groups assessed as beneficial the presence of motivation and a positive social network. CONCLUSION:To prevent early treatment termination a positive patient-therapist relationship, motivation and working through incidents during therapy is essential.

BACKGROUND:Medications are commonly used to treat co-occurring psychopathology in persons with borderline personality disorder (BPD). AIMS:To systematically review and integrate the evidence of medications for treatment of co-occurring psychopathology in people with BPD, and explore the role of comorbidities. METHOD:Building on the current Cochrane review of medications in BPD, an update literature search was done in March 2024. We followed the methods of this Cochrane review, but scrutinised all identified placebo-controlled trials post hoc for reporting of non BPD-specific ('co-occurring') psychopathology, and explored treatment effects in subgroups of samples with and without defined co-occurring disorders. GRADE ratings were done to assess the evidence certainty. RESULTS:Twenty-two trials were available for quantitative analyses. For antipsychotics, we found very-low-certainty evidence (VLCE) of an effect on depressive symptoms (standardised mean difference (SMD) -0.22, P = 0.04), and low-certainty evidence (LCE) of an effect on psychotic-dissociative symptoms (SMD -0.28, P = 0.007). There was evidence of effects of anticonvulsants on depressive (SMD -0.44, P = 0.02; LCE) and anxious symptoms (SMD -1.11, P < 0.00001; VLCE). For antidepressants, no significant findings were observed (VLCE). Exploratory subgroup analyses indicated a greater effect of antipsychotics in samples including participants with co-occurring substance use disorders on psychotic-dissociative symptoms (P = 0.001). CONCLUSIONS:Our findings, based on VLCE and LCE only, do not support the use of pharmacological interventions in people with BPD to target co-occurring psychopathology. Overall, the current evidence does not support differential treatment effects in persons with versus without defined comorbidities. Medications should be used cautiously to target co-occurring psychopathology.

Section 64 of the German Penal Code allows for the detention of offenders with substance use disorders. Almost half of these placements are terminated prematurely, thus raising the question of predictors of successful detention in hospital. So far research in the area discriminates between premature termination of such treatment and successful completion. In this pilot study, we investigated a group in between: the ambivalent patients. Patients with a desire to prematurely end but who nevertheless (successfully) continued therapy (n = 12) were compared with a group of patients who actually terminated treatment prematurely (n = 12) on sociodemographic, clinical and offending data. The groups differed in the number of criminal records, length of placement and occurrence of substance use during placement. Earlier identification of an ambivalence about ending treatment could allow for more support to continue with the course of treatment.

Many jurisdictions implement mandatory substance use treatment for justice-involved persons. Germany is one such country; however, debates about the appropriateness and effectiveness of this disposal abound. Very little attention has been paid in the international literature to patients receiving mandatory treatment in Germany. This systematic review synthesises research on patients receiving substance use treatment in forensic hospitals under §64 of the German Penal Code with regard to three primary outcomes: treatment completion, reoffending, and the recurrence of substance use. Forty-five publications reporting on 36 studies were reviewed; publication dates ranged from 1988 to 2023. On average, 47% of patients did not successfully complete treatment, compared to 45% who did. Average follow-up reconviction rates were higher than in mentally ill and general offender populations as reported elsewhere. Approximately half of all patients reused substances during treatment. Suggestions for future research, including a focus on strength- and recovery-based indicators, and harmonising routine outcomes measurements, are given.

Zusammenfassung Ziel Der vorliegende systematische Literaturreview fasst Überblicksarbeiten zu Effekten von Genesungsbegleitung in formalen klinischen psychiatrischen Settings zusammen, um so ein umfassendes Bild über den aktuellen Stand der Evidenz zu erhalten. Methode Suche in fünf elektronischen Datenbanken nach relevanten Überblicksarbeiten zu Effekten von Genesungsbegleitung im psychiatrischen Setting. Die Datenbanksuche wurde durch eine Handsuche ergänzt. Ergebnisse 16 Reviews wurden gefunden. Diese betrachten vorrangig klinische und psychosoziale Outcomes. Keine konsistenten Effekte werden im Zusammenhang mit klinischen Outcomes berichtet. Eine geringe positive Tendenz zeichnet sich für die psychosozialen Outcomes ab. Schlussfolgerung Die Autor*innen der Reviews beklagten durchgehend die geringe Qualität der Ausgangsstudien. Daher können die vorliegenden Ergebnisse eher als vorläufige Tendenz interpretiert werden. Weitere Studien sind nötig, um die Wirkung von Genesungsbegleitung differenzierter betrachten zu können.

Surveys and questionnaires are widely used in various areas of psychological and psychiatric research and practice. Many instruments have been used in several languages and across cultural contexts. A popular method of choice for their translation into another language involves translation and back-translation. Unfortunately, this method's ability to detect flaws in translation and necessities for cultural adaptation is limited. To address these shortcomings, the Translation, Review, Adjudication, Pretest, and Documentation (TRAPD) approach of questionnaire translation from cross-cultural survey design has been developed. In this approach, several translators with different professional backgrounds translate the questionnaire on their own first and then come together to discuss their versions. Since the translators' expertise is required to vary (e.g., survey methodology experts, translation experts, expert knowledge in the questionnaire's topic) the team approach results in a high-quality translation as well as offering opportunities for cultural adaptation. This article illustrates the application of the TRAPD approach on the basis of the translation process of the Forensic Restrictiveness Questionnaire from English into German. Differences and advantages are discussed.