Querengässer Jan, Baur Alexander
LWL-Akademie für Forensische Psychiatrie (AFoPs), Fachbereich Versorgungsforschung.
Universität Konstanz, Fachbereich Psychologie.
Fortschr Neurol Psychiatr. 2021 Oct;89(10):496-506. doi: 10.1055/a-1389-5782. Epub 2021 Mar 10.
Before a forensic addiction treatment can be ordered by court according to sec. 64 of the German Criminal Code (StGB), a success prognosis must be made and affirmed. The search for appropriate predictors for a "sufficiently concrete prospect of success" was the focus of several studies in recent years. In addition to legal probation, the mode of release from the measure, i.e. whether regular release on probation or an end of the accommodation due to a lack of prospect of success, represents the central success criterion of forensic addiction treatment.
As the first part of a two-part overview of the determinants of success in forensic addiction treatment, the aim of this paper was to provide an overview of the current state of knowledge on predictors of the discharge mode, both univariate and multivariate.
Based on a systematic literature search, the results of 16 empirical studies from the period 1999 to 2019 are summarized and presented in detail. Univariate findings on individual predictors are presented in an overview table, while multivariate results are summarized in "typical" treatment discontinuations.
On a univariate level, the findings were predominantly heterogeneous. The factors personality disorder and psychopathy as well as "static" anamnestic factors such as criminal background could be considered as reasonably reliable predictors. Multivariate, in particular the combination of an early onset of delinquency, a problematic social and/or occupational or educational background together with certain personality components, indicated a very high risk of premature discharge.
The current state of research cannot provide an exhaustive answer to the question of decisive determinants of success or failure of a treatment acc. to sec. 64 StGB - measured by the discharge mode. However, the overview can assist forensic psychiatric experts in making a reliable prognosis of treatment prospects.
根据德国刑法典（StGB）第64条规定，在法庭下令进行法医成瘾治疗之前，必须做出并确认成功预后。近年来，寻找“足够具体的成功前景”的合适预测指标成为多项研究的重点。除了法定缓刑外，治疗措施的释放方式，即定期缓刑释放还是因缺乏成功前景而结束收容，是法医成瘾治疗的核心成功标准。
作为法医成瘾治疗成功决定因素两部分概述的第一部分，本文旨在概述关于出院方式预测指标的现有知识状态，包括单变量和多变量指标。
基于系统的文献检索，总结并详细呈现了1999年至2019年期间16项实证研究的结果。关于各个预测指标的单变量研究结果列于概述表中，而多变量结果则总结在“典型”治疗中断情况中。
在单变量层面，研究结果主要是异质性的。人格障碍和精神病态因素以及诸如犯罪背景等“静态”既往史因素可被视为相当可靠的预测指标。在多变量层面，特别是犯罪行为早发、社会和/或职业或教育背景存在问题以及某些人格成分的组合表明提前出院的风险非常高。
目前的研究状况无法对根据德国刑法典第64条规定的治疗成败的决定性因素问题（以出院方式衡量）给出详尽答案。然而，该概述可协助法医精神病专家对治疗前景做出可靠的预后判断。
