Weber Kerstin, Magnenat Lena, Morier Sandrine, Menu Christophe, Bertschy Philippe, Herrmann François R, Giannakopoulos Panteleimon
Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Avenue Rosemont 12, Geneva, 1208, Switzerland.
Department of Psychiatry, University of Geneva, Chemin du Petit-Bel-Air 2, Chêne-Bourg, 1224, Switzerland.
BMC Psychiatry. 2025 May 26;25(1):538. doi: 10.1186/s12888-025-06958-2.
The reduction of violence risk and crime recidivism is the core marker of progress in forensic psychiatry treatment for mentally disordered offenders, and commonly used to decide upon discharge from prison-based security clinics. While dynamic risk is expected to relate to treatment progress, static risk is expected to predict discharge from prison-based treatments. Integrated risk-protection assessment is thought to facilitate prediction of treatment outcome.
In a two-year prospective observational cohort study using a repeated measures design, we monitored treatment as usual induced changes in violence and protective factors, in 117 offenders of a medium-security forensic clinic in Switzerland. Mixed-effects and multinomial logistic regression models were used to predict longitudinal risk and protection evolution, length of stay, and discharge locations.
Forensic psychiatry treatment was indeed associated with decrease in dynamic risk and enhanced protection, contrary to static risk. After 18-24 months of treatment, protective factors counterbalanced risk factors. For risk, both a numeric scale and a structured professional judgement approach equally showed significant improvement over time. For protection and integrated risk-protection, structured professional judgement ratings failed to show significant treatment-related change. Discharge to low-security psychiatry wards was predicted only by favorable baseline risk, protection, and integrated risk-protection, but not by their treatment-related evolution. Longer length of stay was predicted by higher baseline total risk only.
Study results confirm the need to distinguish dynamic from static risk in forensic psychiatric treatment monitoring, and to include integrated risk-protection measures. Treatment length and discharge are predicted by the offenders' baseline risk profile, but not by the evolution of risk and protection factors. A structured professional judgment approach in risk and protection assessment leads to different longitudinal results than the use of numeric scale scores.
降低暴力风险和犯罪再犯率是精神错乱罪犯法医精神病学治疗进展的核心标志，常用于决定从监狱安全诊所出院。虽然动态风险预计与治疗进展相关，但静态风险预计可预测从监狱治疗中出院的情况。综合风险保护评估被认为有助于预测治疗结果。
在一项为期两年的前瞻性观察队列研究中，采用重复测量设计，我们监测了瑞士一家中等安全级别的法医诊所的117名罪犯在常规治疗中暴力和保护因素的变化。使用混合效应和多项逻辑回归模型预测纵向风险和保护因素的演变、住院时间和出院地点。
与静态风险相反，法医精神病学治疗确实与动态风险降低和保护增强相关。治疗18 - 24个月后，保护因素抵消了风险因素。对于风险，数字量表和结构化专业判断方法随着时间的推移均显示出显著改善。对于保护和综合风险保护，结构化专业判断评分未显示出与治疗相关的显著变化。只有基线风险、保护和综合风险保护情况良好才能预测出院到低安全级别的精神病病房，而不是其与治疗相关的演变情况。仅基线总风险较高可预测住院时间较长。
研究结果证实，在法医精神病学治疗监测中需要区分动态风险和静态风险，并纳入综合风险保护措施。罪犯的基线风险状况可预测治疗时长和出院情况，而非风险和保护因素的演变情况。在风险和保护评估中，结构化专业判断方法得出的纵向结果与使用数字量表评分不同。
