Post-mortem cases involving amphetamine-based drugs in the Netherlands: Comparison with driving under the influence cases

In this study we reviewed the post-mortem cases in the years 1999–2004 that were presented at the Netherlands Forensic Institute. The concentrations of amphetamine-based drugs in femoral blood from cases of suspected unnatural death were compared with concentrations in whole blood from non-fatal cases of driving under the influence (DUI cases) and with literature. Furthermore, the combinations with other drugs and/or alcohol were investigated. Amphetamine-based drugs were present in 70 post-mortem cases and 467 DUI cases. The most detected amphetamine-based drug was MDMA, followed by amphetamine. The presence of MDA could usually be explained by metabolism of MDMA. Methamphetamine and MDEA were rarely present. Frequently, the amphetamine-based drugs were taken in combination with alcohol and/or other non-amphetamine-based drugs such as cocaine or cannabinoids. The 70 post-mortem cases were divided into 38 amphetamine-based drug caused (i.e. the amphetamine-based drug directly caused or contributed to the death) and 32 amphetamine-based drug related deaths (i.e. death was not directly caused by the amphetamine-based drug). In the latter category, other (poly)drug intoxications and death by violence or drowning were the most frequent causes of death.In 30 cases, MDMA caused death directly. The range in blood concentrations of MDMA in these cases was substantial, i.e. 0.41–84 mg/L with a median concentration of 3.7 mg/L (n = 30). MDMA blood concentrations in the MDMA related deaths (n = 20) and in the DUI cases (n = 360) varied up to 3.7 and 4.0 mg/L, respectively. Seven victims died from the direct effects of amphetamine; the blood concentration of amphetamine ranged from 0.24 to 11.3 mg/L, with a median concentration of 1.7 mg/L (n = 7). The median concentrations of amphetamine in the amphetamine related deaths (n = 13) and the DUI cases (n = 208) were much lower, i.e. 0.28 and 0.22 mg/L, respectively. Amphetamine blood concentrations up to 6.0 and 2.3 mg/L were seen in the drug related deaths and DUI cases, respectively. The most frequently encountered amphetamine-based drugs in the investigated deaths were MDMA and amphetamine. The majority of MDMA- and amphetamine-caused deaths, i.e. 90% of these deaths, occurred with blood concentrations above 1.5 and 0.80 mg/L, respectively. MDMA and amphetamine blood concentrations in drug related deaths and DUI cases, however, overlap the range of fatal concentrations. Therefore, MDMA or amphetamine concentrations should never be used alone to establish the cause of death.     

"We are also normal humans, you know?" Views and attitudes of juvenile delinquents on antisocial behavior, neurobiology and prevention

This paper presents and discusses the views and attitudes of juvenile delinquents regarding the implications of genomics and neurobiology research findings for the prevention and treatment of antisocial behavior. Scientific developments in these disciplines are considered to be of increasing importance for understanding the causes and the course of antisocial behavior and related mental disorders. High expectations exist with regard to the development of more effective prevention and intervention. Whether this is a desirable development does not only depend on science, but also on the ethical and social implications of potential applications of current and future research findings. As this pilot study points out, juvenile delinquents themselves have rather mixed views on the goals and means of early identification, prevention and treatment. Some welcome the potential support and help that could arise from biologically informed preventive and therapeutic measures. Others, however, reject the very goals of prevention and treatment and express worries concerning the risk of labeling and stigmatization and the possibility of false positives. Furthermore, interventions could aim at equalizing people and taking away socially disapproved capacities they themselves value. Moreover, most juvenile delinquents are hardly convinced that their crime could have been caused by some features of their brain or that a mental disorder has played a role. Instead, they provide social explanations such as living in a deprived neighborhood or having antisocial friends. We suggest that the hopes and expectations as well as the concerns and worries of juvenile delinquents are relevant not only for genomics and neurobiology of antisocial behavior, but also for prevention and intervention measures informed by social scientific and psychological research. The range of patterns of thought of juvenile delinquents is of great heuristic value and may lead to subsequent research that could further enhance our understanding of these patterns.     

Predictive Validity of the SVR-20 and Static-99 in a Dutch Sample of Treated Sex Offenders

In this retrospective study, the interrater reliability and predictive validity of 2 risk assessment instruments for sexual violence are presented. The SVR-20, an instrument for structured professional judgment, and the Static-99, an actuarial risk assessment instrument, were coded from file information of 122 sex offenders who were admitted to a Dutch forensic psychiatric hospital between 1974 and 1996 (average follow-up period 140 months). Recidivism data (reconvictions) from the Ministry of Justice were related to the risk assessments. The base rate for sexual recidivism was 39%, for nonsexual violent offenses 46%, and for general offenses 74%. Predictive validity of the SVR-20 was good (total score: r = .50, AUC = .80; final risk judgment: r = .60, AUC = .83), of the Static-99 moderate (total score: r = .38, AUC =.71; risk category: r = .30, AUC = .66). The SVR-20 final risk judgment was a significantly better predictor of sexual recidivism than the Static-99 risk category.     

Structuring Legal Institutions

The article is concerned with the question of how legal institutions are structured with the use of constitutive, institutive, consequential, and terminative rules. To that end, the regulation of international treaties as laid down in the Vienna Convention on the Law of Treaties of 1969 is analysed. This leads to the discovery of two additional categories of rules: content rules and invalidating rules. Finally, the special status of unique legal institutions is investigated. Unique legal institutions – for example, heads of state, parliaments, and supreme courts – enjoy validity in a legal system to the exclusion of the validity of any other legal institution of the same category in that system.     

Legal Validity Qua Specific Mode of Existence

The author investigates how the conception of legal validity as a specific mode of existence, adopted by Kelsen in Allgemeine Theorie der Normen (General Theory of Norms), can be reconciled with a conception of the legal system in which conflicts of legal norms remain of logical concern. To this end he makes use of Ludwig Wittgenstein's picture theory of the proposition as set out in the Tractatus Logico-Philosophicus. The conclusion is that in order to reconcile the two conceptions, the legal system itself must be conceived of as consisting of three sub-systems, namely, (i) a sub-system of perceptible legal judgments, (ii) a sub-system of valid legal conditions, and (iii) a sub-system of observable social practices.     

Reliability and validity of the Psychopathy Checklist: Youth Version in Dutch female adolescents

In the present study, the reliability and construct validity of the Dutch version of the Psychopathy Check List: Youth Version (Psychopathie Checklist: Jeugd Versie; De Ruiter, Kuin, De Vries & Das, 2002) were examined in a sample of female adolescents admitted to a secure treatment institution (N=67). The study provides mixed support for the internal reliability of the PCL:YV in female adolescents. Interrater reliability was found to be adequate at the level of factor and total PCL:YV scores. Poor reliability was demonstrated for the behavioral items of the PCL:YV in particular. Finally, the construct validity of the PCL:YV total and factor scores was supported by theoretically meaningful and significant associations with scores on the Minnesota Multiphasic Personality Inventory (MMPI) and the Interpersonal Checklist-Revised (ICL-R). The applicability of PCL:YV items to female adolescents is discussed.     

Predictive validity of the Structured Assessment of Violence Risk in Youth (SAVRY) during residential treatment

This prospective study examines the predictive validity of the Dutch version of the Structured Assessment of Violence Risk in Youth (SAVRY) by examining relationships between SAVRY scores and various types of disruptive behavior during residential treatment. The SAVRY, a risk assessment instrument, was coded for 66 male adolescents on the basis of file information and interviews. The adolescents were referred to Rentray, a juvenile correctional and treatment facility, by the Dutch juvenile courts because of severe behavioral problems or serious offenses. Institutional infractions were retrieved from incident registration files, which included acts of physical violence, verbal threat, verbal abuse, and violation of institutional rules. The interrater reliability of the SAVRY scores was good. The predictive validity of the SAVRY for physical violence against persons was excellent (Risk Total: AUC=.80, r =.33; Summery Risk Rating: AUC =.86, r =.48). The SAVRY also had good predictive validity for violence against objects, verbal threats and violations of rules, but not for verbal abuse. Implications for assessment and management of violent behavior among adolescents in residential treatment are discussed.     

PCL-R psychopathy predicts disruptive behavior among male offenders in a Dutch forensic psychiatric hospital

In this study, the relationship between psychopathy, according to the Dutch language version of Hare's Psychopathy Checklist-Revised (PCL-R), and various types of disruptive behavior during inpatient forensic psychiatric treatment is investigated. Ninety-two male participants were administered the PCL-R following admission to an inpatient forensic hospital. From daily hospital information bulletins, incidents of verbal abuse, verbal threat, physical violence, and violation of hospital rules were derived. Also, the number of seclusion episodes was recorded. As expected, significant correlations were found between PCL-R scores and verbal abuse, verbal threat, violation of rules, total number of incidents, and frequency of seclusion. Psychopaths (PCL-R > or = 30) were significantly more often involved in incidents than nonpsychopaths. Multiple regression analyses revealed that the PCL-R Factor 2 score in particular contributed uniquely to the prediction of the total number of incidents. The findings are discussed in terms of their clinical implications.