Compulsory Psychiatric Treatment Research Articles

Latest findings highlight the continuing uncertainty over the utility of compulsory psychiatric treatment in the community.

Community treatment orders (CTOs) have been introduced in many jurisdictions with evidence of increasing use over time as well as a disproportionate use in marginalised populations. Rates of CTOs also vary widely, both internationally and within the same country, for reasons that are poorly understood. This is despite evidence for effectiveness being mixed and, as a result, there have been calls for a reappraisal of this type of legislation. In the UK, a parliamentary committee on reforming the existing Mental Health Act recommended abolishing CTOs other than for people in the criminal justice system. Two recent Australian papers based on large state-wide administrative data-sets give conflicting results and came to markedly different conclusions regarding the desirability of reducing CTO rates. The debate about the effectiveness of CTOs therefore remains unresolved. This is of concern beyond Australia, as other jurisdictions such as England, Scotland and Canada have similar clinician-initiated orders.

Involuntary psychiatric treatment during the COVID-19 pandemic. An international qualitative study.

During the COVID-19 pandemic, studies report that in the first few months of the lockdown there was a decrease in requests for mandatory psychiatric treatment, while, in contrast, following the second wave, the number of cases increased. This study investigates the use of compulsory psychiatric treatments internationally in the first and subsequent phases of the pandemic. Sixteen key people were interviewed: eight mental health care professionals and eight scholars in Italy, Greece, China and Chile. Participants were asked to discuss their experience of the motivations, diagnoses and management of patients undergoing an involuntary psychiatric hospitalization. The analysis through Grounded Theory highlighted four themes: (a) the culture of psychiatric care services, (b) the effect of the pandemic on involuntary hospitalizations, (c) exceptional management of hospitalization, and (d) policies and suggestions for more inclusive mental health treatments. During the first wave, respondents reported a decrease in the use of involuntary treatments, while a gradual increase was seen in the following months. Italy extended compulsory psychiatric treatment to a group of new users, including young people and adolescents with acute crises; in other contexts, the main users are chronic psychiatric patients.

BRUNNER SYNDROME: FROM GENETICS TO PSYCHIATRY - CASE REPORT

IntroductionMonoaminergic neurotransmitters affect motor control, emotions and cognitive functions. Their relative abundance depends on the action of monoamine oxidase A (MAOA) which catalyses their degradation into inactive metabolites. Brunner syndrome is a rare chromosome X-linked recessive inheritance genetic disorder, which causes loss of function of the MAOA gene, leading to a relative increase in monoamines in affected individuals (typically males). It manifests with moderate intellectual developmental disturbance associated with maladaptive externalising behaviours, low frustration tolerance and marked impulsivity.ObjectivesTo present a clinical case of patient diagnosed with Brunner Syndrome presenting with suicidal and homicidal ideation and to discuss it based on a non-systematic review of the literature.MethodsCase report and non-systematic review of the literature.Results: Case ReportMale born with neonatal asphyxia that consequently presented developmental retardation characterised by learning difficulties and emotional dysregulation. At 18 years of age, he began follow-up in Psychiatry due to self-injurious behaviours and several reactive suicide attempts (SA), being diagnosed with Intellectual Disability. At 22, he was hospitalised due to reactive depression, being discharged doing well with valproate, fluoxetine and olanzapine. Shortly after, he was arrested (aged 23-28) for attempted murder followed by SA. During imprisonment, he was diagnosed with Brunner’s Syndrome after his younger brother diagnosis. At 31, he was hospitalised for suicidal and homicidal ideation, revealing high impulsiveness and low frustration tolerance, and was discharged with compulsory psychiatric treatment. Three weeks later he was again hospitalised for symptoms recurrence having improved on Sertraline 50mg and Aripiprazole 400mg monthly.DiscussionAlthough scarce, the available evidence suggests that dietary modifications and the use of selective serotonin reuptake inhibitors may improve behaviour, reduce serotoninergic symptoms and possibly reverse some neurochemical abnormalities.ConclusionsBrunner syndrome is a rare genetic disorder with neuropsychiatric manifestations, whose course, treatment and prognosis are currently poorly known. Thus, the current treatment is empirical and further studies are needed.Disclosure of InterestNone Declared

In vitro fertilization and a patient in compulsory psychiatric treatment in the community

IntroductionINTRODUCTION: According to the Universal Declaration of Human Rights, everyone has the right to start a family. Under the Slovenian Infertility Treatment Act, everyone has the right to infertility treatment. A case of a patient in compulsory psychiatric treatment who participated in the process of IVF is presented.ObjectivesCASE REPORT: A 40-year-old male with paranoid schizophrenia has already been hospitalized thirteen times. He often discontinued therapy, abused drugs and repeatedly exhibited violent behaviour. He already had a child from a past relationship he didn’t care of.MethodsDuring the compulsory psychiatric treatment ordered by the court his mental status improved because his treatment with antipsychotics was supervised. He was in a relationship with a thirty-year-old partner. After unsuccessful attempts to become pregnant, they expressed a desire to conceive with biomedical assistance. Their application was considered and approved by the IVF Commission.ResultsThe procedure was successful but in the 13th week of pregnancy, the patient’s partner changed her mind due to his aggression. Because she was pregnant for more than 10 weeks, she had to submit a request for artificial termination to the Commission for abortion. Her request was granted and the pregnancy was terminated.ConclusionsCONCLUSION: We live in time of endless possibilities. Despite of violent acts in the past and severe form of mental illness, the couple was granted IVF procedure. Everyone has the right to start a family; however, the question that has to be raised is the extent and reasonableness of involvement of medical profession and/or health care system.DisclosureNo significant relationships.

Legal problems of use of compulsory psychiatric treatment in Russia and Belarus

The subject of the research is the problems of legislative regulation of compulsory psychiatric measures in the criminal legislation of the Republic of Belarus and the Russian Federation.The purpose of the article is to confirm or refute the hypothesis that there are defects in legislative regulation that prevent the effective use of compulsory psychiatric treatment. They are not eliminated in the Criminal Codes of the Russian Federation and the Republic of Belarus. Research methodology. On the basis of a system-integrated approach on an interdisciplinary basis, a scientific analysis of special legal and forensic psychiatric scientific literature and interpretation of the criminal legislation of the Republic of Belarus and the Russian Federation were carried out.Main results. An analysis of the Criminal Codes of the Republic of Belarus and the Russian Federation showed that compulsory psychiatric treatment is an independent institution of criminal law, which is regulated in sufficient detail in the national criminal legislation. The article includes a comparative legal analysis of the norms of the criminal legislation of both states (Chapter 14 of the Criminal Code of the Republic of Belarus and Chapter 15 of the Criminal Code of the Russian Federation) that regulate psychiatric coercive measures applied to persons with mental disorders who have committed illegal acts. Based on the results of the study, a number of problems were identified in the legislative regulation of psychiatric compulsory measures in the criminal codes of both states, the authors propose directions for further improvement of the current criminal legislation.Conclusions. The Criminal Codes of the Republic of Belarus and the Russian Federation contain only general criteria for choosing the type of psychiatric measures of a coercive nature, in the most general form, the procedure for their change and termination is provided, they need editorial clarification of their purpose. There is no legislative definition of the concepts of “coercive security measures and treatment” (Chapter 14 of the Criminal Code of the Republic of Belarus) and “compulsory measures of a medical nature” (Chapter 15 of the Criminal Code of the Russian Federation), etc., which causes serious difficulties in law enforcement practice and indicates the need to continue work to improve the current criminal legislation.The terminology used “coercive and security measures and treatment” (Chapter 14 of the Criminal Code of the Republic of Belarus) and “coercive measures of a medical nature” (Chapter 15 of the Criminal Code of the Russian Federation) does not reflect the specifics of these measures, which in their essence and content are exclusively psychiatric measures. The identified problems of legislative regulation of psychiatric compulsory measures in the criminal legislation of both states require their further resolution, and based on the interdisciplinary medico-legal nature of the problems involved, with the obligatory involvement of forensic psychiatrists in their solution.

Prescription patterns in psychiatric compulsory care: polypharmacy and high-dose antipsychotics.

Antipsychotic polypharmacy and prescription of high-dose antipsychotics are often used for the treatment of psychotic symptoms, especially in compulsory psychiatric care although there is lack of evidence to support this practice and related risks for patients. We aimed to investigate prescription patterns in patients with psychosis under compulsory psychiatric treatment in Cyprus and to identify predictors for pharmaceutic treatment patterns. This was a nationwide, descriptive correlational study with cross-sectional comparisons, including 482 patients with compulsory admission to hospital. Sociodemographic and clinical data were collected. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Prescribed medication patterns, including use of medication pro re nata (PRN, when required), were recorded. Antipsychotic polypharmacy with a PRN schema was reported in 33.2% (n = 160) of the participants. Polypharmacy without a PRN schema was reported in 5.6% (n = 27) of the participants. We found that 27.2% (n = 131) of the participants were prescribed high-dose antipsychotics without PRN included; and 39.2% (n = 189) prescribed high-dose antipsychotics with PRN included. In the logistic regression analyses, predictors for prescription of high-dose antipsychotics were male gender, positive psychiatric history, receiving state benefits and a negative history of substance use. Male gender was the only predictor for polypharmacy without a PRN schema whereas male gender, negative family psychiatric history, receiving state benefits and the total score on the positive symptoms PANSS subscale were predictors for polypharmacy with a PRN schema included. A high frequency of polypharmacy and use of medication PRN beyond clinical guidelines has been reported for the first time in psychiatric compulsory care in Cyprus; revision in antipsychotic prescription is needed.

Disability Rights and Compulsory Psychiatric Treatment: The Case for a Balanced Approach under the Mental Health (Compulsory Assessment and Treatment) Act 1992

This article argues the New Zealand Government's current approach to compulsory psychiatric treatment is unjustifiable in a human rights context. Under s 59 of the Mental Health (Compulsory Assessment and Treatment) Act 1992, clinicians are empowered to administer compulsory psychiatric treatment to individuals without, or contrary to, their consent. This article analyses s 59, and its underlying justifications, in light of the New Zealand Government's commitments under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Further, it analyses the approach for compulsory psychiatric treatment advocated by the UNCRPD in light of Aotearoa New Zealand's mental health context to evaluate whether this approach would be more desirable than the current approach under s 59. The article then advocates for a more balanced approach to compulsory psychatric treatment which puts the rights of disabled individuals at the forefront and also ensures there are limits to these rights which are justifiable within a human rights context.

Use of Compulsory Treatment by Early-Career Psychiatrists: An International Survey.

The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) has been broadly incorporated into national frameworks for compulsory psychiatric treatment. Recently, instructions issued by the UN CRPD Committee discouraged any involuntary treatment and detention of people with mental disabilities, which has sparked clinical, legal, and ethical debates. Early-career psychiatrists (ECPs) are often at the front line of decisions to involuntarily detain psychiatric patients; here, the authors surveyed ECPs to gain insight into their experiences with compulsory psychiatric treatment in clinical practice. An anonymous, voluntary, online survey among ECPs from 43 countries was conducted between July and August 2019. In total, 142 ECPs completed and were eligible to participate in the survey. Most of the survey respondents reported being involved in the practice of compulsory psychiatric care. More than half reported difficulties in providing compulsory psychiatric care, mostly because of the bureaucracy of legal procedures (e.g., legal correspondence with the court) and ethical issues around detention. Most respondents (96%) generally agreed with their country's legal mechanism for compulsory treatment; 43% indicated that it should remain unchanged, and 53% indicated that it should be revised. These findings call for a broader discussion in society and among psychiatrists regarding the practice of compulsory treatment while giving due consideration to the legal, therapeutic, and ethical issues involved. The views of ECPs will be helpful in future revisions of the ethical and operational frameworks of compulsory psychiatric care.

Use of compulsory treatment by early career psychiatrists: Findings from an international survey

Abstract BodyIntroductionEarly Career Psychiatrists (ECPs) are routinely at the front line of clinical practice worldwide, including the use of compulsory measures in psychiatry. However, ECPs practice in this aspect is understudied.ObjectivesThe aims of the study were (i) to clarify whether ECPs experience any difficulties in the process of compulsory psychiatric care; and (ii) to find out how ECPs consider compulsory measures in psychiatry.MethodsAn online anonymous survey of ECPs around the world was conducted in July-August 2019. The final sample had 142 psychiatrists (53% female; mean age 32.3±3.1) from 43 countries. Results. 96% of the Early Career Psychiatrists who responded to this survey agree with the continued use of the current legal framework for compulsory psychiatric treatment in their country, either with or without amendments. More than half of the respondents (57%) reported difficulties in providing compulsory psychiatric care due to either challenging interactions with the courts, documentation issues or moral concerns. Over half of the participants (53%) were keen to reform the legal procedures for compulsory psychiatric care in their countries.ConclusionsThe study has shown that there is an agreement among ECPs around the world that legal compulsory psychiatric care procedures are relevant and useful in clinical practice under certain circumstances. As stakeholders, ECPs could be encouraged and involved in adding their own experience and opinions to the debate on the employment of coercion in psychiatry as an ethical and legal issue.DisclosureNo significant relationships.

Socio-Demographic and Clinical Characteristics of Adults With Psychotic Symptomatology Under Involuntary Admission and Readmission for Compulsory Treatment in a Referral Psychiatric Hospital in Cyprus.

Socio-demographic and clinical characteristics of adults under compulsory psychiatric treatment, have not been reported adequately in Southern European countries. We investigated the socio-demographic and clinical characteristics of adults with psychotic symptomatology who were involuntarily treated in the acute Mental Health Services in Cyprus. A descriptive cross-sectional study was applied. Data collection (December 2016 to February 2018) achieved via a structured questionnaire including demographic and clinical variables. Census sampling was applied in Cyprus referral center for compulsory psychiatric treatment. The sample included 406 individuals (262 males, 144 females). Approximately 86.2% were single, 77.6% were unemployed, and 24.9% held a bachelor's degree. The most frequent clinical diagnosis was schizophrenia or a relevant psychotic disorder (86.4%). The most frequent admission cause was non-adherence to pharmacotherapy along with disorganized behavior (agitation and/or self-care deficit, and/or aggressive behavior, and/or suicidal behavior) (53.6%). Moreover, 70.7% of the sample reported a positive personal history of mental health problems, while 42.1% reported a positive family history of mental health disorders. Half of the participants (52%) were previously involuntarily admitted for compulsory treatment. Adjusted associations of readmission status were reported with Cypriot ethnicity (OR: 4.40, 95%CI: 2.58–7.50), primary education only (OR: 3.70, 95%CI: 1.64–8.37), readmission due to disorganized behavior along with non-adherence to pharmacotherapy (OR: 10.84, 95%CI: 2.69–43.72), as well as along with substance use (OR: 6.39, 95%CI: 1.52–26.82). Readmission was almost five times more likely to occur due to suicidal behavior (OR: 5.01, 95%CI: 1.09–22.99) compared to disorganized behavior not otherwise specified. Additionally, those with a diagnosis of schizophrenia were more than 12 times more frequently readmitted for compulsory treatment compared to other diagnoses (OR 12.15, 95%CI: 1.04–142). Moreover, the participants with higher secondary education had 54.6% less odds to be involuntarily re-admitted compared to Bachelor degree holders (OR 0.442, 95%CI: 0.24–0.79). A high percentage of involuntary treatment was noted due to non-adherence to pharmacotherapy and substance use. Re-evaluation of the effectiveness of relevant community interventions is suggested, as well as implementation of structured educational programs on therapy adherence during psychiatric hospitalization.

Les soins sans consentements peuvent-ils s’appliquer en cas d’addiction dans le contexte français ? Une analyse critique des données

ObjectiveThe objective of this work was to determine whether compulsory psychiatric treatment is applicable in France to patients with an addiction. To this end, several questions were formulated, at the legislative level and in terms of professional recommendations. Our secondary objective was to analyse those practices epidemiologically and in terms of evaluating their impact. MethodsUsing the PRISMA method for systematic research, documents were selected from the following databases: regulatory (Legifrance), scientific societies [High Authority for Health (HAS), French Society of Emergency Medicine (SFMU), French Society of Alcohology (SFA)]; concerning our secondary objective (epidemiological and evaluative) documents from several data bases [Public Health Database (BDSP), Psy Health Foundation, EM-Premium, Pubmed] were reviewed. ResultsThe search retrieved 163 documents, of which 13 were included based on examination. Legislative texts and professional recommendations do not exclude involuntary commitment to treatment in case of an addictive disorder. Epidemiological data describe use disorder as one of the most mentioned disorders in cases of involuntary commitment to treatment, with clinical improvement as long as treatment lasts. ConclusionFrench law does not prohibit compulsory addiction treatment in psychiatry. Compulsory addiction treatment could be an access to health care for some patients and an emergency measure to limit at one point the accumulation of damage or in view of a life-threatening situation.

Ograniczenia konstytucyjnej zasady poszanowania i ochrony wolności człowieka w zakresie udzielania świadczeń zdrowotnych

<p>Konstytucyjna zasada poszanowania i ochrony wolności człowieka nie ma charakteru absolutnego i może doznawać ograniczeń. Konieczność ochrony zdrowia publicznego uzasadnia wprowadzanie ustawowych ograniczeń związanych z udzielaniem świadczeń zdrowotnych i dotyczy przede wszystkim zasady działania lekarza na podstawie uświadomionej zgody pacjenta. W artykule przeanalizowane zostaną sytuacje które stanowią wyjątek od tej zasady, a mianowicie: „stany medycznej konieczności”, przymus badania wobec osób dotkniętych zaburzeniami psychicznymi, przymusowe postępowanie psychiatryczne, przymusowe leczenie uzależnień, przymusowe leczenie chorób zakaźnych. <strong></strong></p>

Judging homicide defendants by their brains: an empirical study on the use of neuroscience in homicide trials in Slovenia.

This paper presents a study that analyses all available homicide trials in Slovenia between 1991 and 2015 for neuro-evidence. Almost every fifth case discusses neuroscience. The most prevalent type of neuro-evidence is neuro-psychological testing, less common are structural neuroimaging and electroencephalography, while we discovered no use of functional neuroimaging. The two largest categories of neurological conditions suffered by defendants are traumatic brain injury and brain damage due to long-term alcohol and drug abuse. When presented, neuro-evidence affected courts’ decisions in 85% of trials (15% of all tried homicide cases) and had an impact on the criminal sentence or another outcome of the trial in 79% of cases. By far most often neuro-evidence affects decisions regarding criminal capacity, ie insanity and (substantially) diminished capacity, which, in turn, strongly reflects in criminal sanctions. Neuroscience information is typically used to mitigate or even reduce the sentence, but never as an aggravating circumstance. It is also frequently utilized to support decisions about medical security measures (compulsory psychiatric treatment). This study further suggests that the double-edged sword of neuroscience is an elusive concept and that the mechanism by which neuroscience affects courts’ decisions in civil-law systems is different from the one in common-law jurisdictions.

Do Community Treatment Orders in Psychiatry Stand Up to Principalism: Considerations Reflected through the Prism of the Convention on the Rights of Persons with Disabilities.

Compulsory psychiatric treatment is the norm in many Western countries, despite the increasingly individualistic and autonomous approach to medical interventions. Community Treatment Orders (CTOs) are the singular best example of this, requiring community patients to accept a variety of interventions, both pharmacological and social, despite their explicit wish not to do so. The epidemiological, medical/treatment and legal intricacies of CTOs have been examined in detail, however the ethical considerations are less commonly considered. Principlism, the normative ethical code based on the principles of autonomy, beneficence, non-maleficence and justice, underpins modern medical ethics. Conflict exists between patient centred commentary that reflects individual autonomy in decision making and the need for supported decision making, as described in the Convention on the Rights of Persons with Disabilities (CRPD) and the increasing use of such coercive measures, which undermines this principle. What appears to have been lost is the analysis of whether CTOs, or any coercive measure in psychiatric practice measures up against these ethical principles. We consider whether CTOs, as an exemplar of coercive psychiatric practice, measures up against the tenets of principalism in the modern context in order to further this debate.

Prediction of Violence, Suicide Behaviors and Suicide Ideation in a Sample of Institutionalized Offenders With Schizophrenia and Other Psychosis.

This study examined the predictive validity of the Spanish version of the Suicide Risk Assessment Manual (S-RAMM) and the Historical-Clinical-Risk Management-20 (HCR-20) in a sample of violent offenders with schizophrenia and other psychosis, who had committed violent crimes and had been sentenced to compulsory psychiatric treatment by the criminal justice system. Patients were prospectively monitored within the institution for 18 months. During the follow-up period, 25% of offenders were involved in any suicidal behavior including acts of self-harm, suicidal ideation and suicide attempts and 34% were physically or verbally violent. The S-RAMM and HCR-20 risk assessment tools were strongly correlated and were able to predict suicidal behavior and violence with a moderate-large effect size (AUCs = 0.81–0.85; AUCs = 0.78–0.80 respectively). Patients scoring above the mean on the S-RAMM (>20-point cut-off) had a five times increased risk of suicide related events (OR = 5.05, 95% CI = 2.6–9.7) and sevenfold risk of violence in the HCR-20 (>21-point cut-off) (OR = 7.13, 95% CI = 2.0–21.2) than those scoring below the mean. Offenders at high risk for suicide and violence had significantly more suicide attempts (p < 0.001) and more prior sentences for violent crimes (p < 0.001). These results support the use of the S-RAMM and HCR-20 for clinical practice by providing evidence of the utility of these measures for predicting risk for suicidal and violent behavior in mentally disordered offenders.

Measure of Security of Obliged Psychiatric Treatment and Story in the Healthcare Institution in the Criminal Law of the Republic Of Srpska // Mjera bezbjednosti obaveznog psihijatrijskog liječenja i čuvanja u zdravstvenoj ustanovi u krivičnom zakoniku Republike Srpske

This paper discusses the measure of the safety of compulsory psychiatric treatment and care in a health institution from the new Criminal Code of Republika Srpska. Here, in fact, it is about “returning” to the law of an old measure that previously existed in domestic criminal legislation until its 2003 reform. Considering that a new one has been abandoned in Bosnia and Herzegovina by the harmonization of criminal justice reform, the procedure against irregular perpetrators of criminal offenses and the introduced security measures that other legislation in the country does not know, we expect this to raise the attention of legal science, jurisprudence and certain international factors under the influence of which the measure was removed from the criminal legislation. With this work, we want to draw the attention of the scientific and professional public to the need for traditional, scientifically based and proven solutions to be quickly and uncritically abandoned, so that after a certain period of time, “after-mindedness,” it was understood that it was wrong and counterproductive.

Exploring experiences with compulsory psychiatric community treatment: A qualitative multi-perspective pilot study in an urban Canadian context

As medical, ethical and clinical effectiveness debates about the use of compulsory psychiatric treatment continues, it is important to further explore the actual experiences and perspectives of all relevant stakeholders in community treatment orders (CTOs). This qualitative pilot study engaged a total of twenty-seven clients, their family members, and care providers in Toronto, Canada. Semi-structured, one-on-one interviews were conducted between February and July 2013 and analyzed using thematic analysis. Top key themes from all the participants identified include, among others: 1) clients' experiences of coercion while treated under CTO, but a preference for CTOs compared to involuntary hospitalization, nevertheless; 2) limited real opportunities for collaboration in treatment decisions expressed by clients and family members; 3) acceptance of the potential for clinical recovery on CTOs while debating the role of CTO in a broader recovery journey by all stakeholders; 4) general preservation of therapeutic relationships between clients and care providers, while acknowledging the tension of taking on an “enforcer” role by providers; and 5) existence of different avenues for asserting agency by clients. The findings of this research illuminate the nuanced, complex, and adaptive perspectives held by different stakeholders, point to the importance of preserving and enhancing procedural justice in their use, and alert the field to incorporate recovery-based approaches in this controversial practice that is a widely and commonly used clinical tool across many jurisdictions.

Postupak za izricanje mera bezbednosti obaveznog psihijatrijskog lečenja i njegov odnos prema opštem i skraćenom krivičnom postupku

In the focus of this paper is a critical review of certain legal solutions related to the initiation and completion of the procedure for pronouncing the security measures of compulsory psychiatric treatment. The relationship between this special procedure and the general and simplified criminal procedure is reexamined and finds that issue of their transformation is not adequately solved. It is noted that main causes of the problem are inadequate legal terminology, a new concept of acquittal, as well as the wrong attitude about legal nature of the special procedure for pronouncing security measures of psychiatric sharacter.

Compulsory psychiatric treatment checklist: Instrument development and clinical application

Instruments designed to evaluate the necessity of compulsory psychiatric treatment (CPT) are scarce to non-existent. We developed a 25-item Checklist (scoring 0 to 50) with four clusters (Legal, Danger, Historic and Cognitive), based on variables identified as relevant to compulsory treatment. The Compulsory Treatment Checklist (CTC) was filled with information on case (n=324) and control (n=251) subjects, evaluated under the Portuguese Mental Health Act (Law 36/98), in three hospitals. For internal validation, we used Confirmatory Factor Analysis (CFA), testing unidimensional and bifactor models. Multilevel logistic regression model (MLL) was used to predict the odds ratio (OR) for compulsory treatment based on the total scale score. Receiver Operating Characteristic analysis (ROC) was performed to predict compulsory treatment. CFA revealed the best fit indexes for the bifactor model, with all items loading on one General factor and the residual loading in the a priori predicted four specific factors. Reliability indexes were high for the General factor (88.4%), and low for specific factors (<5%), which demonstrate that CTC should not be performed in the subscales to access compulsory treatment. MLL reveals that for each item scored in the scale, it increases the OR by 1.26 for compulsory treatment (95%CI 1.21–1.31, p<0.001). Based on the total score, accuracy was 90%, and the best cut-off point of 23.5 detects compulsory treatment with a sensitivity of 75% and specificity of 93.6%. The CTC presents robust internal structure with a strong unidimensional characteristic, and a cut-off point for compulsory treatment of 23.5. The improved 20-item version of the CTC could represent an important instrument to improve clinical decision regarding CPT, and ultimately to improve mental health care of patients with severe psychiatric disorders.

Some Solutions in the Draft of Criminal Code of the Republic of Srpska // Pojedina rješenja u nacrtu krivičnog zakonika Republike Srpske

The paper presents the text and analysis of individual characteristic solutions according to the current version of the Draft of the new Criminal Code of Republika Srpska, which was drafted by the working group of the Ministry of Justice of Republika Srpska. It’s about these institutes from the general part: pronouncement of imprisonment for up to six months, prohibition of driving a motor vehicle, acquisition and prolonged criminal offense and the safety measure of compulsory psychiatric treatment and care in a health institution. Given that almost all of the foregoing is deviating from the multiannual established principles and attitudes of legal science and jurisprudence, we expect that these solutions will cause considerable attention but also cause certain problems in practical application. Considering that some of the selected and processed solutions are unnecessary and the other undefined and undetermined, this paper aims to draw the attention of the scientific and professional public in order to form a view on the real need for such solutions to be truly adopted.