Department Of Forensic Psychiatry Research Articles

Delusions and Delinquencies: A Comparison of Violent and Non-Violent Offenders With Schizophrenia Spectrum Disorders.

The relationship between schizophrenia spectrum disorders (SSD) and violent offending has long been the subject of research. The present study attempts to identify the content of delusions, an understudied factor in this regard, that differentiates between violent and non-violent offenses. Limitations, clinical relevance, and future directions are discussed. Employing a retrospective study design, machine learning algorithms and a comprehensive set of variables were applied to a sample of 366 offenders with a schizophrenia spectrum disorder in a Swiss forensic psychiatry department. Taking into account the different contents and affects associated with delusions, eight variables were identified as having an impact on discriminating between violent and non-violent offenses with an AUC of 0.68, a sensitivity of 30.8%, and a specificity of 91.9%, suggesting that the variables found are useful for discriminating between violent and non-violent offenses. Delusions of grandiosity, delusional police and/or army pursuit, delusional perceived physical and/or mental injury, and delusions of control or passivity were more predictive of non-violent offenses, while delusions with aggressive content or delusions associated with the emotions of anger, distress, or agitation were more frequently associated with violent offenses. Our findings extend and confirm current research on the content of delusions in patients with SSD. In particular, we found that the symptoms of threat/control override (TCO) do not directly lead to violent behavior but are mediated by other variables such as anger. Notably, delusions traditionally seen as symptoms of TCO, appear to have a protective value against violent behavior. These findings will hopefully help to reduce the stigma commonly and erroneously associated with mental illness, while supporting the development of effective therapeutic approaches.

Metabolic syndrome in patients who have been subjected to isolation security measures and treated with atypical antipsychotics.

The main aim of the study was to assess the incidence of metabolic syndrome and its individual components in patients subject to a confinement measure, treated with antipsychotics in mono - or polytherapy. Additional objectives included the analysis of associations between the occurrence of metabolic syndrome and patients' age, psychiatric diagnosis, overweight or obesity, and the presence of addictions to psychoactive substances. The study involved 61 patients of the Department of Forensic Psychiatry, including 9 women and 52 men, subject to a confinement measure from September 2019 to August 2021. All parameters of metabolic syndrome and BMI were measured twice, at the beginning of the stay at the Department and after six months of treatment with atypical antipsychotics. Appropriate statistical comparative analyses were then performed. There was no relationship between the occurrence of metabolic syndrome and the age of the subjects, medical diagnosis, addiction to psychoactive substances, including smoking. It has not been confirmed that the chronic use of atypical antipsychotics with parallel prophylactic and health-promoting effects in conditions of confinement leads to the development of metabolic syndrome and worsens its symptoms, apart from a marked increase in waist circumference and an increase in BMI. Systematic measurements of BMI and waist circumference during treatment with atypical antipsychotics may be accurate tools in assessing the risk of metabolic syndrome. Long-term confinement hospitalizations should include psychoeducational nterventions aimed at minimizing metabolic complications of pharmacotherapy.

Elderly criminal patients in Razi psychiatric hospital of tunis

IntroductionCriminality has become of increasing concern in the practice of psychiatry. However, violence among elderly psychiatric patients is an underestimated and understudied phenomenon.ObjectivesThe aim of the study is to identify differences in the socio-demographic, clinical and criminological profiles between elderly criminals under treatment for psychiatric disorders and those not known to have mental disorders prior to the criminal offense in Tunisia.MethodsWe present a retrospective study on twenty male criminal mental patients, aged sixty years or older, who were hospitalized in the Forensic Psychiatry Department of Razi Hospital during 18 years, following a dismissal for insanity under Article 38 of the Penal Code and Article 29 of Law 92/83 on Mental Health.ResultsPrevalence was higher among elderly criminals without a known psychiatric history (2.42% versus 1.98%). The average age was roughly the same, around 73 years old.Neurological and cardiovascular histories were the most common in both groups. The criminal act was indicative of dementia in 8 cases. Criminal history was more frequent in elderly patients with a personal psychiatric history (55.5% versus 18.2%). Patients whose act was revelatory of their mental disorder committed more violent crimes (63.7% versus 44.4%) using blunt objects (71.4% versus 0%).The victim most often belonged to the aggressor’s family, particularly the spouse (87.5%).ConclusionsScreening for criminal risk factors in the elderly, early diagnosis of mental disorders and a comprehensive therapeutic project are necessary to prevent the risk of violent behaviour.

Research findings on Greek forensic patients found not guilty by reason of insanity. A juxtaposition of patients who committed a criminal offense during their first psychotic episode with those who did so later in the course of their illness

The aim of this study was to compare the baseline characteristics (demographic, psychiatric-psychopathological and legal) among Greek forensic patients found not guilty by reason of insanity. The first step of this approach being differentiating patients who committed a criminal offense during their first psychotic episode from the ones who did so later in the course of their illness. All patients were hospitalized in the Department of Forensic Psychiatry (DFP) of the Psychiatric Hospital of Thessaloniki (PHT) from January 2015 to January 2020 and were examined in order to be included in the study. The final research sample consisted of 78 patients (70 identifying themselves as males and 8 identifying themselves as females) aged 18 and older, 21 of whom committed a criminal offense during their first psychotic episode (FEP, N = 21) and 57 did so later on in the course of their illness (Course, N = 57). Data were collected from multiple sources and several psychometric tools were used (Mini International Neuropsychiatric Interview-M.I.N·I, Positive And Negative Syndrome Scale-PANSS, Addiction Severity Index-ASI, CAGE Questionnaire, Hostility and Direction of Hostility Questionnaire-HDHQ, Global Assessment of Functioning-GAF and Aggression Questionnaire). Comparing the two groups (FEP vs. Course) we found that patients in FEP were younger, had experienced stressful life events in the last 24 months, committed more serious violent crimes, and more frequently attempted suicide after the crime. Their victims were usually members of their family. The main psychometric disparities between the two groups were found in the “Hostility” score of the Aggression questionnaire, and the items “Criticism of Others” and “Paranoid Hostility” of the HDHQ questionnaire, where patients in FEP scored lower. Patients in FEP scored significantly higher in items P1 (delusions), P4 (excitement), P6 (suspiciousness/persecution) and P7 (hostility) of the PANSS scale. No statistically significant differences were found between the two groups regarding their evaluation with the CAGE, ASI or GAF questionnaires. When comparing the patients' present scores in PANSS scale, the patients in FEP had lower total scores in the Positive and the General Psychopathology subscales. Both groups showed significant improvement during hospitalization in all scales (PANSS & GAF), except for the Negative Subscale of the PANSS scale. Through logistic regression analysis, we found that patients in FEP were younger, more likely to have recently experienced stressful life events and more likely to have assaulted a member of their family. Patients with higher scores in the “Hostility” subscale of the Aggression questionnaire were found to remain at risk for committing a crime during the course of their illness. These findings underline the need to design and develop specialized mental health services in order to identify and treat patients involved in violent crime in a timely and effective manner addressing their multiple needs.

A retrospective study on risk assessment and management of forensic psychiatric inpatients in Hong Kong.

The Department of Forensic Psychiatry of Castle Peak Hospital is the only facility in Hong Kong that provides territory-wide forensic psychiatric services for patients with criminal involvement. This retrospective study aimed to explore whether the rehabilitation programs provided by the department could significantly reduce the risks of forensic psychiatric inpatients as measured by the Short-Term Assessment of Risk and Treatability (START). START ratings of inpatients who were hospitalized in the department for more than 3 months and were discharged to the community during the period from 11 April 2015 to 31 March 2019 were analyzed. A total of 79 patients were assessed, of whom 61 (77.2%) were males. Fifty-four (68.4%) patients suffered from schizophrenia. START scores upon admission (strength score = 5.67; vulnerability score = 17.43) and upon discharge (strength score = 6.87, vulnerability score = 11.18) indicated significant reduction of risks among inpatients (p < 0.05).

The implementation of the law 4509/2017 in the Forensic Department of the Psychiatric Hospital of Thessaloniki

According to the Explanatory Memorandum of the law 4509/2017, a significant change is being made to the current institutional framework of Articles 69 and 70 of the ECHR concerning the penal treatment of mentally ill offenders, in order to ensure a high level of treatment for perpetrators with mental or intellectual disorder. In application of the law, it was examined in court the abolishment, maintenance or replacement of the treatment measure of 47 patients from the Department of Forensic Psychiatry in Thessaloniki. The results were compared with the previous status quo. In 22 cases, abolishment was ordered for the patients to be discharged and return to their parent's home or to Psychosocial Rehabilitation Units. In 11 of them, their stay was in direct violation of the law due to exceeding the cap as defined by the severity of the offense. However, 7 patients remain voluntarily in the Department, as no beds are available in reintegration structures. 13 patients who have committed homicide remain with the psychiatrist's agreement beyond the overrunning the ten years of treatment due to the severity of the disease or the risk for violent behavior. The Public Prosecutor has provided solutions in many cases and has appointed lawyers for all patients as prescribed by law. However, the judiciary remains cautious and the trend towards exhaustion of the limits is clear, despite the fact that their fears are not confirmed by international bibliographic data. The application of N 4509/2017 attempts to change the landscape for this particular group of patients and allows visions for de-institutionalization, elimination of the stigma and personalized treatment, despite any ambiguities or potential problems that may arise. However, as the predominant social viewpoint, shown by the media, treats the mentally ill as dangerous, any positive changes are doomed to fail. In addition, it is necessary to develop psychiatric services for the treatment of patients which will not only treat psychotic symptoms but also antisocial and aggressive behavior in general.

Measuring the profiles of the security needs of forensic psychiatric inpatients: Validation of the See, Think, Act Scale.

This study aimed to develop and validate a Chinese version of the See, Think, Act Scale (C-STA). The relational security of the Department of Forensic Psychiatry of Castle Peak Hospital, which provides territory-wide forensic psychiatric services in Hong Kong, was measured. The See, Think, Act Scale was first translated into Chinese, then back-translated into English for comparison, and finally, subject to modification until alignment was achieved. Its content validity and face validity were explored through expert panel evaluation and focus group discussion, respectively. Eighty-nine Chinese mental health professionals were recruited from six service units to measure the relational security of the Department of Forensic Psychiatry using the C-STA. The Cronbach's alpha coefficient for internal consistency was high, with all components exceeding 0.90. The intraclass correlation coefficients for the test-retest reliability of all components ranged from 0.50 to 0.72. Participants had the lowest score on the "patient focus" component (M=2.56, standard deviation [SD]=0.32). A significant sex difference in total relational security scores was found (P<0.001). The C-STA is a valid and reliable instrument to measure the relational security of forensic psychiatric services. "Patient focus" might be the target component of relational security for which the Department of Forensic Psychiatry needs to have interventions. The significant sex difference in total relational security scores needs further exploration.

Comparison of Structure and tasks of Forensic Psychiatry in Iran and European Countries

Background: The purpose of the study was to compare forensic psychiatric setting in Iran with European countries. Methods: First a qualitative study (experience expression) was done, interviewing the forensic psychiatrics. Then to understand the sections of forensic psychiatry department, articles, scientific references and the relevant sites were reviewed. Their work was analyzed using emails and phone calls. Recording data forms that included different services, the way they worked and human resources’ potential in forensic psychiatric system in any of the chosen countries were filled accordingly. Findings: In most studied European countries, the examination method, treatment, rehabilitation and post discharge care are the same. Observing the patient’s behavior and social interactions is one of the most important diagnostic tools. In Europe, forensic psychiatric activities’ focus is on criminal matters: risk assessment, treatment and rehabilitation of criminal patients. The more executive diagnostic facilities of forensic psychiatry and secure mental hospitals with special deparments are important factors that make significant difference. Conclusion: Despite the differences that exist in European departments of forensic psychiatry’s activities, similarities are observed in factors such as mental patients’ examination method, diagnostic and treatment facilities, preparing a psychiatric report for the court. The activity of Iranian’s system isn’t functional enough in comparison to European system, due to factors like lack of standardized and secure diagnostic facilities, and limited access to criminal patients and courts. To improve the system, our country should consider some actions such as: establishment of standardized sections in prisons and psychological hospitals, longterm program to establish special hospitals, using common and standard tools of risk assessment and establishment of follow up clinics and nursing (guardian) houses for post discharge care of criminal patients.

医療観察法病棟における服薬アドヒアランス向上に向けた取り組み(シンポジウム,第25回日本精神保健看護学会学術集会)

医療観察法病棟における服薬アドヒアランス向上に向けた取り組み(シンポジウム,第25回日本精神保健看護学会学術集会)

Predicting offense recidivism in Schizophrenia patients

IntroductionSchizophrenia increases the risk of offending. Recidivism rates are significant.AimIdentifying general and violent recidivism risk factors in schizophrenia patients.MethodsWe conducted a case control study. All included patients were admitted, at least once, to the forensic psychiatry department in Razi Hospital between January 1st, 1985 and December 31st, 2014 after a decision of irresponsibility by reason of insanity. All those who reoffended during this period were considered as cases. A draw was performed to create the control group. Both groups were matched according to their first offences’ types as well as to their ages. A multivariate analysis was performed.ResultsWe included 25 cases and 38 controls. Eight recidivism risk factors were identified. Living in urban poor neighbourhoods (P = 0.039; OR = 1.23), having been unemployed (P = 0.047; OR = 1.22) and not having lived with the family (P = 0.039; OR = 1.36) after discharge were considered as risk factors. The same applied to alcohol (P = 0.032; OR = 1.29) and cannabis use disorders (P = 0.005; OR = 1.34). A hospitalization shorter than 6 months increased the risk by 1.44 (P = 0.039). A combination of conventional antipsychotics (P = 0.003; OR = 1.36) and a poor adherence (P = 0.006; OR = 1.36) were considered as recidivism risk factors too.ConclusionsAll eight recidivism risk factors are dynamic. This makes recidivism prevention conceivable. Measures involving the patient, the health care system, patients’ families, society and the government should be taken.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Paranoia: When criminology predicts vocational prognosis

Patients with paranoia have always been a group of exiting but daunting patients for mental health professionals. Indeed, the risk of a violent acting out with important aggressive discharges confers to these patients an elevated dangerosity potential. If various criminological aspects of violence in paranoia have been described, their link to functional prognosis of patients have been seldom addressed.AimTo determine if criminological details of violence acts in paranoia patients predict their functional prognosis.MethodsA retrospective, descriptive and analytic study have been conducted, based on a chart consult. Twenty-three patients with paranoia (i.e. Chronic delusional disorder type jealousy or erotomania in DSM IV) patients have been included. These patients have been hospitalized in the forensic psychiatry department of Razi hospital of Tunis (Tunisia), between 1995 and 2015, after not being held by reason of insanity, according to article 38 of the Tunisian Criminal Code.ResultsDelusional disorder types were: jealousy (17), persecution (4), erotomania (1) and claim (1). The majority were married (18), undereducated (17), with irregular work (13). Forensic acts were uxoricide (15), attempted murder (5), violence against people (2) and destruction of public properties (1). Patients used bladed weapon in most of the cases (13), in the victim's residence (19), with premeditation in (17) of the crimes. Only 5 patients worked regularly after discharge.ConclusionIf our results expose further data concerning potential dangerosity of patients with delusional disorders, they also highlight the marginalized situation of these patients when released back into society.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Predicting offense recidivism in Schizophrenia patients

IntroductionSchizophrenia increases the risk of offending. Recidivism rates are significant.AimIdentifying general and violent recidivism risk factors in schizophrenia patients.MethodsWe conducted a case control study. All included patients were admitted, at least once, to the forensic psychiatry department in Razi Hospital between January 1st, 1985 and December 31st, 2014 after a decision of irresponsibility by reason of insanity. All those who reoffended during this period were considered as cases. A draw was performed to create the control group. Both groups were matched according to their first offenses’ types as well as to their ages. A multivariate analysis was performed.ResultsWe included 25 cases and 38 controls. Eight recidivism risk factors were identified. Living in urban poor neighbourhoods (P = 0.023; OR = 4.86), having been unemployed (P = 0.042; OR = 2.18) and not having lived with the family (P = 0.039; OR = 1.36) after discharge were considered as risk factors. The same applied to alcohol (P = 0.026; OR = 4.89) and cannabis use disorders (P = 0.018; OR = 6.01). A hospitalization shorter than 6 months increased the risk by 1.79 (P = 0.046). A combination of conventional antipsychotics (P = 0.023;OR = 4.81) and a poor adherence (P = 0.001; OR = 10.42) were considered as recidivism risk factors too.ConclusionsAll eight recidivism risk factors are dynamic. This makes recidivism prevention conceivable. Measures involving the patient, the health care system, patients’ families, society and the government should be taken.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Multi agency working in forensic psychiatry: Theory and practice in Europe

Criminal Behaviour and Mental HealthVolume 26, Issue 3 p. 153-160 Editorial Multi agency working in forensic psychiatry: Theory and practice in Europe Lindsay D.G. Thomson, Corresponding Author Lindsay D.G. Thomson Division of Psychiatry, University of Edinburgh and Medical Director, The State Hospitals Board for Scotland, GermanyAddress correspondence to: Professor Lindsay Thomson, Division of Psychiatry, University of Edinburgh, Morningside Park, Edinburgh EH10 5EY, UK. E-mail: L.D.G.Thomson@ed.ac.ukSearch for more papers by this authorKris Goethals, Kris Goethals Mental Healthcare Westelijk Noord-Brabant, Halsteren, The Netherlands and Antwerp University Hospital, Belgium and Collaborative Antwerp Psychiatric Research Instititue (CAPRI), University of Antwerp, BelgiumSearch for more papers by this authorNorbert Nedopil, Norbert Nedopil Department of Forensic Psychiatry, Psychiatric Hospital of the LMU Munchen, GermanySearch for more papers by this author Lindsay D.G. Thomson, Corresponding Author Lindsay D.G. Thomson Division of Psychiatry, University of Edinburgh and Medical Director, The State Hospitals Board for Scotland, GermanyAddress correspondence to: Professor Lindsay Thomson, Division of Psychiatry, University of Edinburgh, Morningside Park, Edinburgh EH10 5EY, UK. E-mail: L.D.G.Thomson@ed.ac.ukSearch for more papers by this authorKris Goethals, Kris Goethals Mental Healthcare Westelijk Noord-Brabant, Halsteren, The Netherlands and Antwerp University Hospital, Belgium and Collaborative Antwerp Psychiatric Research Instititue (CAPRI), University of Antwerp, BelgiumSearch for more papers by this authorNorbert Nedopil, Norbert Nedopil Department of Forensic Psychiatry, Psychiatric Hospital of the LMU Munchen, GermanySearch for more papers by this author First published: 05 July 2016 https://doi.org/10.1002/cbm.1998Citations: 7 All authors are members of Ghent Group which shares ideas, practice, research and education across European Forensic Psychiatry Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume26, Issue3July 2016Pages 153-160 RelatedInformation

Patricide, matricide: A comparative study among Tunisian patients with psychotic disorders

Parricide is defined as the homicide of a father or mother by a biological or adopted child. In adults, it is generally associated to a psychotic condition. Scientific research on the subject, have been mainly interested in matricide, patricide or double parricide. Studies comparing authors of patricide to those of matricide are rare.ObjectivesTo compare socio-demographic and clinical profiles of patricide and matricide patients.To compare modus operandi in matricide and patricide patients.MethodsA retrospective, descriptive and comparative study was conducted, based on medical charts’ consult. Were included patients suffering from psychotic disorders (DSM-IV), hospitalized in the forensic psychiatry department of Razi hospital between 1995 and 2015, after not being held for insanity according to article 38 of Tunisian Criminal Code. Only patients who committed patricide or matricide were included.ResultsOur sample included 26 patients (13 patricides; 13 matricides). There was non-significant differences between two groups concerning: instructional level (P = 0.277), professional status (P = 0.387) and marital status (P = 0.790). Committers of patricide and matricide did not differ in terms of psychiatric diagnosis (P = 0.242) and substance abuse (P = 0.550). A significant difference was found between the two groups in terms of schizophrenia subtypes, patricide patients suffered from a disorganized schizophrenia whereas matricide patients suffered from paranoid subtype (P = 0.05). Patricide was more frequently associated to a conflictual relationship between son and father (P = 0.05). We did not record a significant difference in the crime weapon or its motivations.ConclusionOur results helps draw a profile for parricide patients in order to help identify the ones at risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

When patients with paranoia commit medicolegal acts: A descriptive study

Patients with paranoia have always been an attractive and redoubtable group of mentally ill to mental health professionals. In fact, beyond complex psychopathology and relatively better functioning, these patients do represent a real threat to themselves and their presumed persecutors.ObjectivesTo explore criminological aspects of medicolegal acts committed by patients with paranoia.MethodsWe conducted a retrospective and descriptive study, based on medical charts consult. Were included, patients suffering from paranoia (persistent delusional disorder: jealous/persecutory/erotomania type, DSM-IV), hospitalized in the forensic psychiatry department of Razi hospital between 1995 and 2015. This psychiatry department provides medical care for male patients not held by reason of insanity, according to article 38 of the Tunisian Criminal Code. Patients’ socio-demographic characteristics were collected as well as criminological details of their acts of violence (victim, weapon type, crime scene, premeditation…).ResultsWe collected 23 patients. Delusional disorder types were: jealousy (17), persecution (4), erotomania (1) and claim (1). The majority was married (18), undereducated (17), with irregular work (13). Forensic acts were uxoricide (15), attempted murder (5), violence against people (2) and destruction of public properties (1). Patients used bladed weapon in most of the cases (13), in the victim's residence (19), with premeditation in (17) of the crimes. Nine patients reported their act of violence to the authorities.ConclusionOur results do expose further data concerning potential dangerosity of patients with delusional disorders, and by that invites mental health professionals to prevent these acts with screening for violence predictors and risk factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Nukentėję nepilnamečiai nuo seksualinių nusikaltimų – psichologinio (ekspertinio) tyrimo svarba atpažinti klaidingus įtarimus

Seksualinės prievartos prieš vaikus atvejus yra sudėtinga tirti, nes dažnai vaikai yra ne tik pagrindiniai, bet ir vieninteliai liudytojai bylose. Ypač sudėtinga vertinti, kai įtarimai dėl seksualinės prievartos pareikšti vaiko tėvui arba motinai tėvų skyrybų kontekste. Šiuo straipsniu siekta 1) apžvelgti literatūrą šia tema, 2) apžvelgti veiksnius, turinčius įtakos vaikui, kaip patikimam liudytojui, tokiose bylose, 3) atvejo analizės tyrimo metodo pagrindu išanalizuoti Vaikų ir paauglių teismo psichiatrijos skyriuje 2009-2014 metais atliktų kompleksinių teismo psichiatrijos- psichologijos ekspertizių duomenis, kai įtarimai dėl seksualinės prievartos pareikšti nukentėjusiųjų tėvui arba motinai, apimant ir tėvų skyrybų kontekstą.

The development and trial of a medication discontinuation program in the department of forensic psychiatry.

BackgroundWhen treating mentally ill criminal offenders, improving medication adherence is essential to achieving goals, such as long-term stabilization of symptoms and the prevention of recidivism. Most subjects who are treated under the Medical Treatment and Supervision Act have schizophrenia, which is considered a particularly difficult disorder for which to improve medication adherence. For such patients, we developed a Medication Discontinuation Program (MDP) that aims to improve medication adherence by discontinuing antipsychotic drugs and monitoring changes in psychiatric symptoms. We examined whether there was any utility for the MDP on a trial basis as well as whether it would be worthwhile to introduce the MDP to psychiatric programs.MethodsWe conducted the MDP with an intervention group (n = 7) and compared Drug Attitude Inventory-30 (DAI-30) scores before and after implementation of the MDP. We also categorized 30 questions of the DAI-30 into three subscales: “awareness of the need for medication”, “awareness of the effects of psychiatric drugs”, and “impression of medication”, and examined factors affecting improvement in medication adherence.ResultsThe total DAI-30 score significantly increased after completion of the MDP (P = 0.002). Significant elevations after completion of the MDP were also observed in the scores for three subscales of the DAI-30.ConclusionsOur study suggests that the MDP has a possibility of improving medication adherence, and this program might have multidirectional and stimulatory effects on each factor related to the improvement of medication adherence.

Opinions of forensic schizophrenia patients on the use of restraints: controversial legislative issues.

The use of restraints is a controversial issue even though legal regulations may seem straightforward. Our aims were to evaluate the forensic patients' opinions on certain aspects of restraining and to compare these opinions with the current legal norms. Inpatients with schizophrenia or schizoaffective disorder at the Department of Forensic Psychiatry in Popovača, Croatia, were asked the following questions about the use of mechanical restraints: (a) Should the patients' family be informed about the use of restraints? (b) Should the physician ask the patient whether to inform the family about the use of restraints? (c) Can the use of restraints be a kind of punishment for intentionally aggressive behavior toward people in their environment? and (d) Should restraints be used if the patient requests to be restrained? The patients were assessed according to the Temperament and character inventory and Positive and Negative Symptom Scale. Fifty-four forensic patients with a history of serious offences were included in the study. Their average age was 44.7 (± 8.39) years and the mean duration of their treatment was 6.6 (± 5.08) years. There was no predominant opinion on sharing the information with the family, but there was a relationship between the opinions and psychopathology and personality. Regardless of the patients' mental state and personality, the opinions on the voluntary use of restraints and the use of restraints as punishment for intentionally aggressive behavior were mainly positive. The patients' opinions suggest a need for the implementation of more specific guidelines in the area of forensic psychiatry.

EPA-1790 – Psychotc disorder acute and medico legal acts: evolutionary terms

Acute psychotic disorders include a heterogeneous group of disorders characterized by the acute onset of psychotic symptoms. Medico legal acts can be observed during these episodes. To study different evolutionary terms of patients hospitalized in department of forensic psychiatry at Hospital Razi, Tunisia following a withdrawal of case by reason of insanity according to section 38 of the Penal Code and having been diagnosed as an acute psychotic d A retrospective descriptive study was carried out on files of patients hospitalized in department of forensic psychiatry at Hospital Razi during the period of January 1991 to December 2011 and whose final diagnosis according to DSM VI was a brief psychotic disorder or schizophreniform disorder. Our sample consisted of 30 patients. The average age was 28.6 years. Criminal acts were varied: they were dominated by homicide in 5 cases, attempted homicide in 5 cases, 4 cases in theft. On admission, the diagnosis of brief psychotic disorder was selected in 12 patients, whereas the diagnosis of schizophreniform disorder was labeled in 18 cases. Two cases of complete remission were objectified. The outcome was chronic in 17 case: it was paranoid schizophrenia in 5 patients, disorganized schizophrenia in 4 patients, schizoaffective disorder in 4 patients and a disorganized schizophrenia in 2 patients. 6 patients developed bipolar disorder later. Acute psychotic episodes constitute a risk period of acting out. Screening for chronic psychiatric disorders occurs by the early identification of patients at risk from the prodromal phase.

Forensic psychiatry in Singapore

Singapore is a geographically small nation-state that has transformed itself from a third-world country to a developed nation after attaining political independence 46 years ago. The pace of change has been tremendous and mental health care is no exception. This paper provides an overview of mental health care and a review of key mental health legislation, including a National Mental Health Blueprint that was rolled out in 2007. On this background, the paper focuses on a description of forensic psychiatric services in Singapore. The role of the Department of Forensic Psychiatry at the Institute of Mental Health, which is the only forensic psychiatry department in the country, will be highlighted. Civil commitment and the treatment of unfit accused persons and insanity acquittees is reviewed. The role of forensic psychiatric assessments in the Singapore courts is examined. The application of the insanity and diminished responsibility defenses are reviewed. A trend is identified in the Singapore courts towards a more rehabilitation-focused sentencing approach and the role that forensic psychiatric assessments play in cases involving mentally disordered offenders is highlighted.