Involuntary outpatient treatment (IOT) is a form of involuntary treatment applied in the community, which seeks to ensure adherence to treatment in patients suffering from severe mental illness, unaware of disease and in which abandonment of treatment poses a high risk of relapse, with the development of disruptive and violent behavior, and repeated hospitalizations (usually involuntary) and frequent emergencies.

In 1997 was the first time was implemented in the province of Guipúzcoa, Spain.

Perform an analysis of IOT in two mental health centers of San Sebastian.

Retrospective descriptive study. The sample comprised all patients who are on involuntary outpatient treatment in two mental health centers in San Sebastian, from 2009 until June 2010.

The collection of information is conducted through a review of the patient’s medical history, analyzing the following demographic and clinical data: age, sex, psychiatric diagnosis, evolution of the disease, number of hospital admissions and care in emergencies

A sample population of 42 patients. 58% are male and 42% female. The average patient age is 48 years. The youngest person is 18 years and 81 years older.

The years of evolution of the illness range from 2 to 25 years, with an average of 12 years. The average hospital admissions per patient is 4.

For diagnosis, schizophrenia is the most common mental disorder. In second place: delusional disorder, bipolar disorder and schizoaffective disorder.

IOT is most often applied to people with schizophrenia which have severe relapses with violent behavior or noncompliance.

Drugs addiction, suicide and mental health disorders are the major problems of inmates health. In Portugal the suicide is the second cause of death and is increasing in a panorama of general decreased mortality in prisons.

To characterize and compare the inmate population with high versus low risk of suicidality, according several variables including the needs for care.

A descriptive study of a non-probabilistic sample constituted by all male inmates referenced to a forensic psychiatric clinic in Lisbon region, during a year (April 2009–2010), was performed. The data was collect from user and professional interviews and user file. The instruments, besides a specific questionnaire, includes MINI; BPRS and the Camberwell Assessment of Need, Forensic Version (CANFOR). The suicide risk was defined by C section from MINI and defined as a dichotomic variable: null/low or moderate/high suicide risk.

The sample was composed of seventy nine inmates (median age 36). Major depression was the only diagnostic significantly associated with suicide risk. There was a significant association between moderate/high risk of suicide and the unmet needs rated by users in psychological distress, safety to self, drugs and company domains and unmet needs rated by staff in daytime activities, psychological distress, safety to self and drugs domains.

The suicide prevention is a crucial issue in prisons. The assessment of suicide risk, psychiatric care and care delivery in unmet needs domains may have a positive impact in self harm and suicide incidence.

The delusional misidentification syndromes (syndromes of Frégoli, Intermetamorphosis, Subjective Doubles and Capgras) are characterized by delusions of misidentification of other persons or of one-self. Aggressive ideas or behaviours often go with these delusions, but the problem received relatively little attention. Capgras’ Syndrome is characterized by the delusional belief that a well-known person has been replaced by a double. The delusion frequently involves significant others and takes place in a paranoid atmosphere with feelings of strangeness and unreality. We stress the importance of considering the potential dangerousness and homicidal acts directed towards family members of patients with Capgras’ Syndrome.

We report a case with histories of paranoid schizophrenia and alcohol and cannabis intoxications who developed a Capgras’ Syndrome associated with homicidal behaviours toward his wife.

Our case met DSM IV-TR diagnostic criteria for paranoid schizophrenia, according to previous studies which show that paranoid schizophrenia is the most frequent mental disorder associated with delusional misidentification. The psychopathological analysis show that homicidal acts are connected to anguish of the ego disintegration and failure of defense mechanisms.

According to the most recent literature, our findings suggest that Capgras’ Syndrome may be linked to a genesis of aggressive behaviours; alcohol and substance intoxications facilitates impulsivity and dissociation. The patients’ acting out directed toward family members occurs during a psychotic breakdown. Capgras’ Syndrome should always be evaluated in order to prevent violent acts.

The use of standardized and objective instruments constitutes a support to the clinical observation in order to evaluate particular and general aspects of an individual's psychic life, and it can represent a valid aid in the evaluation and prediction of aggressivity. Our aim is the assessment of the MMPI-2 ‘s predictive capacity, a self-report personality test, constituted of 567 items, evaluating possible aggressive acts.

20 subjects with a history of aggressivity, in the absence of major psychiatric disorders, were examined. The MMPI-2 test was administered to them, so as to assess their profile with reference to the aggressivity's indicators. It was also administered to a control group of subjects without a history of aggressivity.

In all the examined offenders, unlike the control group, were observed low T values in the K scale (< 40), an increase in the Pd base scale (>65) and supplemental scale O-H (>65); with respect to the derivative indexes, it was noticed a scarce adaptive capacity (Hy< Pa), a low tendency to the tolerance of frustrations and a negative value at T points in the PAI (Hy+100)-(Pd+2Pa).

In concordance with the literature data, the MMPI-2 can be a useful support in evaluating the risk of aggressivity. Subjects at risk of acting out show low values in the K scale (< 40), high values in the Pd scale (>65). Other particularly important risk indicators are: code types 4/6, 4/8, 468, a scarce adaptive capacity (Hy< Pa) and a scarce tolerance to frustrations.

All of the 147 statements on capacity to contract drawn by forensic psychiatrists in Lithuania during the period of five years. The data were sorted by a special questionnaire worked out by the authors. Statistical analysis was done by Pearson correlation method, using SAS, SPSS program packages for statistical processing.

Posthumous examinations made up only 2.7 per cent among all accomplished in 5 years. Witnesses testimonies in 51.7 cases were so contradictory that half odf them had been discarded from considering. Medical files made the major material, however 16.5 per cent of them were psychiatrically irrelevant. 46.2 per cent contained descriptions of mental disorders, the subjects had not been consulted by psychiatrists. From all registered mental pictures 86.6 per cent had a background of somatoneurological disorder, and 13.4 per cent of mental syndrome had no association to physical condition. Mental disorder or severe somatic pathology alone do not always determine patient's incapacity. Due to experts’ 45 per cent contracts were nullified.

Paternal filicide is the killing of a child by his or her father. These offences are rare but when happened they are traumatic to the community and people. Most of published studies focused on child homicide in Westernized developed societies. The aim of this study is to shed light on this rare phenomenon in Kuwait.

The psychiatric, socio-demographic profiles and the religious background of 5 filicidal men hospitalized at Kuwait Psychological Medicine Hospital forensic unit between 2001 and 2005 were reviewed. Information was obtained from a number of sources including:

1- hospital files

2- Police reports,

3-newspaper reports.

Data including psychiatric, psychological as well as criminological assessment of these cases were analyzed in detail.

The average age of those men was 35.6 years (SD ± 4.3 years) with a range of 30 to 42 years. Two men have been diagnosed as schizophrenia; one substance related psychotic disorder (they have active psychotic symptoms at the time of offence and committed their offence under these symptoms), another one depression, and the fifth one has no psychiatric disorder. Religious beliefs and conventions colored the offence in two incidents. Eight of the victims (total number 10) were girls. One filicide man killed his spouse during the act.

Paternal filicide, while unthinkable crime by most people, is seen in developing as well as in developed societies. The impact of cultural and religious background of the filicidal on the act was discussed.

Acquired brain injury has been reported to be associated with violence.

To determine whether an association exists between acquired brain injury and violent offending

Study an association between brain injury and crime and identify associated risk factors.

Systematic search of Medline, Embase, PsychInfo, CINAHL, TRIP, using terms, Acquired brain injury, traumatic brain injury (TBI), head injury, frontal lobe, crime, offending, violent offending, sexual offending, prison.

1. A: Multiple studies reported higher life time history of head injury in prison or offender populations in comparison to control groups. Sampling bias and case definition problems have influenced reported prevalence of head injury in offender population ranging from 3.3% to 82%. Reports from secure psychiatric services identify that patients with history of head injury may be more difficult to discharge. Community based studies report cognitive damage as significant risk factor for domestic violence.

2. B: Large scale population and military cohorts have reported a higher relative risk for criminal conviction in mild traumatic brain injury (TBI) group. TBI increases the risk of mental disorder by two-folds but also that TBI is significantly related to mental disorder with co-existing criminality.

3. C: Childhood conduct problems, loss of a parent, substance misuse, maternal drug use in pregnancy, impaired executive cognitive functioning, structural damage to orbito-frontal and ventromedial areas, amygdala, and hippocampus are reported as risk factors for violent offending in this population group.

The review provides evidence for an association between brain injury and violent offending and also identifies associated risk factors.

Patients with acquired brain injury and other neuropsychiatric conditions may present with a significant risk of violence.

To conduct a qualitative evaluation of violence to inform risk assessment, patient management, service planning, and workforce training in neuropsychiatry

To provide thematic or qualitative categories based exploration of violence to enhance understanding of risk factors and risk presentations while clarifying the nature and types of violence in this patient population.

A service evaluation exercise was conducted using routinely collected clinical information for patient group admitted at a neuropsychiatric service. Data files were converted in word format and transferred on qualitative analysis software NVIV0-8. This software was used for further qualitative analysis through creating free nodes in order to generate qualitative themes or categories of violence in this patient population.

65 Male and 23 Female patients were admitted at the time of this review (working age adults). The qualitative data analysis using NVIVO-8 generated qualitative categories of violence in this patient population

1. 1. Violent Offending: Wounding, murder, criminal damage, sexual offending, arson

2. 2. Institutional violence: Directed towards patients and staff included, scratching, biting, slapping, punching, kicking, grabbing, groping.

3. 3. Sexual Violence: Stalking, rubbing, groping, exposing, masturbating, person directed sexual threats.

4. 4. Types of Violence: Impulsive violence, instrumental violence, grudges based violence, opportunistic violence, predatory violence, erotic violence

Qualitative categorisation of violence amongst a neuropsychiatric population is feasible and provides supportive evidence for further clinical practice and guideline development in violence risk assessment for this patient population.

To determine clinical-dynamic characteristics of combat-related PTSD for best understanding etiologocal and pathogenesis bases in mentioned category.

478 male combatants aged 22–43 y.o., observed in 1993–2008 years.

Clinico-psychopathological; quality of life self-evaluating scales, IES-R and statistical.

According to ICD-10, only one diagnostical category - “reaction to hard stress and adaptation disturbance”- is identified as having explicit etiological connection with psycho-traumatic extraordinary impact. Negative mental symptomatology in combatants is reflected there as “chronical personality changes after catastrophe”.

Contrary to “classical” position personality change may be its chronical outcome and the diagnosis should be stated not only after 2 years. That's why the period of urgent adaptation is characterized by regressive, ontogenetically more early forms of reacting; conscience disintegration.

Appearance of more prolonged and more specifical PTSD symptomatology reflects pathoplastic later development.

PTSD can be understood as a transforming reactive process, fixating in memory traces new behavioral stereotypes. Specifical adaptation in military conditions happens because of cortical behavior control's depression and deep-undercortical philogenetically old vital affects releasing (as the biological base). Positive PTSD symptomatology in combatants are repeated memories about psychotrauma, often transform into obsessive-phobic complexes. In case of increased cortex inhibition impulsive behavior's motives are formed. Initial war stress is complicated by the necessity to adapt to usual conditions and it often becomes a basis for behavioral deviations. That's why we should consider the treatment and rehabilitation of such persons one of the priority medical and social tasks in XXI century.

Since 1999 the Portuguese law envisages compulsory admission as a Court decision based on major psychiatric criteria: dangerousness and need for treatment. The rate of compulsory versus total admissions in Portugal has increased since then, maintaining, however, one of the lowest reported rate in Europe. This trend is also noted in other European countries and there is a current debate concerning the underlying reasons.

To examine whether the decision criteria for compulsory admissions has changed over time in a general hospital in Lisbon.

We conducted a retrospective study in two non-probabilistic samples of compulsorily admitted patients with no prior involuntarily admissions in a general hospital in Lisbon: the first one hundred patients admitted in 1999 and the last one hundred admitted in 2009 were selected. Data was collected from patient files using a standardized questionnaire.

There were no significant differences between samples concerning age, gender, employment, living alone, duration of illness, duration of hospital stay, drugs use or mandatory outpatient treatment. The diagnostic of affective disorders, the overt violent behaviour and depot medication at hospital discharge increased significantly (p < 0.05) in the 2009 sample.

There seems to be no changing in the decision criteria of compulsory admission envolving sociodemographic variables. The increasing rate of compulsory admissions may be due to the increasing admission of patients presenting affective disorders and overt aggressive behaviour, and hence, this may be caused by the application of criteria of dangerousness and of need for treatment.

In this study we evaluated the prevalence of committed acts in the group of male inpatients in forensic setting with major mental disorder and past history of aggressive behavior in community.

In the study we included 80 male inpatients, 41 of them have meet DSM-IV criteria for Personality Disorder, 28 were psychotic, 11 were Drug/alcohol abusers. Past aggressive history was collected from patient interviews and reviews of clinicalforensic records and collateral source of documents.

The inpatients were adults with mean age 35,22±10,50 in Schizophrenia spectrum disorders group and the mean duration of the illness was 11,7±9,48, Personality disorders group with mean age 31,35±9,85 and mean duration of illness 10,70±8,34, Drug/alcohol abusers with mean age 19,1±8,6 and mean duration of illness 4,5±2,6.Personality disorder and Drug/alcohol abuser group of inpatients offenders were more prevalent on homicide acts 40%, and threatening 35%, while Schizophrenia spectrum disorder inpatients were more prevalent in domestic violence 49,2%, threatening acts committing with 33,3% and homicide prevalence 7,9%.

The studies until now showed that the prevalence of Schizophrenia in the homicide offenders is around 6%. Despite this, the prevalence of Personality disorder or of Drug/alcohol abuse is higher: 10% to 38% respectively. Our results showed the same results with prevalence of Schizophrenia spectrum disorder in homicide with 7,9%, and respectively Personality disorder with homicide prevalence 40%.

Violence Risk Screening-10 (V-RISK-10), subjective measure of the programme chairmen performed in the beginning and in the end of the programme. The Aggression Questionnaire and Daily Spiritual Experience Scale as self-assesment scales were performed in the end of the programme. Results point on decreasing of V-RISK-10 results in the end of the programe in all participants. Interested observation was that mentioned results and those on self-assesment scales were not always been correlated positively. We also proved negative correlation between aggressivity and spirituality. As a conclusion, we have indications to believe that is real to expect that comining psychosocial treatment with targeted psuchopharmacological interventions could leed to decreasing the risk of future violent bihevior in forensicly treated psuchiatric patients.

Clinical definitions and differencial diagnosis criteria of «Schizotypal personality disorder» is not enough investigated yet, especially how it differs from schizoid personality disorder and continuous sluggish schizophrenia. It is impossible to consider diagnostic indications (that the symptoms of schizophrenia couldn’t be observed before and during actual examination) sufficient to explain the special place of this mental disorder. Some criteria of diagnosis of schizotypal disorders (for example, suspiciousness and paranoid ideas, episodes of quazi- psychotic disorders) are not applicable.

With the aim to define the clinical features of schizotypal personality disorder 58 patients were examined. All patients were characterized by mainly personality disorders.

1. - Schizotypal personality disorder is similar to deficit states, observed at schizophrenia, clinically limited to personality sphere, without the signs of flow of endogenous process and psychotic disorders.

2. - Schizotypal personality disorder on the clinical content reminds schizoid, but insignificant ideatory disorders are rather typical. Dymamic of psychopathy - disposition to decompensation - is never observed.

3. - Schizotypal personality disorder can be diagnosed as latent, prodromal schizophrenia, because the clinical picture of these states is very similar. The special value acquires a dynamic aspect, allowing to find the signs of «flow» and dynamics typical of the endogenous process.

Thus, the main differencial diagnosing criteria of schizotypal personality disorder are the dynamic aspects and changing of clinical features.

One of the peer-led support programmes in prisons is the Insiders Scheme. Preliminary findings have shown that this has a positive impact on both prisoners and the Insiders. There is no detailed information on the ways in which the Insiders perceive their role. This may help to identify targets of training for Insiders. The present qualitative study aimed to describe the ways in which the Insiders perceived their role.

Two focus group meetings, using the interview guide method, were undertaken with all 3 Insiders in a male prison establishment in the UK. The anonymised transcripts of the focus group meetings were analysed inductively by following established conventions. To ensure the trustworthiness of the analysis, attention was given to coherence,’theoretical validity’ and’catalytic validity’.

The present study has provided a detailed systematic account of the ways in which the Insiders perceived their role. Insiders evaluated their role in terms of different aspects of their role, strategies that they used to help other prisoners, personal impact of their role, difficulties that they experienced during the course of their work, and ways of improving their role.

Some of the Insiders’ views were consistent with their role specification known or agreed by the professionals. Others differed from professionals’ views. The present findings contribute to an evidence-base for peer-derived training for the Insiders Scheme. Therefore, these findings highlight the value of undertaking qualitative research among Insiders to identify specific targets for their training.

It is a common view that mental illnesses are widely associated with dangerous, threat-posing behavior and law-breaking.

The paper analyzes the problem of law-breaking by the mentally disordered.

The analysis of cases concerning compulsory psychiatric treatment or confinement in a medical institution on the grounds of mental incompetence to commit an offence or mental unfitness to stand the trial obtained from the court and the public prosecutor’s office in Silesia Region from 2007 to 2009.

14 cases were analyzed. All the offenders were male, mean age was 44,6. All the offenders were diagnosed by psychiatrists, most of them with schizophrenia (n = 10 cases). Other diagnoses included paranoid personality disorder (n = 1), bipolar affective disorder with manic episode (n = 1), schizoaffective disorder (n = 1), delusional disorder (n = 1). 9 out of 14 offenders were diagnosed prior to the offence, some of whom were also hospitalized (n = 5). 8 of analyzed cases concerned use of violence, 3 concerned larceny, 2 concerned posing a threat to others’ life or health and 1 concerned fraud. 2 of the offenders were previously sentenced for other offences. 12 of the offenders were compulsory treated by psychiatrists, 10 out of whom is still hospitalized.

The small number of the cases analyzed (14 cases in the whole of 5000) suggests that mentally disordered persons do not break law often. There seems to be a higher risk associated with male gender, though. Also, the frequency of violent acts and offences committed despite previous treatment is disturbing.