The Psychiatrists are called to assess the level of risk in violent and sex offenders’ population. There are differing perceptions about formalising the severity and management of risk. The proponents of actuarial decision making propose that it is scientific and evidence based approach. The advocates of professional judgment however think that actuarial tools usually miss out on the interplay of compounding factors and can under or over estimate the level of risk.

To review consecutive patient assessments and qualitatively compare it with HCR-20 and RSVP tools for violent and sex offending patients.

To report the difference in outcome in the domains of overall severity of risk, risk formulation and clinical decision making for management of the risk in these patient groups.

We aim to compare twenty consecutive patients where professional judgment of the clinician determined the severity of the risk, risk formulation and management. We then aim to use the information available to check for any differences in these areas when HCR-20 and RSVP are employed.

The comparison and benefits of professional judgment and actuarial decision making are reported.

The professionals (providers) are being increasingly compelled by commissioners(purchasers) to evidence base their clinical decision making. The professional judgments are more likely to be challenged in the courts. People are easily impressed by decisions which are evidence based though they may have limited understanding of research environment and population studied.

This study was to analyze the sample data collected from divorce marital therapy sessions in the local court system in South Korea as well as diagnose typical symptoms in the divorcing couples.

The survey forms and marital therapy notes were collected from 200 divorce counseling cases in the local court systems, South Korea. The 200 divorce counseling cases were categorized as twelve major themes. Family therapy notes were utilized as an aid in verifying the divorcing couples’ self-reports. The research method was partially adopted from the article, “Working with Korean-American Families: Multicultural Hermeneutics” (Sang Bok Lee, 2003: The American Journal of Family Therapy, 31, 159 – 178). Multicultural hermeneutics was instrumental for explicating multiple layers of multicultural narratives, psychological dynamics, socio-economic systems, and of family systemic relations when dealing with the divorcing couples.

The results were summarized as: economic issues (20%); extra-marital relationship (16%); in-law conflict (12%); substance abuse, addiction & marital violence (12%); international marriage & cross-cultural differences (10%); personality difference (8%); re-marriage issues (6%); sexual conflict (6%); age gap (4%); personality disorder & mental disorder (2%); parenting & children issues (2%); pre-mature marriage (2%). The twelve categories were grouped as mainly

1. (1) family systemic or relationship-related issues,

2. (2) socio-economic issues, and

3. (3) mental health-related issues.

Psychiatrists, family therapists, and mental health professionals who work with the divorcing couples need to be aware of the predominant causes for rapidly increasing divorce rates when conducting therapeutic assessment and implementing intervention for the divorcing couples.

Criminal justice mental health teams were established in The United kingdom in the late nineties of the last century following the publication of the Reed Report 1991.

Two teams were established in South Essex following the geographical locality of each team. Basildon and Thurrock and Southend.

An evaluation form was devised to record all essential areas of assessment.

Twenty five assessment of each team were picked and evaluated randomly over a period of a three months. A comparison was done between the assessment of the two teams.

Referring agency one from the west didn’t mention it

Three of the west didn’t have the index offence;

One of the east and two of the west didn’t have past forensic history.

Three of the west and one of the east didn’t have risk assessment.

One of the west didn’t have summary of concerns

Three of both didn’t mention whether other professionals involved or not.

Comparison between different teams is important to make sure that there is a standard format for assessment and whether it is used in all assessments.

It has been shown that assessments are very good in general in both teams. There are some areas which need to be addressed and managed.

12% of patients on the west didn’t have risk assessment which is very risky.

This comparison has highlighted areas we need to take care off especially risk assessment and liaising with other agencies in managing theses very special group of patients.

The possibility of detention for treatment of mental patients may be controversial since introduces the possibility of the judicial power to dominate one's private life.

It is made an analysis of the legal problems in compulsory internment and treatment in mental patients in Portugal.

The diplomas mainly analysed were the Portuguese mental health law, Constitution and Penal Code. The study was based in four legal principles: necessity, proportionality, subsidiary and adequacy whenever a compulsory detention for mental treatment is imposed and the requisites for that decision.

Compulsory internment may only be determined when it is the only way to guarantee that patient is submitted to treatment, and when is deemed proportional to the danger of the legally protected value in question. Restrictions on patient’s fundamental rights shall be those strictly necessary and suitable to the effectiveness of treatment. Compulsory internment may be petitioned by the Public Attorney, patient's legal representative, public health authorities or any person.

In spite of the diversity of criteria for compulsory mental health care across several countries, Portuguese mental health law emphasizes the need for treatment as an essential condition for detaining patients with mental illness. The compulsory treatment is based on the judge decision supported in the psychiatric report. However, how can we be certain that a mental patient is going to practice a specific crime? Is it fair to punish without crime? Are there scientific criteria capable of ensuring that mental patients cause always violent behavior?

In recent decades, considerable progress has been made in the study of the biomolecular bases of violent behavior, so much so as to rekindle a heated debate on the notions of “free will” and “criminal responsibility”.

To analyze the results of neurobiological research on violent behavior and to investigate the possible repercussions of their application in the field of forensic psychiatry.

Starting from the analysis of a recent judgment by an Italian Court of Appeal, which reduced the sentence of a convicted murderer on the basis of he was a carrier of some alleles thought to be risk factors for the development of violent behavior, we reviewed the scientific literature on this issue.

A growing number of studies have investigated the relationship between genetic polymorphisms and violent behavior. In particular, recent studies have indicated that the principal role is not played by mutations of single genes, but by modifications of several genes and their expression (epigenetics).

While the presence of some specific polymorphisms may be associated to a higher risk of enacting violent behaviors, the phenotypic expression of this “vulnerability” should more properly be interpreted in terms of interference between the genome and the environment. From a forensic psychiatric standpoint, however, it must be remembered that the necessary condition whereby a mental disorder can take on the meaning of “insanity” is that it has caused, in the specific case, such “psychopathological functioning” of the acting subject as to compromise his capacity for cognition and/or volition.

Involuntary admission of mentally ill patients tends to be related to clinical severity and worst therapeutic response.

To evaluate whether there is a relationship between involuntary admission and prescription of two or more antipsychotics (that is, polytherapy) among patients with schizophrenia and other psychosis.

A total of 241 patients (40.2% females, mean age 39.7+/−13.0 years) consecutively admitted during 2009 to a psychiatric inpatient ward with diagnosis of schizophrenia and other psychoses were assessed.

Out of the total sample, 150 (62.2%) patients were on polytherapy, and of the 241 patients 134 (55.6%) were involuntarily admitted. Involuntary admission was unrelated to age (p = 0.335), specific diagnosis (p = 0.452), or length of psychosis (p = 0.234). On the contrary, it was related to gender (61.8% of males vs. 46.4% of females were involuntary, p = 0.018) and to polytherapy/monotherapy prescription (62.0% of patients on polytherapy vs. 45.1% of patients on monotherapy were involuntarily admitted; and 53.3% of voluntary patients vs. 69.4% of involuntary were on polytherapy p = 0.010). After controlling for age, gender, specific diagnosis and length of psychosis the association between involuntary admission and being in polytherapy remained significant (p = 0.047).

Patients involuntarily admitted are more prone to be on antipsychotic polytherapy.

Schizophrenia patients exhibit impairments in facial affect recognition associated with neurophysiological abnormalities. Using the Training of Affect Recognition (TAR) developed by our group behavioural performance in facial affect recognition improved significantly in schizophrenia patients [1]. Purpose of the presented work was to identify the underlying mechanisms and associated generators of neuroelectric activity.

In a randomized controlled (waiting group) design 19 schizophrenia patients received TAR. Concomitant to facial affect recognition performance, ERPs were recorded and analyzed with respect to underlying generators of cortical activity using low resolution brain electromagnetic tomography (LORETA) software.

Schizophrenia patients showed noticeable deviations in neuroelectric correlates of emotion recognition associated with poorer performance in the administered task. As a result of TAR treatment no significant changes in event related potentials were found. However, LORETA results showed a significant increase of activity within relevant brain areas, specific for the processing stages associated with facial emotion recognition (N170 and P240).

EEG findings of the present study indicate that neurophysiologic abnormalities corresponding with poorer performance in schizophrenia patients can be attenuated by training.

The prevalence of psychiatric disorders in prison populations showed in other European countries has not been replicated in Spain.

The aim of the study was to estimate the lifetime and last month prevalence of mental disorders in a Spanish prison population sample. In this posetr we look a drug induced psychiatryc disorders found in this study.

This is a descriptive cross-sectional epidemiological study. 783 male inmates were included in the study. Mental disorders were assessed with Structured Clinical Interview (SCID 1) for DSM-IV Axis 1 Disorders, clinical version and personality disorders were assessed by the Spanish version of the International Personality Disorders Examination.

The lifetime prevalence of mental disorder was 84.4%. Substance use disorder (abuse and dependence) was the most frequent disorder (76,2%): When look at substance induced diosder we found Mood induced disoder had lifetime prevalence of 15,8%(,13,2–18,5) and a last month prevalence of 2,8% (1,6–4,1), anxiety disoders were 16,1% (13,4–18,8) in lifetime prevalence and 5,9 (4,2–7,7) for last month prevalence and for subtance induce psychotic disoder lifetime prevalence was 7,1%(5,2–9,0) and last month prevalence was 2.0 (1.0–3.0). There is a 95 interval confidence on all these data.

The high prevalence of mental disorder and substance misuse is relevant both for the planning of health resource use in the prison environment and the prevention and approach to these disorders.

A Norwegian government publication (1) claims a prevalence of around 50% of Antisocial Personality Disorder (APD) in a small group of male detainees on preventive detention. The present study population is recruited from more or less the same population as those among whom a 50% prevalence of APD has been claimed (1). Norwegian forensic investigators rarely (17%) apply psychometric tools to confirm their clinical diagnosis (2).

To confirm the diagnosis of APD applying SCID axis II. Methods: Fifty six inmates were available at the prison. Twenty eight were willing to participate (50%). Two were excluded. Thus, 26 (46%) inmates participated. DSM IV, SCID axis II was applied.

None of the 26/56 matched the APD criteria, mainly failing to fulfil the diagnosis of Conduct Disorder (CD) before the age of 15 years. All the inmates had a history of antisocial behaviour.

To explain the claim of around 50% APD in view of the present results, close to 100% APD should be found among the remaning thirty non-participating inmates. We consider this unlikely.

A diagnosis of APD based on the history of antisocial behaviour alone represents a pitfall. Lack of quality assurance could lead to false positive diagnosis. The need for a standardized approach and quality assurance in Norwegian forensic psychiatric evaluations seems nevessary to avoid false positive diagnosis.

The article is devoted to the analysis of aggressive criminal behaviour in mentally ill persons.

To develop effective measures to prevent committing dangerous assaultive acts in mentally ill persons.

To study personal, social and clinical characteristics of the disease in mentally ill persons who have committed dangerous assaultive acts.

We examined 25 mentally ill persons that had committed dangerous assaultive acts and have been found insane as regards their offence. The research involved clinical psychopathological study and follow-up.

In 19 cases (76%), schizophrenia was diagnosed; in 3 cases (12%), organic cerebral lesions of traumatic or mixed etiology; in 1 case (4%), epilepsy; and in 2 cases (8%), delirium tremens.

Of the subjects, 21 (84%) had a high education level; 3 (12%), a higher education level (university); and 1 (4%), incomplete high education.

At the time of committing the offence, 9 subjects (36%) had a permanent job; 3 subjects (12%) had seasonal jobs; 10 subjects (40%) didn’t have any job at all; and 3 (12%) subjects were recognized as mentally disabled.

At the time of committing the offence, 13 subjects (42%) were not registered in a public psychiatrist's office.

The personal and social characteristics of the mentally ill offenders have clearly demonstrated the prevalence of poorly educated, socially maladapted persons among them. Most of the subjects had not been registered in a psychiatrist's office. A vast majority of dangerous assaultive acts are committed by schizophrenics in an acute stage of the disease.

Alcohol involves 50% of sexual assault among college students. Eighty-five percent of on-campus rapes are acquaintance rapes. According to Bohmer and Parrot 25% of college women have experienced forced sex at some time during their college careers.

To determine the relationship between alcohol, location and stranger with sexual assault in college women at UNC.

To compare sexual assault in which alcohol was consumed versus assault in which alcohol was not consumed, assault which occurred on campus versus off campus, and friend versus stranger assault.

This was a retrospective cohort study. Data was collected from 2003–2007. Students surveyed were undergraduates and graduates selected on the basis of non probability convenient sampling. Sample size calculation was done using the W.H.O. software where α = 0.05, 1-Beta = 90, Po = 0.55, Pa = 0.35, n (sample size) = 52. Binary logistic regression analysis was used to assess risk factors for the dependent variable of sexual assault with a threshold for selection of p < 0.05.

Friend assault had a high prevalence of assault than stranger assault (35/84; 41.66% v 17/84; 20.23; p < 0.05). On campus assault had an increased prevalence of assault than off campus assault (33/84; 39.28% v 19/84: 22.61%; p < 0.05). Friend assault was the strongest predictor for assault and was 2.35 times (95% CI, 2.27 – 2.40) more as compared to stranger assault.

Alcohol increases the probability of sexual assault if the students are on campus and have friendship with the perpetrator.

Sex differences have been described in depression and more recently in antidepressant response. Animal models and in particular the Forced Swim Test (FST), are widely used to investigate the behavioural response to stress and to antidepressant treatment.

The present study explored sex differences in the stress response during the FST and examined whether antidepressant treatment alleviates the sex-differentiated stress response.

Adult male and female Wistar rats were subjected to a 15 min FST session and then treated with three injections of sertraline 10 mg/kg or vehicle at 0, 19 and 23 hours post-FST. Twenty-four hours after the first FST, they had a second 5 min FST session and their behaviour was recorded.

Vehicle-treated females exhibited 66% longer duration and 70% shorter latency of immobility than males, suggesting enhanced levels of despair. Sertraline did not significantly affect immobility, but exerted its antidepressant effect by elongating swimming duration in both sexes and shortening climbing behaviour in males only. In contrast, to vehicle-treated rats, no sex differences were observed in sertraline-treated rats in any of these behavioural parameters. However, sex-differences in head swinging behaviour, which is unaffected by sertraline treatment, were still observed in sertraline-treated rats.

Females appear more vulnerable than males to the FST, but the post-treatment organisation of FST behaviour is not sex-differentiated. Antidepressants seem to modulate the behavioural response in FST in a sex-specific way, due to sex differences in baseline FST performance. Consequently, the sex-differentiated stress response profile during FST is attenuated by antidepressant treatment.

X-linked mental retardation (XLMR) is a common, clinically complex and genetically heterogeneous disease arising from many mutations along the X chromosome. Although research during the past decade has identified >90 XLMR genes, many more remain uncharacterized. In XY males, duplication of any part of the X chromosome leads to functional disomy of the corresponding genes.

In this paper we present the case of a boy with a syndrome of Xq28 duplication. Methods: We present a 6 years old boy, admitted in the Department of Pediatric Psychiatry for evaluation. He presented sever mental retardation, autistic features, speech delay, hyperkinesia, and dysmorphic features (high forehead, partial palpebral ptosis, small nose, carp-shaped open mouth, micrognathia), recurrent infections. Cerebral MRI was normal. Genetic investigations, including katyotype with GTG banding and array-CGH, were performed.

Array-CGH indicated a dup(X)(q28) of less than 1.5 Mb. There were 15 duplicated genes, including MECP2 gene, which is involved in autism and mental retardation.

Duplications at Xq28 are often associated with autistic features/non-syndromic MR; alterations in MECP2 gene (duplicated in our patient) are described in Rett syndrome or as a specific phenotype. The alteration occurring at Xq28 band is responsible for the patient’s phenotype. Clinical manifestation of this child will be compared with those of other patients with the same duplication previously described to further delineate this syndrome.

Previous studies have found association between several schizophrenia candidate genes and neurocognition in schizophrenia patients and healthy individuals. Both brain-derived neurotrophic factor (BDNF) and disrupted in schizophrenia 1 (DISC1) are important for neurodevelopmental processes and have been implicated as schizophrenia candidate genes, as well as genes influencing neurocognition.

To test for the previously described association of these genes with schizophrenia and neurocognition.

DNA samples from a homogeneous sample of 280 schizophrenia patients and 230 healthy controls were genotyped for polymorphisms in schizophrenia candidate genes DISC1 (rs821597 and rs821616) and BDNF (rs6265). Clinical assessment was performed using the Schedule for Deficit Syndrome and the Positive and Negative Symptom Scale. Neurocognitive functioning was assessed in a subsample of 263 patients and 135 healthy controls by a comprehensive neuropsychological test-battery. Based on the raw neuropsychological measures we calculated a global index of cognitive impairment and domain-specific composite z-scores. Association between the above composite scores and the SNPs was examined using GLM and GENMOD analysis.

The investigated SNPs were not associated with schizophrenia, nor with the deficit or non-deficit subgroups. However we found significant association between global cognitive impairment and rs821616 in DISC1 (F = 3.02, p = 0.05) and rs6265 in BDNF (F = 4.47, p = 0.01); moreover rs6265 was associated with working memory (F = 6.22, p = 0.002) and attention (F = 7.27, p = 0.0074)

Using neurocognition as an endophenotype for psychotic disorders in genetic studies has the potential to determine common and separate genetic factors influencing disease risk and neurocognition.

The presence of an extra X-chromosome, also known as Klinefelter's Syndrome, occurs in approximately 1 in 500 live male births. Epidemiological studies have reported an increased vulnerability to psychiatric disturbances in this group of patients and suggest that the X chromosome may be involved in the aetiology.

Comprehensive review of the scientific literature (Medline, Ovid) on Psychiatric pathology in Klinefelter's Syndrome published over the last 20 years.

This is a case report of a 27 year-old-male with Klinefelter's Syndrome confirmed by karyotyping (XXY), suffering from different neuropsychiatric disorders, such as mental retardation, dyslexia, ADHD and social dysfunctioning. Since the age of 16 he has required multiple psychiatric hospitalizations due to his impulse control difficulties and exaggerated mood swings.This case raises the question of whether Klinefelter's syndrome patients are predisposed to psychiatric pathology (including Schizophrenia, Bipolar Disorder, Anorexia Nervosa or social-emotional processing) at a genetic level.

Reviews of the neuropsychiatric problems associated with Klinefelter's Syndrome confirm an association between disorders in this area and the chromosomal abnormality. Further studies are needed to identify involvement of X-linked epigenetic influence and susceptibility to several psychiatric diseases.

Dopamine and norepinephrine are implicated in the characterization of personality traits. Dopamine-β-hydroxylase (DBH) is the enzyme responsible for conversion of dopamine to norepinephrine. Previous studies have shown that the -1021C/T polymorphism of the DBH gene promoter influences plasma DBH activity. Few studies investigated the association between this polymorphism and personality traits.

To examine the association between the -1021C/T DBH polymorphism and personality traits in healthy volunteers.

The participants were 627 Japanese unrelated volunteers. The subjects with present psychiatric disorders or past history of psychiatric disorders according to the DSM-IV were excluded. The DBH genotypes were identified by a PCR-RFLP method, and personality traits were assessed by the Temperament and Character Inventory (TCI). The study protocol was approved by the Ethics Committee of Yamagata University School of Medicine, and all subjects provided written informed consent to participate.

In the two-factor analysis of covariance with the DBH genotype and sex as factors and with age as a covariate, there was no main effect of the DBH genotype on any TCI score, while the interaction between the factors was significant in harm avoidance. In the post-hoc analysis, the group with the T allele predictive of lower DBH activity had higher scores of harm avoidance than that without the T allele in females (p=0.006), but not in males.

The present study suggests that the -1021C/T DBH polymorphism affects the personality trait of harm avoidance in healthy females.