Although agitation is a nonspecific term applied to an array of syndromes and behaviors, is a common syndrome in patients with schizophrenia (SCH) and bipolar disorder (BD). In Europe the estimation of prevalence of ‘agitation” has been difficult due to the lack of standard studies or systematic data collection about this syndrome, except for few transversal studies.

To assess the prevalence of agitation in patients with SCH or BP in different European Countries and to describe its characteristics. We present the preliminary results obtained in centers from Spain and Portugal.

Epidemiological, observational, cross-sectional, multicenter and international study.

During 1 week were registered the number of episodes of acute agitation attended at the participating centers in the psychiatric ER or Acute Inpatient Unit that met the inclusion criteria. Demographic characteristics, the underline disease, assessment and the management of the episode were also described.

Were report 95 cases of agitation that could be included in the data base, with an overall prevalence of 3.2 %, specifically 6.5% in Emergency Room and of 2.0 % in the Acute Psychiatric Inpatient Unit. The management of the episodes included from non-invasive to more coercive measures as mechanical, physical constraint or isolation, unavoidable in half of the patients (51.6%).

Despite the limitations of this study, the results are matching with the few data reported in the literature and reaffirm that agitation, even though not yet well recognized and defined, can be considered an important challenge in this type of patients.

Examine the validity of the mini-ICF APP in terms of change in relation of clinical characteristics, symptomatology and outcome.

Establish the validity and performance of the mini-ICF APP compared with the Brief Symptom Scale (BSI), Clinical Global Impression (CGI) Scales, Global Assessment of Functioning (GAF) and the Health of the Nation Outcome Scales (HoNOS)

The sample consisted of N = 228 subsequent admissions from one Swiss psychiatric hospital who were assessed the mini-ICF APP, BSI, CGI, GAF and HoNOS at admission and discharge. Repeated measures analyses of variance were conducted to compare changes in Mini-ICF APP scores over time.

Mini-ICF APP scores significantly decreased from admission to discharge. The mini-ICF APP correlated moderately with change measured by BSI; a strong correlation was found with CGI, GAF and HoNOS scores. No main effect of time was found in multivariate models.

The mini-ICF APP seems to be an appropriate measurement instrument applicable in psychiatric settings.

Understanding the causes of poor mental health in early childhood and adolescence is important and one potential and relatively unexplored factor is residential mobility in formative years. Previous studies in this area have been relatively small, and potentially limited due to methodological issues.

To investigate relationship between early residential instability and poor mental health among adolescents and young adults in Northern Ireland.

A census-based record linkage study of 28% of the NI population was used. Our sample was children aged 0-8 years at 2001 (n=49,762) with self-reported chronic mental ill-health in the 2011 census as outcome and address changes assessed six-monthly. Logistic regression was used with adjustment for socio-economic status (SES) and household composition and marital dissolution. The relationship between address-change and non-mental health outcomes was also tested.

Overall, 54% had moved house at least once, and 0.5% of the cohort aged 10-18 at 2011 reported chronic mental ill-health. There was a graded relationship between address-change and mental ill-health (ORadj 3.67, 95%CIs 2.11, 6.39 for 5 or more moves). This relationship was not modified by SES or household composition. Marital dissolution was associated with poor mental health but did not modify the relationship between address-change and mental health.

This large study clearly confirms the close relationship between address change in early years and later poor mental health. Life events, including mobility, should be distinguished based on the overall impact which a transition can have over the individual's life.

In clinical samples of specialized early detection services, ultra-high risk and basic symptom criteria are associated with a 2-year conversion rate of roughly 30%. Objectives/Aim: Their prevalence and course outside help-seeking samples is largely unknown and is therefore studied in the BEAR study. Methods/Results: At baseline, 25% of the young adults from the community (16-40 years) acknowledged the presence of any lifetime risk symptom, but only 3% met any risk criterion. After 2.5 years, those with any lifetime risk symptoms (RISK) and a control group (CONTROL) are re-interviewed. At the time of writing, 87 follow-ups were conducted: in 48 RISK (30% male, baseline age: 36±4 years) and in 39 CONTROL (46% male, baseline age: 36±2 years). Two RISK (4%), but no CONTROL reported the meanwhile development of first-episode psychosis. RISK were significantly more likely than CONTROL to report presence of any risk symptom within the follow-up period (41% vs. 5%). Thus, the relative risk to still report risk symptoms when these had already been reported before was 8.05 (95% CI: 2.0; 32.4). Altogether 18% met criteria for a non-psychotic current or within-follow-up axis-I disorder whose presence was unrelated to presence of at-risk phenomena at first or second interview (13% in both RISK and CONTROL). Conclusions: This indicates that risk symptoms might frequently be not just fleeting experiences but tend to persist. Thereby, they do not seem to increase the likelihood of developing any mental disorder but – should the result hold – might predispose to the development of psychotic symptoms.

Mental illness results from biological, psychological, social and contextual factors and is influenced by global events such as economic crises.

To describe the profiles of psychiatric admissions in four Portuguese hospitals located in the metropolitan areas of Lisboa and Porto, and to assess their evolution in 2002, 2007 and 2012, and the changes associated with the economic crisis effects.

The information was retrieved from the medical charts of all patients (n= 3,647) admitted at three periods: 2002 (no crisis), 2007 (pre-crisis) and 2012 (crisis). Demographic, social and clinical variables were obtained. The statistical binomial test was used to verify the existence of significantly differences between 2007 and 2012.

The number of admissions increased from 2007 to 2012, with greater variation (22%) in the Disorders related to substance use (ICD-9: 291, 292, 303, 304 e 305). Statistically significant positive changes were found in the admissions of: i) patients aged 50 to 64 years (17%, p=0.022), divorced (25%, p=0.032), and unemployed (58%, p<0.001); ii) patients 50 to 64 that referred having attempted suicide (26%, p=0.067) and suicidal ideation (34%, p=0.022) during that year; iii) women 50 to 64 referring attempted suicide (39% p=0.044) and suicidal ideation (39% p=0.044).

Our findings suggest the influence of the economic crisis in the number and profile of people admitted for mental disorders (greater effect in unemployed patients), and its association with an increase of admissions in people with suicide attempts and suicidal ideation, and particularly in women aged 50 to 64.

The Compulsory Health Treatment (TSO) is an action applicable in case of justified need and clinic emergency, in presence of the refusal to Health Treatment Volunteer (TSV) in a subject suffering from specific illnesses, among which there are severe psychiatric illnesses.

The TSO is the subject of discussion, because it's actually an action that violates – even if only temporarily – the free will of the person. It's a procedure justified by the impossibility of applying alternative practices that ensure a speedy recovery to the subject of his psychic integrity, consistent with the need of the person.

The aim of this study is to evaluate the epidemiology of TSO in Trieste between 2011 and 2013.

This retrospective study was conducted on 74 TSO performed at the CMHC and the Emergency Unit of Trieste, on 71 people (22 women, 49 men). Data analysis were on gender, diagnosis, TSO's days' number, frequency and significant changes during the TSO, with a comparison of these variables between the data of 2011, 2012 and 2013.

The number of people under TSO was the same in the three years, with a countertrend of gender (decrease of 30% of women; increase of 46% of men). There was a decrease about days of TSO in the three years.

It's necessary to implement practices that promote good cooperation from the subject, to establish a contractuality which allows to limit TSO only for time strictly necessary.

Determine the prevalence of sexual assault in an inpatient forensic population.

Find individual-biological-social factors that may be associated with sex offending.

A cross-sectional study of patients admitted to a Canadian forensic unit.

Sample of 23 patients (95.7% male), of whom 13% had committed a sex offense. All men, 17% had attempted a murder, 17% had committed a murder, 48% had commited an assault and 5% had commited a different type of crime. 61% of the sample were in the low socioeconomic class and 39% to the medium one. 35% were diagnosed with developmental delay and 30% with personality disorders.

A person that had committed a sexual offense crime was much older, compared to the rest of the forensic population (43.33 ± 17.67 vs. 30.80 ± 11.93 years). Moreover the average stay in the hospital was almost the double for the sexual offenders compared with rest of the sample (199.67 months vs. 89.35 months).

Among the sexual offenders the prevalences of the diagnoses of AXIS I were, 67% psychoses, 33% mood disorders and 67% substance abuse. However all the sexual offenders were diagnosed with a comorbidity different than those compared with those that were not sexual offenders (100% vs 20%, p=0.003)

Older population who commits a sexual offense have a longer average stay at forensic unit.

Increased presence of comorbidities, associated at main diagnosis in axis I and organic comorbidities, as well as different treatments used.

To find out clinical and social factors contributing to specific female crime – infanticide.

clinical, psychological, statistical.

A cohort of 12 females who had killed their children was examined. All women were victims of violence by their husbands or partners. Domestic abuse resulted in long-term mental problems of women. Clinical assessment has revealed depression, anxiety, fear, post traumatic stress disorder, alcohol abuse.

Women of the sample who had committed infanticide displayed pathological altruistic motivation of the crime. Alongside with clinical factors the research had revealed also social factors of infanticide. Women were often exposed to psychogenic situations with high level of stress (financial and housing problems, violence of the partner). In accordance with the Criminal Code of Russia the special article (106) governs infanticide. This law takes into account the psychogenic situation which caused the crime (battered women syndrome) and the fact that at the time of the child murder the mental state of mother was affected by childbirth.

In cases of infanticide the court is free to make verdict more lenient and its reflects more humane approach to such complicated phenomenon as child murder.

The study is supported by the grant 13-06-00127 of the Russian Humanitarian Scientific Fund

There is a need for specific treatment approaches for the subgroup of schizophrenia violent offenders. Deficits in affect recognition were shown to be more severe in this group compared to non-violent schizophrenia patients.

A standardized training of affect recognition (TAR) has been proven effective in non-forensic schizophrenia patients with regard to social-cognitive function. It has not yet been evaluated in the subgroup of forensic schizophrenia patients with violent offences.

To examine feasibility and behavioral treatment effects of TAR in forensic schizophrenia patients. To study electrophysiological correlates of treatment.

19 male schizophrenia patients, forensically detained because of violent offences, received weekly sessions of TAR over 2 months. Performance of affect recognition was tested using a standardized emotional picture set before, immediately and two months after treatment. During testing qEEGs were registered for event related potentials (ERPs) and LORETA analysis.

Study participants had a low drop-out rate and a marked improvement in affect recognition immediately and two months after treatment (Cohen's d = 1,88). Loreta analysis revealed reduced activities at P100 and N170 in left tempero-pariatal-occipital brain regions. At P250 activation increases were observable in the right dorsolateral-prefrontal cortex.

In schizophrenia violent offenders brain activity correlates of improved affect recognition after treatment may indicate an improved efficiency in structural decoding of faces and a more reflective mode of affect evaluation. This could lead to a higher degree of deliberation and behavioral control when responding to emotional facial stimuli.

There are no studies on psychological correlates on Probation Officers/PO in Portugal.

analyze levels of depressive/anxiety symptoms, stress, coping and resilience in a PO sample; explore differences in these variables by gender, marital status, Regional Delegation and types of competences and associations between these variables and sociodemographic/professional variables.

89 PO (females, 75.3 %; M = 47.4/SD = 7.10/range = 27-61) completed a sociodemographic-professional questionnaire, the Depression, Anxiety and Stress Scale/DASS-21, the Brief COPE and the Scale to assess Resilience.

Women presented higher levels of Use of Instrumental and Emotional Support. Professionals from the Centre Delegation had higher scores on Resilience vs. the North Delegation; from the North Delegation had higher levels of Stress vs. the South and Islands Delegation; with mixed competence had higher levels of Anxiety vs. with specific competence. In the total sample, Depression was associated with Denial and Substances Use. In males, Use of Emotional Support and Instrumental Support correlated with Depression and Anxiety. In all Delegations, Resilience higher levels correlated with more positive coping strategies and Depression, Anxiety and Stresshigher levels with lower levels of positive coping strategies and higher levels of negative coping strategies. Anxiety higher levels, either in mixed and specific competence teams correlated with higher levels of negative coping strategies.

Differences found accentuate aspects to address in an intervention with these professionals. Resilience higher levels were associated, as in other professionals, with more positive coping strategies and higher levels of symptoms with more negative coping strategies.

Worldwide, over 10.2 million people are incarcerated. In Europe and the United States, prisoners experience higher rates of psychiatric illness than the general population. Clinical research may help improve the range and quality of psychiatric services in prison. Yet given the history of research abuses against prisoners, and ongoing concern that prisoners may be coerced or exploited by researchers, U.S. and European regulations greatly restrict prisoner research. Scant data exists on whether prisoners view modern clinical research as coercive or exploitative.

To improve our understanding of how prisoners view their participation in psychiatric-related clinical research, we sought to identify whether prisoners perceive their research participation as coercive or exploitative.

70 participants from six psychiatric-related clinical research studies in the U.S. were recruited and asked to rate their agreement with several statements regarding study participation.

No prisoner felt threatened by someone to enroll, and only 1 felt pressured by someone to enroll. One felt taken advantage of by the study, and 2 felt exploited by the study. All but 1 agreed that prisoners should have more access to research in general.

On balance, prisoners from this group do not perceive their study participation as coerced or exploitative and desire greater research opportunities. Given the urgent need for research studies that can address the complex psychiatric problems prisoners face, a better understanding of prisoner views toward research elsewhere in the U.S. and Europe is needed. Such work could support the easing of restrictions on prisoner research.

Risk assessment of future disruptive and violent acts is of great importance to public protection and care in the medical setting. The VA Puget Sound created a Disruptive Behavior Evaluation Clinic, which utilizes clinical forensic risk evaluations in its assessments of veterans with disruptive Patient Record Flags or at elevated risk for violent behavior.

This poster will review the results of a utilization study of the Disruptive Behavior Evaluation Clinic after its first two years in operation.

To better understand the utilization of the clnic for future targeted interventions and allocation of resources to reduce risk of violent or disruptive behavior at the facility.

Medical charts of all evaluees assessed in the Disruptive Behavior Evaluation Clinic were reviewed to assess the evaluee characteristics, mental health and substance abuse histories, recommendations from the forensic evaluator, whether recommendations were followed, and disposition of persons evaluated in the facility's Disruptive Behavior Evaluation Clinic.

Results indicate that the most common diagnoses for persons evaluated in the clinic to date were alcohol or substance use disorders, personality disorder, and primary psychotic disorders. Demographics, referral source, and disposition outcomes were tabulated. As a result of the forensic risk assessment reports generated by the clnic several evaluees subsequently qualified for housing services.

The information on utilization is helpful to better assess the characteristics of veterans most prone to violence at one VA facility. It helps the facility allocate risk reduction resources to targeted clinics or programs.

The authors propose to understand female profile involved in forensic psychiatry, once the existing knowledge is scarce and just a few papers consider gender differences.

The authors proceeded to an intensive retrospective file reviewing 340 women (accused or victim) and complemented with an exhaustive search on Pubmed.

In 340 cases, 244 were accused and 96 were victims, with ages between 7 to 85 years old (16 to 91 in the accused group). The majority was single and unemployed. The most frequent causes of criminal charge are bodily harm (22%), theft (16%) and injuries (9%). On victims' group, sex crime (66%), bodily harm (16%) and maltreatment (10%) prevail. It varies according with the age, profession and psychiatric diagnosis. There are 8 cases of homicide and 1 connection with criminal network. There was a relationship with the victim in 80% of the cases. Psychiatric past was found in 60% of accused women and at least 37% had alcohol abuse history. The predominat diagnosis in this evaluation were mental retardation (28%) and personality disorders (24%). On the victims' group, the majority had mental retardation. 53% of accused were considered unimputable.

Comparing women with general or male forensic populations, it's observed several differences, mainly on the type of the crime perpetrated, relationship with the victim and in the diagnosis. It seems to exist a superior emotional component involving the crime on women. These gender differences suggest adjusted actions for women in order to try reducing this behavior.

The forensic history is a vital part of the assessment in patients referred to forensic services. It influences decisions made about risk and the link between illness and offending behaviour. Doctors should view the police national computer, (PNC) record in all assessments of referrals.

To establish whether PNC records are available to doctors conducting forensic psychiatric assessments of new referrals at a medium secure unit (MSU).

Establish what proportion of patients referred to a MSU in London had a PNC record present at the time the assessment report was presented to the admissions panel.

The admissions panel of a MSU in London has kept data on all assessments carried out since 2011. All of this data was reviewed to see what proportion of patients had a PNC record present at the time the assessment report was presented to the admissions panel.

In total there were 186 patients. 21 of these were women. 165 of these were men. 59% of the assessments had a PNC record present. In 19% of assessments a PNC was not requested. In 18% it was requested but not available. In 4% it was deemed not necessary.

A PNC record was not available in 41% of forensic assessments carried out by a large forensic service in London. In 19% of these cases a PNC had not been requested. Suggested recommendations are that the PNC is requested at the time that the referral is received by the trust.

Parricide is defined as the killing of one's father, mother or any other lawful ascendant. Parricide is a rare event and statistics indicate that accounts for less than 4% of all resolved homicides.

To describe the most common psychiatric pathologies associated with parricide.

The authors performed a non systematic review of literature.

Parricide is a crime committed essentially by males, and the most frequent form is patricid committed by sons. Parricidal offenders diagnosed with psychiatric diseases usually suffer from severe and prolonged mental illness, with clinical symptoms evidenced for years before they commit the crime. As risk factors for parricide, literature refers suffering from paranoid schizophrenia or an alcohol or drug abuse, associated with family and personal history of violence and mental illness, possible cessation of psychotropic medication, and lack of acceptance of the mental illness. Also the presence of a sexual component of the crime was reported. Relating to the symptoms that motive parricide, studies showed that the majority were persecutory paranoid delusions, involving delusional beliefs about the parent and other family members and occurred mostly in individuals with schizophrenia.

The literature about parricide is sparse and the majority of studies performed in parricide have a small sample, which difficult generalization. A great proportion, but not all adult parricidal offenders suffer from a major psychiatric disorder. However, the majority of individuals with severe mental disorders do not kill a parent, so risk factors for parricide among mentally ill adults need to be identified in order to prevent them.

Experience has shown that by the acquisition of a healthy and successful identity, the likelihood of violent and immature behavior in different situations will be reduced and appropriate solutions will be used to face problems. In this study, the identity style of each criminal will be examined in relation to her commitment.

The study is a cross–sectional type. 200 female prisoners of financial crimes, licentiousness, murder and participation in murder, robbery and drug addiction and drug transfer (each n=40) were selected by sampling quotas–randomized and Berzunsky identity style questionnaire.

The identity style of murderers and participants in the murder was normative. Identity style of immoral criminals was Informational, while the identity style of the other groups was confused. Commitment of both normative and informational identity styles was significantly correlated.

In general it can be suggested that the level of commitment, decision-making and problem-solving styles of the prisoners are correlated with their identity styles. Therefore, it can be suggested that the obtained results of this study can be used in the educational and reform programs of the prisons as well as during the interrogation prosess.

Identity style, female Prisoners, Crime, Commitment

Addiction, depression, anxiety and antisocial personality disorder may share common biological mechanisms and changes in impulsivity may contribute to the characterization of different clinical phenotypes.

Our aim was to identify diagnostic profiles in a sample of inmates in a Portuguese prison.

We examined a sample recruited at Paços de Ferreira Penitentiary Centre (n=89). Diagnosis was performed using the International Neuropsychiatric Interview (MINI). Six Version of Addiction Severity Index – European version (EuropASI) and the Psychopathy Checklist –Revised (PCL-R) were used to assess the severity of drug addiction and the presence of psychopathy.

Drug misuse was found in 61.8% of the studied subjects according to MINI. A high prevalence of psychiatric comorbidity was detected, with antisocial personality disorder (70.9%), depression (30.9%), and anxiety (32.7%) being the most common disorders. The total PCL-R score was 24. 1 (SD 8.8), 36 prisoners presented a diagnosis of psychopathy (PCL-R>30). The presence of depression in addicted individuals is associated with a lower severity of dependence (p <0.05) and lower PCL-R scores (p <0.05). The presence of addiction and depression reduces the risk of violent crime, whereas the presence of psychopathy (PCL-R> 30) increases (OR = 3.87, p <0.05).

Psychiatric disorders and addiction were successfully evaluated. Depression is associated with a lower addiction severity. The different types of psychiatric diagnoses produce a modulation in the frequency of violent crimes. The prevalence of psychiatric comorbidity underscores the advantages of a structured psychiatric assessment in prison inmates in order to provide the best treatment.

To evaluate patterns of physical restraint across a mental health trust.

Physical restraint has historically been used to manage mental health crises; however there has been a recent trend for reducing this, not least because physical restraint is associated with the risk of physical harm to patients, but also psychological harm and is potentially damaging to therapeutic relationships.

A commonly cited reason is violent or aggressive behaviour; however other contributory factors may play a role.

We set out to evaluate the characteristics of restrained patients to see if patterns emerged that would explain this.

Retrospective review of monthly trust-wide restraint data from 1 January – 30 June 2014.

Anonomysed data was collected and analyzed using Excel.

All restraints documented through the official reporting system in this period was included.

Patient characteristics and reasons for restraint were evaluated.

The majority of restraints across the trust occurred in Acute Services with 24% on a single ward for Older Adults. 20.7% was recorded on the women's medium secure ward.

Within Secure Services there was a significant gender difference in the use of restraint; 94.5% in female wards and 4.5% in male wards. Significant differences in the reasons for restraint were noted. Female patients were mostly restrained for anti-social behaviour or self-harm and male patients for physical assaults.

Better understanding of reasons and patterns relating to use of restraints is likely to assist in developing improved management plans to reduce the overall use of physical restraint in women's services.

Schizophrenia represents a risk factor for violent behavior, even escalating to murder.

The current study aims to provide information regarding the prevalence and types of criminal acts committed by schizophrenic patients and identifying the precipitating factors.

The purpose of this study is to obtain an overall view on the peculiarity of criminal behavior in schizophrenic patients in order to create efficient means of prediction and prevention.

The current study collected all the data from Medline PubMed, from articles published between 2004-2014, by searching key words like violent behavior, schizophrenia, schizophrenia and criminality.

Schizophrenia spectrum disorders are usually associated with a substantially increased rate of violent crimes, in comparison to the general population. The risk factors include the same as in the general population, with a social and family background, and also specific risk factors found in schizophrenic patients like delusional and hallucinatory elements which drive patients to perform criminal actions.

The criminal behavior manifested in schizophrenic patients shows certain features, especially at a motivational level, emphasizing the need for the early detection of delusional and hallucinatory symptoms that drive patients to do act of crimes, in a close relationship to the social cultural and also family context that creates their background.