Providing mental health services by real-time videoconferencing has been increasingly adopted as a method of reaching hard-to-serve populations since the early 1990s. There is a growing body of evidence investigating the efficacy of delivering online mental health care. Though studies vary in quality, they generally demonstrate that online mental health care is effective across multiple age groups. Online is generally well accepted by patients and specialists and its implementation is feasible. It is also convenient and cost effective.

Due to the fact that almost 75% of Romanian population have internet access and that mental health services are still stigmatized we perceived the opportunity to develop an online platform where patients can easily find and interact with mental health specialists using secured videoconference.

During a timeframe of two years a multidisciplinary team managed to develop and test an online platform where patients can access psychotherapy sessions. Main design and development targets were usability and confidentiality/security. The platform has an appointment tool, a secure videoconference solution and an integrated online payment service.

The platform can be accessed at https://atlashelp.ro. It was launched in mid July 2016 and it already gathers more than 50 mental health specialists. The feedback was excellent from both specialists and patients.

The solution developed is complaint with most of international standards and offers easy to access and high quality psychotherapeutic services for Romanian patients.

Some techniques of psychotherapy are now widely evidence-based and very cost effective, especially cognitive and behavioral therapies. Most of the studies are indirectly based on patient reported outcomes or problematic behaviors evaluated before and after the psychotherapy. Unfortunately, studies struggle to control for what is actually happening during psychotherapy, especially the non-specific aspects, like the interaction between the patient and the therapist, that is a known predictor of psychotherapeutic efficacy. Consequently, it is difficult to make precise links between theory and practice, control its application and understand which of its ingredients are the most important.

Here, we suggest a research framework to extract automatically social signals from psychotherapy videos. We focused on the extraction of synchrony of the motor signal since it was considered to be a predictor of psychotherapeutic outcome in an earlier study and a relevant signal for the study of mother-child interactions.

We developed open source python and R scripts to compute this synchrony of motion history on a database of interaction between a parent and a child http://bit.ly/syncpsy

We confirmed that synchrony, was a relevant signal for studying social interactions since the scores are completely different from synchrony scores computed on shuffle motion history data. However, these scores alone are unable to distinguish the two periods of the videos (with and without disagreement).

Synchrony of motion history is a promising marker of social interactions.

Today telemedicine is a very popular and rapidly growing area, which allows the treatment, regardless of the distance between the patient and doctor. We present the latest research, conducted amongst polish doctors about the usefulness of telemedicine as a therapeutic tool in different medical specialties.

The aim of the study was to examine doctors’ attitude to telemedicine and usefulness of Platform ‘Moneo’ in the therapy of the areas other than psychiatry.

The first part was the polish telemedical project (grant no. POIG.01.04.00–04–219/12) conducted to assess medical Platform ‘Moneo’. It was based on a questionnaire filled by participants in scale 1 to 5. The second study based on authors’ anonymous questionnaires was distributed amongst 105 psychiatrists from Poland.

Everybody noticed advantages of medical platform. The Platform's functionalities, rated as the best by healthcare directors were: educational materials, appointment and therapy planning. Managers indicated parts, which could be improved in e-prescribing system, the process of collecting information about hospitalizations and operations. Functionalities indicated by doctors as desirable to increase the utility of the platform is e-prescribing system, reporting side effects, planning visits, educational materials. In study addressed to psychiatrists, only 15% of them claimed to have an extensive knowledge on telepsychiatry, but they had confirmed the potential of telemedicine in psychiatry.

Telemedicine is a useful method, which can improve quality of healthcare services and make an access to it possible for some people. However, lots of improvements in telemedical services are needed to make it an efficient medical tool.

The current development of new technologies dedicated to healthcare, such as smartphones, provides an interesting opportunity to improve both assessment and follow-up of different illnesses, particularly mental diseases.

To investigate, the contributions and risks of smartphone use among mental health patients.

We conducted a literature research of PubMed and Sciencedirect using the key words “smartphone”; “bipolar disorder”; “schizophrenia”; “anxiety disorders”; “addiction”; “dementia”.

Literature data provide several examples of the use of the smartphone's features for patient monitoring. One such example involved patients with Alzheimer disease. An attempt to deal with the risk of wandering was proposed with the use of the Android app iWander, which works by using the smartphone's GPS to track the patient at all times. As for bipolar disorder, several applications have been proposed both for diagnostic ic instruments…) and interventional purposes (applications that offer subjects psycho-education in the form of emotional self-awareness…). Several other applications can be used in the management of schizophrenia, social anxiety disorder and addictions. Along with its obvious benefits, however, the smartphone use has a dark side. Problematic smartphone use is one form of behavioral addiction recently identified. In addition, the access to Internet through the smartphone opens the door to Internet addiction and its sub-types (cybersexual addiction, cyber-relationship addiction…).

The use of smartphone for medical purposes must be cautious among mental health patients, because of a field of vulnerability that promotes the appearance of other mental diseases, especially addictions, which may darken their prognosis.

The authors have not supplied their declaration of competing interest.

Psychotherapy is one of the most widely investigated and practiced forms of treatment used in the treatment of different mental health problems. However, there are some barriers in delivering this treatment, including long waiting lists, therapist shortage and lack of access to therapists in remote areas. Therefore, using alternative methods to overcome these barriers seems necessary.

The division of psychiatry at Queen's university provides different psychotherapy groups for individuals suffering from different kinds of mental health problem. We gave the participants the opportunity to choose online psychotherapy through an online clinic or the live group sessions. All the patients were assessed by different questionnaires for evaluation of the efficacy of the treatment. The online clinic was designed to facilitate the communication between patients and clinicians and the material was delivered in PowerPoint format through the online platform. All user activities were logged for security purposes.

Statistical analysis showed that this method of delivering psychotherapy significantly reduced patients’ symptoms and also decreased the number of people on the waiting list and increased the amount of compliance in patient's taking part in psychotherapy and number of people who were able to receive psychotherapy.

Despite the proven short and long-term efficacy of psychotherapy, there are some barriers in delivering this treatment. It is an unequivocal public health needs to overcome these barriers through alternative methods of therapy. With Internet use ever rising, developing an online clinic could be a new way in delivering different kinds of psychotherapy.

The use of new technologies is beginning to be embraced by volunteers and professionals, from crisis lines, suicide prevention centers, mental health centers, researchers and politicians.

New technologies have entered the field of suicide prevention with high expectations for the future, despite a relatively slow start. Internet, smartphones, apps, social networks and self-help computer programs have a strong potential to achieve, sustain and help people at risk of suicide, their families, teachers, health professionals and for the survivors.

To provide comprehensive overview on the role of new technologies in suicide prevention.

Given the relatively early and underdeveloped state of this area of inquiry, the author viewed his task as gathering and critically appraising the available research relevant to the topic, with the aim of formulating a hypothesis to be tested with further research.

New cheaper services will soon be available to effectively reach and assist the most vulnerable people and prevent suicides. The potential to help vulnerable people who do not use conventional mental health services and people in regions with inadequate psychiatric facilities represents an attractive target with favourable perspectives for suicide prevention Smartphone, apps, websites, avatar coach, and virtual suicidal subjects are important for both delivering help as well as to educate mental health professionals as in the case of role playing.

Shadows and lights are emerging through the use of new technologies. If more people can be reached there are however concern for improper use of social network and pro-suicide websites.

The author has not supplied his/her declaration of competing interest.

Subclinical symptoms of depression or mania, present prior to clinical manic or depressive episodes in individuals with bipolar disease. Mobile applications that measure habitual behavioral patterns such as mobility, physical activity level and social engagement present an opportunity to identify state transitions preceding relapse. This could lead to earlier intervention and improved treatment outcome.

To identify associations between changes in habitual behavioral patterns measured with smartphone usage and psychiatric emergency room visits or admissions for bipolar patients.

In a case-crossover study, around 70 patients at a specialized outpatient clinic for bipolar disorder will be offered to install MoodMapper®, an application that registers text message and calls (but not communication content or recipients), mobility (but not location), number of steps taken, screen-time, and battery level. A baseline level for each individual will be established. Deviations from baseline habitual behavioral patterns in the time preceding a psychiatric emergency room visits or admissions will be analyzed in order to establish predictor variables. The patients will be followed up to 18 months.

Preliminary results will be presented.

Smartphone-collected behavioral data can be used to predict worsening or improvement of a patient's condition. As smartphone ownership becomes more commonplace, mobile apps present a unique opportunity to detect digital real-time signatures of mental illness in a way that is minimally invasive to individual's daily life and privacy.

Discussing the threat of aggression is not always at the forefront in ambulatory care providers. A structured risk analysis model for ambulatory emergency psychiatry is currently not available, while aggression does occur regularly.

The aim of this study is to evaluate the added value of a risk analysis model and implement the best available model in emergency outpatient practice.

The study design is a mixed method model. Semi-structured questionnaires were administered by nurses and psychiatrists. A benchmark study took place at an outpatient emergency service in South Netherlands. A literature search was performed using PubMed and CINAHL for the period 2000–2014.

From this research, we found a discrepancy between the perception and the actual occurred aggression. Care workers often do not discuss aggression related issues, however, case studies show that aggression does occur frequently. In literature studies we have found several risk assessment models, most of which are used within the inpatient psychiatry.

To avert aggression incidents and prevent recurrence, it is important to maintain a solid risk analysis model. Introducing a checklist risk crisis service (CRC) can promote a critical reflection on the threat of aggression and bring awareness on the theme of aggression. Implementation of a CRC in daily practice can be of great value.

GHB abuse and dependence are common in the Western region of Northern Brabant, a rural region in the south of the Netherlands.

The main goal is to look at the incidence and management of GHB abuse and dependence seen by the CRT in a rural area.

This is a retrospective data analysis based on patient files of all assessments of the Western Northern Brabant crisis resolution team (CRT) from 2013 till 2015. Inclusion criterion was current or recent (<24 hours) use of GHB with or without alcohol and other drugs. Several parameters were studied: frequency, duration and dose of GHB use, reason for referral and treatment/policy, which is used (admission, prescribed medication).

On a total of 4093 cases 50 persons were included. It shows that the percentage over the years has remained about the same (resp. 1.13%, 1.54% and 1.02%). Of all cases 41.5% used GHB only, 39.6% also used other drugs, and 9.4% GHB with alcohol and other drugs. During the assessment in the emergency department 37.7% was treated with a benzodiazepine, while 43.4% received no psychotropic medication.

GHB abuse and dependence are not commonly seen in the CRT, but the withdrawal symptoms can be challenging and GHB withdrawal is often accompanied by aggressive outbursts. Therefore, it is very important to make a decision whether outpatient or inpatient treatment is necessary and if psychotropic medication is needed.

We report the case of a 45-year-old male diagnosed with mixed personality disorder brought the hospital for strange behavior. He is being treated with fluoxetine, lorazepam and topiramate; and visited his psychiatrist 72 hours ago.

He has an adequate level of consciousness and describes retrograde amnesia of the last 72 hours. We found blocks of thought and abnormal behaviors such as dressing and undressing or sorting his belongings repetitively. Urine was only positive for benzodiazepines. In arterial blood gas analysis it performed highlights compensated metabolic acidosis. After ruling out neurological diseases and administrating fluids i.v. the symptoms remitted, persisting only the amnesia, establishing the diagnosis of suicide attempt with topiramate.

The use out-of-guidelines of topiramate in personality and eating disorders is an increasingly common habit in daily clinical practice, as well as suicide attempts with this drug. In therapeutic doses, over 40% of patients taking topiramate, have asymptomatic metabolic acidosis, which in stressful situations may have clinical relevance. In case of acute poisoning, metabolic acidosis is more frequent and severe, manifesting itself by hyperventilation, hypertension and varying degrees of impaired consciousness and cognitive functions. There is also a paradoxical increase in the frequency of seizures. Treatment is supportive and there is no antidote, being lethal cases exceptional. Gastric lavage and administration of activated charcoal have limited use. The determination of plasma concentrations of topiramate is not available for most centers and is not useful in acute poisoning.

The legal criteria for involuntary admission in Norway are that the patient has a serious psychiatric disorder (i.e. psychosis) and is in need of admission to secure needed treatment or that there is a risk of danger. While there have been some studies focusing on coercion in hospitals, less is known about the processes leading up to involuntary admission and the reasoning of referring doctors. In Norway, it is primarily general practitioners (GPs) that refer patients.

To study which factors that GPs who had recently referred patients to involuntary admission thought might have made their latest referral unnecessary.

Seventy-four GPs were interviewed by phone. They had all recently referred patients involuntarily to a major Norwegian university psychiatric hospital. One central question concerned how their latest involuntary referral might have been avoided.

These are the main factors that the GPs thought could have been of importance in avoiding involuntary referral of their patients:

– that the patient took the prescribed medication (28%);

– that they personally had the opportunity to closely follow up the patient in the following days (22%);

– that other health care staff could follow up the patient closely in the patient's own home (i.e. home care nursing, etc.) (19%);

– that a family member of the patient could help the patient (8%).

The GPs suggested that an increased availability of resources and more assistance from other parts of the health service were some of the factors that could be of importance in reducing involuntary admissions.

Increasingly, psychiatric patients are presenting to the emergency department (ED) with agitation. ED staff rarely, if ever, use scale to assess agitation or use any self-assessment tools to determine a patient's level of agitation.

To evaluate the relationship between a patient's self-reported level of agitation and other validated agitation assessment tools.

This is a prospective study using a convenience sample of patients presenting to the ED with a psychiatric complaint. This study was conducted in an urban, inner-city trauma level 1 center with 55,000 ED visits a year. After obtaining consent, a research fellow administered observational tools, PANSS-EC and ACES and BAM and Likert scale self assessment tools on arrival to the ED. SPSS version 24 was used. The study was IRB approved.

A total of 139 patients were enrolled. The most common ED diagnoses were depression, schizophrenia, or bipolar. Majority of patients were African-American (59%), falling in the 25–44 year old age range (56%) 52% male. Self-reported agitation was rated as moderate to high in 72.4% of these patients on the Likert scale and 76.3% on the BAM. There was a significant correlation between the self-reported score versus the BAM (F = 11.2, P = 0.00). However, the self-reported scores were significantly different from the scores assessed by observational tools (P < 0.05).

ED providers should assess a patient's self-reported level of agitation because a patient could be feeling markedly agitated without expressing outward signs detected by observational tools.

The authors have not supplied their declaration of competing interest.

Fratricide comprises approximately 2% of all intra-familial homicides. Analyses of national data on fratricide show that adult males are considerably more likely to be offenders and victims or fratricide. A previous study suggested there were two main categories of fratricide: related to alcohol intoxication or associated with mental disorder.

Present and discuss the results of an original study comprising 28 cases of fratricide.

To provide up-to-date scientific knowledge on fratricide.

This is a retrospective study of 28 cases of fratricides, extracted from a sample of over 1000 consecutive cases of coroners’ files of victims of domestic homicide occurring between 1990–2015.

Two victims out of three were males, most of adult age. There were only 2 female offenders in the whole sample. A majority of victims were Caucasians while 21% were aboriginals. Most victims were stabbed to death. The murders usually occurred at the residence of the victim. In total, 39% of offenders suffered from a major mental illness; 21% were acutely intoxicated at the time. In victims, 29% were under the influence of alcohol and 18% of offenders were free from mental problems.

Our data indicates that fratricides are most often impulsive and lack preparation. The most common method was the opportunistic use of a knife, suggestive of impulsive killing, and this is consistent with the rest of the information including the high rate of alcohol use and intoxication at the time. The study confirmed two main categories of fratricide: impulsive killing in the context of alcohol and dispute and killing associated with psychosis.

The authors have not supplied their declaration of competing interest.

Italian forensic mental hospitals closed on March 31st, 2014 and offenders sentenced to need a psychiatric care are restrained in facilities. Since 2002, the residential psychiatric facility “Tiziano” (Aulla, Massa-Carrara) hosts forensic patients, on appointment with national health system and compulsorily admitted by the justice system.

This descriptional and prospective study provides a thorough report on the main epidemiological, clinical, and criminological features of 60 mentally ill offenders hosted in the “Tiziano” facility between 2002 and June 2016.

Most forensic patients were male (90%, n = 54; average age: 33 years). Sixty percent of subjects (n = 36) had a clinical diagnosis of psychosis (19.4% affective psychosis, 72.2% non-affective psychosis, 8.4% organic psychosis), and about one third of them (31.6%, n = 19) had a personality disorder (63.1%, n = 12, antisocial personality disorder, 42.1%, n = 8, borderline personality disorder, 21.0%, n = 4 other personality disorders). Mental insufficiency was diagnosed in 11.6% (n = 7) of subjects, while substance use disorder affected 35.0% (n = 21) and alcohol use disorder 26.6% (n = 16). Forty-nine patients (81.7%) had committed serious crimes against people; 15% (n = 9) were murderers or attempted murderers, and 46.7% (n = 28) had committed more crimes. The average length of stay is 22 months.

To date, there are no data about long-term follow-up and clinical outcome of mentally ill offenders restrained in Italian psychiatric facilities. Additional studies are needed to assess psychopathology and differentiate treatment according to diagnosis, and to identify risk factors of relapse for criminal behavior relapse.

In response to the Winterbourne scandal, and the large number of people with intellectual disabilities (IDs) and offending behavior being treated in psychiatric hospitals, this study identified the domains that should be used to measure treatment outcomes of this group.

A systematic search of relevant databases was undertaken to identify domains. Sixty studies met the eligibility criteria, and findings were synthesized using content analysis. The findings were refined within a consultation and consensus exercises with carers, service users, and experts.

The final framework encompassed three a priori super-ordinate domains (a) effectiveness, (b) patient safety, and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviors, reactive and restrictive interventions, quality of life and patient satisfaction.

To index recovery, services need to measure outcome using this framework.

Childhood maltreatment is the most important risk factor for the onset of psychiatric disorders. Revictimization is really frequent as well as substance or alcohol abuse, often linked to self-treatment. Accordingly, our pilot study aims to analyze possible implication of childhood maltreatment on resilience and burnout.

Patients admitted to outpatients psychiatric department in a six month period (1st January 2015–30th June 2015) complaining low to moderate anxiety or depression have been administered childhood trauma questionnaire (CTQ) and Maslach burnout inventory.

CTQ results in 71 (87%) Emotional Neglect (EN), 2 (2.4%) Sexual Abuse (SA) and 2 (2.4%) Physical Abuse (PA). Twenty-one showed high emotional exhaustion, 21 high depersonalization, 9 moderate personal accomplishment while 1 showed low personal accomplishment. None of the patients who suffered child sexual abuse shows depersonalization or personal accomplishment difficulties linked to burnout. Patients negative to CTQ show respectively moderate emotional exhaustion (M = 20 ± 20.15), moderate depersonalization (11 ± 9.42) and high personal accomplishment (17 ± 12.38). Patients who suffered emotional neglect show the poorest profile at Maslach, particularly regarding emotional exhaustion. ANOVA reaches statistical significance among the 3 groups of detected abuse (EN, SA, PA) in personal accomplishment (P = 0.013) confirmed at POST HOC between EN and SA (P = 0.0004).

The results obtained in this pilot study highlight two important considerations. First, it seems urgent to stress the huge prevalence of emotional neglect among those referred to psychiatric outpatient department due to moderate anxiety or depression complain. Moreover, emotional neglect appears to be the most compromised factor of burnout, especially if compared to sexual abuse.

Mental health problems among youth, are frequent especially in offenders and as such is very important to identify as early as possible.

To estimate and compare level of some mental health problems between three groups of male youths: juvenile offenders in correctional center, adolescents with conduct problems and university students.

It is cross-sectional quantitative study. The sample consisted of three male groups: 41offenders placed in one correctional center (Mean age = 18.02; SD = 2.20); 41 male students of secondary school with conduct problems (Mean age = 16.97; SD = 61) and 42 male university students randomly selected (Mean age = 19.7; SD = 1.77). They filled questionnaire MAYSI–2. Data processing was done with SPSS 21.0 and Microsoft Excel 2013.

Juvenile offenders in correctional center scored significantly higher than other two groups of youth in alcohol/substance abuse subscale (P = 001), Suicidal ideation subscale (P = 048) and traumatic stress subscale (P = 003) based on Kruskal-Wallis Test. Juvenile offenders in correctional center scored higher but non-significantly in angry/irritable and depression/anxious subscales. Students of secondary school with conduct problems scored higher but non-significantly in thought disturbance and somatic subscales.

Male juvenile offenders have significantly more mental health difficulties. Mental health needs of youths in Kosovo (especially juvenile offenders) seem to be numerous and is important to be addressed properly.

A growing number of studies investigating the relationship between violence and problems in child psychiatry. Consistent findings have been verified in studies related to aggressive behavior, antisocial and post-traumatic stress disorder with the violence against children. The financial costs associated with child abuse and neglect, including future lost earnings and expenses with mental health treatments were estimated at $ 94 billion US in 2010. The abuse and child neglect can cause permanent changes in the body's response to stress, with profound changes in the brain development.

Consisted of an exploratory study of character quantitative and qualitative, with document design. Records of children and adolescents who stayed in the shelter from 2011 to 2015 were surveyed. In order to collect data was used input and shutdown records used for shelter.

Unlike Brazil and the rest of the world's data, the leading cause of institutionalization in this work in the town of Mafra, was neglect rather than abuse. Perhaps for the under-reporting of abuse cases. This, coupled with the fact that there are no typically physical findings associated with sexual abuse, made the detection more difficult. This paper alerts the importance to increase our ability to identify all child abuse experiences, for protecting our children. Not only sexual abuse, but also physical abuse could benefit from strategies to enhance detection.

Violence has important relevance for the criminal justice and health care systems especially forensic psychiatry. Previous studies reported the relation between violence, mental illness and substance abuse. We purpose to investigate the association between addiction and violence among people with severe mental illness through a review of literature.

we conducted a Medline and Pubmed literature search of studies published between “2000 and 2015”, combining the terms “psychotic disorders”, “addiction” “substance use disorder”.

The studies published showed that much of the excessive violence observed in patients with severe psychiatric disorders is due to co-morbid substance use. Increasing violence associated with substance use disorders in these patients had same level than that observed among subjects without severe psychiatric disorders. Increasing violence in subjects with substance use disorder but without severe mental disorders was higher than in patients with only severe mental disorders. In fact, mental disorders could increase the risk of installing on substance use disorders, and therefore increase the risk of partner violence. Among the substances used, if alcohol is frequently identified as a consumer risk for the emergence of violence among subjects with severe psychiatric disorders, stimulants could be causing more violence than alcohol.

Severe mental illnesses are associated with violence. However, most of the excess risk appears to be mediated by substance abuse co-morbidity. This finding improves the need of prevention of substance use disorders and emphasizes the fact that patients with severe mental disorders are more often victims than perpetrators of violence.