Major depression cognitive impairments lasts in remission periods, have an impact on treatment outcome and hamper psychosocial functioning. Thus, its accurate detection and specific treatment has become a crucial step.

In order to assess objective cognitive functioning (OCF), a neuropsychological battery was administered. For subjective cognitive functioning (SCF), cognitive perception was evaluated by clinicians and patients.

To determine the concordance between OCF and SCF.

One hundred and two patients were grouped according to Hamilton Depressive Rating Scale (HDRS−17): 18 remitters (RE < 7), 40 partly remitters (PR, 7–18) and 44 acutely depressed (AD > 18). OCF was computed combining T-scores of digit symbol substitution test (WAIS-IV) with two RAVLT subtests (learning and memory). SCF was assessed with a CGI adaptation for cognitive disturbances severity.

The OFC was 41.21(8.49) for all patients and 45.54(6.8), 41.93(6.8) and 38.7 (9.7) for RE, PR, and AD, respectively. Psychiatrist and patients’ SCF had a poor agreement (α=0.518), with Cronbach's alpha for RE, PR and AD of −0.607, 0.518 and 0.404. Concordance between OCF and SCF was calculated for all patients (psychiatrist, r = −0.317, P = 0.002; patient, r = −0.310, P = 0.002), for RE (r = −0.535, P = 0.022; r = 0.395, P = 0.105) for PR (r = −0.013, P = 0.94; r = −0.328, P = 0.045) and for AD (r = −0.252, P = 0.122; r = −0.333, P = 0.033). Patients rated their SFC as more impaired than did clinicians.

Concordance between clinicians and patients regarding SCF is very poor, worsening in AD group and being null in remission. This study also points out that CF is best detected by patients in acute episodes and by psychiatrists when patients are in clinical remission.

The authors have not supplied their declaration of competing interest.

Life functioning difficulties are a relevant but undervalued consequence of major depression. Mood symptoms and cognitive deficits have a significant, and somehow independent, impact on them. Therefore, cognitive difficulties should be considered a potential target to improve patients’ functioning.

To examine the degree in which objective and subjective cognition explain functional outcome.

To assess objective cognitive function (CF) with a neuropsychological battery and to measure subjective CF using measures of cognitive perception.

Ninety-nine patients with depression were assessed by age, sex and level of schooling. Depressive symptoms severity was measured by Hamilton Depression Rating Scale (HDRS-17). Objective CF consisted in the following cognitive domains: memory, attention, executive functioning and processing speed. Subjective CF was assessed with Perceived Deficit Questionnaire-Depression (PDQ-D). Functioning Assessment Short Test (FAST) was used to evaluate life functioning, excluding the cognitive domain. All the listed measures were included in a multiple regression analysis with FAST scores as dependent variable.

The regression model was significant (F1,98 = 67.484, P < 0.001) with an R of 0.825. The variables showing statistical power included (from higher to lower β-coefficient) HDRS-17 (β = 0.545, t = 8.453, P < 0.001), PDQ-D (β = 0.383, t = 6.047, P < 0.001) and DSST (β = −0.123, t = −1.998, P = 0.049).

The severity of depressive symptoms is the variable that best explains life functioning. Surprisingly, the second factor hindering it is the patients’ perception of their cognition. Current findings highlight the importance of correcting cognitive bias in order to improve functionality. However, results have to be taken cautiously as mood symptoms could partly explain the bias.

The authors have not supplied their declaration of competing interest.

The occurrence of religious symptoms in obsessive compulsive disorder OCD patients ranges from 0% up to 93%. Although, frequent and influential nature of these symptoms, the explanations of its complexity and phenomenology are deficient in the literature.

Determine the most frequent OC religious symptoms among OCD patients. Assess relation between the frequent symptoms of religious OCD and depression.

Cross-sectional study was conducted among 115 consented patients diagnosed as OCD according to DSM-IV. Patients were recruited in one year from Psychiatric clinics, Zagazig University, Egypt. Psychiatric interview and psychometric assessment using Beck Depression Inventory (BDI) and OC religious symptom scale [1] were done.

The majority of patients (57.4%) had various religious OC symptoms. About 44% had doubts in religion in general (e.g. existence of God) and 11.3% had Blasphemous ideas. More than one third reported doubts about performing prayers and ablution perfectly; 34.8% repeatedly claimed they forgot to declare intention to pray, 36.5% had doubts about violating their ablution and 29.6% were skeptical about doing all ablution duties. Moreover, 23.5% reported slow or repeated readings in prayers, 25.2% had suspicions of breaking their fasting. A strong correlation between religious OC symptoms and total score of OC symptoms scale was confirmed. Most of our patients showed positive correlation between degree of depression and total score OC symptoms scale.

Muslim patient present with specific phenomenology of religious OC symptoms. These symptoms are very frequent and negatively influencing their mood.

The authors have not supplied their declaration of competing interest.

Neuropsin (NP, kallikrein 8, KLK8)–a kallikrein gene-related (KLK) endoprotease–plays a key role in neuroplasticity processes. Neuropsin expression takes places both extracellularly and inside neurons within the area of the hippocampus. Various forms of electrophysiological stimulation (kindling, LTP, stress) increase neuropsin expression within the hippocampus and in many other regions of the brain (e.g. neocortex, amygdala). Neuropsin is mainly engaged in the early stage of LTP and in the process of synaptogenesis. Social cognition deficits (difficulties with identification, naming and analysing experienced emotional states) in the group of people suffering from depression have been described in scientific papers published in recent years. They are considered the core features of major depressive disorders.

The aim of this study is to link the human neuropsin gene (hNP) expression with the ability of the examined subjects to use nonverbal communication in social interactions.

120 individuals meeting the diagnostic criteria for a recurrent depressive disorders (rDE) were qualified to participate in the study. The Emotional Intelligence Scale–Faces task and two subtests from The Right Hemisphere Language Battery (RHLB) were used in the study.

Significant interrelations between expression on the mRNA level for the hNP gene and the variables used to assess social competences were confirmed. Results of the statistical analysis make it possible to confirm an inversely proportional correlation between the analysed variables.

Increased hNP expression is associated with a reduction of interpersonal abilities in the people affected by depression.

The authors have not supplied their declaration of competing interest.

Residual symptoms of depressive disorder are major predictors of relapse of depression and lower quality of life. This study aims to investigate the prevalence of residual symptoms, relapse rates and quality of life among Thai patients with depressive disorders.

Hamilton Rating Scale for Depression (HAM-D) and EQ-5D were used to measure the symptoms of depression and quality of life, respectively. Prevalence of residual symptoms of depression was collected. Regression analysis was administered to predict relapse and patients’ quality of life at the 6 months post-baseline.

Two hundred and twenty-four depressive disorder patients were recruited. Most of patients (93.3%) had at least one residual symptom, and the most common residual symptom was anxiety symptoms (76.3%; 95% CI, 0.71 to 0.82). After 3 months post-baseline, 114 patients (50.9%) were in remission and within 6 months, 44 of them (38.6%) relapsed. Regression analysis showed that residual insomnia symptoms were significantly associated with these relapse cases (OR = 5.290, 95% CI, 1.42 to 19.76). Regarding quality of life, residual core mood and insomnia significantly predicted the EQ5D scores at 6 months post-baseline (B = −2.670, 95% CI, −181 to −.027, and B = −3.109, 95% CI, −172 to −.038, respectively).

Residual symptoms are common in patients receiving treatment for depressive disorder and were found to be associated with relapses and quality of life. Clinicians need to be aware of these residual symptoms when carrying out follow-up treatment in patients with depressive disorders, so that prompt action can be taken to mitigate the risk of relapse.

The authors have not supplied their declaration of competing interest.

Discovery of biomarkers for evaluation of efficacy of psychopharmacotherapy is important task.

To study parameters characteristic for albumin binding sited in melancholic depression (MD) using fluorescent laser spectroscopy in range of 30–50 picoseconds.

22 patients with MD (dep) (F33.1 and 2) were investigated in dynamics of antidepressant therapy (venlafaxine: 75–150 mg/daily) for 30 days. Control group (con) consists of 54 volunteers. Decay of fluorescence amplitude (A) of fluorescent probe K-35 from serum albumin was measured using laser. Earlier, we revealed 3 binding sites in albumin with amplitudes A1, A2 and A3 with decay time of 1, 3 and 9 nanoseconds, respectively.

There was revealed significant decrease of amplitude A1dep, normalized on mean value of A1 for controls (A1dep/A1con), for patients with MD after treatment with venlafaxine. In this case, A1depvalues decreased and were equal to A1 values of controls (P < 0.01): A1dep/A1con before treatment–1.23 and after 30 days of therapy–0.97 relative units; for controls this value was–1.00 relative units. The same type of normalization was observed for amplitudes A2 and A3 of melancholic patients. There were revealed significant changes of A3/A1 ratio that points out on conformational changes of serum albumin molecule in dynamics of venlafaxine therapy.

We have registered unidirectional changes in albumin molecule in patients with MD. Investigated parameters can serve as potential biomarkers for evaluation of efficacy of psychopharmacotherapy.

The authors have not supplied their declaration of competing interest.

Relevance of current investigation is conditioned by the high prevalence of depression in population and tendency of increased rate of relapses.

To study efficacy of selective serotonin-noradrenalin reuptake inhibitor–milnacipran in treatment of depressive disorders.

There were investigated 22 patients. Patient's state was defined as depressive episode (F32.1) and recurrent depressive disorder (F33.1). Mean age–33 years, duration of disease–from 2 weeks to 18 years, duration of current depressive episode–5.3 months. Mean point according to HAM-D scale before treatment was 24.0. Patients were investigated in dynamics of antidepressant therapy (milnacipran–50–150 mg/daily) for 4–5 weeks.

Efficacy of treatment with milnacipran was 82% (18 responders, 4 nonresponders). In responder's group decrease of depressive symptoms was started after 1 week of treatment and practical reduction of all these symptoms was observed after 4–5 weeks of therapy (points of HAM-D scale–0.81). Patients of this group receive milnacipran as supportive therapy at least for 3 months after signing out of clinic. During 1 year after signing out of clinic, there were no signs of aggravation of patient's state. 2 patients independently discontinue to take the medicine; there were aggravation of state and they were hospitalized in psychiatric clinic.

Milnacipran is effective in treatment of depressive disorders, ensured effective reduction of depressive symptoms. Its therapeutic effect is realized rather quickly. Milnacipran can be recommended as antidepressant of choice for prophylaxis of depressive disorders.

The authors have not supplied their declaration of competing interest.

The Dutch guideline ECT does not favor any anesthetic drug during electroconvulsive therapy. Although there are differences in seizure duration which may influence the effect of ECT, ethomidate, methohexital and propofol are “equal”. The influence of switching anesthetics during ECT is unknown. The reason for switching anesthetics is insufficient improvement in depressive symptomatology which is based on clinical picture. The Hamilton is a multiple item questionnaire which can give an indication of depression and which can evaluate recovery.

Does the choice of anesthetics or switching anesthetics influence the effect of ECT on the Hamilton depression rating scale?

To determine whether the choice of anesthetic drugs in the case of switching influences the effect on the Hamilton depression rating scale.

We collected data of patients who received ECT for therapy resistant depression over the past five years. Choice of anesthetics, eventually switch and the score on the HDRS before and after ECT were included. The data was statistical analyzed.

50 patients received ECT during past 5 years. ECT gives an improvement on the HDRS in all cases, whether there was a switch or not. Switching from methohexital to ethomidate when shock duration is less than 21 seconds gives a significant difference in improvement on the HDRS (BI 1.288 to 13.538) compared to patients who did not switch.

There are no significant differences on HDRS effect between the different anesthetics. Switching from methohexital to ethomidate gives a significant improvement on HDRS compared with no switch.

The authors have not supplied their declaration of competing interest.

Psychomotor retardation (PMR) in depression is analogous to the hypokinesia in Parkinson's disease, which is associated with the unbalanced direct and indirect pathways of cortico-basal ganglia-thalamo-cortical (CBTC) circuitry. This study hypothesized PMR in major depressive disorder (MDD) should be associated with the hyperactivity of CBTC indirect pathways.

To substantiate the hypothesis that the PMR symptom of MDD might attribute to the hyperactivity of the ortico-basal ganglia-thalamo-cortical indirect pathway which could inhibit psychomotor performance.

We investigated the intrinsic stiato-subthalamic nucleus (STN)-thalamic functional connectivity (FC), three pivotal hubs of the indirect pathway, in 30 MDD patients with PMR (PMR group) and well matched 30 patients without PMR (NPMR group) at baseline, and 11 patients of each group at follow-up who remitted after antidepressant treatment.

The results showed increased STN-striatum FC of PMR group at baseline and no more discrepancy at follow-up, and significant correlation between PMR severity and thalamo-STN FC.

Our findings suggested the increased STN- striatum FC should be considered as a state biomarker to distinguish MDD patients with PMR from patients without PMR at acute period, and thalamo-STN FC could be identified as the predictor of the PMR severity for MDD patients.

The authors have not supplied their declaration of competing interest.

Some patients with acute phase schizophrenia are too agitated to receive treatment in a normal hospital room. They must be isolated for the treatment. Although the stay in an isolation room seems harmful to patients, no study detailing the stress response to isolation with objective measures has been conducted.

Nine patients with schizophrenia or schizoaffective disorder were recruited (mean age = 52 years, male = 3, schizophrenic = 7). At the time of evaluation, they were staying in an isolation room. To evaluate stress response to the environment, the level of salivary amylase was tested when the patients were either in the isolation room (T1) or out of the isolation room (T2). T2 was defined as one hour after the room's door was opened. The data were analyzed by the Wilcoxon rank-sum test.

There is a significant difference between the median (range) levels of salivary amylase at T1 and T2 (19 [2–146] vs 44 [9–178], respectively, P = 0.021).

The data demonstrate that the stress response at T2 was stronger than that at T1, which suggests that the isolation room environment is less stressful to the patient compared to being outside the room. An environment that has many potential stimuli, such as the presence of other patients and a television in the lobby, may be harmful to patients with acute phase schizophrenia. Therefore, although the isolation room is apparently harmful, it could, in fact, have a positive effect on patients.

The authors have not supplied their declaration of competing interest.

Involuntary hospitalization in those presumed to be mentally ill has been a common practice. Although some patients are hospitalized for aggression, two-thirds of the patients are hospitalized because of the threat they pose to themselves. Although these patients require risk assessment and evaluation for possible presence of mental illness, the question is how much these patients will benefit from involuntary admission and what the long-term outcome would be.

All patients admitted involuntary to the psychiatric ward in Kingston, Canada, and psychiatrists involved in their care were interviewed to see whether they think the involuntary admission was helpful. All patients were asked to fill-out MacArthur AES to assess their satisfaction with hospitalization.

Although psychiatrists frequently reported that the admission was justified, only 29 out of 81 patients reported being explained to why they had been admitted involuntarily. Also, there was a significant difference in AES scores between those who were and were not given an explanation for admission. In addition, psychiatrists more often reported that the involuntary admission worsened the therapeutic relationship which was significantly associated with involuntary admission that was not explained to patients.

The results of our study shows that patients admitted involuntarily often feel disappointed with staff and mental health system. It could lead to feeling of hopelessness, frustration and low self-esteem. If explained, some patients who present with risk to self might accept voluntary admissions, that will improve therapeutic alliance with psychiatrists and increase satisfaction from hospitalization. Result of this study could improve the decision making process for involuntary admissions.

The authors have not supplied their declaration of competing interest.

Genetic counselling in psychiatric patients is almost always a challenge on multiple levels of communication, because the mental health specialist is situated between the need to validate the freedom of procreation, and the duty to inform patients about the risk of transmitting their disease to off-springs. Bipolar disorder (BPD) is reputed to be one of the most heritable psychiatric disorder, a factor that complicate even more the ethical situation.

To assess how psychiatrists and psychologists conducted genetic counseling for patients with BPD and the challenges that mental health professionals consider important when they need to make this type of counseling.

Standardized interviewing of 15 psychiatrists and psychologists who experienced during their clinical practice aspects of genetic counseling in patients with BPD.

The most commonly reported problems related to the genetic counseling in bipolar patients were: lack of reliable data on family history (53.3%), amplification of patient stigmatization (46.6%), controversies in the literature on the assessment of the disease risk (40%), difficulties in maintaining a nondirective attitude (33.3%), lack of genetic counseling follow-up (33.3%), disproportionate interest from the partner without mental disorder, when compared to patients, in terms of aspects of genetic counseling (26.6%), alteration of the therapeutic relationship and patients interest in treatment (26.6%).

Genetic counseling is a challenge for mental health professionals, who must cope with the lack of reliable data on the pathogenesis of BPD, negative reactions from the patients’ partners, patient disinterest or hostility and possible negative effects on the therapeutic relationship.

The presenting author was speaker for Astra Zeneca, Bristol Myers Squibb, CSC Pharmaceuticals, Eli Lilly, Janssen Cilag, Lundbeck, Organon, Pfizer, Servier, Sanofi Aventis and participated in clinical research funded by Janssen Cilag, Astra Zeneca, Eli Lilly, Sanofi Aventis, Schering Plough, Organon, Bioline Rx, Forenap, Wyeth, Otsuka Pharmaceuticals, Dainippon Sumitomo, Servier.

The main objective is less to show whether there is a psychiatric, infectious, neurological or any other form of pathological disorder linked to the behaviour of female saints, rather to evaluate all the psychological and social aspects that result in holiness as a mental state being largely a female attribute.

For this, we have tested from birth to death, in what is possible, the lives of sixty religious women, through biographies and autobiographies since they were servants, pious or holy according to ecclesiastical terminology. This set was unavoidable to select twelve cases, which are set out exhaustively in this study.

Limiting ourselves to a purely psychiatric view, we can show the presence of psychopathology associated with exceptional states of consciousness, as would be ecstatic and mystical experience itself, present in most cases. We also found common psychological profiles, out of the sixty biographies and autobiographies of religious women analyzed: e.g. pain is used as a means of atonement and a way of removing the guilt of sin. We rule out major psychiatric disorders in the Santas we have analyzed. The behaviors they presented, even sometimes excessive, cannot be included in any of the current major psychiatric disorders.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The probability that psychiatric care becomes compassionate is higher when individual subjects, groups or organizations utilize mirror neurons to attune with the emotional world of their clients.

To create an algorithm for compassionate care in mental health by attunement of mirror neurons.

To predict the probability of the occurrence of sympathetic care in mental health.

Naturalistic observation of health care organizations identified the major nodes-agents of the organizational-neural network leading to a compassionate care (events A): individual, group, organization and society. Negative influences on compassionate care are (events B) subjective and collective acts.

The probability that compassionate care occurs as a result of a single mediator's action was only 0.167 (16%). The probability that compassion results from training mirror neurons were as follows:.Multiple event probability formula:

– probability of event A that occurs P(A) = 0.667 (66%) [positive subject + group + organization + society)];

– probability of event B that occurs P(B) = 0.333 [negative individual and group];

– probability that both the events occur P(A∩B) = P(A) × P(B) = 0.222 [inhibitory influence];

– probability that either of event occurs P(A∪B) = P(A) + P(B) − P(A∩B) = 0.778.

The probability of organizational compassion (PA) is high when all the agents interact. As compassion is reinforced by mirror neurons, a reduction in the number of people involved in compassionate care also means the final outcome is less likely to appear.

The authors have not supplied their declaration of competing interest.

To describe six axioms for the definition of “exact psychiatry” as “medicine of the soma”. Six axioms will be defined and explained. They are ordered attending to hierarchical and historical priority:

–axiom of the cultural universal of social cohesion: since the antiquity all cultures have cultural universals which promote social cohesion;

–axiom of healing as a form of “isonomia”: health-related cultural constructs are related with help receiving due to body vulnerability. It appears with Hippocratic medicine;

–axiom of nosological realism: diseases really exist. They are biological regularities that accelerate death. It appears in the 17th century;

–axiom of illness subjectivity: the personal impact of disease is subjective. There exist diseases in patients. It appears in the 20th century;

–axiom of the unification of neuroscience: psychiatry and neurology have the same ontological reference, brain diseases. It consolidates in the 21st century;

–axiom of clinical phenomenology as the epistemological specificity of psychiatry: clinical phenomenology characterizes “soma” as the referring of psychiatry. The future.

The author has not supplied his declaration of competing interest.

The work evaluates the nonsmoking program successful experience, carried out between the years of 2008 and 2015 in a psychiatric clinic in the city of Rio de Janeiro, Rio de Janeiro, Brazil.

The program has as objectives to evaluate the treatment of tobacco dependence in patients with disorders for the use of substances and other psychiatric disorders and the experience of transforming the therapeutic space of the clinic in a tobacco-free environment, considering that the use of tobacco is responsible for a large number of avoidable deaths and other aggravations to health.

The program achieved the objectives, assessing the promotion of the tobacco abstinence in a large number of patients, through the utilization of pharmacological treatment, cognitive behavioral psychotherapy, occupational therapy, art therapy and moderate physical activity.

In a 12-month period, after carrying out the program, 48% of the assessed patients kept in tobacco abstinence.

The study showed the percentage of patients who were discharged on tobacco abstinence and the percentage of those who kept abstemious after 12 months, demonstrating that the nonsmoking program is an efficient tool in the tobacco dependence treatment and can be used over a psychiatric hospitalization with promising results.

The authors have not supplied their declaration of competing interest.

Akathisia is probably the most common and one of the most distressing of the movement disorders associated with antipsychotic drugs. Little is known about its prevalence and its risk factors in real-world psychotic and bipolar patients to date.

The main objective of this study was to determine the prevalence of akathisia and to determine the risk factors and the treatments associated with it in a sample of Tunisian patients with schizophrenia, schizoaffective or bipolar disorder.

Seventy-four patients with schizophrenia, schizoaffective or bipolar disorder were included and assessed with a validated scale: the Barnes Akathisia scale (BAS). Ongoing psychotropic treatments were recorded.

The global prevalence of akathisia (as defined by a score ≥ 2 on the global akathisia subscale of the BAS) was 20.5%. Akathisia was significantly more common in patients with schizophrenia or schizoaffective disorder than in patients with Bipolar disorder (27.5% vs 9.4%; P = 0.049). However, the prevalence of akathisia did not differ according to sex, age, the illness duration, the presence of a comorbid anxiety disorder, the number of antipsychotics used, the type of the used antipsychotic (first vs second-generation), the antipsychotic chlorpromazine-equivalent total dosage, the use of benzodiazepines or anticholinergics, or the reported drug compliance.

Akathisia seems to be more common in some psychiatric disorders than in others such as schizophrenia or schizoaffective disorder. Longitudinal studies would be required to draw any firm conclusions concerning the factors involved in the emergence of akathisia.

The authors have not supplied their declaration of competing interest.

The aim of this study was to investigate the moderating role of emotional regulation and mindfulness in the relationship between parenting stress and styles with coping strategies.

The method in this study is correlation. Statistical population consists of all adolescents in 2016, from among which 400 individuals were selected in a multi-stage cluster sampling method from different areas of Tehran and completed Adolescent Coping Scales, Parenting Stress Index, Baumrind parenting styles Inventory, emotional regulation checklist of kids and adolescents and of kids’ and adolescents’ mindfulness measurement. The data were analyzed using multivariate regression and Pearson correlation in SPSS-22.

The results showed the mindfulness and emotional regulation play a moderating role in the relationship between parenting stress and coping strategies (P > 0.0001) as well as the relationship between parenting styles and coping strategies (P > 0.0001).

Despite the poor parenting stress and parenting styles, if the adolescents have emotion regulation and mindfulness skills can reduce the negative effects of inappropriate parenting.

The authors have not supplied their declaration of competing interest.

Video-recorded disclosures of two siblings emerged describing ritual violence activities in a Hampstead “cult” including human sacrifice murder. The UK court processes judged that the mother “coached” the children to make false allegations. In parallel, Marie Black, Jason Adams and Michael Roger were found guilty of child sexual abuse purely based on historical accounts of five children.

The presentation outlines two cases that illustrate the “unbelievable” nature of organized child abuse and what aspects make court rulings “unsafe”.

The presentation aims to compare the Hampstead where the videos were watched by 4 million individuals world-wide with the little that is known about the “Norwich Three” case due to court reporting restrictions.

Materials posted on websites, books and videos were reviewed alongside discussions with whistle-blowers, relatives and friends of people involved.

The disclosures in the Hampstead case were very extreme but similar accounts can be found in books by Sara Scott (UK) and De Camp (US). Those accused of sexual abuse claim that the children have been coached by their mother to make these allegations–the view that the judge adopted. In the Norfolk case, 7 of the 10 defendants were cleared of child sexual abuse allegations but three individuals were found guilty. It remains unclear what the basis was for the conviction as the disclosures could have been classed as the result of “coaching”.

Anyone operating in forensic settings should familiarise themselves with the “hall of mirrors” that cases involving child sexual abuse routinely constitute.

The author has not supplied his declaration of competing interest.