The Community Forensic Mental Health (CFMHT) was set up in late 2005 as part of a regional development to address the needs of mentally ill offenders in Northern Ireland and to provide a seamless service to clients coming through the Medium Secure Unit in Belfast.

The CFMHT developed vision and mission statements.

To improve the mental health and well-being of people with mental disorders, to ensure equal access to services in the least restrictive environment. To minimise offending behaviours, maintain the individual's safety and that of the community, thus enabling this group of people to reintegrate into society.

To provide a holistic approach to meet the needs of people with mental disorders who are at serious risk of engaging in offending behaviours, thereby reducing the risk in the community.

The Northern Trust CFMHT took part regionally in drawing up agreed protocols and functions between Mental Health and Criminal Justice, which has been sent to Heads of Service. This document describes how a CFMHT will function at four levels of intervention.

Level 1 – a one-off specialist consultation with the Community Mental Health Team.

Level 2 – in-depth risk assessment/ management plan with the referring team retaining responsibility.

Level 3 – agreed period of shared responsibility with referring team.

Level 4 – CFMHT taking full responsibility for duration of need.

There are plans to develop a base where therapies will be carried out, allowing for a safe environment for interviewing and assessing.

Accumulating evidence supports the hypothesis that antidepressant treatment prevents suicide. Most of this evidence consists of studies demonstrating decreases in suicide in parallel with increased use of antidepressants in different populations. Since ecological studies cannot establish causality, this individual-based study, analyzing temporal patterns in the toxicology of all suicides in Sweden 1992-2005, aimed at testing the hypothesis that the substantial decrease in suicide during the period was caused by the increased use of antidepressants.

During the eleven years, 16,937 suicides, and 33,426 controls (natural or accidental deaths) were investigated by toxicological screening. The annual numbers of detections of antidepressants, zolpidem, zopiclone, tramadole, and dextropropoxyphene were analysed in suicides and controls.

The annual number of suicides decreased by 332 cases (18.6 %). The expected number of antidepressant positive suicides, as determined only by their increased use in controls, was 741. If the decrease in suicide was caused by antidepressants, the expected number of suicides with antidepressants in toxicology should be reduced with 332 cases i.e. 409. If the decrease in suicide was not caused by antidepressants the expected number of positive cases should be reduced by 18.6 %, i.e. 603. The observed number was 420, indicating causality. The other drugs were detected as expected if they had not caused the decrease in suicide.

This controlled individual-based naturalistic study indicates that the increased use of antidepressants was the cause of the decrease in suicide previously demonstrated in ecological studies. Definite conclusions cannot be drawn, however.

Domestic violence against women is a serious problem in Russia. The main purpose of this investigation was to find out origins of crimes of violence in women.

A cohort of 25 females was examined by psychiatrists and forensic psychiatrists. All women had committed murders. Details of background, psychiatric and offending history were extracted.Each item was assessed with the help of descriptive statistics.

A research has been carried out on the basis of psychiatric and forensic psychiatric assesment of two groups of women who had a long history of violence by their husbands or partners. Clinical picture of their state was presented by depression, anxiety, low self-esteem, PTSD, drug abuse. The research has revealed two types of homocides. Women of the first subgroup displayed pathological altruistic motivation of murder of their children (4 females). Women of the second subgroup (21) had committed homocides of their husbands or partners whose violence towards women escalated in severity.

The research shows the necessity of domestic violence prevention by legal provisions and multidisciplinary research with participation of psychiatrists, psychologists, human rights advocates.

Verification of forensic functionality of two psychiatric classification systems (ICD 8 and ICD 10), determination of similarities and differences between them, and evaluation of difficulties in subsuming particular psychiatric diagnoses into legal categories.

The retrospective method was used, based on comparison of the information from forensic psychiatric expertises made in the Center for forensic psychiatry, Vrapce Psychiatric hospital in Zagreb, in two periods: during 1968 and 1995, chosen at random up to the total of 300 expertises related to criminal law. The shortened version of standardized FPDS (Forensic Psychiatric Documentation System) questionnaire was used, which was modified for the purpose of the study and, due to the necessary reduction of the data for statistical analysis, the questionnaire was additionally shortened to the final version which consists of 51 items.

The basic hypothesis that there is a difference in the level of forensic functionality of the two classification systems compared in this study was only partially confirmed. The other hypothesis, that psychiatric classification system ICD-10 is more functional in forensic psychiatry than classification system ICD-8, is not completely confirmed either. The questionnaire can be also used in other similar studies for evaluation of forensic-psychiatric expertises. The results can be of help in everyday practice in forensic psychiatry, in the field of expertise and in the field of forensic psychiatric treatment.

Convicted people with serious mental disorders are subject to release from punishment.

To bring out criteria determining release from punishment because of mental disorder.

81 convicted people were studied, who had been previously examined by psychiatrists in order to assess the possibility of release from punishment.

According Criminal Code of the Russian Federation, if after committing crime a person develops a mental disorder that disables him either from realizing actual character and social danger of his behaviour (inaction) or from controlling it, is released from punishment, and a person already serving a sentence is released from further serving it. Such people are referred to a compulsory psychiatry treatment.

80% of convicted people released from punishment because of mental disorder were diagnosed with schizophrenia, 8% - with dementia, 7% - with organic mental disorders, 5% had a different diagnosis.

availability of either psychotic mental disorder or dementia; statement of mental disorder intensity depriving a convicted person of the ability to “either realize actual character and social danger of his behaviour (inaction) or control it”, to understand the purpose of punishment, essence of remedial and educational measures applied to him; sufficient duration; availability of pronounced tendency to psychopathologic disorder amplification, its progressive dynamics; pessimistic prognosis in clinical, social, correctional and labour aspects with regard to the term for serving punishment; considerable dysadaptation (microsocial, secure, occupational) disabling from application of correctional measures to a convicted person and from his detention.

Stalking involves repeated and persistent attempts to impose on another person unwanted contact and/or communication. It can have a significant adverse impact on psychological, occupational and social functioning. Mental health professionals are at greater risk than the general population of being stalked.

We assessed the prevalence of stalking behaviour by patients towards psychiatrists working in a large mental health organisation in London, UK.

A questionnaire was sent to all 324 psychiatrists in the service. Stalking was defined as two or more episodes where a patient initiated inappropriate contact outside the normal clinical setting, which caused concern. The response rate was 61%.

Forty-one doctors (21%) were stalked by patients. Most victims were consultants (n=31; 76%). No sub-speciality was over-represented. Most patients had a diagnosis of personality disorder (n=16; 39%) or psychotic illness (n=10; 24%). The majority of stalkers (n=24; 59%) were male, while 49% of victims were female. Sixty-one percent of stalkers were reported to have a previous history of harassment.

Duration of stalking ranged from several weeks to 16 years, with 51% occurring outside the work environment. On average, victims experienced two types of inappropriate contact, most commonly by telephone (n=22; 54%), letter (n=19; 46%) or face-to-face (n=15; 37%). Ten patients loitered while 3 carried out surveillance. Physical threats were made against 14 psychiatrists. None were assaulted.

Stalking by patients towards psychiatrists is common and represents an occupational risk. Healthcare organisations should introduce formal training programmes covering recognition of stalking behaviour and risk-management strategies.

A long tradition of research has highlighted the continuity of mental health disorders between childhood and adulthood. Nevertheless, diagnostic systems have not kept pace with the lifespan concepts that underpin developmental psychopathology. While several important adult diagnoses have been identified in children (Anxiety, Depression) using Research Diagnostic Criteria, few disorders specific to childhood (e.g., ADHD) have equivalents in the adult diagnostic systems (e.g., DSM-IV-TR)

In this paper I describe the continuities and discontinuities of the DSM in terms of childhood disorders with and without adult equivalents. I also describe the current state of program development in our health region and the future steps in that reflect the translation into clinic practice of the body of knowledge related to developmental psychopathology.

A review of the DSM-IV-TR was completed

The demographic and clinical characteristics of the identified population (transitional youth aged 16 to 24) was explored by doing a cross reference of both the RAIS and MHIOS data bases.

There are DSM-IV-TR differences between child and adult diagnoses: these differences give rise to clear implications for treatment path.

Much work needs to be accomplished to ensure that children have appropriate treatment across the transition to adulthood. The follow areas are recommended for development: Develop curricula for the residency training program and for existing professionals. Develop practice guidelines a mechanism for continuous social marketing within the health care community.

To analyze the relationship between sociodemographic and clinical data in a sample of involuntarily admitted patients to an acute psychiatric hospital.

Retrospective sociodemographic and clinical data regarding patients involuntarily admitted in a psychiatric clinic were gathered and statisticaly analyzed.

Of all the patients 33% were unemployed, 30,8% finished high school, 62,8% were single (unmarried, divorced or widow). 33% had no previous history of psychiatric admission. 64,6% had an aggressive behavior against a family member or another person previous to the admission. The most frequent diagnosis of involuntarily admission was psychomotor agitation (61,5%) and was significantly associated with the presence of delusions. Differences found between men and women: men were significantly more aggressive than women and had more frequent substance or alcohol abuse than women, women were involuntarily admitted for a longer period of time than men and had a more frequent diagnosis of psychotic disorder than men. Lack of compliance with the treatment previous to the admission was not significantly associated with the aggressive behavior or the presence of delusions.

The majority of involuntarily admitted patients were unemployed, single, with aggressive behavior, delusions and a history of previous psychiatric admission. Differences regarding the gender were noted in terms of substance and alcohol abuse and the involuntarily admitted period.

The aim of our study was to investigate what are the real objectives of the validation scales.

The sample consisted of 80 subjects (40 non-psychotic patients and 40 graduate high school students) to whom the Amoral-15 scale measuring antisocial tendencies was administered in two different situations - with the standard instruction (E1) and with the instruction to fake the responses (E2). The difference between E1 and E2 was taken as a measure of the ability to fake well. We correlated differential score (E1-E2) with the validation scales (the mix of Marlow-Crown and Eysenck's L scale from the EPQ). NEO-PI-R was administered under standard instruction to measure basic personality dimensions.

Results indicated no significant correlation between the ability to fake good and the scores on validation scales. In some items we found negative correlation which means that subjects who better present themselves in social desirable way have lower scores on the validation scales. By Hierarchical regression analyses we found that about 40% of variance on validity scales could be explained by Emotional Stability, Agreeableness and Conscientiousness and not by ability to fake food.

Socially desirable answers are serious problem in personality assessment and cannot be solved by giving the validation scales because these scales are measuring the basic personality dimensions and not the ability to fake good.

This study directly assessed, for the first time, whether, as expected under the membrane phospholipid hypothesis of schizophrenia, there was a change in brain cell motion-restricted membrane phospholipids in vivo in male forensic patients with schizophrenia who had seriously and violently offended (homicide, attempted murder, or wounding with intent to cause grievous bodily harm) while psychotic, by quantification of the broadband resonance signal from 31-phosphorus neurospectroscopy scans.

Cerebral 31-phosphorus magnetic resonance spectroscopy was carried out in 15 male patients with schizophrenia who had seriously and violently offended (homicide, attempted murder, or wounding with intent to cause grievous bodily harm) while psychotic and in 12 age- and sex-matched normal control subjects. Data were obtained using a 1.5 T Marconi Eclipse system with a birdcage quadrature head coil dual-tuned to proton (64 MHz) and 31P (26 MHz). T1-weighted magnetic resonance images were acquired for spectral localization. Spectra were obtained using an image-selected in vivo spectroscopy sequence (TR = 10 s; 64 signal averages) localized on a 70 x 70 x 70 mm3 voxel.

There was no significant difference in the broad resonances between the two groups, with the mean (standard error) percentage broadband signal for the patients being 57.8 (5.6) and that for the control subjects 57.7 (6.0). The phosphomonoesters and phosphodiesters narrow signals also did not differ between the groups.

Our data suggest that the membrane phospholipid hypothesis of schizophrenia may not apply to the subgroup of schizophrenia patients who have seriously and violently offended.

To ascertain the level of compliance of present documentation of PRN medication with national and local standards of good practice.

To inform changes to current practice where room for improvement is identified.

Data collection form was designed based upon the standards found in the local prescribing policy

Audit was carried out on all inpatients on Chafron and Marlborough House

3 month time period August to October 2006

The medication records of 19 patients were viewed

All PRN medication was included in the audit.

Results against standards:

Not more than 1 medicine from any BNF therapeutic category should be prescribed as a PRN at any one time: 2 patients did not meet this standard

100% Compliance to standards

The following 7 standards achieved 100% compliance:

Legible prescription

Written in black ink

Dose recorded

Method recorded

Signature recorded

Start date recorded

Time given recorded, where applicable.

Reccomendations

Increased prescribing practice training for medical staff (doctors). This is covered by pharmacist staff at induction.

Re-audit in 6 months.

The media coverage of a few homicides committed by psychotic obviously raises questions about the dangerous and violent nature of the mentally ill. Firmly rooted in the collective consciousness is the popular idea that someone who kills an unknown person in the street is mentally ill. On the contrary the epidemiological data are reassuring; only 15% of such murders are committed by the seriously mentally ill (schizophrenia, paranoia, melancholia).

Typing and comparison of murders committed by schizophrenic, paranoiac and melancholic persons.

We consulted and analysed 268 expertises from two psychiatrists. This retrospective study shows several types of pathological murder (schizophrenia, paranoiac delirious disorder, affective disorder: melancholia and hypomania).

From these 268 cases of homicide examined, 27 murderers were psychotic.

Ten of these were young, single, jobless, male paranoid schizophrenics: they drank little alcohol. Most of them have criminal history. They knew their victim (family, friends).

Nine others were paranoiac, for the most part male, older, married, family men, without psychiatric or criminal record. They murdered their wife or husband or neighbour. Alcoholic consumption is often involved. Schizophrenic and paranoiac murderers often have an emotional temper.

On the contrary, melancholic murderers are mostly female, aged around 30, married, family women, drinking little alcohol. Two third of them have psychiatric depressive record and had bipolar troubles and attempted suicide. Their murders are more often premeditated. They know the victim: child or partner. Suicide often follows the murder.