In Sweden two laws govern the use of involuntary commitment in psychiatry. the relation between patient and staff is one of the most important tools of treatment, and an ethical approach in the use of involuntary commitment is of great importance.

This study want to provide an initial view of the use of involuntary commitment in psychiatry in Sweden, based on gender.

The aim is to open up a discussion regarding the use of involuntary commitment generally, and to pinpoint possible differences in the use of involuntary action between genders.

The national patient registry, held by the National Board of Health and Welfare, based on personal identity numbers was used. 2010 is the first year with a comprehensive registration of involuntary commitment.

Out of a total of about 52 000 patients in 2010, about 22% had been treated through involuntary commitment, in accordance with one of the two laws concerned. No gender difference could be seen. the presence of three coercive actions was studied: involuntary medication, restraint and seclution. Involuntary medication was given to 13%, restraint undertaken for 8%, and seclution for 5%. A larger number of women were involuntarily medicated. in total, women were exposed to at least one of the three coercive actions to a slightly higher extent than men. Women did also receive more coercive actions per patient.

This first result of the frequency of coercive actions and involuntary commitment in Sweden can be a starting point for a discussion concerning an ethical approach in psychiatry.

Different opinions have been expressed and discussed about the opportunity for physicians to exert a political role, with consequent social, political and cultural effects on Society. To play such a role would undoubtedly pose dramatic ethical questions. This would be particularly true for psychiatrists.

To investigate and describe the opinions of final-year medical students at the University of Modena and Reggio Emilia (Italy), about the relationships between medicine, psychiatry, ethics and politics.

A mix-method two-phased design was adopted for the present study: in the first phase, medical students were invited to attend an online ad-hoc semi-structured 10-questions survey, leaving “generous” open space for comments. in the second phase of the study (respondent validation), the same students were invited to participate to a focus group.

Qualitative analysis of thick description was performed using the software MAXQDA 10.

The response rate to the survey was 66.96%. Opinions of students were almost balanced on the suggestion that physicians play (or should play) a political role in Society, with a minimal majority (53.3%) agreeing. Differently, the majority of students (84%) agreed on attributing a political role to the psychiatrist, who should be committed in fighting against marginalization, social exclusion and stigma.

The relationship between medicine and politics is still well-ponderated, as far as students’ opinions are concerned; differently, the relationship between psychiatry and politics emerges as being a fundamental element of the profession and its repercussions on the social context.

In Belgium and the Netherlands, euthanasia is legally possible for patients with intolerable physical and/or mental suffering that cannot be relieved and is due to an incurable medical condition. If the condition in not terminal, extra precautions are demanded. Psychiatric conditions are not excluded and can legally qualify after explicit, deliberate, well considered and repeated request.

Using ethical analysis, we aim to determine the problems that arise and precautions that are needed if euthanasia is requested and considered in patients with intolerable suffering due to a psychiatric condition.

Four problems arise that are specific for or more acute in those situations.

1. (1) Distinguishing whether the death wish is a symptom or a deliberate well considered choice parallels the assessment of decision making capacity.

2. (2) Distinguishing the face value of the request from the implicit meanings and interpersonal dynamics underlying the request.

3. (3) If the psychiatric condition is not progressive and degenerative, evolution and prognosis is uncertain and future partial recovery and relief remains a possibilty.

4. (4) The process of carefully evaluating a euthanasia request inevitably takes time, in the meantime undermining hope and orientation toward life, both crucial to safeguard the chances for partial recovery.

A stepwise approach is presented that takes these four problems into account.

From an ethics of care perspective, extra precautions and evaluations are necessary beyond the judicial framework when dealing with a euthanasia request from a patient with intolerable suffering due to a psychiatric condition.

The increase of the number of compulsory admissions in several European countries contradicts the growing attention for patient rights, autonomy and the evolution towards community care and deinstitutionalisation. the increase is not substantiated scientifically either: there is little scientific evidence for the effectiveness of coercive measures in reducing risk nor for the accuracy of risk assessment (false positives).

Using ethical analysis, our objective is to examine the reasons for this increase and its negative consequences.

The increase reflects a societal shift with growing readiness to sacrifice the values ‘freedom’ and ‘autonomy’ for (perceived) safety and security. Both physical safety of patient and others and juducial safety of the psychiatrist (avoidancing litigation) collude.

On the other hand, the scientific attention for the deleterious consequences of compulsory admissions is growing. Perceived coercion is an important risk factor for PTSD symptoms after psychiatric admission. Coercive measures may also be counterproductive, undermining trust and cooperation and inducing regressive behaviour, care avoidance, resistance and a struggle for power and control. Furthermore, an increased association of mental health care with coercion in the public perception might induce fear, aversion and avoidance in those who need help, thus impairing early intervention and raising the threshold for voluntarily seeking help. It also reduces the openness of patients to freely talk about symptoms, feelings and thoughts thus undermining assessment and therapy.

Long term negative consequences of coercion might outweigh short term safety benefits, justifying greater reticence initiating compulsory admissions.

The Rorschach is a projective test frequently used in the forensic ambit for the information it can give in both the cognitive and affective area. the purpose of our work is to identify the personality traits recurring in killings through the examination of the psychometric major indices of the Rorschach.

20 male subjects, authors of murders, between 20 and 50 years were tested (average age, 29); the control group was represented by 20 male subjects aged between 20 and 50 years without history of crimes. all protocols were collected and signed through the method “Scuola Romana Rorschach” and processed by information systems RORCOMP.

From the cognitive point of view there were no significant differences concerning the sense of reality between the murderers and control samples (R +%, F +%: 70–80), but the number of responses was lower than average (80% of subjects R = 20) as well as the number of M (75% of subjects M < 2). the most significant differences in the murderers appeared in the affective area with an extratensive TVI and an affectivity type CF + C > FC; then 78% of the subjects showed an average value of the Impulsivity Index equivalent to 0.85.

Despite the availability of a limited number of cases, the Rorschach indices, in concordance with literature data, showed in the murderers the presence of affective lability and immature object relations, lack of interest in the object, impulsivity, egotism and mild empathy, that identify the cluster B personality traits.

There are two ways of treatment of psychiatric patients: voluntary and involuntary. Involuntary hospitalization is a legal procedure used to force an individual to receive inpatient treatment for a mental health disorder against his or her will. the legal justifications vary somewhat from state to state, but this treatment decision requires two elements: the presence of a severe mental disorder that deprives the individual of the capacity to make treatment decisions and the likelihood of harm to self or to others.

The purpose of this paper was to analyze the social-demographic differences in involuntarily hospitalized patients during one year period in Psychiatric Hospital in Sarajevo.

Next characteristics have been studied closely: sex, age, educational background, working status, marital status, ways of supporting, treatment turnout. Also, patients were analyzed according to diagnosis and previous hospitalization. It was found that, in the Psychiatric Hospital of Sarajevo, from 544 hospitalization in one year period, 32 (5.88%) of them were involuntary ones.

An average involuntarily hospitalized patient during one year period in Psychiatric Hospital in Sarajevo was a man, 35 years old, single, with high-school education, unemployed, on social-aid, already three times hospitalized with diagnosis F 20.0.

A female spouse homicide occurs in France every two days, in majority of cases after an episode of physical violence against the woman. Our objective was to determine socio-demographic, clinical and criminological characteristics of the male authors of a spouse homicide.

We have studied 210 records of psychiatric expertise of homicides perpetrated between 1995 and 2005 in West of France. We have analyzed the socio-demographic, clinical and criminological characteristics of the authors of a female intimate partner homicide (n = 30) and compared to the authors of a non female intimate partner homicide (n = 180).

The authors of a female intimate partner homicide were older (38.4 years old (yo) versus 32.7 yo, p = .019) and had significantly more frequently a personal history of violence (50% versus 28%, p = .045) than the authors of a non-female intimate partner homicide. Compared to the non-female spouse homicides, female spouse homicides were not associated with other criminal behaviours (6.7% versus 21.7%, p = .055). A mental disorder was found in the minority of cases (13.3% versus 18,.3%, p = .506). Paranoid delusional disorder was the most frequent severe mental disorder in the authors of female intimate partner homicide (10%).

Our results confirm the general and the specific risk factors of violence in female intimate-partner homicide. Legal and health care professionals should be aware that women are vulnerable to intimate partner violence and homicide from both nonmarital and former partners as well as from current husbands. the history of domestic violence should be researched by the clinicians.

The establishment of diminished responsibility is rather complicated in comparison to insanity, since it necessitates establishment of doubtless causal logical relation between the criminal situation and actiion.

To discover adaptive disturbances and socio-psychological peculiarities of persons with diminished responsibility.

Reviewing forensic psychiatric opinions in 162 cases of diminished responsibility established in Lithuania during 2006–2010 with a questionnaire created by the authors.

42% of the sample young males (18–29), 71% lower than education, 69% w/o profession and 76% unemployed, 83% no family, 82% no previous convictions, 56% acted under influence of alcohol, 45% trespassed against property, 31% -against human life and health. 79% confessed their perpetration. 120 had previous treatments in psychiatric hospitals (averagely 4 episodes) due to: mental retardation of various degrees (35%), organic disorders (16%), schizophrenia group disorders (12%). 42 cases were diagnosed just during forensic psychiatric examination as mentally retarded (46%), organic disorders (32%) and schizophrenia remission (15%). Passivity and dependence were characteristic of 70% of the sample (lack of initiative, rigidity, difficulty in searching solutions of situations). Asocial behaviour in childhood manifested in 84%, superficial judgments, low self-consciousness in 64%. 55% of them are benevolent, capable to establish and maintain emotional bonds.

Social factors and specific personality features influence criminality of persons with diminished responsibility. Emotional instability, suggestibility and lack of self-criticism restrain their resistance to temptation, capability to alternative actions in one or another situation.

In the UK forensic psychiatric care is provided in 3 different levels of security and patients are expected to progress through this system till rehabilitated. Some patients spend more time than average in secure settings. This group has hitherto been largely neglected within research priorities.

To identify number and characteristics of patients who are “long-stayers” in secure hospitals in the United Kingdom and compare it to other hospitals internationally.

To identify number of patients in secure forensic settings based on various hypothetical cut-offs (time spent in hospital).

To identify patient characteristics.

To compare patient characteristics with those internationally.

Data was collected from 3 high-secure hospitals in the UK along with one medium secure unit with regards to sex, age, date of admission, directorate category and LoS. Descriptive statistics were used to analyse data. Data obtained from 2 units internationally were compared with results from the UK.

Results suggest that mean age of 40 years. the average LoS in high secure hospitals was about 70 months. Around 15% of patients have spent more than 10 years in high secure settings. Average LoS in medium secure was 14 months whilst more than 20% stayed longer than 24 months.

A large proportion of patients spend more than 10 years in high secure hospitals and more than 2 years in medium secure in the United Kingdom. This informs future research in order to identify various patient and system characteristics that prevent them from moving on.

There is increasing demand for psychiatric expert testimony in criminal proceedings. A person is responsible for his actions unless he is subject to the penal code, Section 34 h, insanity. Mental illness is not sufficient to determine insanity; it must be proven that the patient did not understand what he had done, did not comprehend the inappropriateness of his actions: or could not have avoided performing the deed. Opponents argue that the expert testimony is not scientific and not professional and alternatively that the mentally ill avoid responsibility even when there is no connection between the illness and the offense.

The polygraph examination is an important instrument for confirming credibility of the testimony but it has not yet been investigated in the field of forensic psychiatry.

To examine the validity of a polygraph examination in psychotic patients. To compare polygraph tests with psychiatric examinations.

Patients were tested with a polygraph examination on there misjudged psychotic behavior.

24 patients signed a consent form, but not all eventually participated. all patients received antipsychotic medications. in general valid polygraph examination can be performed to patients with the psychotic illnesses (i.e. schizophrenia). Agitated or cognitive deprived patients tests were not reliable. the psychiatric examinations or the expert testimonies were in accord with the polygraph examination.

Preliminary data indicate that polygraph examinations are valid in patients with the psychotic illnesses. But not in agitated or cognitive deprived patients. Expert testimonies were found reliable in determining insanity.

The use of coercive measures within forensic psychiatry has generated much debate across public, professional and academic domains. the use of restraint, seclusion and rapid tranquillisation challenge the key principles of healthcare as well as individual human rights.

To conduct a systematic review of the literature between the years 1980–2010, examining empirical research studies into the use of coercive measures within forensic psychiatry

To examine current literature; frequencies and variations of coercive measures used within forensic psychiatry

A systematic literature search was conducted using the electronic databases ASSIA, BHI, CINAHL, EMBASE, MEDLINE, PAIS, PsycINFO and Sociological Abstracts.

Twenty-five empirical papers were elicited from the literature search. Younger patients or those newly admitted were restrained and/or secluded most often. Findings relating to gender and diagnoses were ambiguous. Interestingly, no significant differences were found between patient ethnicity and use of restraint and/or seclusion. Limited studies related to staff and patient experiences. Both staff and patients were documented as feeling anxious and angry surrounding coercive experiences. Staff perceptions, roles and responsibilities were suggested to influence decision-making and practice in the use of coercive measures.

Whilst the use of coercive measures remains a controversial method of practice, variations have been found in the use of coercive measures. Differences in ward atmosphere, staffing and patients have all been suggested as contributing factors. More research is required however, into how these varying factors might interact and contribute towards reducing coercive practice.

To evaluate and analyze relationship between insight and cognitive performance in this group of inpatients.

In the study we included 83 male inpatients, 63 of them meet the ICD-10 criteria of Schizophrenia spectrum disorder and 20 of them meet the ICD-criteria of Personality Disorder. We assessed insight and cognitive functioning of all subjects using SUMD for insight assessment and MMSE test respectively WAIS to asses cognitive functioning.

Showed no significant correlation between poor insight and cognitive dysfunction, except in subcategory of insight variable awareness of social consequences of violent behavior, which resulted with significant P < 0.01(r = (.338) in Schizophrenia disorders group of inpatients. That relationship was not find in Personality disorder group.

Poor insight was associated significantly with cognitive dysfunction symptoms in Schizophrenia spectrum disorders in subcategory of unawareness of social consequences, although no direct relationship between cognitive dysfunction and other impaired insight components in schizophrenia group was find.

Exploring perceptual in subjects with delusional formations.

Were examined 20 men with interpretative or sensual delirium. Research methods were clinical-psychopathological and experimental psychological.

The perception of all subjects:

1. Differed fragmented, the fixation on parts of images, the presence of addiction to a confusion of figure and ground, the interpretation of the integral image based only on evaluation of a small portion of the image.

2. Combined with the projection of subjective experiences in the form of suspicion, feelings of hostility from others, and feelings of anxiety, which accompanied by violation a holistic assessment of the possibility of stimulus material and contributed to a false recognition of images.

At sick’s with interpretative delirium violated predominantly rational, logical knowledge, a reflection of the internal (causal) relationship to reality. There were restriction of perception with the subjective interpretation of information, involving personal meaning experience and subsequent formation of delirium constructions, combined with increased levels reflection and control products own mental activity. at the heart of the construction of sensual delirium ideas lay violation of sensory perception, i.e., a direct reflection of events, objects and situations that are available perception. in the presence of sensual delirium ideas the evaluation took place around instantly, she had no semantic, logical connection with perception. Subjects revealed impulsive making with the creation of full-scale emotionally rich story with changing of scene, many details in the absence of a foothold in the real presented images.

Forensic psychiatric assessment of shizotipypal disorder still is very difficult because the most of symptoms belongs to personality disorders and subpsychotic level. Some of them belong to the “strange» (“odd”) personality disorders, and some - to sluggish forms of schizophrenia. Despite their endogenous nature, the criteria of forensic evaluation of schizophrenia are not correct for these cases.

For the aim to determine clinical criteria for forensic psychiatric evaluation of schizotypal disorder 67 patients were examined with clinical and psychopathological methods. They suffered from various forms of shizotypal disorder (pseudopsychopatic (32), pseudoneurotic (13) schizophrenia, schizotypal personality disorder (22).

We found that in 22 cases mental condition of patients could be interpreted as stable, in 17 — with signs of activity of the endogeneous process, in 30 cases there was stabilization phase. Stable condition was typical for patients with schizotypal personality disorder. the signs of growing activity of the process were dominated in the cases of psychopathic manifestations (autism, the difficulties of contact with people, rude selfishness, the paradox of emotions and behavior), and positive symptoms (neurotic depression and atypical chronic hypomania with a predominance of obsessive and phobic disorders). Phase of stabilization characterized of progressive reduction of positive symptoms and formation of residual states.

Thus, the definition of the phase of schizotypal disorder (dynamic aspect) may be one of the criteria for a forensic psychiatric evaluation of these conditions.