The authors have not supplied their declaration of competing interest.

Outcome assessment has been highlighted as a crucial factor in the evaluation and transformation of mental health services, providing evidences for the improvement of clinical practice.

This is the first clinical study in Greece to investigate the relationship between the crucial outcome measures of needs, quality of life, disability and psychopathology for patients suffering from schizophrenia. Furthermore, service evaluation based on the assessment of the above outcome measures has never taken place in the country.

To examine the associations between the patients’ needs and other treatment outcome indicators:

– quality of life;

– disability;

– dimensions of schizophrenia symptomatology.

The CAN-R, WHOQOL-BREF, WHODAS 2.0 and PANSS scales were administered to a sample of fifty-three schizophrenia patients and the correlations between the above outcome measures were computed.

(1) Significant negative correlations emerged between the total number of needs and unmet needs and subjectively assessed quality of life. (2) Significant positive correlations emerged between the total number of needs and unmet needs and subjectively assessed disability. (3) Significant positive correlations were found between the dimensions of schizophrenia symptomatology (positive/negative/general) and the total number of needs in our sample.

According to our findings:

– as the number of unmet needs increases patients’ quality of life is lowered;

– a possible relationship exists between unmet needs and subjectively assessed disability;

– a possible relationship exists between needs and all the dimensions of schizophrenia symptomatology.

The authors have not supplied their declaration of competing interest.

Stigma is a multistage process that makes person marked by the stigma to be perceived as diminished or even as “not fully human”. The internalized stigmatization is seen as one of the levels of stigma to be present in persons with mental illness. A new perspective to mediation models between internalized stigma and illness-related factors is needed.

To assess the relationship between insight in mental illness and internalized stigma, as well to verify the knowledge of illness-related factors on the phenomenon of internalized stigma among patients with severe mental illnesses.

A cross-sectional study design conducted among participants of both sexes between 18 years old and 65 years old with diagnosis of psychotic disorders (F20–29) and mood disorders (F30–39), who after reading the information about the study, give their written consent to participate. Among used methods were: a questionnaire of Internalized Stigma of Mental Illness (ISMI) by Ritsher [Boyed] et al. translated into Polish version and self-prepared interviews. Insight into mental illness was assessed using the Positive and Negative Syndrome Scale.

The preliminary results showed patients with the insight into the mental illness have significantly higher scores on the ISMI scale. Moreover, inpatient participants and those with the diagnosis of depression were characterized by higher level of stereotype endorsement compared with outpatients and psychotic patients.

The obtained results may contribute in the clinical and therapeutic fields, assuming that insight and the type of treatment are strongly linked with the process of recovery and the internalized stigma.

The authors have not supplied their declaration of competing interest.

Voting is an essential human right. Being able to vote and participate in elections is an important component of social inclusion; empowering people with mental illness to have a political voice and in turn reducing stigma. Previous research indicates that patients with mental illness are less likely to vote compared to the general population.

This study explores knowledge and uptake of the voting rights of adults living in mental health supported accommodation in Westminster (London) in the 2015 UK general election.

Understand patients’ awareness of their eligibility to register and cast their vote. Identify patients’ interest in engaging in the voting process and strategies to overcome potential obstacles.

A staff-assisted survey was undertaken in all mental health supported accommodation across Westminster prior to the general election in May 2015.

A total of 142 surveys were returned. Nine out of 10 surveyed believed they were eligible to vote; over half wanted to exercise their right to vote & if registered, a third felt they required assistance to vote.

The majority of community patients were positively aware of the impending general election and their own eligibility to vote. Only half wanted to exercise their right to vote, which is lower than the general population. As a third of the patients requested assistance for voting, this shows us that there are potential barriers impacting on their ability to exercise their right to vote. Staffs have an important role in promoting patient's right to vote by providing assistance with both the registering and voting process.

The authors have not supplied their declaration of competing interest.

Being able to vote empowers people with mental illness to have a political voice and promotes social inclusion. Evidence shows that patients with mental illness are less likely to vote compared to the general population.

This study explores the knowledge and uptake of the voting rights of adult patients in a psychiatric hospital in the 2015 UK general election.

To understand patients’ eligibility and intentions to vote during the 2015 UK general election. To establish what assistance patients may require in order to vote.

A staff-assisted survey was undertaken in all mental health wards in the Gordon Hospital, Westminster prior to the general election in May 2015.

A total of 51 surveys were returned. Seventy-five percent thought they were eligible to vote, and 47% had already registered. Of those that had not yet registered, 37% wanted staff support to do so. Fifty-seven percent of the respondents intended to vote and of those 9 out of 10 intended to vote in person. Twenty-six percent of those intending to vote identified needing assistance in this process.

The majority of inpatients were aware of their eligibility to vote. Over half of the respondents planned to vote, which is lower than the UK average. As 1 in 4 patients intending to vote requested support, this suggests potential barriers impacting on their ability to exercise their right.

Multidisciplinary teams can provide valuable assistance to patients in the voting process in many ways, including information provision, organisation of leave and providing staff escort.

The authors have not supplied their declaration of competing interest.

The media has been around for ages, but what we experienced growing up is worlds away from what our children are growing up with today. Media is a double ended weapon that not only can be of priceless value for children if used in moderation but also it could have a tremendous negative impact on their lives.

Highlighting the positive and negative percussions of media on children's behavior.

The first 2 years of life are considered a critical time for brain development. TV and other electronic media can get in the way of exploring, playing, and interacting with parents and others, which encourages learning and healthy physical and social development. As kids get older, too much media time can interfere with their activities such as being physically active, reading, doing homework, playing with friends, and spending time with family. So, while using media in moderation could be very beneficial for education, entertainment, and communication with others of different cultures, it could be very dangerous in encouraging risky behavior as substance abuse, violence, and unhealthy eating habits.

Because it is always a matter of quality time and not the quantity of time spent by our children using different types of media, it is so important for caregivers to monitor media content and set viewing and interacting limits for their children and share them in their healthy interests to ensure that our children will not be left on their own in an unknown and potentially risky media world.

The author has not supplied his declaration of competing interest.

The relationship between traumatic brain injury and neuropsychiatric conditions has a strong clinical link. Despite significant clinical presentations, there has been a limited focus on quantifying the association between traumatic brain injury and psychiatric disorders.

To conduct a systematic review to determine the prevalence and incidence of neuropsychiatric conditions in patients with traumatic brain injury.

To determine the association between traumatic brain injury and psychiatric illness.

A systematic search was made of Medline, PsycINFO, EMBASE and article bibliographies. Search terms for rates of psychosis, mood disorders, anxiety conditions, organic personality disorder, neuropsychiatric disorders, neuro-behavioural disorders, aggression, dementia and frontal lobe disorder were utilised. We followed MOOSE criteria and did not apply temporal limits.

There were 845 relevant searches in total. After exclusion of duplicates, case reports, case series reports, letters, reviews, commentaries, systematic reviews, and editorials there were 143 relevant abstracts identified. This was further reduced to a review of 48 full text papers. We identified prevalence rates of depression between 6.9–62.5%, mania of 9–12.5%, PTSD 1.9–50%, aggression 28.4–57%, anxiety disorders 6–63% (including GAD 8–9%, agoraphobia 2–6%, panic disorder 9%, social phobia 1%) insomnia 11–29%, personality change of 33.3%, dementia 8.16% and substance use 3–8%.

We have identified significant rates of neuropsychiatric morbidity in patients with traumatic brain injury. We have particularly identified limited research studies into psychosis, mania, dementia and personality disorders in this patient group. The review further emphasises the importance of identifying neuropsychiatric comorbidities in post-traumatic brain injury and the importance of addressing these comorbidities.

The authors have not supplied their declaration of competing interest.

The prevalence of major depressive disorder (MDD) is higher in those with the unemployed and those with low social status. Most of the available data comes from studies in developed countries, and these findings may not extrapolate to developing countries. However, the extent of unemployed status cause MDD is unclear. This study seeks to determine whether depressive disorder is associated with unemployment and to further investigate the relationship between occupation, and social class in Han Chinese women with MDD.

Data came from Oxford and VCU Experimental Research on Genetic Epidemiology (CONVERGE) study of MDD (6017 cases, age between 30 and 60; 5983 controls, age between 40 and 60). DSM-IV depressive and anxiety disorders were assessed using the World Mental Health Composite International Diagnostic Interview. All subjects were interviewed using a computerized assessment system. All interviewers were trained by the CONVERGE team for a minimum of one week. The interview includes assessment of psychopathology, demographic and personal characteristics, and psychosocial functioning.

The odds ratio (OR) between employment and MDD is 0.69. An OR of less than one is protective. Lower social class is not associated with an increase in the number of episodes, or with increased rates of comorbidity with anxiety disorders.

This study suggests that in Han Chinese women, employment is positive protect factor to MDD. Lower social status and unemployment increases the risk and severity of MDD. In China, lower socioeconomic position is associated with increased rates of MDD, as it is elsewhere in the world.

The authors have not supplied their declaration of competing interest.

Deliver a detailed analysis of the mental distortions, which led to involuntary hospitalization in a mental health unit in 2014 and their gender distribution.

We analyze the total number of hospitalizations in our mental health hospital unit. From the patient registry, we extract the type of hospitalizations (voluntary or involuntary), the diagnosis and the gender.

In our analysis, we find a total of 315 hospitalizations. One hundred and fifty-nine (50.48%) of them are voluntary, 150 (47.62%) are involuntary and 6 (1.90%) are a result of a judicial order. From the total involuntary hospitalizations, 81 patients were diagnosed as psychotics disorders (60%), 34 (25.18%) affective disorders, 11 (8.14%) personality disorders, 3 (2.22%) adaptative disorders, 2 (1.48%) mental retardation and 2 (1.48%) autism spectrum disorders.

According to article 763 of Spanish Procedural Law (Ley 1/2000 de Enjuiciamiento Civil) from the 7th of January: “The hospitalization of a person due to mental disorders who is not in a condition to decide for himself/herself, even should he/she be a subject to parental authority or guardianship, shall require court authorization, which shall be obtained from the court of the place of residence of the person affected by such hospitalization.” For this reason the involuntary admission is considered as an exceptional and necessary measure, which is limited in time.

The authors have not supplied their declaration of competing interest.

Involuntary outpatient treatment (IOT) is a type of non-voluntary treatment applied in the community, which tries to ensure the therapeutic compliance of patients that have a severe mental illness.

In Spain, a specific legal regulation about this matter does not exist; however, it is a fact in clinical practice. The application of IOT is not without controversy, with advocates, who consider it a way of achieving therapeutic compliance, and detractors, who think it is an infringement of the fundamental rights of a person.

An evaluation of the knowledge on IOT in Spain. Analyze the four ethical principles found in this treatment.

The protection of the patient is encompassed in the principle of beneficence. And how could we combine this with the principle of autonomy? The answer should be individualized and based on a determined disorder. Starting with non-maleficence, we ask if IOT would provoke a rejection so that the patient would distance himself further from the therapeutic environment. As for the principle of justice, the high cost by patients that do not comply with the treatment would be diminished if we are able to have them follow the treatment with higher effectiveness. This would allow a greater number of patients to access these resources.

The proposal of IOT should be preceded by a deliberative process. This process should include a psychiatric diagnosis that includes not only psychiatric aspects, but psychological, familial and social as well. This would compel us to create a personalized design of the therapeutic needs of each patient.

The authors have not supplied their declaration of competing interest.

Seven UK police forces are currently investigating the alleged involvement of the late Edward Heath (Prime Minister 1970–1974) in a child abuse ring with Operation Midland investigating specifically the alleged murder of three boys.

The presentation raises international awareness of the investigation, sheds light on the suspected ‘Satanist’ ideology behind the cult and explores the implications for professional practice.

The paper highlights the corrosive impact on society of powerful pedophile rings that are protected by compromised authority representatives and professionals.

Detailed accounts circulate on the Internet that name dozens of individuals allegedly active in the cult including high-ranking politicians, psychiatrists, psychologist, police officers as well as journalists and academics. Some of the alleged crimes can be corroborated with news reports or successful court prosecutions while the vast majority appear to be ‘known crimes’ that are successfully covered up.

The widespread organisational structures parallel the Marc Dutroux case in Belgium. It appears to be the case that compromised mental health professionals and authority representatives shield the cult. It becomes an ethical obligation for the silent majority to speak out against such criminality and demand from their government effective investigation and prosecution.

Whilst an enquiry into historical allegations of institutional abuse is currently underway in the UK several cases emerged recently where satanic cults seemingly continue to be protected by the vested interests. Mental health professionals must stand up for victims and resist ill-conceived authority attempts to persecute abuse survivors and their supporters.

The author has not supplied his declaration of competing interest.

The problems that a client presents with to therapy may be associated with his possibility of free choice.

Review of psychotherapeutic and cognitive behavioral literature.

From a psychological perspective, freedom may be either inner or outer, depending on the nature of obstacles and barriers that limit freedom. Therapy may be understood as a process through which the client is guided to actively increase his freedom. This refers to freedom from destructive habits, self-limiting attitudes, compulsive actions, symptoms etc. When creating the relationship, neither the client nor the therapist is entirely free as they bring past conscious and unconscious experiences into it. From the point of view of CBT, freedom is always relative. The idea of absolute freedom results from cognitive distortions – black and white thinking. CBT does not consider overall freedom but relatively free decision-making in particular situations that the client is in. The therapist helps the client to identify his errors in thinking and to learn a more realistic way to formulate his experiences and to use the new attitude to decide more freely. The change in attitude is realized through rehearsing freer behavior and experiments with it in one's life.

Freedom may be either inner or outer, depending on the nature of obstacles and barriers that limit freedom. Therapy may be understood as a process through which the client is guided to actively increase his freedom.

The authors have not supplied their declaration of competing interest.

Values influence our thought patterns, emotions, wishes, and needs. Although individuals may be fully aware of their value systems, these often lie more or less outside the area of full consciousness. At least occasional awareness of one's priorities and set of values may be an effective means of self-regulation.

Literature review and description of cases.

Cognitive behavioral therapy is aimed at dealing with practical problems and goals in life through changes in cognitive processes, behavior, and emotional reactions. Changes to some values naturally accompany changes to these processes. Life values also underlie motivation to achieve therapeutic changes. For this reason, clarification of patients’ life values is important to therapists as focusing on values aids in connecting therapeutic goals with important areas of life. In addition to a better understanding of patients’ life stories and difficulties that have brought them to a psychotherapist, the identified value system may become a part of everyday CBT strategies such as time management, cognitive restructuring or accommodation of conditional assumptions.

Identification and assessment of life values and their use in the course of therapy is a process that increases patients’ motivation to face unpleasant emotions and make careful steps in CBT in order to achieve therapeutic goals. Knowing the patient's life values may help the therapist set therapeutic goals that are associated with significant areas of the patient's life. Together with other CBT techniques, this value-oriented approach increases the effectiveness of therapy and durability of its outcomes after its completion.

The authors have not supplied their declaration of competing interest.

In psychiatric clinical practice compulsory admission to hospital is the last option of the overall care provided to mentally ill patients, justified in terms of civil and human rights because of issues of protection for patients’ and society members’ life and health. Usually treating psychiatrists believe that issues of compulsory admission are without doubt associated with the permission, or even obligation, to apply compulsory treatment in a routine daily base.

In this review, we are exploring issues around the implementation of compulsory treatment.

Thorough research of the main databases and web search engines for relevant studies, agencies and organizations, interested in compulsory treatment issues.

Research shows ambiguous views. Conservatives argue that delay of any substantial, even enforced, and well documented treatment, would result in delay of treatment and excess use of other potentially more enforced methods. Using laws and legislation patients’ rights are guarded but we also have the obligation to treat patients. On the other hand, liberals express totally opposite views. Capacity (or incapacity) is not ‘all or nothing’ but specific to decision and should be respected, with the exception to emergency treatment need.

The capacity of decision-making of the mentally ill patient, whether or not being compulsory admitted, should be assessed in a more holistic and systematic approach and become part of the standard practice, followed by dissemination of these decisions to all relevant parties. Restore decisional autonomy should be one of the main goals of any therapeutic intervention.

The author has not supplied his declaration of competing interest.

For an inmate incarcerated for life we could acknowledge factors contributing to the desire to commit suicide, as social isolation, insensitive discipline, lack of privacy, constant threat of violence, fear, guilt, hopelessness, and depression are prominent in the life imprisonment.

To discuss the ethical issues of prevention suicide in inmates incarcerated for life.

We performed thorough research of the main medical databases, and web search engines for relevant studies, articles and opinions and reviewed them independently.

Prevalence of mental illness is high among inmates and several common stressors typically herald an inmate's suicide. Suicide is often the single most common cause of death in correctional settings. Even though some suicide victims have consulted a mental health service-provider before their suicide, the majority of suicide victims were not mentally ill. The paradox, particularly for life sentence inmates is that we are trying to persuade an inmate to live within a disciplinary environment, which has as side effect the increase of suicidality of the inmates.

Prisons’ inability to protect the health and safety of inmates could raise ethical issues. We have obligation to adequate suicide prevention for all inmates, and we should be more broad minded as the will to die in mentally healthy individuals is beside an free will expression, a sign of serious lack of support and humane living conditions. We should be vigilant not to use the prevention of suicide programs as another way to increase punishment of life long imprisonment.

The author has not supplied his declaration of competing interest.

Almost 50 years after the mental health reform in Europe and the deinstitutionalization of the mentally ill, there seems to be a slow change in the social concept of mental disorder. However, in the case of mental retardation, little progress has been made, since the social approach to these patients does not seem to involve the promotion of their autonomy. This is a reality with implications in medical, social and forensic psychiatry settings.

We will present a statistical analysis on interdiction/inhabilitation processes in two districts of Portugal followed by a comparative analysis between Portuguese and other European countries’ civil law concerning the regulation of legal capacity.

Critical analysis of the means by which the concept of legal incapacity has been applied in the Portuguese social setting.

Descriptive and retrospective analyses of 500 expert reports in the districts of Coimbra and Viseu regarding interdiction/disqualification processes. Research on Pubmed and legal databases; keywords used: mental disability, mental retardation, civil law, mental incapacity, legal incapacity, legal capacity, interdiction, curator.

The number of forensic psychiatric examinations has suffered a significant increase in the last years. The majority of these expertise concern interdiction/inhabilitation processes. Mental retardation is the more prevalent diagnosis, and the great majority of the cases were interdicted.

In Portugal, the law has been applied in order to safeguard the economic assets of mentally retarded individuals, but not in order to promote their social integration and autonomy.

The authors have not supplied their declaration of competing interest.

Under the Portuguese law, criminal offenders that are designated as non-criminal responsible – “inimputáveis”, similar those in the United States of America found “not guilty by reason of insanity”, are forced to be committed to inpatient forensic units either in psychiatric hospitals or prison hospitals for mandatory security measures.

To evaluate if patients committed in a regional forensic inpatient unit (RFIU) who had a psychiatric history preceding the crime, were under long acting injectable antipsychotic (LAIA) in during the period of the crime.

During September/October 2015, patients committed to the RFIU in Centro Hospitalar Psiquiátrico de Lisboa were characterized using medical and court records regarding clinical and demographic variables. The type of crime and previous number of criminal acts were also accounted for.

We included 33 patients in the study. During time of the crime, 25 patients (75.8%) had history of previous psychiatric appointments, with an average of 3 commitments to the psychiatric inpatient units. The majority (n = 17; 68%) had a diagnose of “schizophrenia, schizotypal and delusional disorders” (F20–29; ICD 10) and committed “crimes against life” (n = 13; 52%). They had an average of 0.8 previous criminal acts. During the crime, 7 patients (28%) were taking LAIA. Those, 16% (n = 4) were doing an unknown antipsychotic and 12% (n = 3) were doing Haloperidol.

Despite several studies showing the clinical and rehabilitative benefit of using LAIA early in the disease course, most of the patients in our study, who were already being followed in outpatient psychiatric units, did not benefit from them.

The authors have not supplied their declaration of competing interest.

In May 2013, the American Psychiatric Association (APA) published the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in order to bring America's clinical professionals in concert with the World Health Organization's (WHO) international classifications, notably the ICD-10-CM. This effort was met with considerable resistance and changes were delayed until November 2015. Major social-cultural differences between the United States and its European and other North American partners (Canada and Mexico) poses challenges in critical forensic areas such as the clinical/legal assessment of death qualified offenders – a status unique to the USA.

To articulate the clinical/legal differences between the previous DSM's (III; III-R; IV) and the DSM-5 and how the new language provides greater ambiguity in defining the mental status requirements for Mens Rea – competence to understand one's actions.

Present the major legal issues surrounding the US death penalty and brought before the US Supreme Court including: Furman v. Georgia (1972); Greg v. Georgia (1976); Jared v. Texas (1976); Proffit v. Florida (1976); Adkins v. Virginia (2002); Roper v. Simmons (2005); Miller v. Alabama (2012): … and legislative actions such as Rosa's Law (Public Law 111-256; 2010).

Advocacy groups pushed Rosa's Law to mental retardation with – intellectual and developmental disability. This change is reflected in the DSM-5 whereby mental retardation (MR) was once relegated to axis II, is now classified under intellectual disabilities (ID) given the impression that it is a transitory (correctable) and not a fix (organ disability) clinical condition.

The author has not supplied his declaration of competing interest.

To explore criminological aspects of medicolegal acts committed by patients with paranoia.

We conducted a retrospective and descriptive study, based on medical charts consult. Were included, patients suffering from paranoia (persistent delusional disorder: jealous/persecutory/erotomania type, DSM-IV), hospitalized in the forensic psychiatry department of Razi hospital between 1995 and 2015. This psychiatry department provides medical care for male patients not held by reason of insanity, according to article 38 of the Tunisian Criminal Code. Patients’ socio-demographic characteristics were collected as well as criminological details of their acts of violence (victim, weapon type, crime scene, premeditation…).

We collected 23 patients. Delusional disorder types were: jealousy (17), persecution (4), erotomania (1) and claim (1). The majority was married (18), undereducated (17), with irregular work (13). Forensic acts were uxoricide (15), attempted murder (5), violence against people (2) and destruction of public properties (1). Patients used bladed weapon in most of the cases (13), in the victim's residence (19), with premeditation in (17) of the crimes. Nine patients reported their act of violence to the authorities.

Our results do expose further data concerning potential dangerosity of patients with delusional disorders, and by that invites mental health professionals to prevent these acts with screening for violence predictors and risk factors.

The authors have not supplied their declaration of competing interest.

To compare socio-demographic and clinical profiles of patricide and matricide patients.

To compare modus operandi in matricide and patricide patients.

A retrospective, descriptive and comparative study was conducted, based on medical charts’ consult. Were included patients suffering from psychotic disorders (DSM-IV), hospitalized in the forensic psychiatry department of Razi hospital between 1995 and 2015, after not being held for insanity according to article 38 of Tunisian Criminal Code. Only patients who committed patricide or matricide were included.

Our sample included 26 patients (13 patricides; 13 matricides). There was non-significant differences between two groups concerning: instructional level (P = 0.277), professional status (P = 0.387) and marital status (P = 0.790). Committers of patricide and matricide did not differ in terms of psychiatric diagnosis (P = 0.242) and substance abuse (P = 0.550). A significant difference was found between the two groups in terms of schizophrenia subtypes, patricide patients suffered from a disorganized schizophrenia whereas matricide patients suffered from paranoid subtype (P = 0.05). Patricide was more frequently associated to a conflictual relationship between son and father (P = 0.05). We did not record a significant difference in the crime weapon or its motivations.

Our results helps draw a profile for parricide patients in order to help identify the ones at risk.

The authors have not supplied their declaration of competing interest.