The Crisis and Home Treatment Teams (CRHT) in psychiatry manages patients with risk to self and others in the community. The number of patents under CRHT who attempt or die of suicide is high in the UK (Hunt et al BJPsych Bull. 2016;40:172-4). The CRHT is an option to help support patients in managing their risk using various interventions and also aim to prevent admission to acute psychiatric wards where possible.

We intended to study the change in risk to self and others and the factors associated with it during the intervention from a CRHT taking care of adult patients in the West Midlands region of England.

The study was conducted as a service evaluation of patients admitted under the CRHT. Data was collected from the case records, for 100 patients for whom details were available. Risk to self and others were checked, along with overall risk as red (highest risk), amber (intermediate risk) and green (low risk). Demographic and clinical information was collected and the data quality was checked.

There were 46 male and 54 female patients in the study, with mean age of 40.4 ± 12.4 and 40.2 ± 12.8 Years respectively (not significant). They were comparable in number of diagnoses (mean 1.2 each) and number of days (22.2 ± 13.1 v 20.2 ± 17.8) in CRHT respectively. There was no significant association of risk with gender (56.3% females and 44.2% of males), being on benefits or type of accommodation the service users live at. Similarly, there was no significant difference of risk of self-harm based on ethnicity; it was noted that 61.2% of patients of British White ethnicity had a risk of self on admission compared to 41.7% Black and ethnic minority patients. On admission, 89% of patients were categorised as red, amber 8% and 1% green; which changed to 18%, 2% and 77% respectively (missing data was not included, so percentages do not add up to 100%). The risk to self was present in 46% on admission and 18% on discharge (p<0.005); and in 14% this risk continued without change. The risk to others on admission was recorded in 12% which was at 1% on the point of discharge (p<0.05). Eight people had both risk to self and others. In 15 patients the risk continued to remain in red category, while in two patients it changed from amber to red.

The risk levels for patients admitted under the CRHT improved. The majority with overall high risk changed to majority presenting as low risk on discharge. The percentage of patients portraying a risk to self and others also decreased from admission to discharge. Although there was considerable decrease in risk, a proportion of patients did not have any change, or even an increase in their risk, which highlights need for additional risk management strategy for these patients in CRHT.

None Declared

In this research work the sense of resilience was studied, which is an essential factor in reducing the stress of health care workers, it also helps to maintain the sustainability of the work of medical specialists and prevents the burnout syndrome. Aaron Antonovsky’s Sense of Coherence scale was used in this study, which helps to determine how health care professionals are able to preserve their mental and physical health.

This study is aimed to determine the differences in components of Antonovsky’s Sense of Coherence scale for various health care specialists and to describe the factor structure of Coherence scale for health care specialists in Latvia, that forms the sense of resilience for health care specialists.

The questionnaire used in the study is Antonovsky’s Sense of Coherence scale’s (Antonovsky, 1987) Latvian version, that was translated into Latvian and adapted in the research work of A. Veylande, N. Bahmačova (2000). 202 respondents who are representatives of medical professions took part in this study. The obtained data were entered into the MS Excel computer program and were statistically processed using the SPSS 22 computer program.

Looking at the obtained results of this study, it can be stated that Medical Doctors- Specialists have statistically significantly higher Comprehensibility scores than Medical Orderlies (p = 0.01, r = 0.24), while Medical Doctors- Specialists and Medical Doctors- Residents have statistically significantly higher Manageability scores than Medical Orderlies (p= 0.04, r=0.21). Based on the analysis of the results, it has been determined that Doctors-Specialists (p=0.00, r=0.32) and Doctors-Residents (p=0.00, r=0.34) have statistically significantly higher Meaningfulness indicators than Medical Orderlies, as well as Doctors-Specialists (p=0.00, r=0.29) and Doctors-Residents (p=0.00, r=0.31) have statistically significantly higher Meaningfulness scores than Medical Nurses.

Higher scores of the three components of Antonovsky’s scale for Medical Doctors-Specialists and Medical Doctors-Residents compared to Medical Orderlies and Medical Nurses could be explained by a lower overall time that Doctors spend in the department with patients. Higher education helps to overcome stress at work and to become aware of possible strategies for improving the joy of life, ways to reduce stress at work and to relax from work.

None Declared

Hospital at home for psychiatric patients is a new emerging resource of delivering acute mental health care in the community. The main objective of this program is to provide intense care to patients with severe mental disorders at home as an alternative to acute admission.

Although home hospitalisation has begun to develop widely in recent years there is a notable lack of studies

The CAEM Psychiatric Home Hospitalization Unit (HAD-CAEM) has been operating since 2018 and takes place in Santa Coloma de Gramenet; and from March 2022 also in a part of Badalona. Both are sociodemographically depressed areas near Barcelona.

The aim of this study is to describe the characteristics of patients attended at the Psychiatric Home Hospitalization Unit of our hospital and to study differences according to area and place of referral.

Socio-demographic and clinical data were collected retrospectively at admission and discharge of all patients treated at HAD-CAEM between March 2022 to february 2023.

Statistical analysis was performed by using SPSS program.

85 patients were included in the study. 45.9% were women. The mean age was 45.5 years (SD 15.58 years). The main diagnoses of the sample were psychosis and schizophrenia (38.8%), Bipolar disorder (23.53%), Depressive disorder (21.18%), schizoaffective disorder (8.24%) and others (8,24%).

54 (63.53%) patients were from Santa Coloma area and 35 (41.18%) from Badalona area.

The total mean duration of admission was 40.22 days (SD 26.18 days), with a mean follow-up of 10.09 visits (SD 5.39 visits) and 2.41 teleassistence (SD 2.62).

The mean duration of admission for Santa Coloma patients was 43.98 days (SD 28.59), and for Badalona patients 33.68 days (SD 20.13). Trend without significance is observed (t= 1.77, p=0.08)

We found differences in the mean duration of admission according to referral location. Acute psychiatric unit 33.25 days (SD 18.06), Mental health Center 51.93 days (SD 33.45), Emergencies 34.28 days (SD 19.69) (F=5.1, p=0.008).

Sociodemografic and clinical característics obtained in our study are consistent with those reported in previous studies. The duration of admission of patients referred from the mental health center is longer than those referred from the acute psychiatric or emergency unit. Home hospitalization teams have been increasing in recent years, being an alternative to traditional hospitalization.

None Declared

According to data, psychiatric re-admissions rates vary from 10%-80%, while they negatively affect the patients’ quality of life and life expectancy. The limitation of multiple psychiatric hospitalizations represents a clinical challenge for all mental health professionals.

To investigate risk factors of hospitalization in a sample of psychiatric patients in Northern Greece.

1,633 records of psychiatry inpatients were examined retrospectively throughout the 10-year records of the Psychiatry Department of Papanikolaou General Hospital in northern Greece. The research was conducted between 2013 and August 2023. The sample was divided into subgroups according to gender, diagnosis, and year of hospitalization. A bivariate analysis was performed to examine relationships between the examined variables: (a.) place of residence; (b.) age; (c.) type of admission; (c.) hospitalization duration; (d.) number of lifetime hospitalizations; (e.) lifetime prosecutor’s orders for coercive examination; and (f.) lifetime suicide attempts.

A fairly equivalent number of males and females was included in the study (M: 874; F: 759).The mean age of the sample was 44.7 years with males being younger than females (males 43.23; females 46.39). Males residing out of the co-capital as well as females residing within the co-capital of Greece, Thessaloniki, disclosed higher odds of being hospitalized (p<0.03). Coercive hospitalizations represented 47% of cases, bore the highest duration (20.7 days), and involved the youngest patients. Coercively hospitalized male patients outnumbered their female counterparts (p<0.001). Voluntary urgent hospitalizations duration was estimated at 17.04 days, followed by outpatient admissions (12.64 days) and transfers from other clinics (11.35 days). 37% of patients experienced psychosis while 35% experienced affective disorders. Males were more affected by psychosis (Odds Ratio: 1.35; p<0.001). Females were more liable to affective disorders (OR: 1.78; p<0.001). 7% of the sample had committed suicide attempts, with single suicide attempts being ten times higher than multiple suicide attempts (p<0.001). Females were more than twice as likely as males to commit a suicide attempt (p<0.001). Females tended more to be hospitalized self-willingly (p=0.0015) and to voluntarily terminate hospitalizations prematurely (p=0.0014). Patients with a single hospitalization were seven-fold compared to those with multiple hospitalizations (p<0.001). The average lifetime hospitalization number for a patient was one hospitalization, while the average for a patient with previous hospitalizations was three.

Being in position to identify the patients in high-risk for hospitalization -as well as for suicide attempt- the clinician can proceed to initiatives such as treatment modifications or further involving the patient’s family.

None Declared

The prevalence of psychiatric re-admission ranges from 15% to 60%, escalating even more in the first year after admission, affecting the patients’ quality of life. Furthermore, the diagnosis of psychotic or affective disorders represents a risk factor of psychiatric re-admission, highlighting the diagnosis impact to the “profile” of psychiatric hospitalization.

To compare the different “Hospitalization Profiles” in association to the patients’ diagnostic categories.

Overall, 1,633 records of psychiatry inpatients were examined retrospectively throughout the 10-year records of the Psychiatry Department of Papanikolaou General Hospital in northern Greece. The research was conducted between 2013 and August 2023. The sample was divided into subgroups according to gender, diagnoses - according to the International Classification of Diseases (ICD-10)-, and year of hospitalization. A bivariate analysis was performed to examine relationships between the variables: (a.) place of residence; (b.) age; (c.) type of admission; (c.) hospitalization duration; (d.) number of lifetime hospitalizations; (e.) lifetime prosecutor’s orders for coercive examination; (f.) lifetime suicide attempts.

Developmental disorders (F80-89) stood for the youngest average age of hospitalization (26 years) and lowest average hospitalization duration (7 days). Neurodegenerative disorders (F00-09) represented the diagnostic category with the oldest mean age of hospitalization (66 years). Intellectual disorders (F70-79) yielded the longest average hospitalization duration (21 days). Patients with intellectual disorders were found to be facing homelessness at a higher rate (4.76%) than patients of any other diagnostic entity (p=0.096). Psychotic and substance use disorder patients obtained equivalently (p=0.18) the highest rates of coercive hospitalizations (63% and 71%, respectively); compared to other diagnostic categories (p=0.0008). Dual diagnosis and anxiety disorders projected equivalently (p=0.9) the highest rate of premature voluntary discharge (6.9% and 6.4%, respectively). Dual diagnosis, personality disorders, and affective disorders also recorded the highest rates of suicidality (11-15%; with no significant statistical difference among the three diagnostic entities p>0.1) among hospitalized patients of all diagnostic categories (p<0.05).

Interestingly, the study’s results reveal the pathologies of the Greek society, with the most representative example being this of patients suffering from intellectual disorders simultaneously presenting the highest risk of homelessness. Further studies are needed, focusing on the sub-populations of psychiatric patients as well as their status in terms of social security, health care providing, quality of life and life expectancy.

None Declared

The driver’s job is a safety job requiring a meticulous neuropsychological assessment, which can affect the decision on fitness to drive. Professional driving benefits from codified regulations concerning neuropsychological disorders.

To describe the socio-professional characteristics of drivers with psychiatric illnesses

To specify the impact of these pathologies on decisions on fitness for work

Retrospective descriptive study of drivers with psychiatric disorders who consulted the occupational pathology and fitness for work department of the Charles Nicolle Hospital for fitness for work assessment during the period from January 2016 to January 2023.

Out of 98 drivers who consulted our department for an aptitude assessment, nine (n=9) patients had a psychiatric disorder. The average age was 45±7 years. They were all men. They were bus (n=7), light car (n=1), and lorry (n=1) drivers. They belonged to the transport (n=7) and service (n=2) sectors. Length of service ranged from one year to 35 years. The pathologies presented by the patients were: anxiety-depressive disorder (n=7) , bipolar disorder (=1) and drug-addiction (n=1). They were being treated with antidepressants (n=7), anxiolytics (n=3), and thymoregulators (n=1). The medico-legal decision was to avoid professional driving (n=7) and to avoid professional driving at night (n=2).

psychiatric illnesses can compromise fitness to work. The role of the occupational physician in the primary and secondary prevention of people at risk is important.

None Declared

During the COVID-19 pandemic confinement, the number of people shopping online has increased all over the word. To date, little is known about the online shopping behaviours of Tunisians consumers.

Evaluate the characteristics of internet shopping among Tunisian consumers.

A cross-sectional, descriptive and analytical study was conducted among subjects who had already made at least one online purchase. Data was collected using a self-questionnaire published by GOOGLE FORMS. We used a survey form collecting socio-demographic data, personal history and characteristics of online shopping behaviour.

A total of 137 participants aged 34.62 ± 9.82 years took part in this study.

All participants had made at least one online purchase, with 43.8% (N=60) purchasing “More than once a year”. The products purchased were most often textiles and shoes (50.4%; N=69). The main reasons consumers gave for buying online were special offers (37.2%, N=51), reduced prices (25.5%, N=35) and free delivery (14.6%, N=20). Almost half of the participants (N=63; 46%) said that they had visited physical shops less since they started shopping online. Regarding the average online shopping budget, 44.5% of consumers (N=61) spent less than 50 dinars/month and 18.2% (N=16) did not use all the products they bought online. Almost half of participants (N=68, 49.6%) feared that their credit card information would be at risk. The majority of respondents (88.9%) thought they might receive a faulty product following online shopping.

Our study has enabled us to identify certain factors that may act as a blocker for online purchasing. So that, stablishing strategic actions for the continuous improvement of online shopping services with the reduction of subjectivity in customer perception will be helpful.

None Declared

In recents years, the number of social exclusion patients who go to the emergency room for psychiatric evaluation, has increased significantly. This fact may be due to the circumstances associated with migration: economic problems, house searching, moving away from the family origin,… These situations can cause stress before, during and after adaptation, which is a risk factor for presenting psychotic symptoms.

The objective of this study is present another alternative treatment for adults with social exclusion with psychotic symptoms or Psychotic Disorder. Presenting through a case of Acute Inpatient Mental Health Unit.

A 25 year old men was referred to the emergency deparment due to an episode of agitation. As relevant psychiatric history, a previous admission to psychiatry’s hospitalitation with a diagnosis of Schizophrenia. Upon discharge, the patient has not been followed up in Mental Health, although he has gone to the emergency room on several ocassions where ir is reflected that no psychotic decompensation has been observed. He emigrated to Spain two years ago, since then he has been homeless, working intermittenly in agriculture.

At our assessment, after having ruled out consumption of toxic substances, the patient presented a neglected and cachetic appearance. He says that he is worried because some people can not see him and others can.

We admit the patient for study and treatment. Involuntary admission.

During the hospitalitation, a join approach was carried out with Social Work and it was decided to start depot treatment in order to promote therapeutic adherence. In this case, it was decided to apply paliperidone depot every sin month. For this, an induction regimen was followed: fisrt, monthly paliperdione 100mg depot was administered, 4 days later, monthly paliperidone 150mg depot and 4 days later, the biannual injection.

Other depot treatment alternatives would have been aripripazole or risperidone. However, the duration of the depot treatment is shorter than in the case of paliperidone, since today the presentation formulas are monthly and quarterly, respectively.

Long-acting antipsychotics are an effective alternative for the treatment of patients with Schizophrenia, especially for those in whom we can not ensure good therapeutic adherence. In addition, the induction regimen allows treatment to be administered more quickly than that carried out in Mental Health outpatient programs, thus reducing the average hospital stay.

In recent years, great advances have been made in the treatment of psychotic symptoms thanks to depot drugs, which allows for numerous effective alternatives for the treatment of these patients. The figure of the Social Worker for the evaluation of the patient and subsequent follow-up is essential in this case.

None Declared

Until 2020, only Belgium, Luxembourg, Switzerland, and the Netherlands legalized euthanasia and assisted suicide in Europe. Spain joined this list in March 2021 with the Euthanasia Regulation Law. However, the practice of euthanasia and assisted suicide in individuals with severe mental disorders is complex due to potential cognitive and decision-making challenges. Psychiatrists play a vital role in evaluating such requests.

he case of a patient with recurrent depressive disorder requesting euthanasia is presented, followed by a theoretical review of the subject.

A case is presented with a bibliographic review.

An 89-year-old man with a history of one prior brief psychiatric hospitalization for depression three years ago was admitted after attempting suicide with an overdose of medication. He reports depressive symptoms of several years of evolution. Medical tests came back normal, but he had a urinary catheter due to voiding issues. He was initially on a medication regimen of amitriptyline, clomethiazole, and fluvoxamine. Despite his depressive state, he maintained his cognitive and decision-making abilities. Medication adjustments were made, including discontinuing amitriptyline and switching fluvoxamine to amitriptyline. His depressive symptoms worsened after three days, leading to the addition of trazodone to his treatment. He also developed urinary symptoms and was diagnosed with a urinary tract infection and metastatic prostate cancer during urological evaluation. Emotionally, he became more apathetic, anergic, and anhedonic, frequently expressing a desire for euthanasia, even with medication changes. Hyponatremia led to the discontinuation of duloxetine and the introduction of venlafaxine. To address anxiety and sleep problems, clomethiazole was replaced with mirtazapine. Upon learning of his cancer diagnosis, his mood deteriorated further, along with increased anxiety and continued mentions of euthanasia. Lorazepam was introduced, and he was informed of his right to request euthanasia after discussing therapeutic options with urology. Following this consultation, the patient became calmer, stopped expressing thoughts of death, and began making short-term plans, including the possibility of receiving palliative care at home upon discharge.

Euthanasia and assisted suicide in severe mental disorders are complex due to ethical and medical challenges. Patients must understand their condition, prognosis, and have decision-making capacity. Assessing their suffering is crucial. Coexisting mental and organic issues complicate the request’s origin. In SMD, determining irreversibility is tricky, as these are often chronic, non-terminal conditions. Exhausting treatment options is essential before considering euthanasia, despite patient treatment refusal. Limited research underscores the need for more studies.

None Declared

Questions regarding death have generated debates and art since the dawn of civilization. These themes permeate through various areas of study, including religion, philosophy, ethics, medicine and humanities. Various countries have been revising their laws regarding the end of life, especially on the right to aid and choice in the end in the context of medical and phychological suffering. Physician-Assisted Suicide (PAS) and euthanasia are methods by which people, mostly terminal patients, seek to end their lives with the help of medical professionals. PAS and euthanasia have been the target of heated debates in politics and in medicine, with the question of ethics centering most of these.

The authors aim to explore PAS and euthanasia in the context of the ethical debate. Based on the pillars of ethics, based on the principal of do no harm and beneficence, the authors explore the role of the Psychiatrist, if any, in these end of life issues.

The authors performed a brief narrative review of the available literature, with recourse to various databases such as PubMed and Scopus. The search terms utilized in isolation or combination included: physician assisted suicide, euthanasia, psychiatry, mental illness and ethical issues. Taking into consideration the widespread discussion of these themes in the public forum, news articles were included based on their merit and relevance to the explored topic.

The ethical debate appears to rest between the pillars of first, do no harm, the principles of beneficence and nonmaleficence and aut. Here, the conflict between the first and last appear, where the killing of any patient, whether directly or indirectly is clearly contrary to the principle of primum non nocere. However, the prolonging of suffering in a terminal patient, appears to contradict the principles of nonmaleficence. The Psychiatrist is called to evaluate competence to choose, which is allied to autonomy. Other sources explore the role of the Psychiatrist in permitting a suicide to occur, when the profession is dedicated to the prevention of suicide. From the literature, the psychiatric evaluation is rarely regularly carried out, usually being solicited in cases where mental illness which might compromise the capacity to choose is suspected.

In ethical debates, clear cut answers are rarely every developed, with the nuance and greyscale of difficult topics usually dividing those that ferverantly champion each cause. Psychiatric evaluation is usually invoked when patient autonomy, especially in terms of capacity, is called into question. Questions remain as to whether the presence of the psychiatrist should be a regular one in these procedures or if it should be carried out in a selective manner. There is little consensus in regards to this role, which merits further conversation in the various forums of medical and ethical communication.

None Declared

In the age of digital information, the volume of personal information available online continues to grow. Examining patients’ online profiles has become common for various reasons especially in psychiatry, despite ethical concerns. Therefore, it is interesting to explore the attitudes of tunisian psychiatric residents in this regard.

This study aimed to identify the purposes that make psychiatry residents consult their patients’ profiles on social media and to evaluate the consequences of being friends with them or following them on the treatment course and on the doctor-patient relationship.

This was a cross-sectional descriptive study from August to September. A questionnaire on Google form was distributed to psychiatry Tunisian residents.The study evaluated the frequency and causes of patient profiles consultation on social networks, its role and impact in the doctor-patient relationship

The study population included 53 psychiatry residents with a mean age of 28 (+-5) years and a sex ratio of 0.127. Among the responders, 53 % were in their first or second year of residency. And the predominant workplace was El Razi Hospital : a university hospital.

For the frenquency of patient profiles consultation on social networks : 87% of treating psychiatrists declared consulting their patients’ profiles on social media at least once. The purposes of consulting patient’s profiles noted in our study were: looking for signs of pre-morbid functioning (n=32), looking for clinical features of the current episode (n=30). They do it also to verify the informations provided by the patient (n= 18) ,have an idea of their private lives (marital status ,employment, hobbies,..)(n=11) ,or locate a family member (n=5). It can be also out of curiosity (n=21). And this made the psychiatry residents empathetic towards the patient (n=10) .

But, in 91% of cases, patient’s permission was not taken .

Moreover, 4 of treating psychiatrists declared being friends with their patients or following their profiles on social media. Two of them regret it. The friend or follow request was an initiative from the patient, in all cases.

The attitudes of psychiatry residents regarding the consultation of patients’ profiles on social networks were not clear. However, as the boundaries of the digital doctor-patient relationship remain undefined, it is imperative to develop clear guidelines and educational resources.

None Declared

After judgment of the Constitutional Tribunal of 22.10.2020, there are two premises for abortion: when pregnancy was caused by rape or pregnancy is the threat for health and life of a mother. Then some people indicated that the latter should be interpreted more broadly. So far, jurisprudence has interpreted health threats only in relation to physical health, currently – cases classified as mental health threats are included.

The aim of this paper is first to analyze different aspects of this phenomenon: clinical, philosophical, including ethical and legal. The second goal is to point out the best actions for psychiatrists.

The methodology of this paper corresponds to the pastoral paradigm: diagnosis, reflection, action. At first, the arguments of opponents and proponents of the concept of psychiatric premises for abortion were extracted. Then they were assessed from a logical and essential point of view. Finally, some conclusions and guides were included to enable psychiatrists to act appropriately, including ethical, clinical and legal aspects.

Statements and letters from various institutions and societies were analyzed, including the Presidium of the Supreme Medical Council, Polish Pediatrics Society, the Expert Team on Bioethics of the Polish Bishops’ Conference, the Bioethics Committee of the Polish Academy of Sciences, Patient’s Rights Ombudsman, Commissioner for Human Rights. The key arguments for psychiatric premises are presented in the Table 1.Table 1.

According to opponents, using the premise of mental health risks to terminate a pregnancy would be an example of the psychiatrization of life and the abuse of psychiatry for political purposes. There would be a danger of associating psychiatry as a tool for performing abortions, which would perpetuate the phenomenon of stigmatization – of both doctors and patients. Each of the arguments for this has been negated.

This problem illustrates an attempt to replace the paradigm of traditional personalistic ethics with utilitarianism. The concept of psychiatric premises for abortion is contrary to the principles of double effect and proportionality. It is also against the Polish Code of Medical Ethics: art. 39 and art. 54.

None Declared

Allocating a kidney transplant to a non-compliant recipient could present a triple damage: to the donor (and family of a deceased donor), for the recipient (who will experience rejection) and for another potential recipient on the waiting list (who missed the chance for the transplant). Having in mind that kidney transplantation (TX) is the best choice of renal replacement therapy, a thorough individual endeavor to predict the outcome of a TX in a non-compliant candidate is necessary to avoid a worse option. Non-compliance could origin from maladaptation, psychological limitations or a psychiatric condition.

Here we present a 46 years old male patient on chronic hemodialysis (HD) for 4 years due to end stage diabetic kidney disease. He is extremely non-adherent to HD related recommendations, occasionally skipping the sessions, gaining up to 10 kg weight overload between the sessions and avoided visiting psychiatrist, so far. Our objectives were to explore the presence and severity of non-compliance as ethical dilemma for kidney transplantation.

Reviewing the patient’s medical data.

Unlike to non-obedience to dietary and behavioral medical advice, this patient is very much adherent to pharmacological medication. Staying on HD he is constantly on the edge of vital danger, risking pulmonary edema or hyperkalemia related cardiac events. The most important compliance in a kidney transplant patient is adherence to immunosuppressive therapy. In this particular patient we could predict adherence to immunosuppressive medication after a TX and getting rid of volume overload and hyperkalemia once restoring kidney transplant function.

Pretransplant non-compliance in kidney transplant candidate is not always an obstacle for kidney TX. In some cases, as in the one here described, a TX is better option than staying on HD, avoiding the previously described triple ethical damage - to the donor, the recipient and patients waiting on list, while we could predict a good outcome of the TX. Including psychiatrist into the work up and management should not be skipped.

None Declared

Euthanasia is the active deliberate ending of life by another person at the explicit request of a patient who is suffering from an incurable condition deemed unbearable by him or her.young doctors in tunisia might be exposed in their daily practice to a request of (E). In some countries the procedure is regulated by law while in others the issue has not been discussed. Before assessing the public opinion the medical core has to be implicated in the debate about the subject.Within the limits of our knowledge this is the first study on the subject in the countries of North Africa

To describe the attitudes of tunisian medicine resident toward euthanasia

The validated questionnaire of physicians’ Attitudes and opinions on assisted suicide and euthanasia was distributed via mails addresses to 50 tunisian resident. The participation was entirely voluntary and anonymity was guaranteed.

Thirty seven medicine resident participate to the study the response rate was 74%. The average age of participants was 28.2years old.The majority;23 were female and 29 had religious beliefs.The most represented speciality was family medicine with 6 participants.Only 2 of doctors were practicing in Europe.About 8 of young doctors were requested for (E).Tunisian medicine residents are generally supportive of the legalization of euthanasia (29), but many have concerns about their own participation in the procedure.

Ethical and legal complexities surround the topic of euthanasia.It is imperative to deepen our understanding of this practice within the context of the North Africa region,in order to formulate a comprehensive and well-informed policy.

None Declared

Forensic psychiatric services address the therapeutic needs of mentally disordered offenders in a secure setting. Clinical, ethical, and legal considerations underpinning treatment emphasize that the Quality of Life (QOL) of patients admitted to forensic hospitals should be optimised.

This study aims to examine changes in the QOL in Ireland’s National Forensic Mental Health Service following its relocation from the historic 1850 site in Dundrum to a new campus in Portrane, Dublin.

This multisite prospective longitudinal study is part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST). Repeated measures were taken for all inpatients in the service at regular six-monthly intervals. The WHOQOL-BREF questionnaire was offered to all inpatients and an anonymised EssenCES questionnaire was simultaneously used to measure atmosphere in the wards. Data were obtained at five time points for each individual patient and ward. WHOQOL-BREF ratings were obtained across five time points with comparisons for four time intervals, including immediately before and after relocation. For 101 subjects across the four time intervals, 215 sets of data were obtained; 140 before and 65 after relocation with 10 community patients who did not move. Using Generalised Estimating Equations (GEE) to correct for multiple comparisons over time, the effect of relocation, with community patients as a control, was analysed by ward cluster and whether patients moved between wards. Observations were categorised according to security level — high dependency, medium secure, rehabilitation, or community — and trichotomised based on positive moves to less secure wards, more secure wards (negative moves), or no moves.

The hospital’s relocation was associated with a significant increase in environmental QOL (Wald X2=15.9, df=1, p<0.001), even when controlling for cluster location, positive and negative moves. When controlling for ward atmosphere, environmental QOL remained significantly increased after relocation (Wald X2=10.0, df=1, p=0.002). EssenCES scores were obtained within the hospital for three time points before relocation and two time points afterward. No significant differences were found in the three subscales before and after the relocation. All three EssenCES subscales progressively improved with decreasing security level (Patient’s Cohesion: Wald X2=958.3, df=1, p<0.001; Experienced Safety: Wald X2=152.9, df=5, p<0.001; Therapeutic Hold: Wald X2=33.6, df=3, p<0.001).

The GEE model showed that the hospital’s relocation improved self-reported environmental QOL. The cluster location made significant differences, as expected for a system of stratified therapeutic security, with a steady improvement in scores on all three atmosphere subscales.

None Declared

Aggression is a relevant risk factor for criminal behavior. Psychopathy is known to correlate with a higher risk for violent offenses and research suggests that successful therapy of psychopathy is complicated.

Our goal was to explore the overlap between psychopathy and aggression and the specific influence of psychopathic traits on change in aggression during correctional therapy.

A pre-post-study rating psychopathy and aggression in men imprisoned for sexual and non-sexual violent offenses aged between 20 and 67 (M=37.6, SD 11.6) was conducted. The participants filled out standardized pre- and post-treatment ratings after admission and after an average of 16 months (n=144 for pre-rating, n=89 for post-rating). Psychopathy was measured via the PCL-R and aggression with the BDHI (Buss-Durkee Hostility Inventory).

We calculated two-tailed Pearson correlations for BDHI Pre-, Post-, and Change Scores and the PCL-R. Further, the BDHI pre-post-differences were compared using independent t-Tests, effect sizes were calculated using Cohen’s d (small, medium, and large effect sizes are d = .20, .50, and .80). Also, unpaired t-tests were carried out to compare between participants with lower and higher PCL-R sum scores (median split, mdn= 16.8, M=16.8, SD=7.0).

Psychopathy facets 3 and 4 (lifestyle, antisocial) and the sum score correlate significantly with the pre-, and post-BDHI total score and the subscale direct hostility but not with indirect hostility. Regarding BDHI change scores, only the interpersonal facet of PCL-R correlated significantly with direct hostility and the total BDHI score. In the whole population, a significant reduction of the BDHI was only found in the subscale indirect hostility (p=.015, cohens d= .26). In the subgroup of individuals with lower PCL-R (<16.8) showed a reduction of indirect hostility (p<.001, cohens d= .50) and the total BDHI score (p=.003, cohens d=.42). Interestingly, in the group with higher PCL-R scores no significant reduction of self-assessed hostility via BDHI was observable during therapy.

We identified a significant correlation between psychopathy and aggression, especially regarding facets three, four, and the sum score. Only the interpersonal facet correlated with the change in aggression during treatment in prison. In the group with higher psychopathic traits, no change in aggression was achievable during therapy. Thus, in the aspect of aggression and hostility, our data suggest that higher psychopathic traits may be viewed as a complicating factor for successful therapy.

None Declared

In the Romanian forensic psychiatric and legal system, the legislation allows people diagnosed with mental disorders and who have committed a crime, without discrimination, to come under the Criminal Code, thus applying the safety measure of medical hospitalization. Although it is a complex measure, which requires increased attention in its application, any omission on the part of the authorities could lead to the violation of various human rights. The role of this measure is to improve the mental state of perpetrators, who represent, both for them and for society, an important danger. Approaching from this perspective we can say that this legal framework defines and limits the circumstances in which this measure can be produced to prevent the violation of human rights..

The objective of this presentation was to carry out an analysis of the applying criteria for the safety measure of medical hospitalization, as well as the procedural aspects, in the national institutions where the perpetrators serve their sentences, called “psychiatric and security hospitals”

In this way, in our research we wanted to discover the most frequent pathologies blamed to be the cause of crimes and determined the application of these measures.

All the results were evaluated and integrated according to the objective of this study.

In parallel with this analysis, we wanted to identify the main aspects that make the activity difficult and also to be able to offer the possibility of creating some solutions to improve the forensic psychiatric and legal system.

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Legal professionals frequently encounter forensic mental health issues in the criminal justice system. These issues can significantly impact the outcome of cases, making it essential to understand the attitudes and perceptions of these experts towards mental illness. Despite a high number of individuals with mental illness in prisons, the availability of forensic mental health services is limited. While prior research has shown widespread stigma towards mental illness, there hasn’t been a study assessing the attitudes of judges and lawyers.

This study aims to investigate the stigma related to mental health among Lebanese legal professionals.

An online questionnaire was sent to judges and lawyers practicing in Lebanon. The survey included a section on demographics and personal data with the following scales: Reported and intended behavior scale (RIBS) which measures mental health stigma–related behavior and Perceived devaluation and discrimination scale (PDD) measuring the extent to which a person believes that most people will devalue or discriminate against someone with a mental illness.

A total of 215 participants, with a mean age of 38.69 and a mean 13.16 years of experience, completed the questionnaire. Most were female (62.8%) and worked as civil attorneys (47.4%). Only a minority received instruction on mental health or mental health law during training (10.7% and 8.8%). About a quarter believed their education on mental health issues was sufficient (27%). Participants with positive attitudes (RIBS) were more likely to have a family member with a mental illness (p value = .001), feel comfortable handling cases involving mental health (p value = .001), and have lived with someone with a mental illness (p value = .007). Feeling adequately educated about mental health issues was associated with lower perceived stigma (PDDS, p value = .021). No significant associations with stigma scores were found for factors like age, gender, occupation, years of experience, contact with a mental health professional, taking psychotropic medications, disclosing personal mental health issues to friends or co-workers, receiving education on mental illness or mental health law, or working with individuals with mental health issues.

The findings imply that enhancing mental health education and awareness within the legal profession could be a key strategy to reduce stigma and improve the overall treatment of individuals with mental health issues within the criminal justice system in Lebanon.

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Participatory research (PF) actively involves people with lived experience (pwle), e.g. for a disease, in research. This improves the relevance, quality and impact of research and can help to raise third-party funds, increase recruitment numbers, select research methods. Pwle can support all stages of the research process, including dissemination. While PF is already standard in other countries, Germany is still lagging behind. Our participatory advisory board aims to create a sustainable structure to involve underrepresented patients.

In the PART advisory board, pwle and researchers should actively cooperate in projects in the field of forensic psychiatry. In preparation to establish the advisory board procedures, key documents and training material were developed. In addition experiences, opinions, ideas and concerns of stakeholders and pwle in relation to PF were collected.

Guided interviews were conducted with stakeholders (clinical, research) and focus groups with in-patient pwle from forensic psychiatry. They were asked how they imagine the structure, tasks and goals of a participatory advisory board, what opportunities and obstacles they see. Anticipated framework conditions and support needs for the successful implementation were also asked. The interviews and focus groups were audio-recorded and transcribed. Data was analysed with MAXQDA using thematic analysis.

In total, 8 expert interviews and 2 focus groups with 15 pwle were conducted in the first half of the year 2023. The analysis so far shows great interest in PF, although the term is mostly unknown and experience seems to be limited. The respondents identified opportunities for participatory research, but also challenges that need to be overcome in terms of its implementation. Both groups emphasise the importance of PF, especially in the field of mental illness, and express ideas for its implementation.

The results will be incorporated into the structure of the advisory board, so that PF in the field of forensic psychiatry will be more successful and the exchange between researchers and pwle will be facilitated. Detailed results as well as impressions from the first meeting(s) of the advisory board will be presented at the EPA conference.

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Although Hungarian forensic psychiatry has a historical legacy dating back to the 1890s, for the past few years there has been a dramatically increasing shortage of forensic psychiatry experts in Hungary, which affects both health care practices and the judiciary.

In order to join the international academic unity of forensic psychiatry including research, education and treatment besides expert witnessing, our workgroup aims to facilitate the development of high-level quality standards in modern forensic psychiatry in Hungary. Based on our pilot study on this topic, in the current nationwide study we attempted to delineate the preferences of Hungarian judges regarding the role of forensic psychiatry and forensic psychology experts in both criminal and civil legal proceedings.

With the help of the National Office of the Courts, Hungarian judges were asked to complete a questionnaire that - besides personal characteristics – comprised specific questions in several areas including; hearing the experts; their preferences when assigning experts; the value of the expert’s oral statement in court; the extent of their reliance on the psychiatric or legal knowledge of the experts; and the ways judges assess their own psychiatric and psychological knowledge. They were also asked to disclose their opinion about the attributes of optimally applicable expert opinions. Respondents provided their answers as rating on a 10-point Likert scale; or as percentage estimates. Besides descriptive statistics, we investigated the difference between the two groups of judges using Chi-square statistics and ANOVA with respect to the association between the answers and the main personal characteristics of judges.

The dataset contains >400 completed questionnaires, returned from all over the country, and the analyses are ongoing. Preliminary results are available for a sample of 125 respondents: 53 criminal court and 72 civil court judges, with 64 of them having a maximum of 14 years and 61 having more than 14 years of work experience. Rating the characteristics of assigned experts, we found a significant association between being a criminal court judge and assigning an expert who is considered as an “acknowledged authority” by peers (p=0.002). Finding it crucial what the assessed people report on the legal case itself was significantly associated with civil court judges (p=0.026).

In the absence of any available nationwide information in Hungary, our study is expected to provide much-needed and fundamental information to the current practice of forensic psychiatry in the country.

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