Crigler-Najjar 1 (CN1) due to exon 3 mutations of the UGT1A1 gene is a not rare genetic disease in Tunisia with a founder effect. CN1 syndrome is very severe, and most of CN1 Tunisian patients die soon after birth, within a maximum of one year, due to kernicterus. Liver transplantation, which is the only available therapeutic method for CN1, remains unreachable.

The aim of this study was to report behavioral and neurocognitive phenotypes in CN1 patients who survived to school enrollment.

We have selected all patients evaluated from 2004 to 2010, both clinically and molecularly, for a deficiency of bilirubin-UGT enzyme activity leading to a pathological elevation of unconjugated bilirubin with a suspicion of CN1 syndrome. Direct sequencing of targeted PCR amplification products was performed for molecular analysis of UGT1A1. Behavioral and mental features of patients were studied through our genetic counselling.

We identified 15 patients with the homozygous c.1070 A>G Tunisian mutation. Their age at diagnosis ranged from one week to 9 months for 13 patients. Six of them died within a month of molecular investigation. Only two boys were of school age, i.e. 6 and 9 years. The first had been hospitalized at 3 months year-old for a prolonged jaundice treated with phenobarbital and phototherapy. His psychomotor and neurological development was normal, with school attendance at the age of six. The second patient presented with an unexplored jaundice at the age of 3 days, which was later complicated by seizures and treated with phenobarbital. Despite neurological and motor sequelae associated to language impairments with slurred speech, he attended school at the age of six.

The neurological and behavioral profile of CN1 patients depends on familial and medical management. Quick diagnosis, close follow up and early liver transplantation can improve prognosis.

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After the success of polygenic risk scores (PRS) that embed a useful summary of genomic information in a comprehensive score, the wish to develop summary statistics for DNA methylation had become more pressing. Developing such a score faces challenges, as the score has to be specific and sensitive as well. Epidemiological research on DNA methylation and depression would benefit from such score.

Here, we test a score trained on incident depression (case-control), i.e., a list of published weights for particular CpGs, for its validity in the context of depression severity as measured using MADRS in our sample with depressed patients only.

DNA methylation was assessed using the Illumina Infinium MethylationEPIC 850k BeadChip on a sample of 119 patients with a diagnosis of MDD. After data cleaning, 113 participants were included in the analysis (Mage= 47 years, 57.98% women, MMADRS=27.7). Data processing was conducted using the RnBeads package. From the published reference for the overall sample, a list of 196 CpGs was provided, 170 of these were present in our dataset and used for the score. The list of non-smokers comprised 144 CpGs, of which 124 were available. The score per individual was built using M-values, using the formula: S(weight*DNA methylation value). The score was tested in association with depression and other typical confounders using multiple regression in R. Confounders included ancestry, BMI, age, sex, and 6 cell types. We tested both scores in our sample: smokers and non-smokers.

In contrast to our expectations, none of the regression analyses showed a significant association with depression (MADRS-score). Nonetheless, a significant association was seen with biological sex for both analysis (overall: p=0.036, non-smokers: p=0.026). A reduced model with only this predictor explained 5% and 4% of the variance of the summary score calculated (R2), respectively (overall: p=0.013; non-smokers: p=0.019). One of the ancestry components was marginally significant too in the non-smoker summary score (p=0.065). This was not the case anymore in the reduced model.

Our results show that caution is still in place when using methylation risk scores as specificity and sensitivity might not yet be optimized. The score built for depression incidence does not seem fitting for depression severity at this moment. The use of DNA methylation, a marker that is generally sensitive to confounding factors, for a risk score, might pose more challenges in the context of reliable summary statistics, in particular also for cross-trait examination, which is currently a typical use of polygenic risk scores.

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In females, congenital adrenal hyperplasia (CAH), a spectrum of inherited genetic conditions related to the disruption of adrenal steroidogenesis, is among the most common conditions leading to inappropriate virilization. For adolescent and adult women, progression of hirsutism may have many psychological concerns.

To explore the psychological distress of a young Tunisian woman who sought medical help and psychological support at a late stage, after suffering from genital ambiguity and severe virilization.

Harboring phenotypic male transformation at puberty, our patient attended genetic counselling for cytogenetics assessment. Clinical, biological, psychological and genetic explorations were thus carried out.

A 17-year-old female was born from first-degree consanguineous parents, and had healthy siblings (a sister and three brothers). After a single menstrual episode at puberty, she developed amenorrhea and an unexpected progressive virilization, including hirsutism with an inappropriate beard that she had to shave every day and a male voice. Clinical examination revealed a male morphotype with an enlarged clitoris that resemble a penis, male-type pubic hair, underdeveloped of breasts, abnormal cutaneous hyperpigmentation, and a short stature. Pelvic ultrasound revealed a small uterus, but with no visualized gonads. Genetic exploration showed a female 46,XX karyotype and the absence of Y chromosome sequences. Diagnosis of a non-classic CAH was confirmed. Psychological assessment found that the psychological development of the sexual identity corresponded to the assignment of the female sex. A severe psychological suffering due to the non-acceptance of her virile appearance impaired the quality of her daily personal and social life. Stigmata of a depressive syndrome were also revealed.

Particular attention to the psychological assessment of patients with CAH is recommended, as changes in physical appearance have a detrimental impact on psychological and mental well-being.

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Recently, the new therapeutic approach based on genome editing using the CRISPR/Cas9 system has been applied to treat cancer and other monogenetic disorders. CRISPR/Cas9 allows specific correction of the altered gene without affecting the rest of the genome.

The aim of this study was to report the current CRISPR/Cas9 genome editing clinical trials in neurodevelopmental and mental disorders.

We conducted a search via the ClinicalTrials platform to describe clinical trials that have been conducted using the CRISPR/Cas9 genome-editing tool in neurodevelopmental disorders.

Our research revealed three clinical trials that used the CRISPR/Cas9 tool for diagnostic and therapeutic purposes. The first study aimed to investigate the pathological role of KMT2D mutations in 40 Kabuki syndrome patients in order to facilitate the identification and characterization of therapeutic strategies to improve symptoms, to identify the consequences of KMT2D mutations on epigenetic marker changes and cellular structural changes and to finally attempt gene correction by CRISPR/Cas9. The therapeutic approach was an epigenome editing approach aimed at increasing the expression of the wild-type KMT2D allele to restore the functional activity of a histone H3-lysine 4 (H3K4)-methyltransferase (MLL4) in treated mesenchymal stem cells. The second clinical trial aimed to validate gene editing based on CRISPR/Cas9 technology combined with AAV delivery for the correction of the most common MECP2 mutations in Rett syndrome both in vitro and in vivo. The third GENEPI clinical trial aimed to identify acetylation profiles as epigenetic markers to assess the causality of CREBBP and EP300 variants in Rubinstein-Taybi syndrome, which is considered as a genetic model of neurodevelopmental abnormality with an epigenetic component.

CRISPR/Cas9 clinical trials in polygenic conditions, such as psychiatric disorders, could be envisaged at the level of the epigenetic component of these pathologies. This therapy could be applied ex vivo to perform tissue-specific gene editing.

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Nowadays, following the increasing digital technologies, the cyber aspect of violence is becoming more common (Willard, Journal of Adolescent Health 2007; 41) At this point, we can think that cyber violence victimization, environmental factors such as childhood traumas, exposure to violence, and moreover psychological and biological factors play a role (Fan et al., Front. Psychol 2921;12)

Our aim was to conduct a study to determine the prevalence of cyber violence victimization among university students and to examine whether this prevalence would be related to negative childhood traumas.

We reached university students in many cities of Turkey through an online survey between 01 January 2023 and 31 March 2023. A total of 600 students participated. In our survey, we used the Turkish forms of the Childhood Adverse Experiences Scale and the Cyber Victimization Scale, for which sociodemographic data, validity and reliability studies have been completed in Turkish.

University students from 8 different provinces participated in our study. According to the results of our study, it was evaluated that university students who had negative childhood experiences were more likely to become cyber victims. We are exposed to many traumas from the moment we are born, and this exposure is the relationship with the mother, then relatives, friends, teachers, colleagues, etc. It continues throughout life through relationships. There is a moderate relationship between victimization of blocking and damaging behaviors in cyberspace and negative childhood relationships (r = 0.304), a low level relationship between victimization of sexual bullying in cyberspace and negative childhood relationships (r = 0.289), and victimization of spreading rumors in cyberspace. A low degree of correlation (r = 0.277) was found between and negative childhood relationships. (p <0.05)

The widespread use of technology today facilitates the digitalization of violence, as in every field. As a result, cyber violence, like other types of violence, may be associated with childhood traumas, and this can be prevented by being exposed to the least trauma during childhood, and moreover, if we look from Bronfenbrenner’s perspective, if the next generation grows up in a suitable ecological environment, cyber violence victimization can be prevented to that extent.

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Despite promising research there is still hesitation in implementing peer support work in some hospitals. Especially in forensic hospitals reservations are held against peer support workers.

We aim to give an overview of reviews about the effects of peer support work in psychiatric settings and its implementation. Special emphasis on implications for forensic psychiatric settings shall be given.

Five electronic databases and archives of four relevant journals were searched in December 2019 and updated in April 2022. In addition, references of articles were searched and relevant authors were contacted for unpublished data. Results of reviews were clustered by one author and checked by another.

22 reviews were identified of which 15 reported on effects of peer support work and six on factors influencing its implementation and one review on both. Several effects of peer support work on clinical, psychosocial, organizational and other outcomes (e.g., cost savings) were described. Psychosocial outcomes were the most promising ones whereas no effects were described in most reviews for clinical, organizational and other outcomes. Factors influencing the implementation of peer support work were described during preparation, recruitment, early employment and further development of the peer support worker’s roles. Most factors, beneficial and challenging, were described for the preparation stage of the implementation process.

The authors of the reviews often reported concerns about the low quality of the included studies. Therefore, the present results have to be considered as preliminary. Nevertheless, it is clear that peer support has a positive influence on psychosocial factors and thus complements classic therapeutic approaches. To achieve the best possible effect, the implementation of peer support needs to be carefully planned. Further studies are necessary in order to be able to consider the effect of recovery support in a more differentiated way.

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Severe schizophrenia is often closely related to delinquency resulting in relative overrepresentation of these manifestations of disease in forensic institutions.

The aim of the present work is to report the therapeutic challenges in a case of severe schizophrenia in a forensic institution from a clinical viewpoint as a basis for discussion.

The case report is based on the available clinical documentation, exploratory interviews as well as a structured clinical interview (PANSS).

Presenting a case of a 41-year-old, male Caucasian inpatient suffering from a catatonic schizophrenia, we report the challenges in treatment of chronic, major schizophrenic disease resistant to antipsychotic medication. Without any previous criminal convictions, he has been instutionalized in a forensic psychiatry after a bodily harm to a random stranger about three years ago. Regarding medical history, information is limited to a few inpatient admissions prior to detention documenting intravenous opioid and cocaine abuse. Initially, the patient presented sexual disinhibition and ongoing endangerment of others with frequent assaults to other patients and prison guards. From a psychopathological viewpoint several phenomenona such as delusional intuition, acoustic, tactile and coenaesthetic hallucinations, echolalia, mannerisms and thought diffusions reflect the severe course of the disease (PANSS: P 34/49, N 38/49, G 73/112; total 145/210). Therapeutic attempts with an antipsychotic combination of risperidone, olanzapine and quetiapine as well as valproic acid resulted in insufficient recovery with persistent physical assaults and florid psychosis. In reaction to that zuclopenthixol for impulse control was added. As from the beginning of this year a switch of medication by gradually replacing risperidone and zuclopenthixol with haloperidol and clozapine showed modest success. Under the current medication and therapeutic drug levels the patient does not pose endangerment to others. However, regular tonic-eye fits require supplementary treatment with biperiden, and the patient still presents frequent periods of self-harm punching himself, verbal lack of impulse control and the psychopathological phenomenona described before. In addition to pharmacological treatment the patient receives psychotherapeutic one-on-one conversations. Despite approaching all limits of the available antipsychotic repertoire, psychopathology is only insufficiently controlled leading considerations to electroconvulsive therapy as a treatment of last resort.

Certainly, the present case is exemplary for a severely ill population of patients reaching – after a long and untreated course of disease - a chronic stage that does not sufficiently respond to a multitude of treatment attempts despite proper compliance raising the urgent need for further treatment options.

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Previous studies showed, that reduced executive function can be associated with antisocial and aggressive behavior. For the measurement of executive functions numerous standardized neuropsychological tests are available.

We thought to compare the results of an executive function examination with Wisconsin Card Sorting Test (WCST) of patients observed at the Semmelweis University’s Department of Psychiatry and Psychotherapy to normative data from published database. We also performed a subgroup analysis between the violent and non-violent groups of the patients.

After data clearance our dataset consisted of 20 patients, who were divided into two groups based on whether the crime they committed before their admission was violent according to the Cornell scale.The analyzed parameters were the number of perseverative errors, the percentage of perseverative errors, and the number of completed categories. For comparison, the data bank from the 1993 edition of the WCST manual as normative data was used. The deviation from the healthy average for all three parameters was compared between the violent and non-violent groups using a two-sample T-test.

There was significant difference between the patient and normal populations in all the 3 analyzed WCST parameters: the mean difference was 9,37+2,764, (p=0,0008) in the number of perseverative errors, 14,04+2,21 (p<0,0001) in the percentage of perseverative errors and -2,39+0,34 (p<0,0001) in the number of completed categories (Table 1).Table 1:

The difference between the average scores of healthy individuals grouped by age (from the 1993 WCST manual) and the scores of the patients.

On the other hand, there were no significant differences between the violent and non-violent subgroups in the average deviations (from the normative data) of the number of perseverative errors, the percentage of perseverative errors and the number of completed categories (with p-values of 0.092, 0.34 and 0.59, respectively).

As a limitation, it is important to note that due to the low sample size, and our sample’s heterogeneity in terms of psychiatric diagnosis, drawing reliable conclusions is not possible. However, our results were in line with previous similar research in the forensic psychiatric population (though not under forensic mental state observation) regarding the significant deviations in two examined WCST parameters when compared to normative data. Additionally our study did not find significant difference between the violent and non-violent subgroups of the patients.

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The psychopathology of female crime perpetrators is not well understood since female criminality rates have remained distinctly lower than male criminality.

This study draws on over 20 years of psychiatric expertises to identify sociodemographic, clinical, and forensic characteristics of female perpetrators.

• - To describe the epidemiological and clinical profile of female offenders examined for criminal psychiatric expertise.

• - Describe the criminological and forensic characteristics of these women.

Retrospective and descriptive study, which focused on 56 criminal psychiatric expertise files of female offenders, examined at the psychiatric department “C” at the CHU Hedi Chaker in Sfax, Tunisia, over a period of 24 years.

For each offender, we examined the expert report and the judicial research report. We then transcribed the socio-demographic and clinical information, as well as the criminological and forensic characteristics, onto a pre-established form.

The accused women in our study had an average age of 35 years and 06 months, and 67.86% of the cases were under 40 years of age, with an educational level no higher than primary school in 62.5% of cases. They were unemployed in 71.4% of cases. Among the accused examined, 76.8% had mental disorders, including 46.6% with personality disorders, 16.3% with intellectual disability, 16.3% with bipolar disorder, 9.3% with depressive disorder, 9.3% with psychotic disorder, and 2.3% with substance use disorder (anxiolytic). We recorded 55.4% offences against persons, including 37.5% homicides and attempted homicides, and 44.6% offences against property, including 23.2% thefts. Dementia in the legal sense was identified in 30.4% of cases. Bipolar disorder accounted for 41.1% of legally demented subjects.

It emerges that the profile of the female criminal is that of a woman under 40, with a low educational and economic level, and most often with an antisocial personality or intellectual disability. It would therefore be important to step up primary prevention work by better educating these at-risk women and to combat the factors contributing to dangerousness among the mentally ill by optimizing their psychiatric care.

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The association between the intake of antipsychotic drugs and the occurrence of thromboembolic complications is widely described in the literature. The occurrence of this complication may call into question the medical responsibility of the attending physician.

The objective of this work is to describe the physiopathological mechanisms involved in the occurrence of thromboembolic complications in a patient under antipsychotic treatment, whether or not associated with physical restraint and to discuss the forensic implications.

Our study is retrospective on cases of fatal pulmonary embolism, discovered at autopsy, in connection with the taking of antipsychotics. The autopsies were carried out in the Department of Forensic Medicine of the Tahar Sfar University Hospital in Mahdia. The cases were collected over a period of 04 years. A review of the literature was carried out. We only selected articles published until February 2021 and dealing with cases of patients on antipsychotics, diagnosed with pulmonary embolism by performing a chest CT scan or during an autopsy.

915 autopsy cases were performed during the study period. Twenty cases of pulmonary embolism, discovered at autopsy, were collected. Four cases were related to the taking of antipsychotics (incidence 0.004%), including two men and two women, aged between 25 and 52 years. They were all on antipsychotic treatment for at least 5 years, with the exception of one case who was put on 3 antipsychotics, 7 days before his death, with indication of physical restraint. After analysis of the memorial data, the external examination and the autopsy, the results of additional examinations, the death was attributed, in the 4 cases, to a massive fibrino-cruoric pulmonary embolism. A selection of 45 studies regarding thromboembolic complications associated with taking antipsychotics, was included in the final review.

The reported cases provided additional evidence on the involvement of antipsychotics in the occurrence of thromboembolic complications. Psychiatrists should be careful when prescribing these treatments. The establishment of therapeutic guidelines, taking into account the thromboembolic risk factors, becomes essential, in order to avoid the occurrence of a complication which could engage both the vital prognosis of patients and the responsibility of the physician.

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The transgression of the law can be a deliberate act by a lucid adult, but it can also be the result of a deficiency in judgment and discernment due to lack of age or insanity. Psychiatric expertises are more and more solicited in the penal field with the objective of identifying the causal link between mental illness and the criminal act.

The objective of this work was to give an overview of the subjects expertised, the offences and the pathologies encountered through the report of a psychiatric expertise activity in criminal law.

It is a retrospective descriptive study carried out on the criminal psychiatric expertises made for a forensic act in the psychiatric department of Mahdia during the period from January 1, 2003 to March 30, 2022.

In total, we collected 101 defendants. The average age of our study population was 35±12.07 years. The majority of our study sample was male (98%), from an urban area (50%). 46.6% had primary education and only 11.2% had higher education. The defendants were single in 57.8% of the cases, and almost half (45.7%) had no occupation. Two-thirds of the accused (61.2%) had experienced emotional deprivation at a young age. The problematic use of psychoactive substances was found in 10.3%, as well as alcohol consumption in 46.6%. Moreover, 39.7% of the patients had a personal psychiatric history and 19% had been incarcerated at least once. The forensic acts were mostly against people (62.9%) dominated by physical aggression (33.6%) followed by homicide or its attempt in 19% of the cases. The majority of patients were not related to their victims (62.1%). The nosographic diagnosis found was a personality disorder in 32.75% of cases, followed by schizophrenic disorders in 22.4% of cases.

Psychiatric expertise is a useful, complex and noble clinical act. Determining the predictive factors of a possible acting out allows to specify the objectives of interventions aiming at limiting the acts of violence, hospitalizations and incarcerations of patients suffering from mental disorders.

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Autism-spectrum-disorder (ASD) is a heterogenous neurodevelopmental condition with a wide range of symptoms. Typical deficits, such as impairment in social communication and interactions, can lead to violent behaviours. However, ASD is often underdiagnosed and little is known about patients with ASD in forensic institutions.

To highlight the diagnostic challenges and offending behaviour of people with ASD in the context of the criminal justice system (CJS) through a case report.

The case report is based on exploration, third party anamnesis, medical documentations and court files

A 25-year-old man was placed in detention in 2021 after having committed a dangerous threat to unknown persons and was considered not guilty by reason of insanity. Since early childhood the patient presented with extreme mood swings and impulsive-aggressive outbursts that led to criminal mischief later on. During elementary school he developed concentration problems as well as specific learning deficits. Due to his deviant social behaviour, he was rejected from his peer group. Over the course of the years, he showed no significant responses to different psychopharmacological treatment approaches. His social anxiety grew and ultimately, he started experimenting with various drugs and drinking excessive amounts of alcohol, which induced multiple psychotic episodes. Due to the psychotic exacerbations, he was repeatedly admitted to psychiatric units for acute treatment, however the autistic disorder remained untreated. At the time of the crime an independent psychiatric assessor diagnosed schizophrenia simplex and multiple drug abuse. The patient had been in psychiatric treatment since the age of 5 and received multiple diagnoses such as combined personality disorder, different subtypes of schizophrenia, ADHD, Tourette syndrome, depressive disorder and ASD at the age of 14. Nevertheless, prior to his detention he had never received a complex therapy focusing on his ASD. According to the verdict he was admitted to a medium secure forensic ward in Lower Austria, where he was treated with antipsychotic and anxiolytic medication. Furthermore, he participated in the day-structuring treatment program ensuring routine.

Neurodevelopmental disorders such as ASD often impose a diagnostic challenge, particularly without intellectual disability. This can lead to under- and misdiagnosis, inadequate treatment or even criminal behaviour. Impaired theory of mind, poor emotional regulation and problems with moral reasoning should be recognized and treated specifically early on to prevent further damage to both the individual and society.

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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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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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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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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.

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.

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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

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

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