Previous studies have found substantial weight gains in forensic mental health patients (FMHP) during hospitalisation. However, previous studies have not compared in- and outpatients, thus the weight change could be a general change over time. Research on the association between proportional hospitalization time (PHT) and weight change is lacking.

To investigate the association between time hospitalized and weight change among FMHP.

Retrospective cohort study including FMHP with schizophrenia or bipolar disorder treated in the Region of Southern Denmark between 01jan2016 and 06apr2020. Patient characteristics and data on body weight was extracted from electronic medical records. The association between PHT and weight change per year was analyzed using linear regression. PHT was determined between each measurement as the total number of days hospitalized divided by the total number of days. Analyses were adjusted for gender, age, smoking, and antipsychotic medication.

The cohort included 328 FMHP, of which 91% were diagnosed with schizophrenia. PHT had a significant positive dose-response association with weight change, with an estimated difference of +4.0 kg/year for FMHP who were hospitalized 100% of the time, compared to FMHP who were exclusively treated as outpatients. The associations were different for FMHP belonging to different categories of BMI at baseline (test for interaction; p=0.006). Underweight hospitalized FMHP had the largest difference in weight gain compared to FMHP treated outside hospitals (+18.0 kg/year, p=0.006), and the difference was smallest in obese FMHP (+2.3 kg/year, p=0.21).

PHT was positively associated with weight change among FMHP.

No significant relationships.

No statutory mental health services exist for justice-involved individuals in Pakistan. The lack of expertise in forensic psychiatry serves to deny individuals with mental illness the critical support needed for mental healthcare and adequate court dispositions with serious unintended consequences including capital punishment for those who could otherwise be deemed treatment and not punishment worthy. A landmark judgement by the Supreme Court of Pakistan in February 2021 criticized the lack of forensic psychiatry expertise in Pakistan and directing the development of forensic mental health services and forensic psychiatry training in Pakistan.

The key objectives are: 1. Understanding the timeline of how justice invloved individuals are manged by psychiatric services 2. The importance of the Supreme Court of Pakistan Judgement in affecting change 3. Highlights on how Queen’s University will enhance forensic psychiatry in Pakistan

A literature review and personal networking facilitated the collection of important data in how justice invloved individuals are supported in Pakistan. The author has published and presented to Pakistani psychiatrists and the Pakistani judiciary on this topic. Queen’s University is aiming to implement a 3-year plan to develop an online curriculum and certificate course to help train the trainers.

In the Pakistan’s most populous province, Punjab, prevalence rates for psychotic illnesses (3.7%), major depression (10%), and personality disorders (65%) among men with higher rates for psychotic disorders (4.0%) and major depression (12%) among women.

In conclusion there is a dire need to develop forensic psychiatry in Pakistan and other low/middle income countries.

No significant relationships.

Schema-therapy (ST) - one of the promising integrative models of psychotherapy, which shows its efficacy in many mental disorders. ST has main theoretical concepts: early maladaptive schemas (EMS), coping styles, modes and basic needs. EMS are self-defeating emotional and cognitive patterns established from childhood and repeated throughout life. Existing literature shows the connection between EMS and behavioral problems, which could be more significant for patients with personality disorders. The prevalence of personality disorders is relatively low in the general population, but it’s highly overrepresented in the forensic population, especially in groups of sex offenders.

The aim of this study is to examine if there is a prevalence of some EMS between sex offenders and their association with a diagnosed psychiatric disorder.

Medical records and criminal case materials of 27 patients were reviewed, all of them were blamed for committing sex crimes and had to stay at the department for one month for forensic psychiatry examination. During their stay patients were examined several times and questioned with YSQ S3R.

Most of the patients had psychiatric disorder: specific personality disorders (14), pedophilia (3), dependence syndrome (4), organic personality disorder (3). Some of them had several psychiatric diagnoses. The most prevalent EMS were abandonment, emotional deprivation, insufficient self-control and defectiveness.

These findings show the prevalence of personality disorder and several EMS in sex offenders, which could be useful for the full understanding of the concept of PD and improve the organization of medical care for these individuals.

No significant relationships.

Qatar established its Forensic Community Mental Health Team (FCMHT) in 2019 as part of the region’s first comprehensive forensic psychiatry service. We present here the data on clinical and offending outcomes since its establishment and compare this with data from before the service was established

To compare clinical and offending outcomes in mental health patients with criminal offending histories in Qatar before and after the establishment of Forensic Community Mental Health Team (FCMHT).

This is a retrospective study comparing the socio-demographical characteristics, clinical outcome and recidivism measures of forensic patients, under the FCMHT for the last two years with data from a similar period before the services were in place.

Data for 170 patients in total was analyzed. 85 patients currently under the active care of forensic community team were matched with a comparable group before the establishment of the services. The re-admission and reoffending rates after the establishment of the service over 1 year of follow up was 15% and 20% respectively compared with 60% and 85% of the group before the service.

Since its inception, the FCMHT has made significant positive impact on quality of life, mental well-being and safety of patients under its care. Close working relationships with criminal justice system, families and carers has helped fight stigma and promote safer community.

No significant relationships.

There is an established association between serious mental illness and violence. Secure forensic psychiatric services provide care and treatment to mentally disordered offenders. The majority of patients in forensic services suffer from severe mental illnesses such as schizophrenia, with co-morbid polysubstance abuse and maladaptive personality traits. Psychiatric services are under significant pressure to reduce the use of seclusion and restrictive practices, whilst mandated to provide safe environments for patients and staff.

To determine the number and characteristics of violent incidents in a secure forensic hospital in Ireland.

A retrospective review of all incidents in Central Mental Hospital, Ireland between 1st March 2019 and 31st August 2021 was completed. Incidents were categorised into physical assaults and other violent incidents. Demographic measures and measures of violence risk (HCR-20), functioning (GAF), programme completion and recovery (DUNDRUM tool) were collated.

A total of 321 incidents took place during the period examined, of which 47 (14.6%) involved physical assaults perpetrated by patients. Between March 2020 and August 2021, numbers of assaults increased by 50% and 78% compared to the preceding six-month period respectively. The majority of assaults were committed by a relatively small group of patients. Victims of assaults were more likely to be patients (n=27, 57.4%) and more likely to be males (n=43, 91.9%).

Physical assaults and other violent incidents happen in forensic and general psychiatric units. Restrictive practices, used in accordance with the law, are necessary at times to prevent serious harm to patients and staff in psychiatric hospitals.

No significant relationships.

Throughout training, medical students are often only exposed to a limited selection of psychiatric specialities, predominantly general adult inpatient settings. This medical student had the opportunity to undergo a placement at a high security forensic hospital. With only three such hospitals in England, this is an environment that few students and even qualified doctors have been able to experience. In this presentation, the author will explore their prior expectations, key skills gained, and surprising realisations that made the elective highly valuable.

To reflect on the skills learned and revelations made during the elective period and share these as a presentation.

The author completed a 6-week placement at Ashworth High Security Psychiatric Hospital. He then reflected on his experiences.

This placement allowed the development of a range of skills and personal discoveries. The skills included enhanced personal safety awareness, improved use of varied communication styles, and de-escalation and management techniques with higher risk patients. The main finding was the fine line between Ashworth’s patients and mainstream society, and how easily these two entities can overlap. Carl Jung spoke of a ‘shadow’ that must be integrated, and the humanity within each patient made this philosophical concept a sobering reality.

High security placements are valuable educational opportunities and teach important skills, not often found in the current medical school curriculum. These placements offer the transferable communication and interpersonal skills essential in any budding psychiatrist, and also provide a vital environment for self-reflection and personal growth.

No significant relationships.

Forensic mental health services provide care to people in secure psychiatric hospitals and specialised community teams. Measuring outcomes is important to ensure such services perform optimally, however existing measures are not sufficiently comprehensive and are rarely patient reported.

To examine a novel instrument for measuring outcomes in forensic mental health services, the FORensic oUtsome Measure (FORUM), which consists of a complementary patient reported questionnaire (FORUM-P) and clinician reported questionnaire (FORUM-C).

Inpatients at a forensic psychiatric service based in a regional healthcare organization in the UK completed the FORUM-P, while members of their clinical teams completed the FORUM-C. Patients and clinicians also provided feedback on the questionnaires.

Sixty-two patients participated with a mean age of 41.0 years (standard deviation 11.3). For internal consistency, Cronbach’s alpha for the FORUM-P was 0.87 (95% confidence interval (CI) 0.80-0.93) and for the FORUM-C was 0.93 (95% CI 0.91-0.96). For test-retest reliability the weighted kappa for the FORUM-P was 0.44 (95% CI 0.24-0.63) and for the FORUM-C was 0.78 (95% CI 0.73-0.85). For interrater reliability of the FORUM-C the Spearman correlation coefficient was 0.47 (95% CI 0.18-0.69). The FORUM-P received an average rating of 4.0 out of 5 for comprehensiveness, 4.6 for ease of use and 3.9 for relevance, while the FORUM-C received 4.1 for comprehensiveness, 4.5 for ease of use and 4.3 for relevance.

Outcome measures in forensic mental health can be developed with good measures of reliability and validity, and can be introduced into services to monitor patient progress.

No significant relationships.

Violence is considered both a societal issue and a public health issue. Due to the high economic, societal, and individual cost associated with exposure to violence, clinical risk assessment-tools are now being implemented in the public health care system as well as outside of it. To ensure early identification and prevention, various professional groups perform structured risk assessments in Norway, including police, doctors, and psychologists.

There is a need to examine competence and organizational factors, which may affect the ability to make accurate assessments in different levels of the health service, as well as in the police who often are involved in early identification and action-taking concerning violent individuals. Based on variation in risk assessment competencies, and characteristics of different work environments, our project aims to investigate whether some factors seem to be more important than others in clinical assessments when comparing different professional groups with or without a professional background in health care.

In our study, we will be able to tell if there is a significant difference in how different professional groups emphasize different risk factors, and in which way individual factors such as formal competencies, years of experience, and personal and professional attitudes to violence affect the risk violence assessments performed.

We hypothesize that retrospective, clinical, and dynamic risk-factors are interpreted differently by different professional groups, and therefore entail significant variations in assessments, and the health care provided.

In this planned study, we will examine variations in the practice of violence risk assessment in Norway.

No significant relationships.

Patients with schizophrenia suffer from increased mortality rates equivalent to 15-20 years shorter life expectancy. Up to 60% of this excess mortality can be explained by preventable, somatic conditions like cardiovascular, metabolic, and respiratory comorbidities. As forensic psychiatric (FP) patients often experience the triple stigmatization of mental illness, substance misuse and criminal conviction, the risk of suboptimal diagnosis and treatment may be high. Although benefits from the addition of general practitioner (GP) services to non-FP wards have been shown elsewhere, this cross-sectoral approach has never been attempted in a Danish FP ward.

One purpose of this project is to evaluate the associations between self-reported quality of life and objective measures of somatic health.

A clinical intervention in which a GP consults patients in all medium secure wards in the Central Denmark Region (N=72). The consultation includes a physical examination, medication review, and evaluation of blood samples. Data is collected from: electronic patient files and questionnaires regarding quality of life (SF-12), lifestyle, and attitude towards GP services.

The population will be described in regards to socio-demographic, clinical, and forensic characteristics. Associations will be made between quality of life (SF-12), metabolic syndrome, blood markers, and heart-SCORE risk. Risk profiles for endocrinologic and coronary illness will be examined.

Results may guide future health interventions and will be used as a basis for adjustments to the current project.

No significant relationships.

Public Health England published a report in 2017 on Obesity in Secure Mental Health units. A key finding was that not only is obesity and overweight more prevalenr in the population detained within mental health secure units (reported rates of up to 80%) than in the general population (around 60%), patients appear to be more at risk of weight gain when they are detained.

1.To implement a traffic light system on food and confectionaries sold at the shop at a Medium secure hospital. 2. Provide healthier food options at the shop by using traffic light system as a visual aid 3. To achieve weight reduction and promote healthy life style choices in patients admitted to our medium secure Forensic unit

1.Buying a new till system which is able to quantify what type of food is sold 2.Labelling food sold using traffic light system 3. Calculate the types of food sold following a three- month period after implementation.

/Intended Outcome Traffic light system provides a visual aid to patients in choosing healthier food Patients in our medium secure unit achieve a reduction in their weight Traffic light system can be replicated/ adopted by other secure hospitals

The purpose of this research is to implement a traffic light system on food sold at a shop in our medium secure unit and that this will help improve food choices in the unit.

No significant relationships.

Secure forensic mental health services have a dual role, to treat mental disorder and reduce violent recidivism. Quality of life is a method of assessing an individual patients’ perception of their own life and is linked to personal recovery. Placement in secure forensic hospital settings should not be a barrier to achieving meaningful quality of life. The WHO-QuOL measure is a self-rated tool, internationally validated used to measure patients own perception of their quality of life.

This aim of this study was to assess self-reported quality of life in a complete National cohort of forensic in-patients, and ascertain the associations between quality of life and measures of violence risk, recovery and functioning.

This is a cross sectional study, set in Dundrum Hospital, the site of Ireland’s National Forensic Mental Health Service. It therefore includes a complete national cohort of forensic in-patients. The WHO-QuOL was offered to all 95 in-patients in Dundrum Hospital during December 2020 – January 2021, as was PANSS (Positive and Negative Symptoms for Schizophrenia Scale). During the study period the researchers collated the scores from HCR-20 (violence risk), therapeutic programme completion (DUNDRUM-3) and recovery (DUNDRUM-4). Data was gathered as part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST).

Lower scores on dynamic violence risk, better recovery and functioning scores were associated with higher self-rated quality of life.

The quality of life scale was meaningful in a secure forensic hospital setting. Further analysis will test relationships between symptoms, risk and protective factors and global function.

No significant relationships.

The state of knowledge from scientific literature will be presented from biologic perspective, psychopathology and social context in development of agression.

The aim of this presentation is to create a bio-psycho-socio model of agression.

The literature research in risk factors of aggressive behaviour was done, and the results grouped in three domains biologic, psychologic and social. A didactic bio-psycho-socio model was constructed.

The complex picture of aggressivity could be distorted if we reduce understanding to a narrow super-specialization perspective. This presentation enlarge approach with genetic, endocrine, neurologic, psychologic and sociologic perspective. All this data will be include in a schematic bio-psycho-socio model, and describe the application in mental health practice in understanding the patients with psychiatric disorder. The main result will be a Bio-psycho-social model of aggressive behavior, which could be helpful in understanding and predicting aggressive behavior.

Complex perspective of aggresive behaviour could help better understand and prevent aggresive behaviour

No significant relationships.

Mental health remains key comorbidity in the transgender population. There are more grave consequences on mental health if there is long-term incarceration history of a transgender person. 21% of transgender women are incarcerated in their lifetime, compared to <3% of the US general population. Incarcerated, transgender women are typically at risk for verbal, physical, and sexual assault that has been cross-sectionally linked to poor mental health in transgender patients. Childhood traumas and Adverse childhood experiences like sexual abuse may attribute to gender dysphoria as well as the externalizing and internalizing behaviors of the child in later part of life.

Better understand Gender Dysphoria and Incarceration.

A case report and review of the literature.

X is a 56-year-old transgender female, admitted for Major Depressive disorder with Psychotic features, and substance abuse disorder. She was disoriented to person place, or time, believing she was at the “Federal Penitentiary.” She was also selectively mute and socially isolative as well as unable to perform ADL’s. She has an extensive legal history, which started in 1985 when she burglarized a pharmacy store for estrogen. Patient was started on Sertraline, Mirtazapine, and Risperidone. She was still socially withdrawn but was soon oriented to person place, and time and was able to complete her daily tasks.

In this poster we discuss the challenges of managing an acute patient with extensive legal and substance abuse history, while also addressing the features of gender identity disorder and highlighting the difficult path of both the patient and physician in managing these challenges.

No significant relationships.

Secure forensic mental health services offer care and treatment to mentally disordered offenders, with high rates of schizophrenia and major mental illness in these groups. Much of the excess morbidity and mortality seen among patients with schizophrenia is due to cardiovascular disease and obesity. Sedentary behaviour is associated with negative symptoms of schizophrenia and obesity.

The aim of this study was to ascertain the level of sedentary behaviour among inpatients in a secure forensic psychiatric hospital, Dundrum, Ireland, using a structured self-report measure of sedentary behaviours, the SIT-Q tool.

A cross sectional study of self-reported sedentary behaviour was completed amongst the secure forensic inpatient population of Dundrum Hospital (N=94). Demographic details, details pertaining to diagnoses, ward level of dependency and length of stay were collated.

The majority of patients in the sample were male (89%) and the most common diagnosis was schizophrenia (71.7%). Mean age was 44.7 years (SD 11.42). 58.2% met criteria for obesity. We found high rates of self-reported sedentary behaviour across all wards of the service, with significantly high rates of sedentary behaviour being associated with screen time use in the hospital, including both personal screen time and therapeutic sessions based on screen time.

Sedentary behaviour among in-patients in secure forensic hospitals is a significant issue. Measuring sedentary behaviour in a systematic manner is possible and identifies a potentially modifiable target to reduce co-morbidity and pre-mature mortality independent of other risk factors in this vulnerable patient group.

No significant relationships.

Since the rates of female criminality are rising it would appear important to conduct the study of the relationship between criminal behaviour and psychiatric diagnoses in female offenders.

The main purpose of this investigation is to find out origins of crimes in women and to reveal the influence of child and adolescent maltreatment on personality disorders in adult women.

Clinical psychopathological, psychological, statistical.

A cohort of 13 females with diagnosis of personality disorders was examined. All of them had committed crimes of violence. In the majority of the sample women had a previous history of psychiatric admissions (child psychiatric hospitals, adolescent units). The retrospective review revealed that the majority of women in their childhood were exposed to emotional, physical and sexual abuse in their families. Our results point that maltreatment may distort personality formation and social adjustment and contribute to behaviour problems, negative relation to socialization and criminal behaviour in adulthood.

The study revealed that psychiatric disorders in childhood and adolescence are predictive of adult criminality in females and also revealed the risk of girls who are victims of maltreatment to become a perpetrator in adulthood. This findings may be used as prognostic indicators of development of aggression in female forensic patients.

No significant relationships.

Maladjustments and failures of programmable ventriculo-peritoneal shunts have been reported in patients encountering powerful electromagnetic fields, e. g. MRI.

We describe the case of a 53-year old man treated for hydrocephalus with a programmable Codman-Hakim shunt valve. During his hospitalization in Forensic Psychiatry, the patient’s valve pressure setting changed randomly despite frequent reprogramming and surveillance.

Maladjustments and failures of programmable ventriculo-peritoneal shunts have been reported in cases in which patients have encountered powerful electromagnetic fields, e.g., MRI. Through a case, this study shows easy maladjustment of a Codman-Hakim programmable valve also by small magnetic fields from everyday life.

A 53-year old man presented with periventricular hydrocephalus due to aqueductal stenosis. The patient was treated with a left ventriculo-peritoneal Codman-Hakim programmable shunt valve. During his hospitalization in Forensic Psychiatry, the patient’s valve pressure setting changed randomly, presumably by walking through electromagnetically controlled doors of a hospital ward. With a test dummy, changes in pressure settings were tracked.

Both - pressure settings of the patient’s Codman-Hakim programmable valve as well as pressure settings of a new valve - were unwantedly modified simply by walking through standard doors in a hospital ward.

Thus already weak magnetic fields (< 200 mT) might cause changes in the pressure settings of programmable shunt valves and therefore lead to maladjustment. Patients should be informed and pay attention to using everyday life’s devices, like rod magnets or mobile phones.

No significant relationships.

The estimation of the percentage of mentally ill among prisoners and of the most severe psychiatric disorders has been the subject of few studies in Tunisia.

To study in a general way the extent of psychiatric disorders among prisoners. To describe the socio-demographic and judicial characteristics of prisoners. To describe the clinical, evolutionary and therapeutic characteristics of the main psychiatric disorders.

This is a cross-sectional and descriptive study, carried out over a period of 4 months (February 2021-May 2021) on one hundred and twelve inmates of the civil prison of Mahdia followed in psychiatry. Data were collected using a pre-established questionnaire. It is made up of 30 items.

The prevalence of mental disorders in prison was 9.03%. The descriptive study revealed an average age of 37.57 years, a majority having a single marital status (62.5%), the professional activity before imprisonment were workers in 61.6%, a history of imprisonment more than twice in 62.5% of cases and 50.89% declared having been victims of physical acts, psychological or sexual abuse during their childhood. Murder, armed robbery, drug trafficking and rape were the most frequent offenses with respective rates of 25.2; 17.07; 13.82 and 9.75%. Anxiety was noted in 53.57% of cases, of the respondents, depressive syndrome was in 28.57% of cases, schizophrenia was reported in 18, 75% of cases and substance-related disorders were noted in 21.42% of cases.

Longitudinal studies should, in the coming years, try to understand the impact of imprisonment on the onset and evolution of psychiatric disorders.

No significant relationships.

In Romania, in accordance with current law, “the will is the unilateral, personal and revocable act by which a person named testator disposes, in one of the forms required by law, for the time when he will no longer be alive”. The increasing complexity of modern financial and family structures has led to an increase in testamentary disputes, a fact reflected by the large number of forensic examinations in civil cases.

Mental capacity are the majore concerns in the many of issues in elders but the great challenge is its retrospective evaluation, when the patient no longer exists. We focuse on the testator’s mental capacity at the time the will was written.

We present two cases of will contestation in post mortem, in which the testator’s age was 65, respectively 70 years at the time of executing the will.

In the first case the testator dies one month after he signed the will, the cause of death was cardiorespiratory arrest; cervical neoplasm; In the second case the testator dies two years after he signed the will. In both cases the patients did not have a history of neuropsychiatric disorders in the family doctor’s records. The circumstances of the production of a will, including the mental state of the testators and the true wishes of the testators were reconstructed using a psychiatric autopsy, based on the documents provided.

The complexity and subtlety of the problems reflected in these cases highlights the need to go beyond traditional criteria and assess situation-specific factors.

No significant relationships.

Sexual assault constitutes a major problem in Tunisian society. There is no definitive typology of the characteristics of those who sexually assault. The great diversity of sexual assault behaviors and the different underlying motivations do not allow us to describe a typical profile of the sexual assailant. There may be cognitive, personality trait, lifestyle, and pathway distortions involved in the etiology and maintenance of deviant sexual behaviors.

To establish the socio-demographic and clinical profile of the perpetrators of sexual assault appraised in the psychiatric service of Mahdia.

This is a descriptive retrospective file-based study on all subjects assessed at the Taher Sfar Mahdia psychiatric department for sexual assault during the period from January 01, 2010 to December 31, 2020.

Our sample consisted of 18 interviewed subjects. The median age was 40 years with extremes of age of the accused ranging from 30 to 61 years. The entire population is male. He was essentially of average socio-economic level. A psychiatric diagnosis was retained in 50% of the perpetrators of sexual assault: bipolar disorder (27.7%), schizophrenia (11.1%), antisocial type personality disorders (5.5%) and mental retardation (5.5%). Indecent assault was the most common assault followed by rape. The minors were victims in 33.3% of the cases Among those arrested, 72% were considered responsible for their acts and only one is considered irresponsible.

The studies having focused on the characteristics of the sexual aggressors concluded with a profile of the young man, single and badly inserted which does not constitute in any case a typical profile.

No significant relationships.

There is a current trend towards an increase in the number of elderly prisoners due to the increase in life expectancy and the change in the attitude of society and the judicial system. The cut-off for “older offender” is defined from the age of 50, due to the lifestyle previous to prision and premature ageing.

The authors intend to understand the challenges of aging in prison and forensic services, highlighting the psychiatric comorbidities of inmates and how these services can adapt to the needs of this population.

Non-systematic review of the literature.

Studies of elderly in prisons and elderly forensic psychiatric patients are limited. Prisoners have increased physical and psychiatric morbidity and early mortality as they are more exposed to risk factors and more likely to have at least one health problem compared to older adults in the community. Compared to older people in the community, older prisoners are at higher risk for most psychiatric disorders including depression, psychosis, bipolar disorder, cognitive impairment, personality disorder and anxiety. Suicide rates are also higher among elderly prisoners. The inadequacy of the prison system to respond to the unique needs of elderly prisoners has a detrimental impact on their overall experience of incarceration. The development of specific services for elderly prisoners or the adaptation of mixed units for the elderly population is proposed.

The elderly population in prisons is growing and has higher risk of psychiatric pathology compared to community elders. Prison services with difficulties in identifying and meeting these needs.

No significant relationships.