Some acts of murder are committed out of insanity by individuals suffering from psychotic mental disorders. According to the law in many countries, these individuals do not have criminal responsibility. They are defined as not guilty due to insanity and therefore cannot be punished.

This study aims to explore the sociodemographic, psychiatric, criminal and forensic characteristics/factors of insanity murders and murderers. This examination has not yet been conducted in Israel, which is a multicultural country with social, religious, ethnic complexity.

This study examined the hospital records (investigation material, indictments, admission summaries, and expert testimonies) of all 80 inpatients who had committed murder and been hospitalized in the maximum security unit from its opening in 1997 until 2021, and were found not guilty due to insanity.

Demographics characteristics (at the time of the offense). The participants were men ages 18-85 (M=36.11, SD=11.84). 58.8% were born in Israel, 21.3% immigrated from the former Soviet Union, 6.3% from Ethiopia, and 13.8% from other countries. The majority (82.5%) were Jewish, 16.4% were Arab. Most lived in urban centers (86.3%). Most were not married at the time of the offense: Single (62.5%), divorced (21.3%). Only a minority was married (16%).

Psychiatric characteristics. Most participants were diagnosed with schizophrenia (90%); had at least one hospitalization prior to the offense (70%), and had a previous hospitalization due to violence. Most of them were not compliant with psychiatric treatment and follow-up (only one participant was fully compliant). In most cases (74%) pre-murder deterioration was recorded.

Criminal characteristics. At least 52.5% had a criminal record prior to committing the offense (a higher number is possible, the information is based on the medical file only, there was no access to an official criminal record).

Murder/forensic characteristics. At least 48.8% there was no prior planning. In most cases (66.6%) the motive described was paranoid delusions and only in 5% there is command hallucinations. In most cases the murders took place in the home of the victim and/or the assailant (67.5%), one person was murdered (91%) and the victim was known to the assailant (88.8%), most of them a family member (61.3%). In at least 75% of the cases there was a brutal murder with multiple stabbings, use of multiple means/actions, abuse of the body or dismemberment. Following the murder, 58.3% of the assailants remained at the site of the crime and/or called for help, 27.4% left the site (no information for the remaining subjects).

The findings are consistent with existing knowledge and may assist in identifying at-risk populations, develop and implement relevant prevention programs as well as improving the therapeutic continuum from hospitalization to the community.

None Declared

The Council of Europe’s Model Mental Health Act places emphasis on the need for a ‘debriefing’ discussion with patients after incidents of restrictive practices to arrive at a common understanding concerning what happened and to consider future prevention strategies. For the patient, issues may arise that may be subjectively reinforcing or subjectively aversive and staff may feel that the incident has, or does not have, alienating consequences.

The aim of this study was to evaluate the consequences for the patient and for staff of incidents and use of subsequent restrictive practices, as a basis for future understanding of what debriefing might usefully include.

A prospective cohort study was completed whereby incidents were rated using the Dynamic Assessment of Situational Aggression (DASA) and DRILL tool ‘consequences’ scales in the Central Mental Hospital (CMH). The DRILL consequences scale consists of three ladders, ‘re-enforcing’, ‘aversive’ (both rated from the point of view of the patient) and ‘alienating’ (rated from the point of view of ward based staff). Data were gathered as part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST). An omnibus General Estimating Equations model (GEE) was tested with the DRILL ‘consequences’ as dependent prior to dismantling studies.

In this study, the 384 patient-days were in scope, 411 lines of data including 326 patient-days, 85 harmful incidents and 63 incidents of seclusion. In an omnibus GEE with the three-item DRILL consequences scale as dependent variable, DASA on the day before Wald X2=3065.9, p<0.001; DRILL behaviours scale Wald X2=970.7, p<0.001; DRILL interventions Wald X2=140,159.1, p<0.001; DUNDRUM-1 Wald X2=1638.9, p<0.001. The three items of the DRILL consequences scale were individually tested as dependent variables in GEE models with DASA the day before, DRILL behaviour scale, DUNDRUM-1 and each of the eight items of the DRILL interventions scale. Only increasing observation levels were not re-enforcing, with searches and seclusion strongly re-enforcing.

We have shown that consequences of harmful behaviours and preventive, restrictive interventions are measurable and proportionate for patients and for staff. Short-term risk on the day prior to an incident was able to predict the re-enforcing and aversive consequences for the patient, but not the alienating consequences – or lack of them – for staff. Future research will examine the way in which the baseline need for security mediates or moderates the relationship between incidents and patients and staff views of the consequences of incidents and restrictive practices.

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The world is increasingly burdened by complex, interwoven crises—economic, social, and political— and societies must examine and adapt their institutions to prevent and mitigate violence. Developing countries such as Serbia are transitioning from a history of conflict and face many difficulties in this regard. Lingering stigma around mental health, limited resources, and collective societal trauma complicate the task of responding to incidents of violence. One of these is the recent school shooting which has, on the one hand, highlighted deficiencies in early identification and intervention for at-risk adolescents, and has, on the other hand, pointed out the potential role of forensic psychiatry in transforming both prevention and post-crisis mediation.

The aim of this study will be to propose potential pathways to redefine the Serbian forensic psychiatric landscape, through delineating interdisciplinary interventions such as implementing community-based mental health education, expanding risk assessment protocols for youth, and providing prophylactic care for vulnerable populations.

Drawing on comparative data from international practices, this paper explores several potential culturally adapted forensic models, focusing on early intervention, trauma-informed care, and interdisciplinary collaboration.

The dialogue between forensics and restorative justice could help define models for facilitating community healing, as well as enabling accountability and rehabilitation for patients. This paper proposes that changes in forensic psychiatry might facilitate the development of evidence-based frameworks directed at reducing future violent incidents, if applied in an communal, distributed model which includes social workers and other persons of interest. These interventions would be crucial in aligning Serbia’s forensic practices with current socio-political dynamics, potentially fostering a more effective and scientifically informed approach to justice and rehabilitation.

Implementing a culturally adapted, interdisciplinary forensic psychiatric model in Serbia could provide a vital framework for violence prevention, community healing, and the integration of restorative justice practices.

None Declared

This study is probably the first study on stalking conducted in the Republic of Serbia.

The aim of this study was to examine the stalking experiences of a sample of persons who, according to the Court’s judgment, were in need of treatment.

This retrospective study was conducted from January 2020 until January 2024 and included 46 persons on the measure of treatment treated at the Clinic for Mental Disorders “Dr Laza Lazarević” in Belgrade. All obtained data were from their medical records and based on the judgment of the Court. The data were processed using SPSS version 21 to produce mainly descriptive and inferential statistics. Difference were considered statistically significant if p< 0.05.

The participantes were mean age 49.5 ±12.9 years, and most of them 41 (89.1%) were men. The stalker was in most cases a male, he was unemployed (65.2%), unmarried (91,3%), lived with his parents (67.4%) in the city (91.3%). Stalkers were most often diagnosed with F22 (23.9%) and F23 (23.9%). The stalker with the diagnosis F22 most often pursued the desired partner (33.3%) and the stalker with the diagnosis F23 a person from the social environment (33.3%). After the treatment measure is completed, the stalker often repeats the same act (12.83%).

Stalking remains a major problem and insufficiently tested that must be taken seriously. It is best to look at stalkers as a heterogeneous group whose behavior can be motivated by various psychiatric illnesses, predominantly psychoses.

None Declared

In forensic psychiatry, the most common diagnoses among the affected population are mood and psychotic disorders, personality disorders, or other conditions including intellectual disabilities. These individuals are either offenders or victims in criminal cases. Moreover, the tendency towards criminal behavior, disinhibition, agitation and aggression may also be associated with a neurocognitive disorder. Criminal behavior has been detected in 37.4% of frontotemporal dementia, 7.7% of Alzheimer’s disease, and 20% of Huntington’s disease patients.

Raising awareness on the potential presentations of disinhibited behaviors through three case reports and on the importance of detailed clinical evaluation to differentially diagnose and appropriately manage forensic referrals.

Each case was evaluated based on a predefined procedure comprising the anamnesis, mental status examination, review of previous medical and forensic records, neurological consultation including neuropsychiatric battery, social investigation and any other relevant information. Informed consent was obtained from all patients before presentation.

Case 1

A 63-year-old male, presented with a legal request of determining the need for a legal representative. The patient, who previously showed no similar behavior, repeatedly took loans under his own name, sold his assets at undervalued prices, experienced difficulties managing money, and was easily deceived. The patient was determined to exhibit frontal-type memory impairment, consistent with behavioral variant FTD (bvFTD), and it was deemed appropriate to appoint him a legal representative.

Case 2

A 52-year-old male, presented to assess his criminal responsibility regarding a theft offense. Anamnesis revealed forgetfulness, difficulties in managing money, tendency to take items from stores without paying, and repetitive behavior of cooking. Detailed examination and tests conducted led to a diagnosis of anxiety disorder, with a conclusion indicating full criminal responsibility.

Case 3

A 72-year-old male was hospitalized regarding an insult towards legal authorities. During the observation period in the inpatient ward, he exhibited similar behaviors. However, the final diagnosis was consistent with no significant psychopathology, and the patient was deemed criminally fully responsible for this act.

In cases where behavioral disturbances predominate, the possibility of frontal lobe dysfunction should be considered. Nevertheless, temporality relationships in symptomatology and the course of the disease, as well as where, when, and how the criminal act happened should also be taken into account. Cases which have similar initial presentations may finally lead to unrelated diagnoses. Systematic evaluations are necessary to accurately guide the legal authorities as well as planning treatment.

None Declared

There is a scarcity of research on the application of EMDR in addressing PTSD within correctional facilities, presenting varied results due to the difficulties associated with prolonged imprisonment. Prisoners encounter persistent mental health conditions such as depression, trauma, PTSD, and substance use disorders, contributing to maladaptive behaviors within the aggressive and psychologically taxing prison environment. Racial tensions and the pressure to conceal emotions further complicate matters, affecting daily life within the prison setting.

To conduct a systematic review, following PRISMA guidelines, to assess the efficacy and evidence supporting the use of Eye Movement Desensitization and Reprocessing (EMDR) therapy for Posttraumatic Stress Disorder (PTSD) within forensic settings, in order to address the limited research available and provide insights into the outcomes and challenges related to treating PTSD in incarcerated individuals.

A review of 11 studies meeting the inclusion criteria was conducted. The study involved 156 incarcerated participants with a median age of 36.9 years, examining gender-based differences in reported trauma experiences and evaluating the effectiveness of EMDR therapy for PTSD in forensic environments. Primary assessment tools included PCL-C and CAPS scores for pre- and post-therapy evaluations. The timing of the initial EMDR session post-incarceration and symptomatic improvements over sessions were analyzed.

Analysis of the study revealed significant improvements in symptoms over an average of six EMDR sessions, with no reported adverse events during therapy. The study highlighted the challenges and outcomes of implementing EMDR therapy for PTSD in correctional settings, shedding light on the effectiveness of the treatment among incarcerated individuals.

Despite positive initial results, it is vital to approach the interpretation of the benefits of EMDR therapy with caution, given factors such as the absence of standardized clinical trials, variability in reported outcomes, and the potential for study bias. Recognizing the need for additional investigation, further exploration is warranted to understand the lasting effects of EMDR therapy on recidivism rates, taking into account variables like the nature of the offense, length of incarceration, and frequency of reoffending.

None Declared

Although criminal behavior is not expected in the elderly, especially those diagnosed with dementia, it is important to keep in mind the potential forensic significance of dementia. Also it is especially important to focus attention on the participation of people with dementia in the legal process, given that their cognitive impairments may impair their ability to participate in the judicial process, as well as their capacity to protect their rights and interests.

The aim of the study is to provide an overview of the forensic meaning of dementia and the assessment of persons with a diagnosis of dementia in a legal context.

For the purpose of the research, a review of relevant studies in the PubMed database was performed, related to the field of forensic psychiatry of offenders diagnosed with dementia and criminal behavior of the elderly.

During the forensic assessment of people with dementia, it is important to assess their cognitive impairment, for which purpose various psychological tests and diagnostic processing are applied in addition to diagnosing other comorbid diagnoses, especially depression or the existence of a psychotic disorder. In dementia, an important criminogenic factor can be the use of alcohol, along with the potential for committing violent crimes.

Depending on the severity of cognitive impairment and the existence of psychotic symptoms or a delirious state, the legal capacity of people with dementia can be significantly impaired. It is important to assess the need for security measures of psychiatric treatment, as well as the possibility of participating in the court process with regard to cognitive impairment. It is also necessary to pay attention to the protection of the rights and interests of people with dementia, as well as the ability to reason.

None Declared

There is growing awareness of the need for Police Officers to develop skills to assist those who have Autism. The development of skills is essential for a positive outcome, be it managing an emergency call out, making an arrest or interviewing a victim of crime. This is being championed by the development of co-responder teams which consist of a Police Officer and a Mental Health Professional who are dedicated to responding to emergency calls that may have a mental health component. These teams report a high rate of call outs involving those with Autism and frequently request further training in the area.

To develop a training pilot study in Ireland which could be expanded to an international cohort of Police Officers and co-responder teams in the United States.

We were invited to train a small group of Irish Police Officers. We used the opportunity to obtain feedback which we then used to identify common training needs and used to improve the presentation. This was then delivered to the Framingham Police, Boston, USA and a group of co responder trainees. Feedback was again sought and used to improve the presentation to better address the needs of the group. A presentation was delivered to a conference for those who co-ordinate co-responder teams in Law Enforcement, Universities and Colleges in the United States and feedback sought.

In the initial training to Irish Police Officers, feedback demonstrated improvement with significant p-values in all domains examined with questions e.g. ‘I understand the common difficulties those with Autism experience’ and ‘This training will help me in my day to day work’. The feedback from the conference demonstrated significant interest and engagement in the training with questions e.g. ‘The program maintained my interest’ and ‘The presenters responded to the questions and needs of the attendees’.

There is growing recognition of the need for Police Officers to have the skills to recognise, communicate with and support those with Autism. Our program has demonstrated a need and interest of Police Officers and co-responder teams for training in this area. We have also demonstrated effectiveness of the training using feedback from the attendees.

None Declared

Outpatient compulsory observation and treatment by a psychiatrist (OCOTP) is, according to Russian Law, a coercive measure of medical nature. It was put into effect in 1997 and may be assigned by the court to persons suffering from mental disorders who have committed criminal offenses. Forensic psychiatric examination is a mandatory condition for the court to make a decision.

To provide an overview of (1) the purposes of OCOTP, (2) the differences between OCOTP and outpatient mandatory psychiatric treatment, (3) the basis for judicial decisions to order and terminate OCOTP, the duration of OCOTP, and its effectiveness.

An analysis of scientific publications and professional literature on the topic and my own practical experience as a forensic psychiatrist who recommended such a measure to the court, and the treating psychiatrist who carried it out in a mental institution.

OCOTP may be imposed by the court (1) in relation to defendants found NGRI, who committed socially dangerous acts primarily in a state of “temporary mental disorder”, (2) following completion of compulsory inpatient treatment of an insane person, (3) as a preventive measure in conjunction with punishment when the offender is found guilty but has a mental disorder that can be treated on an outpatient basis. OCOTP is ordered for an indeterminate period, and the court considers its extension or termination annually.

OCOTP is an evolving concept and the topic of discussion in professional literature.

None Declared

Patients with schizophrenia often require civil capacity assessments when participating in civil activities. The primary focus of the assessment involves evaluating patients’ understanding of the issues at hand, their awareness of potential choices and the corresponding outcomes, and their ability to make decisions after considering the advantages and disadvantages. As such, the ability to make decisions is the fundamental neuropsychological mechanism underlying civil activities.

This study systematically reviewed existing research on decision-making ability in patients with schizophrenia.

Both major international and Chinese databases were systematically searched. Relevant studies were summarized in aspects of the assessment, neuropsychological mechanisms, and neurobiological mechanisms of decision-making ability in patients with schizophrenia.

1. 1. The most frequently employed experimental paradigms in studies focusing on economic decision-making include the Iowa Gambling Task (IGT) and the Game of Dice Task (GDT). Patients with schizophrenia performed significantly worse on the IGT compared to healthy individuals, often overestimating immediate gains and losses while failing to learn from the frequency of wins. There are relatively few studies utilizing the GDT, and the findings are inconsistent across studies.

2. 2. Cognitive domains related to the decision-making ability in patients with schizophrenia could be executive function, verbal memory, and working memory. Psychiatric symptoms related to the decision-making ability include diminished motivation, lack of interest, depressive symptoms, and negative symptoms. Moreover, emotion plays a critical role in decision-making behaviors. Decision-making ability can also be influenced by medication and the overall severity of the illness; however, some studies found no association between decision-making ability and psychiatric symptoms, the illness stage, or medication usage.

3. 3. Imaging studies consistently indicate that the prefrontal cortex is a critical brain region associated with decision-making abilities. Brain areas such as the orbitofrontal and ventromedial prefrontal cortex, amygdala, frontoparietal cortex, medial prefrontal cortex, dorsomedial prefrontal cortex, bilateral thalamus, and the left dorsal anterior cingulate cortex may play a role in decision-making processes in patients with schizophrenia. Nonetheless, some research found no association between decision-making ability and the functioning of the dorsomedial prefrontal cortex.

Deeply exploring the neuropsychological and neurophysiological mechanisms behind decision-making ability can help the understanding of the decision-making behavior of patients with schizophrenia in civil activities and can benefit forensic evaluation of civil capacity.

None Declared

Quetiapine is a serotonin-dopamine antagonist widely used for the treatment of bipolar disorder and schizophrenia. Patients with bipolar disorder and schizophrenia are also at high risk of drug abuse. Illicit substances are often traced in such patients during manic and psychotic episodes. Urine drug tests are commonly used to detect illicit substance use during hospital admissions.

We report a case of an adult male patient treated with 600mg o.d. quetiapine who falsely tested positive for tricyclic antidepressants in a routine urine drug test

A male patient with a prior history of alcohol, cannabis and cocaine abuse acutely developed psychotic-like symptoms (persecutory delusions, psychomotor retardation, social withdrawal) and attempted to commit suicide. He was admitted to our psychiatric hospital, and he denied illicit drug use during the last 5 months.

The patient was treated with quetiapine monotherapy, progressively titrated up to 600mg o.d. As a routine procedure and because of his personal history of drug abuse, he has been subjected to a urine drug test, which revealed positive results for tricyclic antidepressants. Due to uncertainty whether he abused tricyclic antidepressants prior to this admission, a second test was ordered after two weeks of quetiapine monotherapy and close inpatient monitoring, which was also positive for tricyclic antidepressants.

Quetiapine has a three-ringed chemical structure which shares similarities with tricyclic antidepressants. in vitro tests proved cross-reactivity of quetiapine and tricyclic antidepressants with some commercially available immunoassays. However it is not clear if the cross-reactivity is due to quetiapine or its active metabolites. In any case, the interpretation of a urine test positive for tricyclic antidepressants should take into account the possibility of such cross-reactivity with quetiapine, especially in cases of suspected drug overdose when the urine test is used to deduct the possible offending drug. Moreover, this cross-reactivity might be eploited in cases of suspected non-adherence to quetiapine treatment.

None Declared

Carbohydrate-Deficient Transferrin (CDT), a biomarker for excessive alcohol consumption, has been used in driver’s license regranting programs in the UK and other European countries, but relevant data is lacking in Taiwan. This study collected %CDT data from repeat drunk driving offenders to monitor their alcohol consumption and aims to provide local data to inform policies in Taiwan.

The objective of this study is to assess whether alcohol consumption decreases over a 12-month period, as measured by %CDT values and Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) scores.

Study Design

This study was conducted from 2020 to 2023, involving 65 recidivist drunk drivers whose licenses had been revoked and who sought to reapply. Participants were referred to our hospital for a one-year, monthly evaluation and intervention program. Data were collected on gender, age, marital status, education level, employment status, years of alcohol consumption, primary type of alcohol consumed, DSM-5 severity, AUDIT, and AUDIT-C scores. Blood tests, including GGT, AST, ALT, triglycerides, cholesterol, and %CDT, along with AUDIT-C assessments, were conducted at the 1st, 4th, 7th, and 11th evaluations.

Basic demographic information is shown in Image 1. There was no significant difference in %CDT before and after the intervention (p = 0.332), with values of 1.99% and 2.28%, respectively. Among 42 participants who completed the 12-month intervention, %CDT showed no significant change (p = 0.46; 1.93% vs. 1.83%). For 23 participants who did not complete the intervention, %CDT also showed no significant difference (p = 0.219; 2.11% vs. 3.14%).

However, AUDIT-C scores significantly decreased across all groups. The total group’s scores dropped from 4.51 to 3.20 (p = 0.00091), the completion group from 4.00 to 2.60 (p = 0.011), and the non-completion group from 5.43 to 4.30 (p = 0.025). These results are shown in Image 2, and the correlations between baseline variables are displayed in Image 3.

Image 1:

Image 2:

Image 3:

Our study found that monitoring drunk-driving recidivists with %CDT every three months did not yield a statistically significant change in %CDT, but did result in a significant reduction in AUDIT-C scores. Fleming et al. (2004) suggest that psychological pressure from long-term biomarker monitoring may have a therapeutic effect, with bimonthly CDT follow-ups potentially beneficial. Thus, using %CDT for license reinstatement is feasible, though adjustments to assessment intervals and inclusion of other biomarkers should be considered.

Fleming et al., Alcohol Clin Exp Res 2004; 28: 1347–55.

None Declared

Two high security Forensic Psychiatric Centers (FPC) were implemented in the last decade in Flanders (FPC Ghent and FPC Antwerp). FPCs provide court[1]ordered treatment for forensic psychiatric patients (called “internees”) that have committed a criminal offense related to their psychiatric disorder and who are at a high risk for recidivating.

Treatment is often mandatory and lengthy, and per[1]sonal rights are highly restricted, which has an impact on treatment motivation and overall patient wellbeing (Lutz et al., 2022). While the Risk Need Responsivity (RNR) model - which focuses on risk reduction – was and still is the prominent model for offender rehabili[1]tation, other aspects are currently given more atten[1]tion. This includes the Good Lives Model (GLM) and the recovery movement, that aim at improving the achievement of skills necessary to maintain a good live and give meaning and value in one’s existence (Lutz et al., 2022).

Data collection and statistical analyses The descriptive analyses of categorical and continuous variables was done using SPSS version 28. Valid per[1]centages were given. Assumption testing was per[1]formed and found that the data were not eligible for parametric examination. The significance level was set at .05.

Weight and BMI At the initial measurement, the mean weight was 89.3 kg (SD ¼ 21.64, range ¼ 46–222 kg). The mean weight at second measurement was 92.6 kg, with a standard deviation of 21.90 and a range of 46.6–185.6. The second weight measurement occurred 812.2 days or 2.2 years (SD ¼ 552.39, range ¼ 7–3084 days) after the initial measurement. The weight difference between the two measurements ranged from a weight loss of 53.8 kg to a weight gain of 51.6 kg and showed a mean weight increase of 2.2 kg (SD ¼ 10.41)1

The overall conclusion of the study is that obesity, MetS, smoking, as well as substance misuse are highly prevalent among our high security population. These are all risk factors associated with somatic morbidity and mortality. Our study showed that obesity and MetS were found across psychiatric diagnoses and the presence of metabolic syndrome was not limited to the use of SGA.

None Declared

While gambling problems are increasingly recognized as a public health concern, knowledge of the prevalence and impact within psychosocially vulnerable populations is scarce. Never before has the prevalence of gambling problems been studied in a forensic psychiatric patient population. Given the risk for gambling problems to exacerbate existing mental health conditions, cause financial strain, and contribute to criminal behavior, understanding its prevalence and associated factors within this population is critical.

The study aims to estimate the prevalence of gambling behavior and gambling problems among forensic psychiatric patients in Denmark and compare the results to the general Danish population. Additionally, the study seeks to identify associations between psychosocial and demographic variables and the occurrence and severity of gambling problems. Lastly, the study will explore gambling motives and their relation to gambling problems in this patient population.

This observational, cross-sectional study will include inpatients and outpatients in Central Denmark Region forensic psychiatric care and inpatients in Capital Denmark Region forensic psychiatric wards from June 1 to December 31, 2024. Participants must be 18, and speak Danish, English, or Greenlandic. Data will be collected via self-report questionnaires and electronic patient records. Key measures include gambling behavior (past year gambling, frequency, and expenditure), gambling problems (the Problem Gambling Severity Index), and gambling motives (the Gambling Motives Questionnaire-Financial).

Data collection ends by December 31, 2024; preliminary findings will be presented at the conference.

Results will provide valuable insights into the prevalence and characteristics of gambling problems in this population, informing clinical care and potentially guiding the development of targeted interventions. By highlighting the need for attention to gambling issues in forensic psychiatric settings, the study may enhance rehabilitation and recovery efforts and successful discharge by addressing potential risk factors for recidivism.

None Declared

Participatory research can enhance the relevance, quality, and impact of studies, increase recruitment, and optimize research methods. It can also help to secure third-party funding,. The participatory inclusion of forensic psychiatric patients in research has so far primarily been implemented in the UK. With the establishment of the PART advisory board, founded in December 2023, this gap is intended to be closed in Germany by creating sustainable, previously lacking structures for the involvement of forensic psychiatric patients. The acronym PART refers to participation/ participatory. In the PART advisory board, people with lived experience and researchers actively cooperate in projects in the field of forensic psychiatry. In preparation for their role, people with lived experience received training where they were provided with knowledge and skills for their work. The board has now advised several research projects and issued recommendations.

The purpose of this presentation is to critically reflect on the first experiences and consider how to incorporate these insights to improve the structure and working methods of the advisory board: What experiences have researchers, people with lived experience and those presenting their research projects made? How were participants involved? What impact did the advisory board have on specific research projects? What challenges arose, and how were they addressed? What are the lessons learned so far?

To answer these questions, various evaluation tools were used. These include feedback questionnaires from participants assessing each advisory board meeting and project presentation, interviews with participants at least two times throughout the project, statements from the advisory board to project presenters, and responses from the presenters on how the board’s recommendations were implemented. Additionally, the perspectives of involved project staff were considered.

By the time interim results are presented at the EPA Congress 2025, the PART Forensic Advisory Board will have met at least 12 times and at least five research projects will have been presented to the board and received its recommendations. It has already become clear that involving participants, especially in forensic psychiatric settings, requires specific framework conditions. These address overarching structural aspects, disease specific patient relevant needs, as well as knowledge- and method-based issues relevant to participants.

Even at this stage, the advisory board can be considered successfully implemented. Participatory research with people with lived experience in forensic psychiatric settings is possible, feasible, and above all, meaningful.

None Declared

Borderline personality disorder (BPD) is common in incarcerated persons. Psychiatric medications are prescribed in prisons for the treatment of psychiatric illnesses, but also for the reductions of symptomes triggered by the specific conditions and environment. The use of psychotropic medications in incarcerated persons is beneficial in terms of prevention of aggression and violent outbursts. Clozapine, as the most effective antipsychotic for aggressive and violent behavior could be very useful in forensic population, but is avoided due to adverse effects and the need for regular monitoring (Cekerinac et al. IJOPH 2024).

The objective of this reserch is to analyze the use of clozapine among incarcerated persons with BPD, and to evaluate the incidence of adverse effects.

A cross-sectional, epidemiological survey was used to measure the prevalence of antipsychotic prescribing among adult prisoners in Sremska Mitrovica Prison (Serbia) in 2020.

Of 1280 incarerated persons, (all men, average age 36.3 years), 80 (6.25%) were prescribed an antipsychotic. More than a half (N=44) were prescribed clozapine, but in doses lower than recommended for approved indications. None of them had an approved indication for clozapine, so this can be defined as off-label use. The average dose of clozapine was 51.14 mg/day, while the recommended maintenance dose is 300–450 mg/day. The other commonly used antipsychotic in this population was olanzapine (N=30). No cases of elevated white blood cells count were noted during regular monitoring. For the broader purpose of the study, metabolic parameters were assessed for the users of both antipsychotics, BMI, plasma glucose levels, plasma cholesterol levels and plasma triglyceride levels. Only the mean values of the levels of glucose and triglycerides in the plasma were slghtly elevated compared to the referent values of the Prison Hospital (Table 1.).

Table 1. Metabolic parameters in inmates prescribed olanzapine and clozapine vs. inmates who were prescribed metabolically inert antipsychotics

We justify the off-label use of clozapine in prison settings due its benefits in reducing violence and aggression; however, further research would be necessary to clarify does the use of clozapine in incarcerated persons cause behavioral improvements that could reduce recidivism and improve post-imprisonment outcomes. The prevalence of adverse effects is rare; however, that is possibly due to low doses of the prescribed antipsychotics and specific prison settings in terms of dietary options and physical activity, as well as the average young age of the inmates.

None Declared

Bioethics is a discipline based on ethical principles aimed at guiding healthcare practice. Four fundamental principles are defined: autonomy, non-maleficence, beneficence, and justice. The first of these is autonomy, which expresses the ability of each individual to make decisions regarding their own health.

This case presents a 47-year-old male patient diagnosed with schizophrenia, legally incapacitated and under guardianship by a Foundation. He has no awareness of his illness, is on pharmacological treatment in a controlled environment, and does not cooperate for testing or procedures. He has been involuntarily admitted to the Psychiatry Unit since 2022, awaiting transfer to a residential facility.

In recent months, the patient has exhibited dysphagia and constitutional syndrome. A tumor suspicious for malignant oropharyngeal neoplasm is identified. He is informed in simple terms, in the presence of his legal guardians, that he has a tumor with malignant characteristics, which will grow over time, eventually blocking his airway and leading to death. Testing is necessary to reach a diagnosis and propose treatment.

The patient repeatedly and firmly expresses his desire not to undergo any tests or treatment. In coordination with the Psychiatry and Otorhinolaryngology services, and in consultation with the Bioethics Committee, it is decided to respect the patient’s autonomy and his decision to refuse tests or invasive procedures. At all times, comfort measures and pain management are provided.

Autonomy is the ability to have control over one’s own life. Every person has the right to make decisions about their health. Mental impairments can alter a person’s autonomy, as they hinder the conscious process of decision-making.

The dignity of the person plays a key role in the protection of life, physical and psychological integrity, and the freedom of individuals with mental disorders.

None Declared

Physical restraint in psychiatry is a widely used practice intended to protect patients from harming themselves or others, guided by strict procedures and monitoring. Recent reports and legal updates aim to regulate its use more closely

This study assesses the extent of physical restraint use and explores healthcare workers’ perceptions and experiences regarding this practice, focusing on ethical issues.

Between April and May 2024, we conducted a cross-sectional descriptive study involving healthcare staff from psychiatry departments across Tunisia, including hospitals in Sousse, Monastir, Kairouan, Mahdia, Sfax, and Tunis. Participants were surveyed using a literature-based questionnaire, and data were analyzed with SPSS21 software.

The study included 16 men (28%) and 43 women (72%), predominantly aged 20-30 years (72%), with most participants from Kairouan (52%). Sixty-four percent of staff viewed physical restraint as a therapeutic tool. Opinions on its impact on the therapeutic alliance and physical integrity were mixed, with 33% considering it dehumanizing. The most common emotions reported were fear (58%) and pity (39%), while anxiety was the least reported (9%). Coping strategies included rationalization (63%) and discussing experiences with colleagues. Sixty-six percent of staff reported encountering ethical dilemmas, with varying frequencies. Views on patient consent were divided, with 42% opposing seeking consent, and differing opinions on obtaining consent from patients with good insight or in relapse.

The study reveals diverse and complex attitudes towards physical restraint in psychiatry. It underscores the need for continuous training, ethical reflection, and efforts to align practices with ethical standards to mitigate negative impacts on staff.

None Declared

People with mental illness often experience stigma and discrimination, which can reduce treatment outcomes and quality of life. Numerous studies have shown that stigmatizing attitudes among physicians negatively affect both psychiatric and somatic care. Recently, technological advancements have led to the emergence of digital medicine as a new avenue for health care. However, little is known about how stigmatizing attitudes toward patients with mental illness might impact clinical decisions in the context of digital medicine

This study aims to assess how implicit and explicit stigma against mental illness among medical students and general practitioners affects their decision for recommending treatment through a digital mHealth app.

A total of 62 general practitioners and 60 medical students participated in the anonymous online survey. After providing demographic information, participants reviewed two case vignettes: one depicting a patient with a comorbid mental and somatic illness, and the other depicting a patient with only a somatic illness. Participants rated, on a scale from 1 to 10, the likelihood of prescribing an mHealth app designed to enhance treatment of the somatic disease. The Social Distance Scale (SDS) and the Implicit Association Test (IAT) were used to measure explicit and implicit stigma, respectively. The IAT is a computer-based task that assesses implicit bias regarding the perceived incompetence associated with psychiatric disorders compared to somatic disorders.

On average, participants were more likely to prescribe an mHealth app for patients with only a somatic illness than for patients with both somatic and comorbid mental illness (p < .001). Furthermore, implicit stigma was a significant predictor of participants’ preference to treat patients with somatic over mental disorders (p = .013). There were no group differences in the IAT score.

Our findings indicate a bias against people with mental illness among both medical students and physicians, even within the context of digital medicine. Future research is needed to further examine the scope and impact of stigmatizing attitudes on patient health care outcome.

I. Papazova: None Declared, N. Hartmann: None Declared, J. Grimmer: None Declared, A. Hasan Consultant of: Rovi, Recordati, Otsuka, Lundbeck, AbbVie, Teva and Janssen-Cilag, Speakers bureau of: Janssen-Cilag, Otsuka, Recordati, Rovi, Boerhinger-Ingelheim and Lundbeck, N. Khorikian-Ghazari: None Declared

Diagnostic overshadowing, or the tendency to attribute physical symptoms to mental illness, poses a significant risk to psychiatric patients, significantly delaying diagnostic and treatment possibilities. This case study highlights the potentially life-threatening consequences of dismissing physical complaints in patients with a history of mental health disorders.

To examine the impact of diagnostic overshadowing on patient care and outcomes, emphasizing the need for comprehensive, unbiased medical assessment, regardless of psychiatric history.

We present the case of a 72-year-old female patient with an extensive history of multiple psychiatric admissions, primarily for somatization and depressive episodes. The patient’s journey began with an initial admission in our psychiatric service. However, her condition rapidly degenerated, as she developed chest pain, leg numbness, and digestive issues. These symptoms were initially attributed to her psychiatric conditions by the internal medicine team, leading to a critical delay in appropriate medical intervention.

As a consequence, the patient’s condition deteriorated rapidly, culminating in a severe septic state. Further investigation revealed that the sepsis had a pulmonary origin, with Serratia marcescens identified as the causative pathogen. This underscores the potential for seemingly benign symptoms to mask serious underlying infections in vulnerable populations. The patient’s case was further complicated by the emergence of several severe medical conditions, including toxic hepatitis, cardiomyopathy, and valvular insufficiencies, highlighting the potential for cascading health issues when initial symptoms are not thoroughly investigated. In the course of treatment, the patient experienced additional complications arising from medical interventions, most notably drug-induced hepatotoxicity, serving as a reminder of the delicate balance required in managing complex cases and the potential for treatment-related adverse events to further complicate patient care.

This case study underscores the critical importance of conducting thorough and unbiased medical evaluations in psychiatric settings, or in cases where psychiatric history is present. It vividly demonstrates how preconceived notions and unconscious biases regarding psychiatric patients can lead to delayed diagnosis and treatment of serious medical conditions, potentially resulting in life-threatening consequences. The case serves as a wake-up call for healthcare providers to approach each patient with an open mind, regardless of their psychiatric comorbidities.

None Declared