Italian Evaluation and Excellence in REMS (ITAL-EE-REMS): appropriate placement of forensic patients in REMS forensic facilities.

Background: We set out to assess the appropriateness of current placement of mentally disordered offenders allocated by the courts in Italy to REMS or to forensic community residences. We hypothesised that as in other countries, the match between a standardised assessment and the decision of the court would be imperfect.

Methods: The DUNDRUM Toolkit was translated into Italian.

Transfer to community and prison mental health care from Ireland's main remand prison over three years: 2015-2017.

Background: The post-release period is associated with an increased risk of morbidity and mortality. Previous studies have identified deficits in pre-release planning for mentally ill people in prison, particularly in remand settings.

Objectives: We aimed to determine the proportion of mentally ill people in Ireland's main remand prison who were referred for mental health follow up in community and prison settings, who achieved face to face contact with the receiving service.

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: Nurses' observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion.

Excellence in forensic psychiatry services: international survey of qualities and correlates.

Background: Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development.

Positive and negative syndrome scale in forensic patients with schizophrenia spectrum disorders: a systematic review and meta-analysis.

Among forensic patients with schizophrenia spectrum disorders, the association between symptomatology and violence is still not entirely clear in literature, especially because symptoms shift both during the acute phase of the illness and after. The aims were to investigate the level of symptomatology in forensic patients and to evaluate if there are differences in the level of symptoms between forensic and non-forensic patients. According to PRISMA guidelines, a systematic search was performed in PubMed, Web of Science, and ProQuest, using the following key words: "forensic" AND "Positive and Negative Syndrome Scale" OR "PANSS".

Reform of Forensic Mental Health Services in Italy: Stigma and Blaming the Messenger: Hermenoia.

About 40 years after the reforms leading to the closure of psychiatric hospitals (Ospedale Psichiatrico [OP]) in Italy in favor of a widespread model with a strong rehabilitation emphasis, Italy has chosen to close High Security Hospitals as well (Ospedale Psichiatrico Giudiziario [OPG]). The new forensic treatment model is expected to be more respectful of the person, including the perpetrators of violent crimes, and aims to be less stigmatizing and more rehabilitative. Despite the favorable premises of the reform (Law n.

Online video games and patient-staff power relations. A qualitative study of care and custody in forensic psychiatry.

WHAT IS KNOWN ON THE SUBJECT?: Frontline forensic mental health staff often face challenges when providing recovery-orientated care, as they must balance between caring for the forensic psychiatric patient and at the same time ensuring safety and security for all other patients and staff at the ward. Research shows that balancing between care and custody in everyday clinical practice is possible, but more practical nursing studies showing ways of balancing power relations are needed to guide clinical practice. Online video games are increasingly recognized as promising new tools to promote social relations, establish competencies and re-articulate power relations in therapeutic environments.

Psychiatric court reports and diversion outcomes in a remand prison over three years.

Objectives: There has been a notable increase in requests for psychiatric reports from District Courts for persons remanded to Ireland's main remand prison, Cloverhill. We aimed to identify if reports were prepared for persons with severe mental illness and if they led to therapeutic benefits such as diversion to healthcare. Measures of equitability between Cloverhill and other District Courts were explored.

Is non-completion of treatment related to security need?

Background: Treatment completion difficulties are common in forensic mental health settings and may have a profound impact on recidivism rates.

Aims: To test for associations between measures of risk and of security needs on the one hand and treatment non-completion on the other among male offender-patients in one medium security hospital.

Methods: We conducted a retrospective file study in a Flemish medium security hospital.

SafePsych: improving patient safety by delivering high-impact simulation training on rare and complex scenarios in psychiatry.

Introduction: Despite an evidence base demonstrating simulation to be an effective medical education tool, it is not commonly used in postgraduate psychiatry training as it is in other medical specialties.

Objective: This paper outlines the development and effectiveness of a hybrid-virtual simulation-based workshop designed to improve patient care by improving clinical skills of non-consultant hospital doctors (NCHDs) in detecting and managing rare and complex psychiatric emergencies.

Methods: Three clinical vignettes based on near-miss psychiatric cases were developed by a multidisciplinary team of physicians and nurses in psychiatry and experts in simulation-based medical education.

Women and men of mafia between traditional cultural contexts and new social roles.

The Italian mafia organizations represent a subculture with values, beliefs, and goals that are antithetical to and undermining of the predominant society. The conduct of individual members includes such extreme violence for material gain, it may at least superficially suggest a severe personality disorder. Since the first edition of the DSM and into the 21st century, various terms have been used, sometimes interchangeably, but over time inconsistently, to designate the mentality and practices of mafia members.

The neurology-psychiatry interface in epilepsy.

Epilepsy and mental illness have a bidirectional association. Psychiatrists are likely to encounter epilepsy as comorbidity. Seizures may present as mental illness.

Risk of adverse outcome of COVID-19 among patients in secure psychiatric services: observational cohort study.

Background: Secure forensic mental health services treat patients with high rates of treatment-resistant psychoses. High rates of obesity and medical comorbidities are common. Population-based studies have identified high-risk groups in the event of SARS-CoV-2 infection, including those with problems such as obesity, lung disease and immune-compromising conditions.

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders).

Background: Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure hospitals to assess necessity and proportionality between imminent violence and restrictive practices including de-escalation, seclusion, restraint, forced medication and others.

Forensic psychiatry and Covid-19: accelerating transformation in forensic psychiatry.

Swift medically led scientifically informed responses to the Covid-19 epidemic nationally have been demonstrably superior to other, non-scientific approaches. In forensic psychiatry and across all psychiatric services, urgent and clinically led responses have underlined redundancies and confusions in the governance of mental health services and a vacuum in policy makers. For the future, a greater emphasis on services for patients with schizophrenia and other severe, enduring mental disorders must aim at reducing standardised mortality ratios, managing risk of violence and improving hard outcomes such as symptomatic remission, functional recovery and forensic recovery of autonomy.

Moral cognition, the missing link between psychotic symptoms and acts of violence: a cross-sectional national forensic cohort study.

Background: People with schizophrenia are ten times more likely to commit homicide than a member of the general population. The relationship between symptoms of schizophrenia and acts of violence is unclear. There has also been limited research on what determines the seriousness and form of violence, such as reactive or instrumental violence.

Gender, diagnosis and involuntary psychiatry admission in Ireland: A report from the Dublin Involuntary Admission Study (DIAS).

Involuntary admission and treatment are common, long-standing features of psychiatry but the relationships between gender, diagnosis and other features of involuntary treatment are not clear. We studied all voluntary and involuntary psychiatry admissions at Tallaght University Hospital, Dublin over 2 years (n = 1230). Admission rates in Tallaght were lower than national rates for all admissions (224.

Perspective On Excellence in Forensic Mental Health Services: What We Can Learn From Oncology and Other Medical Services.

We propose that excellence in forensic and other mental health services can be recognized by the abilities necessary to conduct randomized controlled trials (RCTs) and equivalent forms of rigorous quantitative research to continuously improve the outcomes of treatment as usual (TAU). Forensic mental health services (FMHSs) are growing, are high cost, and increasingly provide the main access route to more intensive, organized, and sustained pathways through care and treatment. A patient newly diagnosed with a cancer can expect to be enrolled in RCTs comparing innovations with the current best TAU.

Clozapine-induced interstitial nephritis in a patient with schizoaffective disorder in the forensic setting: a case report and review of the literature.

We present a rare case of Acute Interstitial Nephritis (AIN) that occurred following a re-trial of clozapine in a 56-year-old lady with schizoaffective disorder. On initial trial of clozapine, this patient felt generally unwell with respiratory symptoms. Her inflammatory markers were raised and her renal function showed a mild, transient deterioration which normalised on the day of cessation of clozapine.

Structured versus unstructured judgment: DUNDRUM-1 compared to court decisions.

Background: Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Courts largely rely on the evaluations of the prison psychiatrists and psychologists to form their decision. None of the few available instruments - e.

Culturomics and the history of psychiatry: testing the Google Ngram method.

Objectives: Culturomics is the study of behaviour and culture through quantitative analysis of digitised text. We aimed to apply a modern technique in this field to examine trends related to the history of psychiatry. In doing so, we aimed to explore the nature of the Google Ngram methodology.

The psychiatric management of prisoners on hunger strike: developing a management algorithm using the Delphi technique.

Purpose: The assessment and management of prisoners on hunger strikes in a custodial setting is complex. There is limited clinical guidance available for psychiatrists to draw upon in such cases. The purpose of this paper is to develop a management algorithm through expert elicitation to inform the psychiatric care of prisoners on a hunger strike.