Mirror exposure therapies (MET) have been proposed to reduce symptomatology in patients with Anorexia Nervosa. However, most MET protocols or related studies do not specify the patients’ distance to the mirror, or when they do so, such a distance may differ significantly (from 0,5 to 3 meters). Such modifications of mirror positioning could imply variations in patients’ fixation patterns on different body parts (i.e., attentional bias between weight-related and non-weight related body parts), since previous studies shown that dissociated neural systems (either in left or right cerebral hemispheres) are involved in the attentional patterns and scanning strategies depending on the distance (i.e., in near and far space). Furthermore, as the body-related attentional bias (AB) has been shown to be a part of the maintenance mechanism of AN symptomatology, any modification of attentional patterns due to mirror’s distance variations may influence the efficacy of MET.

This study aims to use Virtual Reality (VR) and Eye-Tracking (ET) technologies to precisely analyse the effect of the distance to the mirror on the attentional patterns.

137 female college students were immersed in a VR environment in which they could look in the mirror at their respective avatars created from the measurements and photos of their real bodies. The mirror was positioned at 3.30m in front of the participants in “group 1” (n1 = 54), and at 1.54m in front of the participants in “group 2” (n2 = 83). Eye-Tracking feature and OGAMA software (Freie Universität, Berlin, Germany) were used to record and process the visual attentional pattern of each participant, during a 30-second free viewing task at her avatar. Complete Fixation Time (CFT) was assessed as the fixation time difference between weight- and non-weight- related body parts, defined from the weight scale of the PASTAS questionnaire. Independent Sample t-Test was conducted to analyse CFT mean difference between both groups.

Independent Samples t-Test shows statistically significant CFT mean difference (F (1, 135) = 1.571, p < 0.001, 95% IC [1717; 5581]) between both groups. While fixation pattern of the group positioned further to the mirror (group 1) was more focused on weight-related body parts (CFT mean = 2282ms, SD = 809), the fixation pattern of the group positioned closer to the mirror (group 2) was more focused on non-weight-related body parts (CFT mean = -1367ms, SD = 587).

This study shows new opportunities to use VR and ET technologies to precisely analyse the variations of fixation patterns as a function of mirror position in MET. Such information may contribute to adapt and develop new MET’s protocols for AN patients, optimizing the distance to the mirror. It also underscores the importance of specifying the distance to the mirror in MET-related studies to improve replicability.

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Obesity, defined by an excessive body fat accumulation, is a non-communicable condition attaining epidemic proportions in economically developed countries.

To provide evidence to the link between serotonin (5-HT), energy metabolism and the human obese phenotype, the present study investigated the binding and function of the platelet 5-HT transporter (SERT), in relation to circulating insulin, leptin, glycolipid metabolic parameters and body-mass indices (BMIs, Kg m-2).

The study included an observational clinical cohort of 74 drug-free subjects (51W; 23M), recruited on the basis of divergent BMIs (16.5-54.8 Kg m-2). All subjects were tested for their blood glycolipid profile together platelet [3H]-paroxetine ([3H]-Par) binding and [3H]-5-HT reuptake measurements from April 1st to June 30th 2019.

The [3H]-Par Bmax (fmol/mg proteins) was progressively reduced with increasing BMIs (p<.001), without changes in affinity. Moreover, Bmax was negatively correlated with BMI, waist/hip circumferences, triglycerides, glucose, insulin and leptin, while positively with HDL cholesterol (p<.01). The reduction of 5-HT uptake rate (Vmax, pmol//min/109platelets) amongst BMI groups was not statistically significant, but Vmax negatively correlated with leptin and uptake affinity values (p<.05). Besides, [3H]-Par affinity values positively correlated with glycaemia and triglycerides, while [3H]-5-HT reuptake affinity with glycaemia only (p<.05). Finally, these correlations were specific of obese subjects, while, from multivariate linear-regression analysis conducted on all subjects, insulin (p=.006) resulting negatively related to Bmax independently from BMI.

The present findings would suggest the presence of a dysfunctional insulin/5-HT/leptin axis in obesity, differentially impinging the density, function and/or affinity of the platelet SERT, as the result of complex appetite/reward-related interactions between the brain, gut, pancreatic islets and adipose tissue. In addition, they support the foremost cooperation of insulin and 5-HT in maintaining energy homeostasis.

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Eating disorders are serious medical conditions labelled by severe disturbances to one’s eating behaviours. These disorders can affect employees’ physical and mental health.

This study aimed to evaluate the association between eating disorders and workers’ mental health.

The study was conducted among a group of workers from an electricity society. Data were gathered between January-June 2022 using a self-administered questionnaire including socio-professional characteristics, eating disorders evaluation, and mental health assessment using the Hospital anxiety and depression scale (HADS).

Our study included 92 workers. Their mean age was 43.8 ± 11.7 years and 73 were male (79.3%). The average job tenure was 17.6 ± 11.2 years. Thirty-eight participants (41.3%) had eating disorders. With the reference to HADS, 47 (51.1%) and 16 (17.4%) participants presented symptoms of anxiety and depression, respectively. Regarding the patients’ anxiety levels, it was found that 82.6%, 12%, and 5.4% appeared to have mild, moderate, and severe anxiety, respectively. As for the depression levels of patients, 45 were mildly depressed (48.9%), 31 were moderately depressed (33.7%), and 16 were severely depressed (17.4%). Participants with eating disorders had higher scores of anxiety and depression p=0.001 and p=0.003 respectively.

According to our study, eating disorders had a significant association with the mental health of workers. Therefore, it is important to provide training for workers to have a healthy balanced diet to guarantee good mental health.

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Depression has been described very comprehensively and is a highly prevalent mental condition. However, how its features develop and clinical course shape remains not fully understood.

The study aimed to compare mRNA characteristics between specific symptoms and identification of differently expressed genes (DEGs) in patients with depression with specifiers such as loss of appetite, loss of weight, sleep disturbances and psychomotor retardation.

Material and method we used was transcriptome profiling of peripheral blood mononuclear cells in 30 patients diagnosed with depressive episode in course bipolar or unipolar affective disorder. The blood samples were drawn during acute depressive episode with at least moderate severity. The diagnosis and specific symptoms were described according to ICD-10 and DSM5 criteria using SCID-I, OPCRIT, and HDRS. Agilent microarrays were used for transcriptome profiling and GeneSpring software was applied. Minimal fold change 2 and significant p-value <0.05 were assumed. DAVID and KEGG databases were searched.

Comparing depressed patients with and without decreased appetite or weight loss revealed 718 DEGs. When compared depressed patients with and without psychomotor retardation, 95 genes were up- or down regulated. In both comparisons DEGs were not identified as significant according to DAVID and KEGG database. When considering weight loss of more than 2 kg per month, 418 DEGs were identified. According to searched databases only one, characterized with phosphoserine phosphatase activity, was indicated as having a significant role in molecular functioning. The most numerous list of DEGs (n=855) was found when compared depressed patients with and without insomnia. Among these genes, several were indicated as significant for biological processes and cellular components: those linked with response to oxygen-compound, cytoplasmic and secretory vesicles and granules and circulatory system.

Numerous genes are differently expressed in depression with specific clinical features, such as appetite and sleeping disturbances, but their role in pathology remains unclear. One might expect that secretory and circulation activity is involved.

This research was funded by the National Science Center, Poland (Grant No: 2016/23/B/NZ5/02634) and supported by the Poznan University of Medical Sciences in Poland (Statute sources: 502-20-22196440).

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Wenicke-Korsakoff syndrome (WKS) is a neurological disorder caused by thiamine deficiency. Wernicke Encephalopathy (WE) is the acute phase and the chronic phase is called Korsakoff-syndrome (KS).

To review the current literature on the management of WKS in a patient with anorexia nervosa.

We report the case of a 63-year-old woman admitted to the Psychiatry Unit after weight loss in the last 3 months (from 39 kg to 33,500 kg). She only made one meal a day. By exploration and analysis, neoplastic disease is ruled out (thoraco-abdomino-pelvic CT without pathological findings). She has maintained restrictive intakes for more than 30 years. A long-term anorexia nervosa (AN) is suspected, with a worsening of restrictive behavior in recent months. Upon admission, she has a weight of 33,500 kg and a BMI of 14,10. She has a left palpebral ptosis and an alteration of the anterograde memory as well as affectation of executive functions. Progressive oral diet is started, and due to the suspicion of a WKS, thiamine ev is started for a week and then continued with oral thiamine. Thiamine levels are extracted once the ev treatment has begun, so we do not have previous levels to know if they were decreased. Brain MRI shows bilateral hyperintensities in white matter and at supratentorial level in T2 and FLAIR. After a month and a half of admission, the patient has progressively regained weight, has managed to make adequate intakes and has improvement in memory.

An adverse consequence of severe malnutrition in AN due to severe food restriction and purging behavior is thiamine deficiency, and also global cerebral atrophy and concomitant cognitive deficits can be found. Thiamine deficiency occurs in 38% of individuals with AN and is often unrecognized. WKS is caused by thiamine deficiency, and WE is the acute phase of this syndrome (presentation of triad can vary). The chronic phase is KS and consists in amnesia with confabulations. WKS typically develops after malnourishment in alcoholic patients but can be associated in nonalcoholic such as prolonged intravenous feeding, hyperemesis, anorexia nervosa, refeeding after starvation, thyrotoxicosis, malabsorption syndromes; hemodialysis; peritoneal dialysis; AIDS; malignancy. WKS is a clinical diagnosis, and no specific abnormalities have been found in cerebrospinal fluid, brain imaging or electroencephalograms. MRI has a sensitivity of 53%, but high specificity of 93%, and shows an increased signal in T2 and FLAIR sequences, bilaterally symmetrical in the paraventricular regions of the thalamus, the hypothalamus, mamillary bodies, the periaquedutal region, the floor of the fourth ventricle and midline cerebellum.

If the disorder is suspected, thiamine should be initiated immediately in order to prevent irreversible brain damage, with an estimated mortality rate of about 20%, or to the chronic form of the WE in up to 85% of survivors

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Besides the traditionally studied group of young females, disordered eating occurs in all age groups (Eedena, Hoekena, and Hoek 2021). In recent years, there has been an increase in the prevalence of eating disorders and symptoms in middle-aged and older women (40 years old and over) (Mangweth-Matzek and Hoek 2017).

Experts in eating psychopathology in special groups such as Samuels, Maine and Taltillo (2019) suggest the use of the Screen for Disordered Eating (SDE; Magen et al. 2018) in the psychometric assessment of women in middle age and older. The SDE was developed to allow the Eating Disorders (ED) screening in Primary Health Care in people of all ages and without excluding Binge Eating Disorder (BED).

The SDE is composed of five items (yes or no answers), extracted from other validated self-reported questionnaires for the assessment of eating psychopathology.

To analyze the psychometric properties of the Portuguese Version of the Screen for Disordered Eating in a sample of women from the general population aged 40 and over.

Participants were 516 women with a mean age of 50.28 of years old (± 8.063; range: 40-80). They answered an online survey including the preliminary Portuguese version of the SDE and the Portuguese version of the Eating Disorder Examination – Questionnaire (EDE-Q-7; Pereira et al. 2021).

Confirmatory Factor Analysis showed that the unidimensional model presented good fit indexes (χ2/df=1.502; RMSEA=.0311, p<.001; CFI=.987 TLI=.995, GFI=.965). The Cronbach’s alfa was .762. All the items contributed to the internal consistency, as they presented item-total correlations above .40 and the exclusion of each one would decrease the alpha. Pearson correlations between SDE and the EDE-Q-7 were significant (p<.01), positive and moderate/high, as follows: .516 with the total score and .318, .503 and .536 respectively with the dimensional scores of Dietary restraint, Shape/weight overvaluation and Body dissatisfaction.

As observed with the original English-language scale, the Portuguese version of the SDE has shown good validity (construct and concurrent) and internal consistency. As such, the SDE might be a useful tool to investigate disordered eating psychopathology in older women. In the near future we will determine the SDE cut-offs with the best combination of sensitivity and specificity to screen for eating disorders in this populational group.

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Bulimia Nervosa (BN) is a highly prevalent eating disorder related to multiple risk factors. In this regard, familial variables can play a critical role in the development and maintenance of BN.

The existing studies frequently explored mothers and maternal factors, while fathers and paternal variables have been less extensively investigated in this field. Therefore, we aimed to systematically review the studies on the role of paternal factors in BN.

This systematic review process was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. As a result of the literature search on PubMed, Web of Science TM, and APA PsycINFO, 419 candidate papers were determined and evaluated based on the eligibility criteria. The quality assessment of the final 59 studies was conducted using the JBI Critical Appraisal Tools.

Then, we thematically arranged and narratively reported the qualitative and quantitative research findings. Paternal attitudes (e.g., critical, abusive, aggressive, uncaring, and unaffectionate), family dynamics (e.g., chaotic, rigid, less communicative, and emotionally involved), and father-specific features (e.g., personality traits, eating psychopathology features) were found as three main groups that could be directly or indirectly associated with the development and maintenance of BN symptoms. The eligible qualitative studies also indicated that fathers could positively influence the recovery process of their daughters with BN (e.g., by helping them develop healthy adaptive body image, self-adequacy, and self-esteem).

The contradictory outcomes were discussed for further research and clinical implications.

None Declared

Childhood maltreatment (CM) is recognized as non-specific risk factor for the onset of various psychiatric disorders and is associated with a greater severity in their clinical presentation and poorer treatment outcome. These data suggest that maltreated people with eating disorders (ED) may be biologically other than clinically different from non-maltreated people.

Aim of the present study was to investigate cortical thickness (CT), a possible biomarker of neurodevelopment, in people with ED with or without history of CM and in healthy women.

Study participation was proposed to patients consecutively admitted to the adult ED outpatient centre of the University of Salerno. Twenty-four healthy women, 26 with anorexia nervosa (AN) and 24 with bulimia nervosa (BN) underwent a 3T MRI scan. All the participants completed the short form of the Childhood Trauma Questionnaire (CTQ). All neuroimaging data were processed by FreeSurfer. Maps of CT were computed in order to perform a vertex-by-vertex analysis. CT maps underwent a general linear model analysis to evaluate differences among groups. Age and body mass index (BMI) were included as nuisance covariates.

Based on CTQ cut-off scores, 12 participants with AN and 12 with BN were identified as maltreated and 14 participants with AN and 12 with BN as non-maltreatment. All healthy women were “non-maltreated”. Therefore, participants were split in 3 groups: 26 maltreated participants with ED, 24 non-maltreatment participants with ED and healthy control (HC). Compared to HC, maltreated people with ED showed lower CT values in the left rostral anterior cingulate gyrus, while compared to non-maltreatment people with ED showed lower CT values in the left superior frontal, in right caudal middle frontal and in right superior parietal gyri. No significant differences emerged in CT measures between HC and non-maltreatment people with ED.

Present findings show for the first time that in adult people with ED childhood maltreatment is associated with cortical thinning in areas implicated in the modulation of brain processes that are acknowledged to play a role in the psychopathology of ED.

None Declared

Orthorexia is a neuotic behavior characterized by an obsession with healthy eating. This trend is growing among medical students; it may be related to the stress experienced by these young people.

The aim of this study was to determine the prevalence of orthorexic eating behaviors among medical students in Tunisia and to examine the relationship with perceived stress.

Our study was descriptive and analytical cross-sectional, carried out with medical students in the faculty of medicine of sfax (Tunisia) during October 2022.

An anonymous survey was asked to the students.

Data collection was done by a self-administered questionnaire via Google Forms administered in the students’ Facebook groups. The questionnaire was composed of a part for the collection of socio-demographic data and two psychometric scales :

-The ORTO-15 was used to assess orthorexia

- Cohen’s Perceived Stress Scale (PSS) to determine the level of stress

Atotal of 95 responses was collected.The average age of our samplewas 25.8±3.4 with sex ratio M/F=0,25.Tobacco and alcohol usewere found in 14.7% and 13.6% of casesrespectively.A psychiatric history was reported by 17.9% of students, 76.5% of whom are anxiety disorders.Average body mass index was 23.64 ± 3.53 kg/m2. More than half (58%)of the students were dissatisfied with their feed. In our sample, 8.4% of students have already consulted a nutritionist and 58.9% regularly practiced sport at gym.According to the ORTO 15, 52.6% of the students presented orthorexia. The mean score of the ORTO-15 was 39.19±4.48.According to PSS scores, 21.1% of students had severe level of stress, 69.5% had moderate stress level while 9.5% had low level of stress.Severe stress was significantly correlated with female gender and psychiatric follow (p=0.047), (p=0.001) respectively.Orthorexia was significantly correlated with the practice of sport (p=0.042).Orthorexics students had a higher level of stress without significant correlations.

Our study showed significant frequencies of orthorexia and a considerable level of stress among medical students. A high level of stress was observed in these orthorexic students. Further studies should be conducted to better investigate this relationship in order to promote student mental health

None Declared

Disgust and self-disgust are aversive emotions which are often encountered in people with eating disorders.

The aim of this systematic review is to conduct a synthesis of studies that have measured aspects of disgust and self-disgust in people with EDs.

We conducted a systematic review and meta-analysis of disgust and self-disgust in people with eating disorders using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review of the literature revealed 52 original research papers.

There was substantial heterogeneity regarding the research question and outcomes. However, we found 5 articles on disgust elicited by food images, 10 studies on generic disgust sensitivity, and 4 studies on self-disgust, and we proceeded to a meta-analytic approach on these studies. We found that women with eating disorders have significantly higher momentary disgust feelings in response to food images (1.32; 95% CI 1.05, 1.59), higher generic disgust sensitivity (0.49; 95% CI 0.24, 0.71), and higher self-disgust (1.90; 95% CI 1.51, 2.29) compared with healthy controls.

These findings indicate the potential clinical relevance of disgust and self-disgust in the treatment of eating disorders.

None Declared

The COVID-19 pandemic control measures such as isolation and social restrictions are related to an increase in the incidence of anorexia nervosa and deteriorating symptoms by increased social media exposure, limited access to psychiatric services, disruptions in relationships between families and adolescents.

Aim of study was to investigate the psychiatric and psychosocial impacts and clinical changes in anorexia nervosa patients, who applied to the Ege University Child and Adolescent Psychiatry for the first time in 2018, during the 2019-2022 pandemic period.

Our study was carried out 35 anorexia nervosa patients. Voluntary written informed consent, self-report form; using The Visual Analog Scale (VAS), Screen for Child Anxiety Related Disorders Scale (SCARED), Eating Attitudes Test (EAT), The Quality of Life Scale (QOLS), The Difficulties in Emotion Regulation Scale (DERS), The Autism Spectrum Screening Questionnaire (ASSQ), Atilla Turgay DSM-4 Based Screening and Evaluation Scale for Behavioral Disorders in Children and Adolescents (TURGAY) forms filled out online. Clinical diagnosis and progress are obtained through archieve records by The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) and Clinical Global Impression (CGI) scales. Approval number is 22-6T/7, Ege University Ethics Committee.

In 35 patients;15 female patients completed all the forms. The mean age was 16.67±1.63 years. 11 (73.33%) patients have at least one comorbidity; 7 (46.66%) patients have major depressive disorder, 3 (20.00%) anxiety disorder, 2 (13.33%) attention deficit and hyperactivity disorder, 1 (6.66%) mood disorder. The SCARED score was 37.23±12.67, and the CDI score was 17.23±10.85. When comparing the pre-pandemic period, obsession level (z=-2.254, p=.024), exercise level (z=-2.508, p=.012), technology exposure (z=-2.290, p=.022) is increased; level of social activity (z=-2.206, p=.027), the quality of education (z=-2.167, p=.030), and the perception of learning (z=-3.301, p=.008) decreased during pandemic. Quality of life scores was inversely correlated with eating attitudes scores (r=-.601, p=.039). It was noteworthy that number of admissions from the first appointments was higher in participants, compared to the patients who did not participate in the study (n=20) (p=.033). The first admission BMI values were negatively correlated with CGI scores of the patients (r=-.743, p=.002).

As a result, Covid-19 has negative psychosocial effects in anorexia nervosa symptoms such as increased excercise at home and technology exposure; decreased in social activity. Sharing clinical experiences about our patients’ mental health may be beneficial in planning the treatment processes and approach for further unexpected extraordinary situations.

None Declared

Historically, eating disorders (ED) have been regarded as the diseases of heterosexual, affluent white women. Instead, research shows that the population most at risk of ED is lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic/agender (LGBTQIA+). Indeed, in addition to many of the same sociocultural influences on body dissatisfaction faced by their peers, LGBTQIA+ individuals experience unique body- and gender-related concerns as well as high levels of stress due to interpersonal prejudice and discrimination.

This narrative review presents an overview of current research on treatment approaches to ED among LGBTQIA+ individuals.

We conducted a PubMed search for studies published after 1990 using terms that aimed to represent the primary concepts of “eating disorder” and “LGBTQIA+” and “therapy.” Next, we inductively created relevant macro-themes by synthesizing the data from the included articles.

Of 123 PubMed studies, we included 12 studies and identified three relevant macro-themes. The first macro-theme, “ordinary treatments,” focused on efficacy studies of conventional ED therapies applied to this category of patients. In particular, the first study proved the efficacy of the dissonance-based intervention, engaging participants to induce cognitive dissonance concerning the thin-ideal standard of beauty; the second study showed that sexual minorities patients accessing day hospital treatment reported greater overall ED and comorbid symptoms but started treatment with higher scores and improved at a faster rate compared to heterosexual patients; the third study provided evidence that transgender/nonbinary individuals and cisgender individuals showed similar improvement in ED symptoms during higher levels of care treatment, but the first group had less improvement in depression and no improvement in suicidality during ED treatment. The second macro-theme, “relational approach,” investigated newer treatment paradigms involving family and school support, both revealing positive implications for eating and weight-related behaviors. The third macro-theme, “gender-affirming therapy,” focused on medical and surgical treatment toward gender transition, which has been shown to correlate with improvements in body image, ED psychopathology, and psychological functioning.

Members of the LGBTQIA+ community are at greater risk for ED; to our knowledge, there is no targeted treatment that considers the entirety of their experience. These findings denote the need to focus future research efforts on effective treatment strategies specific to sexual and gender identity groups.

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Forensic psychiatrists, as well as other mental health professionals, provide the legal system with clinical information and assessments concerning the offenders’ functioning, mental state and capacities at the time of the alleged offense and/or trial. These forensic assessments play a crucial role in court, influencing subsequent decision-making on sentencing, placement, or treatment of mentally disordered offenders.

Determining criminal responsibility at the time of arrest

Exploring the role of psychiatric disposals in different countries.

The information was primarily gathered through written sources: peer review articles, reports, and legislation. A literature search was performed in PubMed and PsycINFO using the following keywords: criminal responsibility (reports/evaluations), pre-trial assessment,psychiatric expert, (forensic) psychiatric assessment, sanity evaluation and insanity defense. Additional articles were identified through reference lists This resulted in 36 peer review articles and nine reports or book chapters. In addition, a leading expert (i.c. psychiatrist) from every country was contacted for providing information and validating the information from this article pertaining to their country. They suggested eight more articles or book chapters. The respondents represent the authors of this article.

See table.

In summary, it appears that there are distinct differences between the abovementioned countries with respect to criminal responsibility assessments. Although Canada is considered a pioneer with regard to forensic mental health, Britain, the Netherlands and Sweden appear to have a well-established system in conducting these assessments. In Sweden the system is very strict, meaning that all reports are delivered by a governmental agency with their own staff. The court orders the report from the agency and not from the experts.

None Declared

Violent behavior has been linked to deficits in social cognition, namely cognitive and affective aspects of empathy. Schizophrenia and antisocial personality disorder have been associated with violence and empathy deficits.

Our main objective is to search for differences in empathy between patients with schizophrenia who have committed a violent offence, patients with schizophrenia with no history of violent offence and patients with antisocial personality disorder.

A total sample of Ν=100 participants was divided into four groups: 1) 27 patients with schizophrenia and history of committing a violent offence, 2) 23 patients with schizophrenia with no history of committing a violent offence, 3) 25 participants with antisocial personality disorder and 4) 25 general population participants comprising the control group. Symptoms of schizophrenia were rated using the Positive(P), Negative(N) and General Psychopathology (G) subscales of the Positive and Negative Syndrome Scale (PANSS). Empathy was evaluated using a) The Empathy Quotient (EQ). Theory Of Mind was evaluated using a) The First Order False Belief task, b) The Hinting task, c) The Faux pas Recognition Test and d) The Reading the Mind in the Eyes Test (Revised).

The four groups differed in PANSS scoring (p<0.001), EQ scoring (p<0.001) and Theory of Mind tests (p<0.001), but this difference was only significant between the controls and the three groups of patients. The three groups of patients did not differ to each other in any of the Theory of Mind tests. No difference was also found between the two groups of psychotic patients.

Patients with antisocial personality disorder, schizophrenia and schizophrenia with a history of violent offence do not seem to perform differently in affective and cognitive empathy tests.

None Declared

In Italy, subjects with severe mental illness (SMI) considered “in danger of posing a threat to others” are hospitalized into structures known as “REMS–Residenze per l’Esecuzione delle Misure di Sicurezza”, designed to provide rehabilitating programs. There are also specialized forensic teams to support Community Mental Health Centers (CMHC) in helping patients who committed crimes. A better characterization of clinical and real-world functioning of forensic patients represents a topic of clinical interest (Caruso R et al. Curr Psychiatry Rep 2021; 7 29; Barlati et al. Eur Arch Psychiatry Clin Neurosci 2022, in press; Fazel et al. Br J Psychiatry. 213 609-614).

Aims were to compare clinical and psychosocial functioning characteristics in three cohorts of SMI patients.

A total of 29 patients hospitalized in REMS facilities were included into this study; starting from this first group an equal number of individuals matched for sex, age, and diagnosis were included in other two groups of outpatients cared for by the forensic team and of non-forensic outpatients treated by CMHC. Clinical severity was measured through the Clinical Global Impression scale – Severity (CGI-S) and real-world functioning was measured through the Personal and Social Performance scale (PSP). Analyses included Chi-Square test for categorical variables and Kruskall-Wallis test for continuous variables with Mann-Withney U test for post/hoc comparisons. P values < 0.05 were considered significant.

Significant between-groups differences emerged regarding psychosocial functioning (p=0.013): that was more compromised in the REMS group (mean:34.0) when compared to the forensic team subjects (mean:41.3) and to the subjects in the CMHC group (mean:47.7).

Results concerning clinical severity point in the opposite direction: more severe symptoms were observed in the CMHC group (mean:4.7) compared to the REMS group (mean: 4.3) and the forensic outpatients (mean:3.5). The difference in the CGI-S mean scores is significant for the forensic outpatients when compared to the REMS group (p=0.011) and to the CMHC group (p<0.001).

Specialized teams are central in the managing of forensic patients: of particular interest are the data regarding clinical symptoms severity, which could also be read with a de-stigmatizing focus, highlighting that a worse clinical severity is not associated with being more dangerous to other people and to the society in general.

None Declared

In Forensic Mental Health, standards of treatment offer a legal, ethical and organizational backbone for professionals facing challenging patients and complex procedures. Grounded in UN resolutions, standards implement human rights and ethical principles in forensic psychiatry. Guidelines establish recommendations for optimizing patient care and agreements on minimum standards. Internationally, diverse approaches to standards and guidelines have developed due to differing medicolegal systems.

This review´s objective was to provide insight into which areas are considered essential in standards of treatment and guidelines in forensic psychiatry. Furthermore, we aimed to investigate if American Psychological Association (APA) principles for the publication and implementation of guidelines were applied and if European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) criteria were considered.

A systematic literature search was carried out. PubMed, Psyindex, Livivo, Scopus, Google Search and Google Scholar were searched for records published by August 2022. The following search terms were used in different variations and combinations: “forensic", “mental health”, “psychiatry”, "standards”, “treatment” “service provision “principles” “quality” “indicators” “Forensische Psychiatrie” “Maßregelvollzug” and “Qualitätsindikatoren”. Standards, guidelines and reviews in Forensic Mental Health in English and German were included. The guidelines were assessed by applying APA principles for guidelines and CPT recommendations.

The search identified 12 documents. Eight documents were excluded as they were focusing only on models of care, forensic evaluation or were in the state of a discussion paper for one specific healthcare system. Four publications from Australia, Canada, Germany and UK were included in narrative synthesis. The selected documents vary in scope, objective, thematic focus on ethical or practical aspects, and level of detail. Our assessment showed that APA-recommended elements of a guideline were often missing. The guidelines discussed were also not fully compliant with CPT recommendations. A more extensive source citation is often needed. In total, “Standards for Forensic Mental Health Services” (UK, 2021) demonstrated good compliance with APA and CPT criteria and comparatively the best practical applicability.

This systematic review indicates that standards and guidelines in forensic mental health still require improvement in terms of formal frameworks of medical guidelines. Human rights compliance in forensic psychiatry must be continued to be monitored and standards of treatment and guidelines offer an important opportunity to ensure adherence. Further research on the implementation of standards into day-to-day procedures is needed.

None Declared

Secure forensic hospital settings provide care and treatment to mentally disordered offenders with a history of serious violence. Most modern forensic hospitals operate a system of stratified therapeutic security, where patients are placed on the internal care pathway according to individual risks and needs. Unfortunately, at times patients move ‘backwards’ from a unit of lower to a unit with higher therapeutic security. This is a challenge to manage from an individual patient and service perspective.

The aim of this study was to analyse backwards moves along the care-pathway within a complete national cohort of forensic in-patients in Ireland over a five-year period. We aimed to clarify the reasons for these moves and ascertain if they were linked to mental illness, security or other issues.

A naturalistic retrospective five-year observational cohort study was completed. All in-patients in the Central Mental Hospital, Dundrum, Ireland or associated high support hostels between January 2016 and January 2021 were included (60 months). Demographic data, data pertaining to diagnosis, data pertaining to backwards moves and reasons for those moves were gathered. Data was gathered as part of the Dundrum Forensic Redevelopment Evaluation study (D-FOREST study).

A total of n=231 patients were included; the majority (n= 203; 87.9%) were male. The most common diagnosis was schizophrenia (64.1%), followed by schizoaffective disorder (12.6%), bipolar affective disorder (4.8%) and autistic spectrum disorder (3.5%). Mean age at admission was 35.9 years, SD 9.5.

Over the 60-month period, a total of 93 backwards moves relating to 50 patients occurred. Reasons for backward moves included deteriorating mental state (8.7%), assaults (4.3%), challenging behaviour (4.3%), security (1%) and others. Binary logistic regression demonstrated that lacking capacity to consent to medication (Odds ratio 0.352, 95%CI 0.198-0.627, p<0.001) and higher (worse) scores on HCR-20 Historical scale (Odds ratio 1.13, 95%CI 1.01-1.27, p=0.035) were associated with backwards moves, when adjusting for age and Dundrum-1 need for therapeutic security scores.

Backwards care pathway moves are a major issue in forensic hospitals both nationally and internationally. We were surprised at the strength of association between lacking capacity to consent and backwards moves. Understanding backwards moves will assist in supporting patients and minimising length of stay.

L. Jordan Grant / Research support from: This study was funded by the Health Service Executive for the Republic of Ireland as part of the Dundrum Forensic Redevelopment Evaluation (D-FOREST) study, G. Crudden: None Declared, D. Mohan: None Declared, H. Kennedy: None Declared, M. Davoren: None Declared

The clinical relevance of Routine Outcome Monitoring (ROM) to formulate longitudinal evaluations of treatment appropriateness/efficacy and to assist decision making aimed at improving the quality of person-centered interventions has been poorly implemented in forensic psychiatry, also in Italy. Indeed, very few assessment instruments have been developed in this crucial field.

As reliable ROM instruments are lacking, the aim of the current investigation was to examine psychometric properties (i.e. reliability, concurrent validity and sensitivity to measure scores’ longitudinal changes) of the Parma Scale (Pr-Scale) (a new instrument fro the evaluation of offenders with mental disorder) in an Italian sample of forensic psychiatric patients.

Participants were male adult offenders with mental disorder recruited within the Parma REMS (“Residence for the Execution of Security Measure”) or the Parma Penitentiary Institute (PPI). Exclusion criteria were known moderate/severe intellectual disability or any other medical condition inducing inability to express a valid consent for participating in the research. The Pr-Scale includes 20 items divided into 3 main domains: “Historical”, “Clinical” (observational) and “Treatment Plannining". To test psychometric properties of the Pr-Scale, we examined interrater reliability, short-term (1-week) test-retest reliability and internal consistency. As measure of concurrent validity, a correlation analysis of Pr-Scale item scores with corresponding HKT-R (the “Historisch, Klinische en Toekomstige – Revisie” instrument) item subscores was performed. Finally, we examined the Pr-Scale sensitivity to measure scores’ longitudinal changes over a 3-month treatment follow-up period.

60 male adult patients were recruited in this study. Our findings showed good to excellent interrater and test-retest reliability, concurrent validity and internal consistency for the Pr-Scale. Pr-Scale scores also display a moderate to large changeability over time (Intra-Class Correlation coefficient = 0.963, coefficient of stability = 0.997, Cronbach’s ɑ = 0.736). Statistically significant correlations of Pr-Scale item scores with the corresponding HKT-R scores were found. Across the 3-month follow-up period, we observed statistically significant sensitivity values in measuring longitudinal changes for the Pr-Scale total score and Pr-Scale domain and item subscores.

Our results support the clinical use of the Pr-Scale in different forensic psychiatric settings (i.e. prison, REMS) as reliable ROM instrument.

None Declared

The closure of forensic psychiatric hospitals and the conversion to a residential model of care based on secure residential units in the community (REMS) has made Italy the first and only country in the world to have followed the principles of the deinstitutionalization movement. Following the reform, several management issues have emerged, such as the creation of long waiting lists for admission to REMS. Improper hospitalization in Acute Psychiatric Units (SPDC) has often been used to address this issue. In addition, the handover of inmates’ care to Mental Health Departments (DSMD’s) has posed further challenges. To date, the field has received little attention from international literature.

Description and analysis of a sample of offender inpatients hospitalized in an acute psychiatric unit.

We conducted a retrospective study including male offenders admitted to the SPDC of San Gerardo Hospital (ASST Monza), between January 2007 and September 2022. Data analysis was performed by using SPSS.

120 male offenders were included for a total of 204 admissions. 98 offenders (81.7%) were hospitalized once. We observed an absolute (N=1; N=30) and percentage (0.2%;12%) increase in the number of hospitalized offenders per year during the time period under study. Jail was the main provenance in the sample (46.6%), followed by residential care facilities (27%) and the psychiatric observation unit (ROP) of Monza’s jail (10.8%). The two most prevalent diagnoses were personality disorders (37.5%) and psychosis (39.2%). In addition, 66 subjects (55%) had a history of substance abuse. The average duration of hospitalization was 19.45 days; it increased to 77 days for inpatients waiting to be transferred to REMS. Hetero-aggressive behavior as the reason for admission was associated with longer hospitalization (p=0.031), while attempted suicide correlated to shorter hospital stay (p=0.032). Out of the 55 offenders who attempted suicide, 41 came from jail (74.5%). Finally, longer hospitalizations were associated with an increased number of adverse events (p=0.001).

Psychiatric hospitalizations of offenders have increased over the last years. This population tends to require longer hospital stays (regional average of SPDC hospitalization in Lombardy: 14 days), which are even lengthier for inpatients destined to REMS. Longer hospitalizations exert a large burden on DSMD’s and impact the general health of patients, exposing them to a higher risk of adverse events. Further studies are needed to confirm our findings and to develop better strategies for the management and care of offender patients.

None Declared

Resilient potential of 100 young male offenders (aged 16-17), in Buenos Aires was assessed using a translated and revised version of the Resilience Scale (RS) of 14 items (Wagnild, 2009). Data on family criminality, school achievement and socioeconomic status was also obtained for both groups. The greater the resilient potential the greater the opportunity of not to reoffend irrespective of being controlled by key risk factors.

1-Do repeat offenders have lower resilient potential than one-time offenders? 2. If a relationship between resilience and repeat offending does exist, is this explained by family criminality, low school achievement or low socioeconomic status?

Psychosocial interviews with each participant were conducted by the named author, under strict judicial conditions considering privacy in all cases, based on informed consent, with the condition of maintaining the concealed identity of the participants. In all cases it was clarified that youth participation was voluntary.

Table 1.

M (SD) M (SD) t d p

Age 16.20 (0.41) 16.45 (0.50) 2.70 0.66 0.008

Resilience M (SD) M (SD) t d p

Factor I 29.92 (7.25) 63.45 (4.92) 27.16 5.41 <0.001

Factor II 7.37 (1.95) 16.59 (1.87) 24.13 11.33 <0.001

Total Resilience 37.29 (8.67) 80.09 (6.49) 27.82 5.59 <0.001

Risk Factors % % chi d p

Family Criminality 44.9 3.9 20.81 1.03 <0.001

Low School Achievement 98.0 11.8 71.31 3.15 <0.001

Low Socioeconomic Status 42.9 11.8 10.73 0.69 0.001

Table 2. Independent Predictors of Repeat Offending

Variables β p

Criminality in the family 2.994 <0.001

Low school achievement 5.886 <0.001

Low socioeconomic status (SES) -1.727 <0.001

Note. All comparisons p<.001.

Taking into account the lack of studies on resilience in juvenile offenders in both national and international research the findings of the present study provide an important contribution in the field of juvenile offending, particularly in the view of further interventions aimed at the prevention and rehabilitation in the near and long term of juvenile offenders in Argentina.

None Declared