The purposes of this study were to determine criminal behaviors patterns, clinical diagnosis and to compare clinical features of a new after discharged care program to that of the regular program for the mentally disorders offenders under compulsory treatment order.

The sample was consisted of 35 mentally disordered offenders sent by the court under a hospital order refer to the section 48 of Criminal Code. They were discharged during 1st October 2001 to 30th September 2007. Data were collected from medical records of Galya Rajanagarindra Institute. Quantitative data were analyzed by using descriptive statistics and Chi-square Test.

Most of the samples, convicted to life and body-harm offenses which were taken places at houses and in the communities. The used weapons were knives. Their motivated to crime were psychosis symptoms with no planning. Most of the victims were acquaintances who had no active participation. Three quarters were diagnosed of schizophrenia. After these patients were discharged to the community, more than half were readmitted but only one was recidivist. Most could access to mental health services regularly. There was not statistical different between clinical features of the new after discharged care program and that of the regular one.

The new after discharged care program showed that more than half of cases were readmitted but only one case for recidivist. Most patients could access to mental health services regularly. The new program did not differ from the previous one, therefore, the new program need to be revised.

There is a growing knowledge about the prevalence and manifestations of autism spectrum disorder (ASD) in adults. However, major diagnostic problems are encountered in a forensic evaluation of persons from different social and cultural backgrounds.

At the conclusion of this presentation, the participant should be able to

1. 1) apply diagnostic criteria for ASD in a forensic evaluation,

2. 2) recognize cultural differences in signs and symptoms presentation,

3. 3) apply risk assessment methods in non-native persons diagnosed with ASD.

I performed a MEDLINE search of English-language literature from 1980 to 2009 to identify reports on autism and criminal behaviour in adults with emphasis on the role of ethnicity. Furthermore, I evaluated cultural differences in a series of illustrative vignettes of persons from different social and cultural backgrounds who met diagnostic criteria for ASD in a forensic evaluation.

Very few studies examined whether environmental factors predict later outcomes of ASD. IQ is the strongest predictor of outcome. Psychiatric and somatic comorbidity, and poor accessibility of mental health services are associated with negative outcomes. The lack of empathy is a core symptom that accounts for a higher risk for criminal behaviour. The diagnostic process, as well as risk assessment, in non-native adults with ASD is affected by cultural factors.

More cross-cultural research on ASD is needed to further our understanding of forensic problems related to this disorder during the life course.

Deviant sexual preference is known as a risk factor for child abuse. Most often the examination of sexual preferences relies on interviews, self-ratings like the Multiphasic Sex Inventory or rather invasive methods like phallometry respectively the so called Abel-Screen, derived from the latest. The computer based Implicit Association Test (IAT) has proven its validity in several fields like sexism or racism by measuring the subjects attitude to certain association. Gray et al. from Cardiff published in 2005 significant associations between children and sex in pedophiles.

As part of a larger study about visual erotic stimulation of child abusers and internet sex offenders, we conducted the IAT in two different versions with visual stimuli on both child abusers and internet sex offenders as well as on male and female comparison samples. Psychological and Personality profiles were assessed by HAWIE, WCST - 64, SKID, MMPI, MSI, IPO and SCL-90 R.

Preliminary data suggests discriminant validity of the IAT concerning sexual preference. In addition, tests for frontal inhibition show poor performance of child abusers in contrast to controls and internet sex offenders.

Our preliminary data about the IAT suggests that both child abusers and internet sex offenders display other associations on visual erotic stimulations than the comparison sample. Further research about deviant sexual preferences should take the impact of cognitive processes into consideration.

The purpose of this experiment is to confirm the influence and determine the intensity and mechanisms of Kryptopyrrole (2, 4-dimethyl, 3-ethylpyrrole) effect on taking aggressive actions. Basing on existing literature, we have designed this experiment which consists of 3 different phases. All of these phases are crossing over and they are complement one another, that the outcome we are expecting to receive, will give us more clear and deep insight on this influence.

Objects will be selected from material of Department of Forensic Psychiatry of Institute of Psychiatry and Neurology in Warsaw (IP&N). All of selected objects will be convicts for crimes of aggressive acts, which previously were forensic psychiatric examined as suspects. 50 objects, 50 controls will be included.

1. Phase - 1st. The forensic psychiatric examination. All of selected objects and controls will undergo MRI and the examination of their general health and mental status.

2. Phase - 2nd. From all subjects and controls a sample of the urine will be collected. Level of urinal Kryptopyrrole and its concentration will be detected.

3. Phase - 3rd. Post mortem neuropathomorphological assessment of 30 young criminals with known medical history, convicted for aggressive acts, who committed suicide in prison.

We are expecting statistical importance of comparison of outcome of neuroimaging vs. post mortem studies, which will correlate to mental status and Kryptopyrrole level in urine vs. controls. Effect of its toxicity may be proved by comparison of neuroimaging vs. post mortem studies of brain morphology.

To find out clinical and social factors contributing to specific female crimes - infanticide and neonaticide.

Psychopathological, psychological, statistical.

A cohort of 16 females who had killed their children was examined. All women were victims of violence by their husbands or partners. Domestic abuse resulted in long-term mental problems of women. Clinical assessment has revealed depression, anxiety, fear, PTSD, alcohol abuse.

There were two types of homicides. Women of the first subgroup (9) had committed infanticide and they displayed pathological altruistic motivation of the crime. Women of the second subgroup (7) had committed neonaticide. Alongside with clinical factors neonaticide reflects mostly social factors. Women of the second subgroup were younger and often exposed to psychogenic situations with high level of stress (financial and housing problems, concealment of illegitimate pregnancy, violence of the partner). In accordance with the Criminal Code of Russia the special article (106) governs infanticide and neonaticide. This law takes into account the psychogenic situation which caused the crime (battered women syndrome) and the fact that at the time of child murder the mental state of mother was affected by childbirth.

In cases of infanticide and neonaticide the court is free to make verdict more lenient and its reflects more humane approach to such complicate phenomenon as child murder.

Schizotypal disorder comprises a wide spectrum of schizophrenic disorders from personality to sub-psychotic disorders. As a result, psychiatric evaluation of this psychopathology is ambiguous and a challenge to forensic psychiatry.

The aim of study was to define criteria for forensic evaluation of schizotypal disorder according the form of disease by examining 82 patients who committed crimes and who had been diagnosed “schizotypal personality disorder”(12), “schizotypal disorder” (pseudopsychopatic (38), pseudoneurotic (13), schizophrenia with bare symptoms (16), schizophrenic reaction (3)

There was evidence of different forms of schizotypal disorders related to the degree of responsibility for the crime committed (9 patients with schizotypal personality disorders) compared with (46 patients with mild forms of schizophrenia) considered not responsible. The sample of patients were considered as having diminished responsibility (27 patients with different forms of mild schizophrenia). The criteria for psychiatric evaluation were: intensity of negative symptoms, quasi-psychotic symptoms during period of crime, dynamic aspects of disease, connection between psychopathology and character, motives, causes of crime, level of critical and prognostic abilities, intensity of personality disorders, level of social function and adjustment.

Forensic conclusion depends on the form of schyzotypal disorder. The patients with schizoptypal personality disorder demonstrate integrity of cognitive sphere and singularity of emotions, rather high level of social adjustment. That's why the are mostly considered as responsible. The patients with mild forms of schizophrenia show pathology in sphere of thinking and emotions, social problems, so forensic conclusion can be different from irresponsibility to diminished responsibility.

Detection of deception is important for the practice of psychiatry, especially for forensic psychiatry. Previous neuroimaging studies have identified that activity of the prefrontal and parietal cortices was associated with deceptive behaviors. However, the temporal sequence of neural activation in these regions remained unknown.

In this fMRI study, we used a face recognition deception paradigm involving three mental processes in the following temporal order of a deceptive response:

1. (1) Perception

2. (2) Formulation

3. (3) Response, to examine the activation of the brain regions during the process of deception.

Fourteen healthy males were scanned by a 3T Philips scanner while performing the deception task. A 2-way ANOVA model was employed to understand the activation pattern of neural correlates of deception during the three processes studied.

Activations of the prefrontal, the fusiform, the supramarginal, the postcentral, the angular, the precuneus, and the rolandic areas were found to peak at different processes. Specifically, the fusiform, the prefrontal, and the precuneus regions were activated first, with their activation peaked at the perceptual process. On the other hand, the activity of the supramarginal, the angular, and the postcentral regions peaked at the formulation process. Activity of the rolandic region was peaked at the response process.

This study showed that there are different temporal gradients of neural activations with respect to the cognitive processes that evolve in deception. By understanding the specific role played by each of the neural correlates during deception, the accuracy and reliability of lie detection could be enhanced.

To review how children's memory, communicative skills, social knowledge, and social tendencies can influence the quality of forensic interviews with children, in the special setting of child sexual abuse.

A review of the studies designed to evaluate children's capacities as witnesses.

The research demonstrates both

1. 1) how much researchers and interviewers have collectively learned about children's communicative and memory retrieval capacities and

2. 2) that this information can be used by interviewers to maximize the value of their investigative interviews with alleged victims of abuse.

Controlled studies have repeatedly shown that the quality of interviewing, reliably and dramatically improves, when interviewers employ a structured interview protocol.

Professional (and popular) interest in child sexual abuse was prompted in part by dramatic increases in the numbers of reported cases, and by awareness that many cases of abuse might go unrecognized because the victims were the only possible sources of information and were seldom given the appropriate opportunities to describe their experiences to those who might have been able to help them.

The use of a structured protocol improves the quality of information obtained by investigators from alleged victims, thereby increasing the likelihood that interventions will be appropriate.

To asses competence to consent to treatment in involuntary committed patients (ICP) for a mental disorder, as compared to matched acute voluntary hospitalized patients (VHP). To evaluate the effect of psychopathology severity and cognitive dysfunction on decisional capacity.

Cases were recruited among ICP at the Umberto I Hospital, ‘Sapienza’ University of Rome; controls were age- and sex-matched VHP, in the same ward and time period. Subjects were diagnosed according to DSM-IV-TR criteria and further evaluated through a) MacArthur Competence Assessment Tool for Treatment (MacCAT-T) b) Brief Psychiatric Rating Scale-24 (BPRS) c) Raven's Colored Progressive Matrices (CPM) d) Mini Mental State Examination (MMSE).

Eighteen cases were enrolled (67% women), mean age was 25.1 ± 2.8 years. There were no differences between groups in: diagnostic distribution (40% schizophrenic spectrum disorders, 40% mood disorders, 20% other diagnosis), disease duration, MMSE. ICP had higher BPRS total scores (mean difference ± S.D.= 10.3 ± 19.4; [95% C.I.= 0.6 ÷ -20.0]), and performed worse than VHP in MacCAT-T comprehension (-1.0 ± 1.3; [95% C.I.= -1.6 ÷ -0.3]), appreciation (-1,7 ± 2.0; [95% C.I.= -3.0 ÷ -0.7]), reasoning (-2.1 ± 2.9; [95% C.I.= -3.6 ÷ -0.7]) and expression of a choice (-0.8 ± 1.0 [95% C.I.= -1.3 ÷ -0.3]). Competence to give informed consent was associated with psychopathological dimensions but not with MMSE and CPM scores, in the sample overall.

Competence to consent to treatment was reduced in ICP compared to VHP. Involuntary commitment was not necessarily associated with incapability of making treatment decisions.

To develop a clinician-oriented semi-structured interview for the assessment of sexual consent: the Sexual Consent Competency Assessment Scale (SCAS). To assess sexual consent competence in a sample of hospitalized patients, affected by bipolar disorder (BD) and schizophrenic spectrum disorders (SSD, schizophrenia or schizoaffective disorder).

Patients were recruited at the Psychiatric ward of S. Spirito Hospital, Rome and diagnosed according to DSM-IV-TR criteria. The SCAS items were derived and adapted from Kennedy et al. (Am J Ment Retard 2001;106:503-510). The scale items were directly rated by 2 independent clinicians, on a 3-point Likert Scale corresponding to 3 possible outcomes: capable, marginally capable or incapable. Internal consistency, test-retest and inter rater-reliability were good. Principal component factor analysis (PCA) with varimax rotation was applied.

Fifty-four BD patients (51.9% females) and 31 SSD patients (71.0% females) were recruited (mean age, years: 38.1±13.4; 38.4±9.7 respectively; p=0.91). BD patients had better sexual consent competence compared to SSD, there were no gender differences. Cognitive functioning as measured by the Raven Progressive Matrices appeared to moderate the relationship between diagnostic group and sexual consent decisional capacity, with better scores corresponding to higher competence. PCA revealed two interpretable factors 1) cognitive-emotional and 2) consequences-prevention. There were no significant group differences between BP and SSD in the second factor.

The SCAS proved good psychometric validity and reliability. Patients with bipolar disorder showed better sexual consent competence compared to schizophrenic spectrum disorders.

To compare stress and mental health in criminals serving a sentence in prison and serving an alternative punishment.

120 offenders were randomly selected (60 in prison (imprisoned group=IG), 60 undergoing an alternative punishment (Not Imprisoned Group=NIG)), and were assessed using SCL90-R and Coudron's Stress Scale.

All of 9 Symptom Scales of SCL90-R and levels of stress in the Stress Inventory were significantly higher in IG than NIG.

These findings suggest that other alternatives for prison (fines, punishment suspension, deprivation of social rights, restricted liberty…) have the advantage of better mental health and less stress experience by convicts; factors crucial for the criminals’ rehabilitation and social adjustment.

Psychiatric patients have a rather infamous, albeit widely publicised distinction of causing harm to themselves: at times leading to suicide and equally worryingly for society: harm to others occasionally leading to homicide.

There is a collateral knock-on distress, aside of incremental cost effects to various members of society, inclusive of both parties. These acts resulting in harm are termed “irrational”, “mad”, “and dangerous” and were deemed predictable. No doubt, improved psychotropic medications, evolving teams with greater responsibilities and incorporating ever improving psychological therapies have improved delivery of high quality care to our patients.However, the quest for a standardised, valid, generalisable, user friendly risk tool remains elusive, albeit increasingly improving, or is it?

Psychiatrists now more than ever are tasked with the challenge of assessing, managing and preventing if not predicting such harm and to aid seamless recovery and rehabilitation into society and thereof.

Risk assessment has gone through four generations of tools/ methods. All have their merits and areas that can be improved upon. Significantly, all emphasise a time limited and context driven assessment rather than one off documents. Each method has its place and time and contribute not only to effective risk management but also to recovery oriented treatments and facilitating, monitoring and supervising optimal rehabilitation needs of psychiatric patients.

In this poster we follow the journey of risk assessment tools ranging from the “unstructured/clinician based” to START (Short Term Assessment of Risk and Treatability), pondering if we have now come full circle?

The risk factors of criminal behavior in patients with schizophrenia are not well explored. This study is to explore the risk factors for criminal behavior in patients with schizophrenia in rural China.

We used data from a 14-year prospective follow-up study (1994-2008) of criminal behavior among a cohort (n=510) of patients with schizophrenia in Xinjin County, Chengdu, China.

There were 489 patients (95.9%) who were followed up from 1994 to 2008. The rate of criminal behavior was 13.5% among these patients with schizophrenia during the follow-up period. Compared with female subjects (6 cases, 20.0%), male patients had significantly higher rate of violent criminal behavior (e.g., arson, sexual assault, physical assault, and murder) (24 cases, 80.0%) (p< 0.001). Bivariate analyses showed that the risk of criminal behavior was significantly associated with being unmarried, of younger age, previous violent behavior, homelessness, lower family economic status, no family caregivers, and higher scores on measures (PANSS) of positive, negative, and total symptoms of illness. In multiple logistic regression analyses being unmarried and previous violent behavior were identified as independent predictors of increased criminal behavior in persons with schizophrenia.

The risk factors for criminal behavior among patients with schizophrenia should be understood within a particular social context. Criminal behavior may be predicted by specific characteristics of patients with schizophrenia in rural community. The findings of risk factors for criminal behavior should be considered in planning community mental health care and interventions for high-risk patients and their families.

The issues of my research study concern psychosocial and personality conditioning of criminal thinking styles of juveniles.

The objective of my research study is to distinguish and characterize profiles of criminal thinking styles of juvenile boys and girls who committed a criminal offence and to define psychosocial (restricting to the family environment - a guardian system) and personality factors conditioning a criminal thinking style of juveniles.

For the purpose of the research following methods have been used: PICTS by G. Walters - has been adapted into polish circumstances, Values Scale (Rokeach), Davis Empathy Scale, The Tennessee Self-Concept Scale (TSCS) by Fitts, Skala Postaw by Plpoa, KBPK by Kurzyp-Wojnarska.

In the analysed problem the following research tasks are involved:

1. · Singling out of juvenile criminal thinking styles

2. · determining the criminal predicators in criminal thinking styles

3. · establishing predicators of criminal thinking styles, defining factors determining criminal thinking style of juveniles (a group of explanatory variables include: thinking styles of parents (guardians), parents’ attitude towards a child, a value system of parents, personality variables of a juvenile, i.e. self-esteem, empathy level (level of emphatic understanding), a sense of control and a social competence level).showing (presenting) constitutive differences and similarities In terms of criminal thinking styles between the group of minors and their parents (guardian)

4. · establishing the differences and similarities in terms of cognitive functioning (thinking styles) of the juveniles due to the criminal act.

Community forensic mental health teams are a new service within the widening range of specialized community services, providing an interface between Generic and Forensic Services. Few teams have been set up in the UK, and many have been developed without a pilot scheme. The service in Hertfordshire was established in 2004, with no previous audits or reports done to evaluate the working of this team.

This work aims to ascertain and evaluate the role of this service, comparing with standards formulated in accordance to guidelines set by Clinical Governance bodies such as NICE, DoH, FR&D, Sainsbury Centre, following principles outlined in the Reed Report. It also identifies gaps in the service and recommends implementing changes to improve clinical effectiveness.

A literature review was conducted to outline the characteristics of a community forensic service. Referrals over 12 months from July 2007 until July 2008 were analysed to look into the number, source, appropriateness, acceptance, response time and response methods. Data collection involved review of notes including meeting minutes, computerised notes and patient file. Information was recorded against a question template. Analyses are represented with use of graphs.

indicated the number of referrals and the quality of response from the team.

Service gaps were identified, and recommendations were made to implement proposed changes. The completion of the Audit cycle which is due in December this year will add to the evidence base which can then guide development of newer teams or improvement in functioning of existing teams.