To our knowledge, a limited number of studies address criminality among psychiatric patients as depicted in legal files.

The objective of the present study was to provide demographic, psychiatric, legal/criminal data about psychiatric patients in Greece.

Legal case files of 100 adult subjects, 90 male/10 female, 88 Greeks/12 foreigners were reviewed.

Seventy eight percent of the subjects had at least one psychiatric evaluation prior to the commitment of the crime. The main diagnoses at the time of the criminal act were: schizophrenia spectrum psychosis (18%), anti-social/borderline/mixed personality disorder (15%), substance use disorder (15%), alcohol use disorder (10%), depressive affective disorder (6%), mixed anxiety/depressive disorder (6%), bipolar disorder (5%), anti-social personality disorder/substance use disorder (5%), schizophrenia/substance use disorder (3%). In 11% the diagnosis was unknown. Eighty four percent of the crimes committed were homicides/attempted homicides, 6% assaults/(attempted) homicides, 3% property crimes/(attempted) homicides and below 3% assaults, property crimes, sexual offences, drug crimes. The weapon used was a knife/sharp object (42%) or a gun (40%). Perpetrator and victim were strangers in 25% of the cases, just acquaintances in 14%, had a professional relationship in 7%, their relationship was conjugal (15%), they were partners (13%) or relatives (7%). In persons with schizophrenia spectrum psychosis the victims were relatives/spouses in 41.2%, while in other diagnoses the respective percentage was 21.5% (P = 0.044).

In accordance to the international literature, there is a vast need for further research in order to improve forensic psychiatric services and prevent criminality among psychiatric patients.

The authors have not supplied their declaration of competing interest.

To our knowledge, few studies address the issue of criminal responsibility among psychiatric offenders. In Greece, articles 34 and 36 of the penal code regulate criminal insanity and diminished responsibility, respectively.

The objective of the present study was to provide psychiatric/legal data considering the appeal to articles 34/36 of the Greek penal code.

Legal case files of 100 adult subjects, 90 male/10 female, 88 Greeks/12 foreigners were examined.

According to the first degree court, one defendant was found criminally insane, 29 with partial responsibility, while the rest were regarded as fully capable. The decisions of the court of appeal/the supreme court of appeal were 2 criminally insane, 36 partially responsible and 62, fully criminally responsible. The decisions were unanimous in 78% of the cases.

The most common diagnoses were schizophrenia spectrum psychosis (18%), antisocial/borderline/mixed personality disorder (15%) and substance use disorder (15%). Court decisions of criminal insanity/diminished responsibility were higher when the perpetrator had an Axis I diagnosis (47.5%), significantly lower in cases of personality disorder (22.2%) and even lower in cases of substance use disorder (16.7%). In patients with prior hospitalizations the percentage of criminal insanity/diminished responsibility was 55.6%, significantly higher than in cases without (24.4%).

Schizophrenia is the most common mental disorder correlated with offenders criminally insane/partially responsible, while a history of psychiatric hospitalization is a very strong positive predictive factor for the successful appeal of the aforementioned articles.

The authors have not supplied their declaration of competing interest.

To our knowledge, a relatively small number of studies address the agreement between psychiatrists and court decisions concerning criminal responsibility among psychiatric offenders.

The objective of the present study was to examine the agreement between psychiatric evaluations and court decisions in Greek penal cases.

Legal case files of 100 adult subjects, 90 male/10 female, 88 Greeks/12 foreigners were studied, and agreement was assessed by the κ (kappa) statistic.

Seventy eight percent of the subjects had had contact with psychiatric services before the commitment of the crime. The most common diagnoses were schizophrenia spectrum psychosis (18%), antisocial/borderline/mixed personality disorder (15%) and substance use disorder (15%). In 30% of the cases criminal insanity/partial responsibility was attributed in the first-degree court. The presence of a psychiatrist (n = 63), attending, defense, prosecution or appointed by the court, significantly increased the possibility of such an attribution (41.3% versus 10.8%).

The highest agreement (κ = 0.780) was observed between court's decision and the evaluation of the psychiatrist appointed by the court, in the 35 cases in which such an expert was present (P < 0.001). Very significant agreement (κ = 0.805) was observed between the decisions of second and first-degree courts (P < 0.001). In 91% of the cases, the decisions remained unchanged.

Criminal insanity/diminished responsibility, were attributed in 30% of the reviewed cases. The presence of a psychiatrist already at the first-degree court is a prerequisite for such an attribution, especially when, he is appointed by the Court.

The authors have not supplied their declaration of competing interest.

Statistics shows that in most countries prevalence of mental health problems are much higher among prisoners than the general population. Country approach to regulating mental health needs of persons with mental disorder who come into contact with justice system depends on variety of cultural or legal traditions, as well as on different concepts and structures of mental health care delivery.

The aim of the survey was to study and assess the established practice of implementation of the legal procedure relating to individuals who commit crime and have mental health problems in Georgia.

Qualitative analysis including desk review, in-depth interview and focus group discussion was conducted. Preceding from the research objectives the current legislation with regard of people with the mental disorder has been analyzed; the interviews on the shortcomings and problems of the implementation of the law in practice have been conducted with key informants.

The study acknowledges that recent changes in Georgian legislation imports much of the civil law standards and processes relating to admission, detention and compulsory treatment of criminal detainees with mental health problems. However, due to the ambiguous, ambivalent and incomplete nature of the aforementioned changes, the penal and administrative courts, as well as the clinicians are facing serious difficulties and confusions in their work.

It is discussed that there is a strong need for closer cooperation between mental health and justice systems to treat mentally disordered persons both in the system and after they are released into the community.

The authors have not supplied their declaration of competing interest.

In some forms of sexual perversion, sexual satisfaction is achieved only by treating one's partner violently (sadism) or conversely, by suffering pain (masochism).

The objectives of our study were to understand the complex relationship between psychotic and perverse structures, and discuss the importance of some criminal risk factors for psychotics who have sexually perverse behaviors, through clinical observation and review literature.

Mr AB was 35-year-old, single and unemployed. He was hospitalized in our forensic psychiatric department following a dismissal for criminal responsibility for an act of emasculation on a child aged 5 years without sexual abuse. In his biography we have objectified cruelty to animals, charged judicial history (imprisonment for theft, murder and escape from prison, hetero aggressive acts) and substance use.

The patient explained with indifference that he heard voices making fun of his “sexual impotence and loss of his manhood”. The day of the forensic act, he got an uncontrollable urge to emasculate the first man he met on his way at the behest of this hearing hallucinatory activity. Psychiatric experts retained the diagnosis of psychosis with perverse arrangements. Under neuroleptic treatment, psychotic symptoms disappeared but the patient's sadistic problems remained present and active throughout his hospitalization.

The following case illustrates the issue of dangerousness and responsibility in a perverse psychotic author assault of a sexual nature. Given their clinical history, the path between perversion and psychosis shows that perverse manifestations are prior to the first psychotic symptoms and the perverse constitution is developed parallel to the psychotic illness.

The authors have not supplied their declaration of competing interest.

Zoophilia consists of sexual intercourse by a human being with a lower animal. There is a paucity of literature on this paraphilia.

In this paper, we report an uncommon case of homicide committed by a man with co-morbid borderline personality disorder and paraphilic disorder, and review the literature.

Mr SH was a single and unemployed 30-year-old male. He was hospitalized in our forensic psychiatric department following a dismissal for criminal responsibility for an act of attempted murder with premeditation. There was no history of any other psychiatric disorder, chronic physical illness or drug dependence. He complained that he had been suffering for the past ten years from sad mood, sleeplessness, loss of interest, and feelings of guilt worthlessness, and hopelessness. He had started sexual intercourse with animals eight years ago. He harbored feelings of guilt for his sexual experiences with animals. There was no formal thought disorder or perceptual abnormality. At the beginning of bestiality, he explained his unconventional behavior, by the fact that he had been bewitched, by his uncle's wife. Projective tests found borderline psychopathology. The crime occurred after a zoophilic sexual intercourse. Mr SH was obsessed with bewitchment thoughts, and got an uncontrollable urge to kill his uncle's wife. The crime was impulsive and violent. Psychiatric experts retained the diagnosis of co-morbid borderline personality disorder and other specified paraphilic disorder (DSM-5).

In this case, we discuss the clinical and therapeutic challenges of this complex case, and the legal liability of Mr SH.

The authors have not supplied their declaration of competing interest.

The etiology of autism spectrum disorder (ASD) is unclear. Studies involving children with ASD suggest that oxidative stress could explain some of the pathology. Few reports have investigated the role of oxidative stress into adulthood. Furthermore, the knowledge on psychiatric and somatic comorbidities, as well as socio-economic status in a trajectory across lifespan is sparse.

Investigating oxidative stress related markers in ASD, along with trajectories in socio-economic functioning and comorbidities.

To evaluate the importance of oxidative stress in the neurobiology of adults with ASD and assess the socio-economic level of functioning and comorbidities.

Plasma levels of antioxidant super-oxide-dismutase isoenzymes (SOD1 and SOD2) and pro-oxidant xanthineoxidase (XO) were measured in 56 patients ≥18 years of age, diagnosed in childhood with ASD (F84.0, F84.1, F84.5 or F84.8), along with gender and age matched controls. Participants were interviewed regarding their health, familial predisposition and social status.

Cases showed higher levels of SOD1 (268.2 ng/mL vs. 205.6 ng/mL). We found no differences regarding SOD2 and XO. Patients had a higher BMI (27 vs. 24), fewer drank alcohol (40% vs. 75%), more had a psychiatric co-morbidity (50% vs. 2%), more had family member with a psychiatric diagnosis (80% vs. 50%). None of the bio-psycho-social factors showed association with biomarker levels.

Oxidative stress seems to play a role in ASD. Furthermore, patients with ASD often have psychiatric comorbidities; more often have a family history of psychiatric diagnoses, and are less healthy physically.

The authors have not supplied their declaration of competing interest.

Even though it has begun to be investigated in recent years, studies of microRNA (miRNA) in anxiety disorders are limited. Our research is the first miRNA expression study in panic disorder, which excludes of drug use and additional psychiatric disorders.

We aimed to determine the availability of miRNAs as biomarkers in the serum levels of panic disorder and to demonstrate the changing expression of miRNAs.

In the research, 35 panic disorder patients and 35 healthy controls were administered a socio-demographic and clinical information form, SCID-I, PDSS. 2 tubes of peripheral venous blood were taken from each group for genetic evaluation. miRNA expression analysis was performed in those samples by the RT-PCR method.

Compared with the healthy control group, 8 miRNA expression levels were found different in panic disorder group. Five of them were up-regulated and 3 of them were down-regulated. There was no correlation between the level of miRNA expression and PDSS total score and PDSS sub-items. miR-1297 and miR-4465 expression levels were statistically significant between the two groups. Both miRNAs are also known to arrange the gene regions that affect GABAA receptor subtypes.

miR-1297 and miR-4465 regulate the GABAA gene that is thought to play a role in the etiology of panic disorder (Wong et al., 2014, Wang 2016). In panic disorder group, miR-1297 and miR-4465 expression levels were found to be up-regulated from the healthy control group.

The authors have not supplied their declaration of competing interest.

Several studies have asserted the existence of a strong and complex genetic component in the determination of psychotic disorders. GWAS studies conducted over the past decade lead to the identification of only a few low effect associations, calling questioning the hypothesis of “common disease – common variants” for a model involving a large number of rare variants.

Here, we studied a multigenerational multiplex family with schizophrenia a high rate of consanguinity, located in the northwest of Algeria. This study aims to identify inherited rare variants of schizophrenia using new genetic technologies.

This family has received complete clinical (DIGS, DSM-IV criteria), genealogical investigations, CNV analysis using CGH Microarray Kit 244 K (Santa Clara, CA) and WES (by GAIIx Illumina/HiSeq 2000) focused in CNV regions, that were performed in the department of genetics in the university hospital of Geneva.

We identify 11 affected members by psychotic disorders. The main CNVs analysis results found in a schizophrenic member a Del 22q13.33 affecting SHANK3 gene. WES regarding these regions identified a mutation at position 511178000 in SHANK3 gene in all the selected affected relatives.

Several studies have asserted the association of SHANK3 mutations with schizophrenia and autism disorders. This is the first observation of rs511,178,000 in schizophrenia phenotype.

In total, this highly informative family have identified new rare genetic variant of schizophrenia. The search for this mutation in wider control population in would be useful to validate these data.

The authors have not supplied their declaration of competing interest.

Co-morbidity between cancer and psychiatric disorders including adjustment disorder, depressive disorders or angst can seriously influence the prognosis and the quality of life of patients.

The identification of the psychological and biological profile of patients at risk for such co-morbidity is not yet available. Classical candidate genes such as the BDNF, the 5-HTLPR and genes whose products are involved in inflammatory events have received some attention, but results are inconclusive.

In the present review the association between cancer and psychiatric disorders is reviewed, a focus on the investigation of the Gene X environment and the epigenetic control over the activation of the HPA axis is proposed as a tool to refine the definition of the biologic profile at risk for co-morbidity between psychiatry and cancer.

A number of genes and socio-demographic variables that may influence risk to suffer from a psychiatric disorder after a diagnosis of cancer is identified and discussed. The identification of such biologic and socio-demographic profile is instrumental in the identification of subjects at risk of a double diagnosis, both somatic and psychiatric. An early identification of such profile risk would pave the way to the implementation of early intervention strategies.

The authors have not supplied their declaration of competing interest.

22q11.2 deletion syndrome is a primary immunodeficiency due to micro-deletion on the large arm of chromosome 22. Patients suffer from several anomalies, including metal illness, that such the case we present, mean a warning sign for further study.

Twenty-one years-old male, with psychotic symptoms, typical of schizophrenia, behavioral disorders and mental confusion, plus epileptic episodes and psychomotor agitation. Two previous incomes with the diagnosis of psychotic disorder not otherwise specified. Treated with anti-psychotics at low doses with inter-episode stability.

Prematurity, low birth weight, neonatal asphyxia, generalized seizures, otitis and recurrent urinary tract infections, hypernasal voice, poor academic performance, difficulty relating. Physical examination: hypernasal voice, furred tongue, dysmorphic faces, scoliosis, hipotanía, stereotypes, delusions, auditory hallucinationsd negative symptoms.

We considered the possibility of a neurodevelopmental disorder, with a multidisciplinary approach, resulting in the diagnosis of paranoid schizophrenia and velocardiofacial syndrome, which had gone unnoticed. Mean doses of clozapine, haloperidol and topiramate were used. He accepted psychiatry and other specialties follow-up, since it requires a complex and multidisciplinary approach.

Definition of velocardiofacial Syndrome and lack of consensus on terminology:

– syndrome 22q11.2 DS as genetic subtype of schizophrenia? Opportunity to study the pathogenesis of schizophrenia;

– the importance of a comprehensive approach to early diagnosis, clinical improvement and preventing complications.

The authors have not supplied their declaration of competing interest.

Addiction to computer games (CA) is growing with a lightning speed in whole world. Very few studies are focused in the genetic basis of this disorder.

To study the COMT and MAOA polymorphism in addicts to computer games.

Totally 42 persons were included in this study, 22 of them had CA and 20 were totally healthy. Out of 22 gamers, 10 persons had only CA. The rest of 12 patients suffered from another psychiatric disorder besides of CA (Schizotypal disorder, depression, bipolar disorder). Their mean age was 16 years (15; 17) and all of them were males.

The total frequency of alleles 3R and 5R of MAOA gene in patients with CA was 30.0%, which doesn’t have any statistical difference with the healthy persons. The genotype frequency of Val158Met of COMT gene is high in CA rather than in healthy persons (χ2 = 6.85, P = 0.03). Also, the homozygotes Val are much more in CA patients (59.1%) than in healthy persons (25%). On the other hand, the Val/Met combination is lower in CA patients (18.2%) than in healthy persons (55.0%).

The Val158Met polymorphism of gene COMT may lead to CA formation.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The author has not supplied his declaration of competing interest.

Pregabalin is a well-established anti-epileptic drug in the treatment of epilepsy. It is also indicated for the treatment of generalised anxiety disorder and neuropathic pain. In addition, it has mood modulating properties. In people with intellectual disabilities it is used to treat epilepsy. There is little evidence of the use of pregabalin in managing mental health difficulties in people with intellectual disabilities.

To describe the use of pregabalin in adults with intellectual disabilities.

A descriptive case series of adults with intellectual disabilities living in the community, under the care of a community psychiatrist, who are prescribed Pregabalin. Outcomes of treatment were measured using the health of the nation outcome scale for people with intellectual disabilities (HoNOS-LD).

Fourteen cases were identified in the community service of adults with Intellectual Disabilities. Twelve were men and two were women. The average age of the sample was 29 years. The range in duration of using pregabalin was from 3 to 72 months. Thirteen adults had a diagnosis of Autism of which three also had ADHD. The indications for using pregabalin and numbers were : anxiety (12); liability of mood (2); generalised anxiety disorder (1); epilepsy (1). The daily dose range was from 150 mg to 300 mg The mean change in HoNOS-LD scores was 32%.

Pregabalin is a useful treatment in people with intellectual disabilities who experience anxiety. It is especially effective among adults with ID and autism to modulate mood and anxiety symptoms.

The authors have not supplied their declaration of competing interest.

In Germany, mental health care in people with IDD is mostly determined by experts’ opinions. Particularities of the psychiatric assessment and treatment of people with IDD and a co-morbid psychiatric disorder are taught neither at medical schools nor in the scope of the medical training of psychiatrists.

The present study examined the influence of socio-political aspects of health care on quality and organisation of mental health care in people with IDD.

Various aspects of health care systems in Germany and three other European countries were explored and juxtaposed subsequently with a special developed questionnaire.

The health care systems of four different European countries differ in socio-economical, educational and system-financed aspects.

Differing organisational levels of national health care systems and socio-economical aspects within these countries contribute to the organisation of the mental health care system in people with IDD. Suggestions for a better harmonisation of European mental health care in people with IDD are offered.

The author has not supplied his declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Since the 1990's the main form of vocational rehabilitation centers in Poland were occupational therapy workshops (OTW), but the low ratio of the employment of the participants of OTW‘s led to the creation of newer, more effective institutions called Occupational Activation Centers (OAC). They were expected to be professional activity establishments, aimed at launching new career paths of people with intellectual disabilities, enabling the candidates to pass through various stages of rehabilitation and vocational activation.

The analysis of available statistical data concerning the activity of OAC‘s in Poland was done.

In the whole country the number of these facilities is 53, while the number of occupational therapy workshops is 665. The Law on OAC‘s restricts the employment of people with moderate disability in total employment to 35%, this indicator covering not only the persons with mental retardation, but also people with autism and mental illness. In addition the OAC‘s activity generates the cost of creating them inadequate for the quantity and quality of jobs being created.

It turned out that the creation of OAC‘s occurred too slowly in relation to the already operating OTW‘s and the weaknesses in the Polish system of rehabilitation and employment of people with intellectual disabilities necessitates the need to find innovative ways to solve this problem.

The authors have not supplied their declaration of competing interest.

COI: Bhathika Perera, I have received travel grants from pharmaceutical companies to attend ADHD conferences and I have been a speaker at pharmaceutical company sponsored events on ADHD.

COI: Bhathika Perera has received grants to attend conferences and speak at ADHD conferences by pharmaceutical companies.