Economic crises can contribute to a worsening of mental health problems and, consequently, to a possible increase of the use of psychotropic medication.

To assess the use of psychotropic medication in Portugal before and after the onset of the economic crisis, and to better understand the impact of the economic crisis in this highly hit country.

This 2015 follow-up epidemiological study re-interviewed a probability sub-sample of respondents to the 2008 national mental health survey, the first nationally representative study of psychiatric morbidity and treatment patterns in Portugal. Socio-demographic and clinical variables were assessed using a structured interview in 2008 (n = 2060) and 2015 (n = 911). All participants were questioned about the last 12 month use of psychotropic medication for mental health problems. Descriptive analysis was conducted to assess the use of psychotropic medication by group and gender in 2008 and 2015.

Between 2008 and 2015 there was an overall increase in the use of the main groups of psychotropic medication (22.5% to 28.6%), with a particularly relevant increase in the consumption of anti-depressants and anxiolytics. The use of psychotropic medication was higher among women in 2008 and 2015 (31.1% and 36.7%) compared to men. However, the increase in consumption was more relevant in men (13.3% to 20.0%), particularly in relation to anxiolytics (6.0% to 11.6%).

The economic crisis was associated with a substantial increase of psychotropic medication's use in Portugal, consistent with the increased prevalence of mental health problems that this study also found.

EEA Grants Programa Iniciativas em Saúde Pública.

The authors have not supplied their declaration of competing interest.

During economic crises additional mental health risks emerge and social inequalities in health can widen. In order to ensure universal coverage of mental health care and to reduce the impact of the crisis, it is crucial to assess the needs of the population to be able to reorganize mental health care accordingly.

To analyse the use of services for mental health problems in Portugal during the economic crisis.

In this follow-up epidemiological study, a probability sub-sample of respondents to the 2008 national mental health survey (n = 911) was re-interviewed in 2015. Socio-demographic variables and treatment patterns were assessed using a structured interview, and psychological distress was measured using the Kessler-10 Scale. Descriptive analysis was conducted to characterize the use of services for mental health problems.

In total, 27.9% of the respondents sought treatment for mental health problems in the previous 5 years, and GPs were the most contacted professionals. Only 57.7% (n = 119) of the respondents with moderate or severe psychological distress (n = 197) reported recognizing they needed treatment. Among people with moderate or severe psychological distress who recognized their need for treatment, most received treatment (80.5%, n = 105), which was minimally adequate for 74.4% (n = 81). Low perceived need and structural barriers were the main obstacles for access to care.

Under-treatment, low continuity of care and low adequacy of treatment are problems that the Portuguese health system must address in order to meet the mental health challenges of the economic crisis.

EEA Grants: Programa Iniciativas em Saúde Pública.

The authors have not supplied their declaration of competing interest.

The armed Colombian conflict is one of the bloodiest and most extensive in the contemporary history of Latin America, with multiple factors and causes implicated.

Determine the factors involved in the emergence of Colombian political violence from neurobiological, anthropological, social and psychoanalytic models.

We revised the report Basta Ya! of The National Center for Historical Memory, which approximates the casualties and victims of the armed conflict in Colombia. In addition, we conducted a rigorous review of current scientific and clinical literature on the neurobiology of violent behavior, social psychiatry and psychoanalytic papers about war, death, and survival instincts.

Violent behavior can be explained by the neurobiological model of aggressive response as an imbalance between the prefrontal cortex and the limbic system. There is evidence to support a geographically-based violence in Colombia with a fragmentation of the territory, the State, and the Colombian identity. Moreover, we found the psychological component raised by Freud and in psychoanalysis, about war, and life and death instinct, as antagonistic manifestations of life-present in acts of violence.

The violence from the armed Colombian conflict has been one of the longest in modern history, determining its causality has been complex. However, understanding violence multifactorially allows us to improve social psychiatry and our role as clinicians in this new post-agreement era, in order to better establish mental health policies for victims and perpetrators in future reparation.

The author has not supplied his/her declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

In the context of the 500th anniversary of the Reformation, it is time to take a survey of the history of Martin Luther's (1483–1546) pathography.

Relevant writings were evaluated.

While in a 1035 page work written in German between 1937 and 1941, the Dane Paul Reiter retrospectively diagnosed Luther as manic-depressive, Kretschmer (1888–1964) in 1955 saw in Luther “a great polemic and organizer”. In 1956, Grossmann was unable to prove persistent synchronicity of depressive mood and reduced motivation in Luther in the key years 1527 and 1528, which led him to conclude that Luther had a cyclothymic personality with a pyknic constitution. In Roper's view in 2016, Luther suffered from “a condition […], that we would call depression today”.

In 1948, Werner concluded that Reiter's pathography was based on an incorrect assumption: Luther's solution of the cloister conflict as a dilemma situation between paternal and clerical authority was not a flight into “the mysticism of despair”. Hamm adopted this interpretation in 2015 in viewing the escalation of the emotional conflict potential as a logical consequence of an interiorized and individualized intensified piety. In 2015, Scott saw a cyclothymic temperament in Luther starting in about 1519, but emphasized the elasticity of Luther's emotional reserves: “For the rest of his life, Luther oscillated between euphoria and dejection but not to the point of dysfunction”.

Luther can be used as an example of the importance of religiousness as a curative resource for the psyche.

The authors have not supplied their declaration of competing interest.

It is not a rare phenomenon to ask a bed in the ICU in a basis of emergency. Then, the answer coming from the intensivists may be more than surprising. Objective of our study is to highlight the fact that emotional reasons and not medical criteria are the dominant ones for accepting a patient in the ICU.

We present 4 cases of interest.

A poor Russian 75-year-old man with gastric cancer, anemia and haemodynamic instability was not accepted in the ICU with the oral and not written rejecting answer that he suffers from advanced cancer. A 35-year-old transplanted patient with bone marrow, fever, severe lactic acidosis, was not accepted in the ICU for hours because the intensivist would give her consent only if the patient would undergo a cholecystectomy first! The intensivist was a pneumonologist! In the end multiple liver abscesses were discovered, so an operation would not help. An 80-year-old man operated for colon cancer with haemodynamic instability was accepted in the ICU without delay. A 72-year-old with colon cancer, cachexia, thrombopenia and severe dementia, coming from the Psychiatric Hospital where he remained for months, was accepted in the ICU without delay.

If there is not an Ethics Commitee to examine these unexpectability matters concerning patients needing a place in ICU, then a psychiatric evaluation of Intensive Unit physicians might help, for the good of patients. Would a member of the Parliament or a celebrity receive a “No” from the ICU?

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

In 2012, forensic psychology Professor Jane Ireland published initial research claiming that two third of psychological assessment reports sampled from UK family courts were ‘poor’ or ‘very poor’. ‘Fitness to practice’ concerns were raised by vested interest and dismissed after a 1-week hearing – four years later.

The presentation outlines the nature of various UK institutions, such as family courts, HCPC and GMC as well as their practices which raise questions about their fitness to regulate.

Delegates will start to learn how institutions that purport to serve public interest yet can be easily exploited by vested interests.

Case studies are used to illustrate how extremely serious concerns were ignored but persecution concerns upheld.

In one case, four courts appointed experts ignored an obvious child trafficking process where a toddler was raped to cover up birth and disappearance of a newborn baby that succeeded from incestuous rape. In spite of a clinical psychologist failing to cover the two index incidents, the concerns did not meet the HCPC ‘Standard of Acceptance’. A ‘revenge concern’ was raised by vested interests. In another case, the GMC refused to investigate a psychiatrist who had lied and rather absurdly claimed that repeatedly seeking return of her children was evidence for a mother's personality disorder. In a widely publicized case Psychiatrist Dr Hibbert accused of unnecessarily, breaking up families was investigated but cleared of misconduct by the GMC.

Institutions tasked with protecting public safety and fairness appear to be unduly biased towards shielding inadequate professionals and persecuting whistle-blowers.

The author has not supplied his/her declaration of competing interest.

Quaternary prevention, concept coined by the Belgian Marc Jamoulle, are the actions taken to avoid or mitigate the consequences of unnecessary or excessive intervention of the health system. The concept alludes to actions to avoid the over-diagnoses and over-treatment, trying to reduce the incidence of iatrogeny in patients, which is a serious public health problem and even more in mental health.

Systematic review of bibliography.

Do a systematic review of bibliography and through the results invite to the analytic and critic reflection of our professional activities and the current situation of mental health.

There is not enough studies about quaternary prevention in mental health.

–Some studies found that about one-third of diseases of a hospital are iatrogenic, most of them for pharmacological causes.

–There is iatrogeny at different levels of the attention of mental health: primary prevention, diagnosis and treatment.

–Non-treatment indication avoids in multiple cases iatrogenesis and contributes to the correct distribution of the economic and care resources.

Since one of the fundaments of medicine is “primun non nocere” that means “first do no harm” and one of principles of bioethics is “non-maleficence”, quaternary prevention should prevail over any other preventive or curative option.

–We should define in a more realistic way the limits, benefits and damages of our interventions in order to not promote a passive and sick role.

–Must be recognized the non-treatment intervention as a therapeutic and useful intervention, and one of the best tools of quaternary prevention.

The author has not supplied his/her declaration of competing interest.

Over centuries, clinicians have had the responsibility to take care of dying patients. Lately, the withdrawal of life sustaining treatments have assumed a main role in these patients because of ethical aspects. Competent patients have the right to refuse medical care but not always these rights are respected or even explained to them, especially if they are old or they don’t have any close family. A multidisciplinary team should agree on how they think it is best to care for the patient and whether withdrawal of medical interventions is appropriate by using patient's wishes.

To identify the most relevant aspects to deal with in old aged dying patients.

Systematic literature review in Up-to-date and Pubmed.

Clinical case 83 years-old-man with a gastric cancer state IV. Married with a woman with Dementia who is waiting for a long stay public residence. No children. No cognitive damage. Fatal prognosis with a need of permanent enteral nutrition, which, he doesn’t want to use and clinicians strongly recommends. Great anxiety and suffering. Decision making capacity. Wish to die.

Patients with the capacity to make medical decisions can refuse medical care even if this refusal results in their death. Sometimes, a “comfort measures only” can be a better option than trying to keep life. Old people with no family are often less informed and taken in count in making decisions. A symptom management, good patient-clinicians communication, psychosocial, spiritual, and practical support and respecting patient's wishes and decisions is a main goal in any medical care.

The authors have not supplied their declaration of competing interest.

The legal dispute between doctors and patients is increasing. The “frivolous lawsuit” is spreading and the psychiatrist is being dragged to court in the dock. Guidelines and operational protocols become the bastions of the defensive psychiatry. Defensive psychiatry involves, for example, a larger number of hospitalizations, also involuntary admissions, and psycopharmacological prescriptions.

We want to see if the issue of defensive psychiatry is perceived by psychiatrists as a risk in their clinical practices and what consequences may result in the relationship with the patient.

Through an audit and through a literature review get to define the defensive psychiatry.

Though there is much confusions and uncertainty in this field, the defensive psychiatry distorts the relationship with the patients and proposes the questions of social control.

The authors have not supplied their declaration of competing interest.

There is little research comparing patients’ views with those of their treating psychiatrists. In a survey of patients’ views conducted in 1993 for MIND (UK) by Rogers, Pilgrim and Lacey only 10% saw their problems in terms of mental illness. This highlights the tension between psychiatric codifications of mental abnormalities and explanations provided by patients themselves.

This pilot project explores the perceptions of mental health issues in patients and their psychiatrists in a regional Western Australian setting.

A mixed methods approach including semi-structured interviews of patients and their treating psychiatrists. Recruiting 5 consecutive people in the categories of involuntary in-patients, voluntary in-patients, patients on CTO, community patients and their psychiatrists.

Questions asked of the patients were:

– Why are you here?

– What problems do you have?

– What can be done?

– What control do you have?

– What control do other people have?

Psychiatrists were asked similar questions. Responses were recorded, transcribed and thematically analyzed to reveal key themes. Quotations are used to illustrate points participants wished to make.

We report on differences in understanding in both groups. This study reveals areas for further enquiry.

Considerable diversity is revealed. A key conclusion is that insight is a concept relevant both for treated and treating.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

The authors have not supplied their declaration of competing interest.

In the society we belong to, elders are the target of abuse which is many times generated by the social cultural tendency which promotes different expressions in terms of age, a tendency which also measures capacity in terms of age.

To evaluate elder physical abuse – cases reviewed at the Forensic Institute, Tirgu Mures County, Romania.

An experimental design was used, focusing on elder physical abuse cases involving victims aged 65 or older, who requested a forensic certificate. All cases were reviewed at the Forensic Institute Tg. Mures, Mures County, Romania between 1st of Jan–31st Dec 2014. Variables included: age, gender, environmental origin, physical abuse, sexual abuse, relationship with the perpetrator (relative, known person/neighbor, unknown person, husband/wife), the required number of days of hospitalization, victim previous psychiatric diagnosis, aggressor previous psychiatric diagnosis.

A total of 5252 forensic medical certificates were issued at request by the Forensic Institute of Tg Mures. One hundred and twenty (2.28%) were related to acknowledgement of the aggression of an elderly peIntroductionrson (≥65 years, with an average age of 69.89 years CI: 68.8903–70.8930). The majority of subjects were males (65%), of rural origin (64.17%). The same address as the aggressor's was identified in most of the cases (41.66%). 35.83% were hurt by neighbours/acquaintances, 22.5% were attacked by strangers.

We are aware of that an elder abuse appears to occur most often in domestic home situations, men from rural, more often than women, are involved that victims and may be perpetrated by adult family members, or other persons.

The authors have not supplied their declaration of competing interest.

Forensic psychiatric care is aimed at improving mental health and reducing the risk of recidivism of mentally ill offenders. For some mentally disordered offenders long forensic psychiatric care is required. Due to different legal framework, policies and resources in member countries, treatment programs and care provided for these subjects may vary substantially across Europe.

COST Action IS1302, a EU project aimed at establishing a European network of researchers, clinicians and service providers about long-term forensic psychiatric care, has involved nineteen European countries for 2013 to set the basis for comparative evaluation and research on effective treatment and the development of best practice in long-term forensic psychiatry in Europe.

It is constituted by three main areas of interest and research. One group works on determination of patient characteristics, looking into prevalence, duration of stay and the most determinant characteristics of long term patients. The second area of research aims at obtaining better understanding of complex external factors that influence the poor progress of patients residing for an above average time in forensic services. Third group of research focuses on knowledge about specific needs brought about by psychiatric symptoms and how these specific needs might optimize the quality of life of patients in long term forensic psychiatric care.

Launched four years ago, the action is at its last of activities. We display features, activities and data emerging from the research conducted so far.

The authors have not supplied their declaration of competing interest.

Prisons are a specific environment, in terms of population and various factors that affect health in the broader sense. According to the report of the board of prisons for Slovenia in 2013, 1 078 people who have had problems with illicit drug use were identified, representing 23.04% of all incarcerated persons. Moreover, an increase in the use of various types of new psychoactive substances, the so-called designer drugs, was recorded in recent years.

The research aimed to point out the psychoactive drugs most used in Slovenian prisons and to explore whether these pose a public health issue.

We conducted statistical research with semi-standardised epidemiological and psychoeducational questionnaires, which were distributed among prison population in Maribor region, Slovenia.

The analysis of the questionnaires received, which was completed by 54 prisoners, has shown that 54.55% of people aged between 18 and 35 years take synthetic drugs regularly, 30.30% of the population enjoys synthetic drugs occasionally. In the category of over 50 years, no one enjoyed these drugs. The most popular synthetic drugs were synthetic cannabinoids. Although a third of the users of these drugs has experienced at least one side effect, as many as 55.56% do not know how to act in such a case.

This study confirmed that the majority of users of synthetic drugs are young adults who are convinced that their use is less harmful than the use of “ordinary” psychoactive substances. A surprisingly low awareness of side effects measure was stated.

The authors have not supplied their declaration of competing interest.

“Head banging” is a common form of self-harm, linked to numerous negative outcomes including significant brain damage. However, little research has investigated the prevalence and correlates of head banging behaviour in clinical populations.

Head banging episodes were identified from the incident records (n = 5417) of two inpatient forensic services (one intellectual disability and one mental health), using relevant search terms. Rates were compared between individual patients, by gender, diagnosis and level of security. Incident accounts were analysed qualitatively using thematic analysis.

Two hundred and twenty nine incidents of head banging were recorded, occurring approximately every three days in each service. The prevalence of the behaviour between individual patients varied widely, ranging from one to 38 incidents within one year. Women and patients with intellectual disability appeared more likely to engage in head banging. Qualitative incident reports indicated that head banging was associated with mental distress, anger, and psychotic experiences.

Head banging occurs frequently in forensic services, and has documented associations with traumatic brain injury in affected individuals, thus negatively impacting progress through the care pathway and treatment outcomes. Further research should investigate short and long term management strategies and treatment approaches, in order to minimise harm.

The authors have not supplied their declaration of competing interest.

Inpatient mental health settings have been described as “obesogenic” environments, due to factors including psychotropic medication, high calorie food, restricted physical activity and sedentary lifestyles. No research has investigated obesity among forensic intellectual disability inpatients, despite this populations’ increased risk. Therefore, this paper aims to evaluate the prevalence and correlates of overweight and obesity on, and during admission.

The weight and body mass index data of 46 inpatients (15 women and 31 men) within a specialist intellectual disability forensic service was examined for the study.

Only six patients (13%) were a normal weight at admission, whereas 40 (87%) were overweight or obese. During their admission, 28 (61%) gained weight (average 11.8 kg), and one (2%) maintained. However, 17 patients (37%) lost weight (average 6.2 kg), though 16 remained in overweight/obese categories. There was no correlation between length of stay and weight/BMI.

The majority of patients were overweight or obese on admission, and approximately 60% gained weight during their admission. Women appeared at greater risk of obesity. There was no relationship between length of stay and weight. This is potentially due to the high prevalence of obesity on admission and the impact of previous admissions on weight. The results highlight the need for effective weight management interventions with this population.

The authors have not supplied their declaration of competing interest.

The aim of this paper is to make a comparative study on serial killers from different countries and link them to one of the traditional seven deadly sins in the Judeo-Christian culture.

Firstly, it was necessary to define each different deadly sin and establish its behavioural correlate. This was achieved thanks to a questionnaire designed to measure the interrate agreement within a sample population. Once the categories were defined (pride, lust, envy, sloth, wrath, gluttony and greed), 30 serial killers from America and Europe were analyzed in order to determine the sin behind their motivation to commit a crime. The evaluation was based on the Coding Guide – Serial Killers Research Project – created by the unit of analysis of criminal behavioural (University of Salamanca, Spain). Afterwards, an ex post facto descriptive non experimental study was carried out to find out the relation between the serial killer's own characteristics and the deadly sin linked to their motivation.

The results show a clear predominance of pride, lust and greed as the main motivations within the study sample. As well as some possible dependency relations between killers’ motivations and some other variables, which could be helpful when applied to the offender profiling field like sex or personality.

The authors have not supplied their declaration of competing interest.