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In this paper we aim to offer a balanced argument to motivate (re)thinking about the mental illness clause within the insanity defence. This is the clause that states that mental illness should have a relevant causal or explanatory role for the presence of the incapacities or limited capacities that are covered by this defence. We offer three main considerations showing the important legal and epistemological roles that the mental illness clause plays in the evaluation of legal responsibility. Although we acknowledge that these advantages could be preserved without having this clause explicitly stated in the law, we resist proposals that deny the importance of mental illness in exculpation. We argue, thus, that any attempt at removing the mental illness clause from legal formulations of the insanity defence should offer alternative ways of keeping in place these advantages.

Background. Comorbidity has profound implications in both the clinical field and research, yet little is known about the prevalence and structure of comorbid mental disorders. This article aims not only to present data on the prevalence of mental disorders and comorbidity, but also to explore relationships between comorbid mental disorders by using a network approach. Methods. Data used in this cross-sectional study are part of a prospective cohort study within penitentiary psychiatric centers (PPCs) in the Netherlands. It includes DSM diagnoses of 5,257 unique male patients incarcerated in one of the PPC's. Prevalence rates of mental disorders and comorbidity were calculated, the network of comorbid DSM diagnoses was constructed using regression coefficients. Results. Schizophrenia spectrum and substance-related disorders were most prevalent within this sample (56.7 and 43.1%, respectively), and over half of all patients were diagnosed with a comorbid disorder (56.9%). Four distinctive groups of disorders emerged from the network analysis of DSM diagnoses: substance use, impulsivity, poor social skills, and disruptive behaviors. Psychotic disorders were considered as a separate group as it was unconnected to other disorders. Conclusions. Comorbid mental disorders can be described, at least in part, as connected networks. Underlying attributes as well as direct influences of mental disorders on one another seem to be affecting the presence of comorbidity. Results could contribute to the understanding of a possible causal relation between psychopathology and criminal behavior and the development of treatment programs targeting groups of disorders.

Objective Patients with OCD differ markedly from one another in both number and kind of comorbid disorders. In this study, we set out to identify and characterize homogeneous subgroups of OCD patients based on their comorbidity profile. Methods In a cohort of 419 adult subjects with OCD, the lifetime presence of fifteen comorbid disorders was assessed. Latent class analysis was used to identify comorbidity‐based subgroups. Groups were compared with regard to core clinical characteristics: familiality, childhood trauma, age at onset, illness severity, OCD symptom dimensions, personality characteristics, and course of illness. Results The study sample could be divided in a large group (n = 311) with a low amount of comorbidity that could be further subdivided into two subgroups: OCD simplex (n = 147) and OCD with lifetime major depressive disorder (n = 186), and a group (n = 108) with a high amount of comorbidity that could be further subdivided into a general anxiety‐related subgroup (n = 49), an autism/social phobia‐related subgroup (n = 27), and a psychosis/bipolar‐related subgroup (n = 10). Membership of the high‐comorbid subgroup was associated with higher scores on childhood trauma, illness severity, and the aggression/checking symptom dimension and lower scores on several personality characteristics. Conclusion Grouping OCD patients based on their comorbidity profile might provide more homogeneous, and therefore, more suitable categories for future studies aimed at unraveling the etiological mechanisms underlying this debilitating disorder., In this study, we set out to identify and characterize homogeneous subgroups of OCD patients based on their comorbidity profile. This might provide more homogeneous and therefore more suitable categories for future studies aimed at unraveling the etiological mechanisms underlying this debilitating disorder.

Advances in the use of neuroimaging in combination with A.I., and specifically the use of machine learning techniques, have led to the development of brain-reading technologies which, in the nearby future, could have many applications, such as lie detection, neuromarketing or brain-computer interfaces. Some of these could, in principle, also be used in forensic psychiatry. The application of these methods in forensic psychiatry could, for instance, be helpful to increase the accuracy of risk assessment and to identify possible interventions. This technique could be referred to as ‘A.I. neuroprediction,’ and involves identifying potential neurocognitive markers for the prediction of recidivism. However, the future implications of this technique and the role of neuroscience and A.I. in violence risk assessment remain to be established. In this paper, we review and analyze the literature concerning the use of brain-reading A.I. for neuroprediction of violence and rearrest to identify possibilities and challenges in the future use of these techniques in the fields of forensic psychiatry and criminal justice, considering legal implications and ethical issues. The analysis suggests that additional research is required on A.I. neuroprediction techniques, and there is still a great need to understand how they can be implemented in risk assessment in the field of forensic psychiatry. Besides the alluring potential of A.I. neuroprediction, we argue that its use in criminal justice and forensic psychiatry should be subjected to thorough harms/benefits analyses not only when these technologies will be fully available, but also while they are being researched and developed.

BackgroundResults of research regarding a possible causal relation between autism spectrum disorders (ASDs) and violence are mixed. Several explanations have been proposed.AimsTo assess prevalence rates of comorbid disorders in a large sample of mentally ill offenders diagnosed with ASD. Offenders with and without comorbid mental disorders were compared on several characteristics. To better understand the relationship between ASD and violent criminal behavior, the predictive value of several proposed risk factors (comorbidity, negative social network/influenceability, and childhood trauma/victimization) on violent offending was investigated.MethodData of 394 male offenders with a diagnosis of ASD were included. Prevalence rates of comorbid mental disorders next to ASD were calculated, and characteristics were compared using chi-square or t-tests. The predictive value of the risk factors was assessed using a binary logistic regression (n = 357).ResultsHigh rates of comorbidity were found (78.9%), specifically for substance use disorders (39.8%), schizophrenia spectrum disorders (31.7%), and neurodevelopmental disorder other than ASD (24.1%). Offenders with and without comorbidity differed significantly in their criminal and mental health care history. Both comorbidity (OR = 1.68; 95% CI 1.27–2.18) and a negative social network/influenceability (OR = 1.49; 95% CI 1.11–1.99) showed to be significant predictors of violent offending within this sample.ConclusionsThe highest rates of comorbid disorders found were disorders that have been previously linked to violent offending, and the risk of violent offending could be unrelated to ASD. However, the role of social functioning indicates a risk specific to the symptoms of ASD.

The current debate on closed-loop brain devices (CBDs) mainly focuses on their use in a medical context; possible criminal justice applications have only received incidental scholarly attention. Unlike in medicine, in criminal justice, CBDs might be offered on behalf of the State and for the purpose of protecting security, rather than realizing healthcare aims. It would be possible to deploy CBDs in the rehabilitation of convicted offenders, similarly to the much-debated possibility of employing other brain interventions in this context. Although such use of CBDs could in principle be consensual, there are significant differences between the choice faced by a criminal offender offered a CBD in the context of criminal justice, and that faced by a patient offered a CBD in an ordinary healthcare context. Employment of CBDs in criminal justice thus raises ethical and legal intricacies not raised by healthcare applications. This paper examines some of these issues under three heads: autonomy, human rights, and accountability.

When it becomes available, neuroscience-based apprehension of subjective thoughts is bound to have a profound impact on several areas of society. One of these areas is medicine. In principle, medical specialties that are primarily concerned with mind and brain are most likely to apply neurotechnological thought apprehension (NTA) techniques. Psychiatry is such a specialty, and the relevance of NTA developments for psychiatry has been recognized. In this article, I discuss ethical issues regarding the use of NTA techniques in psychiatric contexts. First, I consider the notion of neurotechnological “thought apprehension,” as well as some limitations of present-day NTA applications. Next, I identify ethical priorities for its possible future use in psychiatry. The topics I explore concern key (bio)ethical issues: confidentiality, trust and distrust, consent and coercion, and, finally, responsibility. I conclude that mental health-related use of NTA entails some specific ethical concerns that deserve careful attention before introducing these technologies in psychiatric practice.

Background: Prison can be characterized as an impoverished environment encouraging a sedentary lifestyle with limited autonomy and social interaction, which may negatively affect self-control and executive function. Here, we aim to study the effects of imprisonment on self-control and executive functions, and we report the change in neuropsychological outcome after 3 months of imprisonment. Materials and Methods: Participants were 37 male inmates in a remand prison in Amsterdam, Netherlands, who completed six tests of a computerized neuropsychological test battery (the Cambridge Automated Neuropsychological Test Battery) in the first week of arrival. Participants were retested after 3 months of imprisonment. Change in performance was tested using the Wilcoxon Signed-Rank test. Results: After 3 months of imprisonment, risk taking significantly increased (measured as an increase in the proportion of available points used for betting) and attention significantly deteriorated (measured as increased variability in reaction times on a sustained attention task), with large to medium effect sizes. In contrast, planning significantly improved (measured with a task analog to the Tower of London) with a medium effect size. Discussion: Our study suggests that 3 months of imprisonment in an impoverished environment may lead to reduced self-control, measured as increased risk taking and reduced attentional performance. This is a significant and societally relevant finding, as released prisoners may be less capable of living a lawful life than they were prior to their imprisonment, and may be more prone to impulsive risk-taking behavior. In other words, the impoverished environment may contribute to an enhanced risk of reoffending.Keywords: prison, executive functions, impoverished environment, self-control, impulsivity, offenders, CANTAB

Objectifs : Décrire et analyser les modalités de prescription de psychotropes chez des patients suivis en ambulatoire à l’hôpital psychiatrique. Méthodes : Etude descriptive transversale sur la prescription de psychotropes chez 509 patients, suivis à la consultation externe de l’EHS (Etablissement hospitalier spécialisé) psychiatrique d’El Madher, durant une période de trois mois (du 10 février 2015 au 10 Mai 2015). Résultats : Sexe ratio H : F 3,1 : 1. Age moyen : 40,7 ans, 67% avaient des antécédents d’hospitalisation. Les troubles avaient duré plus de 5 ans pour 69,7% des patients. Le diagnostic le plus fréquent était la schizophrénie (64,2%) suivi par les troubles anxieux (11,1%), les troubles bipolaires (3,7%) et les troubles dépressifs (2,9%). Uniquement 10,6% des patients étaient sous monothérapie ; le nombre moyen de médicaments par patient était de 2,8. Les antipsychotiques étaient les médicaments les plus prescrits (88,2%) suivis des anxiolytiques (38,3%) puis des antidépresseurs (26,5%). Un antiparkinsonien de synthèse est retrouvé chez 26,1% des cas et un thymorégulateur chez 16,6%. Les neuroleptiques à action prolongés étaient prescrits chez 19,1% de patients. Les antipsychotiques de première génération étaient prescrits chez 85,6% des patients schizophrènes et les antipsychotiques de seconde génération chez 62,1%. La majorité des patients recevaient une bithérapie antipsychotique (65%). Comparés aux tricycliques, les inhibiteurs de la recapture de la sérotonine étaient plus prescrits dans les troubles dépressifs (60% vs 40%) et les troubles anxieux (54,4 % vs 36,8%). Les thymorégulateurs étaient prescrits dans les troubles bipolaires dans 63,1% des cas et dans la schizophrénie dans 13,7%. Les benzodiazépines étaient associées aux antidépresseurs dans les troubles dépressifs dans 86,7% des cas et dans les troubles anxieux dans 93%. Conclusions : On note une tendance vers la prescription des nouveaux médicaments antipsychotiques et antidépresseurs. La polymédication reste élevée. Il y a une utilisation importante de benzodiazépines dans les troubles anxieux et les troubles dépressifs.

Particle-laden gravity flows, called turbidity currents, flow through river-like channels across the ocean floor. These submarine channels funnel sediment, nutrients, pollutants and organic carbon into ocean basins and can extend for over 1000’s of kilometers. Upon reaching the end of these channels, flows lose their confinement, decelerate, and deposit their sediment load; this is what we read in textbooks. However, sea floor observations have shown the opposite: turbidity currents tend to erode the seafloor upon losing confinement. Here we use a state-of-the-art scaling method to produce the first experimental turbidity currents that erode upon leaving a channel. The experiments reveal a novel flow mechanism, here called flow relaxation, that explains this erosion. Flow relaxation is rapid flow deformation resulting from the loss of confinement, which enhances basal shearing of the turbidity current and leads to scouring. This flow mechanism plays a key role in the propagation of submarine channel systems.

The terminal stages that come prior to the exitus – in incurable diseases, „fin de vie des vieux“ – are characterised, among others, by a number of psychological changes and psychiatric disorders that need to be diagnosed and therapeutically tackled through psycho-therapy and appropriate medication, in order to improve the quality of life. International research in this field and also own observations of the authors of the study on the structure of the entities that can be found and their order frequency are presented in the paper. Among the most frequent are the following: anxiety, depression, delirium, suicidal risk, cognitive disorders that are detailed according to intensity, evolution, therapeutical response. Anxiety occurs as a result of awareness of the proximity of the death. Management of the depression includes antidepressant medication and, especially, supportive psychoterapy. With reference to the suicidal risk, a careful assesment of the risk must be done. Cognitive disorders are more serious and difficult to be influenced therapeutically.

The role of a voluntary association for bereaved detainees? Sharing experience. In the process of grieving the death of a loved one, the basic needs of a bereaved person is talking about the deceased and to express their emotions. How is it possible with prisoners, forced into loneliness and isolation? As volunteers trained in bereavement, how to stimulate a group of prisoners with all their specific needs and difficulties? We met with these men and women and now invite you to share our experience in order to understand and better help these prisoners.

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ZusammenfassungDie repetitive Transkranielle Magnetstimulation (rTMS) ist eine innovative Technologie, mit der nicht-invasiv neurobiologische, physiologische und psychologische Funktionen des Gehirns moduliert werden können. In Konferenzen deutscher TMS-Experten wurde, einem formalen Konsensusprozess folgend, das Nutzen/Risiko-Verhältnis der rTMS als therapeutische Technik für die Psychiatrie beurteilt. Die rTMS wurde als viel versprechendes und innovatives Verfahren beurteilt, dessen weitere Erforschung wünschenswert ist. Zurzeit erscheinen depressive Störungen unter der Vielzahl untersuchter Diagnosen als mögliche Hauptindikation einer rTMS-Behandlung. Die überwiegend medikamentös vorbehandelten und zum Teil therapieresistenten depressiven Patienten zeigten in den existierenden Studien ein positives Nutzen/Risiko-Profil im Sinne einer moderaten klinischen Verbesserung bei zugleich niedriger Nebenwirkungsrate. Die rTMS sollte grundsätzlich von in der Methode erfahrenen oder speziell ausgebildeten Ärzten durchgeführt werden. Die aktuellen Sicherheitsempfehlungen sind dabei zu berücksichtigen und ein engmaschiges Therapiemonitoring sollte erfolgen. Obwohl der wissenschaftliche Datenbestand zur rTMS stetig wächst, ist die Methode gegenwärtig noch als experimentelles Therapieverfahren einzuschätzen, das bislang noch weniger gut untersucht ist als vor einer Zulassung stehende Psychopharmaka.

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OBJECTIVE: A project of quality management funded by the German Ministry of Health is presented which aims at recording and reducing of coercive measures (seclusion, restraint, forced medication). METHOD: Since 1997, a study group for prevention of violence and coercion consisting of physicians, nurses and other psychiatric professionals from 18 psychiatric hospitals is working in Baden-Wuerttemberg and Bayern. A common documentation of coercive measures has been introduced, variables of interest such as percentage of patients exposed to coercive measures in each principal diagnostic group of the ICD-10 have been defined for purposes of benchmarking. Aims of the project are 1) a complete documentation of all coercive measures in 12 psychiatric hospitals in a 12-month period and a benchmarking, taking into account structural characteristics of the hospitals and the respective catchment area, 2) providing a manual for a one-day de-escalation training for all professional groups working with psychiatric patients. PRELIMINARY RESULTS: A pilot study demonstrated that about 9 % of all admitted patients have been exposed to coercive measures in a subset of the participating hospitals. The variance between the hospitals was rather high. Language: de

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