European Psychiatry - Volume 41 - April 2017

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S594 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S583–S644
EV0583
Persons with mental disorder in jails
and prisons – legislation and practice
in Georgia
N. Zavradashvili ∗, M. Eliashvili , E. Zhorzholadze ,
N. Makhashvili
1 Ilia State University, Social psychiatry, Tbilisi, Georgia
2 Acad. O. Gudushauri National Medical Center, Department of
Psychiatry, Tbilisi, Georgia
3 Parliament of Georgia, Committee of Health and Social Issues,
Tbilisi, Georgia
4 Ilia State University, Mental Health Resource Centre, Tbilisi, Georgia
∗ Corresponding author.
Introduction Statistics shows that inmost 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.
Objective The aimof the surveywas to study and assess the estab-
lished practice of implementation of the legal procedure relating to
individuals who commit crime and have mental health problems
in Georgia.
Methods 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.
Results 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 crim-
inal detainees with mental health problems. However, due to the
ambiguous, ambivalent and incomplete nature of the aforemen-
tioned changes, the penal and administrative courts, as well as
the clinicians are facing serious difficulties and confusions in their
work.
Conclusions 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.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0584
Sadistic sexual assault, perversion and
schizophrenia: A case report
M. Zghal ∗, F. Fekih Romdhane , G. Jmii , F. El Ghali ,
A. Belkhiria , L. Jouini , I. Ghazeli , R. Ridha
1 Razi hospital, Forensic Psychiatric, Tunis, Tunisia
2 Razi hospital, consultation and emergency department, Tunis,
Tunisia
∗ Corresponding author.
Introduction In some forms of sexual perversion, sexual satisfac-
tion is achieved only by treating one’s partner violently (sadism) or
conversely, by suffering pain (masochism).
Objective and method The objectives of our study were to under-
stand the complex relationship between psychotic and perverse
structures, and discuss the importance of some criminal risk fac-
tors for psychotics who have sexually perverse behaviors, through
clinical observation and review literature.
Case report 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 (imprison-
ment for theft, murder and escape from prison, hetero aggressive
acts) and substance use.
The patient explained with indifference that he heard voices mak-
ing 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 hallucina-
tory activity. Psychiatric experts retained the diagnosis of psychosis
with perverse arrangements. Under neuroleptic treatment, psy-
chotic symptoms disappeared but the patient’s sadistic problems
remained present and active throughout his hospitalization.
Conclusion The following case illustrates the issue of dangerous-
ness and responsibility in a perverse psychotic author assault of a
sexual nature. Given their clinical history, the path between per-
version and psychosis shows that perversemanifestations are prior
to the first psychotic symptoms and the perverse constitution is
developed parallel to the psychotic illness.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0585
Homicide, borderline personality
disorder and paraphilic disorder:
A case report
M. Zghal ∗, F. Fekih Romdhane , F. El Ghali , M. Mezghani ,
L. Jouini , I. Ghazeli , R. Ridha
Razi hospital, Forensic Psychiatric department, Tunis, Tunisia
∗ Corresponding author.
Introduction Zoophilia consists of sexual intercourse by a human
being with a lower animal. There is a paucity of literature on this
paraphilia.
Method In this paper, we report an uncommon case of homi-
cide committed by a man with co-morbid borderline personality
disorder and paraphilic disorder, and review the literature.
Case report Mr SH was a single and unemployed 30-year-old
male. He was hospitalized in our forensic psychiatric depart-
ment 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 feel-
ings of guilt for his sexual experiences with animals. There was no
formal thought disorder or perceptual abnormality. At the begin-
ning 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 bewitch-
ment 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).
Conclusion In this case, we discuss the clinical and therapeutic
challenges of this complex case, and the legal liability of Mr SH.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.