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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S53–S68


Workshop: Forensic psychiatry in Europe in 2017:

Discussing similarities and differences of five

national systems


Forensic care in italy: Changes,

illusions and realities

G. De Girolamo

, V. Bulgari

Saint John of God Clinical Research Center, Psychiatric Epidemiology

and Evaluation Unit, Brescia, Italy

Corresponding author.

Violence and the risk of violence posed by patients with severe

mental illness is a major public health problem for many rea-

sons. Firstly there is the obvious harm to victims, secondly the

counter-therapeutic effect on patients of the violence itself, thirdly

the restrictive measures typically deployed by services to manage

the violence, and finally the significant additional financial cost of

these specialist services. Within mental health services the some-

times inaccurate estimate of risk of violence posed by patients can

lead to the frequent use of a variety of coercive measures includ-

ing involuntary hospitalization, enforced medication, restraint and

seclusion. These restrictive and costly interventions are almost

unanimously perceived as traumatic by the patients and can, in

turn, trigger frustration, therapeutic resistance and even aggression

instead of treatment adherence and cooperation.

Services for the treatment of psychiatric patients who pose a risk

of violence are developing and maturing across Europe. New mod-

els of care for this extremely complicated multiple needs clinical

population exist. However across Europe intervention strategies

and service organization and delivery for these patients are very

different, and have never been comparatively evaluated. The

lack of reliable comparative data has prevented many European

countries benefiting from innovative strategies already tested in

those countries which have made the greatest efforts in research

and service innovation. In this workshop we will compare the

organization and functioning of forensic mental health services in

different countries; inparticular this presentationwill informabout

the recent changes in forensic mental health services occurred in


Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.


Forensic care in France

T. Fovet

, P. Thomas

CHRU de Lille, Nord, Lille, France

Corresponding author.

In France, the number of inmates with psychiatric disorders has

grown substantially during the last two decades. In this context,

significant changes occurred in France’s forensic psychiatry service

provision in recent years. Especially, full-time inpatient units for

inmates (called unités d’hospitalisation spécialement aménagées,

UHSA) have been created in 2010. These changes clearly improved

access to mental health care for inmates. Moreover, some recent

trends in indicators such as the suicide rate in French prison, which

has fallen slightly, are promising

[1] .H

owever, the practice of psy-

chiatry in prisons is a subject of debate between the proponents

of the development of a specific care system for inmates and those

considering that psychiatric teams must stay out of prison. One

should insist on the dichotomy between the justice system and the

health system, which appears constitutional in France. Indeed, the

professional independence of caregivers from the judiciary system

and the medical confidentiality are fundamental values on which

French model has been built. Furthermore, the improvement of the

quality of health care in prisons could alarmingly lead the judges

to preferentially choose imprisonment for patients suffering from

mental disorders committing offences while prison should in no

way be considered as a patient care setting. This trend is evidenced

by the low rate of individuals judged irresponsible for their crime

because of mental health status currently observed in France.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.e


[1] Fovet T, Thomas P, Adins C, Amad A. France’s forensic psychia-

try provision: the long and winding road. The Lancet Psychiatry



Forensic care in Germany

H. Dressing

1 ,

, H.J. Salize





Central Institiute of Mental Health, Psychiatry, Mannheim, Germany

Corresponding author.

Although the idea that offenders suffering from a mental dis-

order must primarily be considered as ill and should therefore

be exempted from punishment is of considerable antiquity legal

frameworks and key concepts, which are applied in this field, dif-

fer widely in European Union member States. The respective legal

regulations and epidemiological data of Germanywill be presented.

In German penal law the question of the guilt of an offender is of

central significance. Legal regulations on the placement and treat-

ment of mentally ill offenders in a forensic psychiatric hospital

are subsumed under the section “Measures on improvement and

safety”. Section 63 of the German penal law provides for the tem-

porally unlimited commitment to a forensic- psychiatric hospital.

In accordance with section 64 of the German penal law addicted

offenders can be committed to a detoxification center for a period

of up to two years. The available epidemiological data show a clear

increase in the admissions to forensic psychiatric hospitals and to

detoxification centers since beginnings of the 1990s. Recently the

German parliament passed a new law. The aim of the new law is to

strengthen patients’ rights and to diminish the number of forensic


Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

Workshop: Allostasis insulin and the brain:

Implications for the disease modeling and

treatment in psychiatry


Insulin resistance and telomere length

in treatment of depressive disorders

N. Rasgon

1 ,

, B . M


2 , K.W

. Lin



Stanford University School of Medicine, Psychiatry and Behavioral

Sciences, Stanford, USA


The Rockerfeller University, Harold and Margaret Milliken Hatch

Laboratory of Neuroendocrinology, New York, USA


Stanford university, Center for Neuroscience in Women’s Health,

Stanford, USA

Corresponding author.

Insulin resistance and markers of Allostatic load in depression