Starting in 2015, the Residencies for Execution of Security Measures (REMS) became the place of treatment and care for dangerous offenders who were acquitted due to a mental disorder in Italy. Schizophrenia spectrum disorders (SSD) and personality disorders (PD) are the most common psychiatric disorders among REMS patients. This study aimed to identify and describe potential clinical, therapeutic, and criminal-related differences in REMS patients with SSD and PD. A sample of 528 REMS patients extracted from a previous observational retrospective study underwent secondary analysis. The group of PD patients (n = 150) comprised more females ( < 0.001) and had a higher frequency of substance abuse ( < 0.001) than the SSD group (n = 378). The SSD group was more frequently admitted to the REMS due to homicide/attempted homicide ( < 0.001). Among SSD patients, we found a higher recognition of criminal irresponsibility ( < 0.001). Patients with PD were more likely to engage in violent behavior in the REMS than their SSD counterparts ( < 0.001). Patients with SSD were more likely to receive antipsychotic polypharmacy ( < 0.05) and a higher dose of antipsychotics (p < 0.001). These initial results provide empirical evidence to support the need for personalized forensic treatment paths.

Migration process is a well-known risk factor for a number of mental disorders, particularly psychotic, trauma-related and major mood disorders. However, refugees and asylum seekers (RAS) often face several challenges in accessing mental health facilities, leading to treatment delays, resulting in worse prognosis and increased risk of referral to the emergency departments or receiving coercive measures, including involuntary hospitalizations in the psychiatric settings. This review aims to delineate the prevalence of coercive measures within the RAS population and identify potential predictors for such interventions, in order to highlight possible preventive strategies. The relevant PubMed, Scopus and Web of Science databases were searched for papers. Twenty-three articles were included in the review. Our findings highlight that the RAS population is at higher risk of being coerced compared to the native population due to clinical factors, cultural differences and the many barriers to the access to mental health services. Since coercive measures are often harmful and lead to a worse clinical outcome and possible (re)traumatization of patients, specific strategies to prevent this phenomenon are urgently needed.

Inmates' food refusal is a large-scale phenomenon raising clinical, ethical, and professional responsibility issues. Obtaining a clinical balance of the right to refuse food with the right to protect the inmate's health can be a challenging process. Several reasons may support inmates' choice of refusing food, including political or protest reasons, as well as psychiatric disorders. The World Medical Association defines a hunger striker as a mentally competent person who has indicated his/her decision to go on a hunger strike by refusing to take any food and/or liquid for a significant amount of time. Force-feeding of mentally capable people is not allowed by a legal standpoint, nor medical treatment can be carried out without patients' explicit consent. According to these premises, both the clinical assessment of possible concurrent psychiatric disorders as well as the assessment of inmates' mental capacity to make decisions about refusing food might help in understanding this behavioural issue. We will also discuss the ethical and legal implications related to the right of refusing food according to the current Italian legislation.

After the approval of the law 81/2014, a new care-framework has been outlined for the psychiatric offenders in Italy and alternative facilities have been gradually activated. This pilot national survey was conducted in order to explore the attitudes of a panel composed by Italian psychiatrists, engaged in forensic not-engaged in forensic activities, on the changes related to the application of the law. We employed an ad-hoc questionnaire named SOPF: (in english: The Psychiatric Forensic Assessment after the Closing of the Forensic Psychiatric Hospitals) to explore the opinions regarding ten relevant issues in the field of forensic psychiatry and forensic assessment. Findings suggested that the lack of specific resources for the management of psychiatric offenders in the Departments of Mental Health in Italy may lead to clinical risks for patients and health professionals. In particular the task of treating offenders in the community may be even more challenging for those patients whose social dangerousness has been revaluated and their security measures expired.

In an era marked by escalating international crises, environmental shifts, and sociopolitical volatilities, global mental health is facing profound challenges. With its distinctive position at the intersection between clinical and judicial domains, forensic psychiatry can be predisposed to the consequences of adverse external determinants and events. At present, geopolitical conflicts, rising insecurities, climate change, forced and voluntary migration, and regressive sociopolitical ideologies are all compounding role responsibilities, care models, and ethical expectations across forensic-psychiatric practice; in short, complex distal factors are increasingly informing domestic considerations. These far-reaching concerns indicate a need for adaptive and proactive responses, underpinned by cultural sensitivity, social justice, and respect for human rights. Through illustrative examples from different regions, this perspective paper calls for a greater recognition of the transnational dynamics that are affecting local contexts of practice. Equally, it outlines the importance of advocacy, interdisciplinary collaborations, and potential evolutions in training and ethical frameworks to address contemporary issues. By adopting these approaches, forensic psychiatrists can promote more just systems and equitable mental healthcare for patients amidst the uncertainties of an interconnected and rapidly transforming world.

Homicide-suicide is a tragic event characterized by multiple fatalities within the intimate relationships, familial bonds, and community networks. Our aim was to explore the extent of coverage of homicide-suicide cases in the newspaper reports delivered in Pakistan during the COVID-19 lockdown (March-August 2020). We conducted a quantitative content analysis of news- reports obtained from eight Pakistani newspapers published in English and Urdu languages and daily reviewed by the authors. A total of 50 news-reports have been selected and analyzed, documenting 107 deaths due to homicide-suicide incidents. The majority of these cases involved male perpetrators within family settings, such as parent-child and spousal/married couples, often attributed to factors such us familial discordance and poverty. Negligibly, reasons for homicide-suicides included mental health issues of the perpetrators. Gunshot wounds emerged as the most prevalent method of homicide-suicide. Given the familial backgrounds in most of cases, it is likely that they occurred within the domestic environments. These findings may suggest the need of specific family interventions across the country in order to prevent family discordances or cope with relevant issues within the families, as both may contribute to homicidal and suicidal incidents, either independently or concurrently.

Although sex and gender differences are well-known in psychiatry, their research in the forensic psychiatric population is still limited. This study is aimed at bridging this gap by examining gender-specific factors and treatment needs among forensic psychiatric patients who are highly dangerous. By retrospectively analyzing data from a 1-year observational study on the Italian Residences for the Execution of Security Measures (REMS) patients (n = 730), we compared the main sociodemographic, clinical, and criminological variables between n = 80 female and n = 650 male patients. Female offenders exhibited a higher prevalence of personality ( < 0.001) and depressive disorders ( < 0.001), as well as more severe crimes leading to REMS admission, notably homicide or attempted homicide ( < 0.05). Furthermore, female offenders had a less frequent history of substance abuse ( < 0.001) than male offenders. Despite these differences, there was no evidence of gender-based differences in different sociodemographic and clinical parameters. This study highlights gender differences in forensic psychiatric patients and underscores the importance of nuanced assessment for implementing tailored interventions in forensic psychiatric care.

Suicide is a major public health issue worldwide, and scholars now recognise the multifactorial perspective of this phenomenon. However, psychiatric disorders are often considered the main determinant of suicide risk, and psychiatrists are commonly requested to assess and manage such a risk. The establishment of the medical model suggests that treating mental disorders prioritises reducing the probability of a suicidal gesture. However, this model appears obsolete and implies that the entire management of such a complex phenomenon relies on psychiatrists' treatments. In their central role, psychiatrists and other figures can reasonably anticipate the future by proper suicide risk assessment and appropriate documentation of therapeutic plans. In its unpredictability, clinicians should relate the suicidal phenomenon to foreseeability, with proper implementation of the standard of care, which ensures adequate protection from medical-legal instances. Psychiatrists should be trained to assess and manage suicide risk through clinical skills while fostering alliances with patients, families, and other clinicians. The article introduces the importance of suicide risk formulation, the correct categorisation of each patient by an in-depth study of the suicidal scenario, and the role of mental pain as a critical factor for reducing the main sources of suffering in each unique patient.

Turkiye, with its origins in an enduring civilisation rooted in preceding Turkish states from ancient and medieval eras, possesses its own firmly established legal traditions. Legislation concerning to the mentally ill was introduced post the French Revolution in the Ottoman Empire and underwent reforms with the advent of Turkiye's modern Republic in 1923, led by Mustafa Kemal Atatürk. This remains an ongoing process of enhancement, despite the absence of a well-established mental health law. Although forensic psychiatry is not considered to be an official subspecialty of psychiatry in Turkiye, the former constitutes a considerable amount of psychiatric practice in the country today. This article provides an overview of the legal basis and the organisation of forensic psychiatry in Turkiye. The primary forensic psychiatric practices of expertise, court-ordered treatments and prison psychiatry are described. Facilities as well as models of care are outlined. Finally, we consider the strengths and challenges of forensic psychiatry in Turkiye, to summarise the practice and system as well as to address rooms for improvement and highlight their possible reflections on the future.

Victims have a right to participate in restorative justice practices, also if offenders are detained within forensic mental healthcare. However, the deployment of restorative justice interventions in the context of forensic psychiatry is limited. This study aims to gain more insight in opportunities and challenges regarding victim engagement in forensic psychiatry. To achieve this, a narrative review study and an elite interview study with ten key figures in the field of victim-offender engagement within forensic psychiatry were carried out. Both studies focused on the following three themes: first, the impact of various diagnoses on victim engagement; second, the effects of victim-offender interaction on treatment, and, third, challenges for victim-offender interaction. The main findings are that restorative justice can, in principle, be carried out successfully within a forensic psychiatric context and that no diagnostic category on the part of the offender should be excluded in advance. Furthermore, victim engagement can contribute to the treatment of mentally disordered offenders by increasing awareness, motivation and compliance, improve self-image and uncover areas of concern. Apart from these opportunities, several challenges - such as adequate preparation, correct timing, and expectation management - have to be taken into account for effective restorative justice practices.

To investigate the effectiveness of treatments approaches in reducing the risk of reoffending in stalking perpetrators.

Eating disorders represent a disabling, deadly and costly condition, whose principal treatment is constituted by weigh restoration and psychotherapy. Partial or total refuse of treatment is very common, leading some authors to question their decision-making capacity (DMC) to consent to treatment. However, very few studies have investigated treatment DMC, leading to contrasting results. Forty-five women were enrolled at the Psychiatric and Eating Disorders Unit of the University Hospital Policlinico Umberto I of Rome. Psychiatric symptoms severity (Brief Psychiatric Rating Scale Expanded, BPRS-E), treatment DMC (MacArthur Competence Assessment Tool for Treatment, MacCAT-T), depressive symptoms (Hamilton Depression Rating Scale, HAM-D), anxiety symptoms (Hamilton Anxiety Rating Scale, HAM-A), symptoms and psychological characteristics of eating disorders (Eating Disorder Inventory, EDI-3) and Metacognitive beliefs (Metacognitions Questionnaire 30, MCQ-30) were assessed. Sixty-seven percent of the total sample showed low treatment DMC; specifically, 70.4% of patients affected by Anorexia Nervosa, 72.7% of patients affected by Bulimia Nervosa, and 42.9% of patients affected by Binge Eating Disorder. Specific psychopathological symptoms enhance or hamper patients' decisional capacities. Clinicians should be aware of the risk of impaired DMC in this vulnerable group of patients and pay attention at those factors suggesting the need of an in-depth evaluation.

Studies about violence by women with severe mental disorders are rare. The aim of this paper is to analyse the sample of women diagnosed with Schizophrenia Spectrum Disorders (SSD) from the EU-VIORMED study who had offended violently and were admitted to forensic facilities (cases), and compare them to women with SSD who never exhibited violent behaviour (controls). Cases and controls matched for age and diagnosis were compared for sociodemographic, clinical, neuropsychological, and treatment-related characteristics using a standardised assessment. When compared to 36 controls, the 26 cases were significantly older, with longer duration of illness, had fewer years of education, were less likely to have children, and were more likely to have a comorbid personality disorder. Cases were less functionally impaired and scored lower on cognitive domains. There were no differences between the groups in exposure to childhood or adult violence, but a greater proportion of cases reported more frequently being witness to and victims of violence and more frequently reported being beaten, kicked, or punched. Results suggest that the emergence of violent behaviour in women with SSD might be shaped by various factors including violent victimisation, personality factors, soft cognitive impairment and perhaps as a result a more extended duration of illness.

This systematic review aims to explore the condition of Transgender Inmates (TGI) in correctional facilities (CF), focusing on their mental health, their access to Gender-affirming Treatments (GAT), and their placement within the CF. Medline, Embase, Scopus, PsychInfo, and CINAHL were searched for studies on TGI in CF. Pooled Odds Ratios (ORs) with 95% confidence interval (95%CI) were estimated through inverse variance models with random-effects. A narrative synthesis of each study's findings was also performed since only a few studies included a control group. Thirteen studies were selected and four considered in the meta-analysis, corresponding to 1,255 TGI and 174,314 controls. Although limited by the small number of studies, the meta-analysis showed that TGI have a higher risk of depression, post-traumatic stress disorder, and suicide attempts during detention than the controls (OR = 3.07, 95% CI = 1.33-7.06; OR = 2.23, 95% CI = 1.46-3.43; OR = 2.25, 95% CI = 1.46-3.49, respectively). Limited access to GAT and housing based on sex assigned at birth rather than gender identity were additional challenges for TGI, threatening their safety and self-affirmation. Our findings highlight the critical role of incarceration as a social determinant of health for TGI. A comprehensive policy reform and staff education should be promoted to foster inclusive and supportive correctional environments and improve safety and health of TGI.

This contribution explores the significance of Marco Cavallo in the history of psychiatry using Walter Benjamin's concept of . Here the concept of the image and the idea of fragmentation are seen as bringing to the surface certain thought-images (). As properly pre-theoretical () elements of our cognition, images operate revolutions: breaking from the familiar and opening a pathway to the exposure to shock []. This gathers together the power of images to configure cognizability, as well as their possibility to rewrite history through the relationship of present to past. Marco Cavallo is offered as both image and metaphor for what is concealed behind mental health experiences, and as an image of the geography of "inside and outside", both in terms of social and public spaces, as well as collective practices of care.

In this paper, taking a cue from the image provided by Walter Benjamin, I argue that the work of the psychiatrist can be compared to that of the ragpicker who collects what others consider to be 'waste', rescuing it from oblivion and transforming it into a key resource for treatment. I review two 'logics of discovery'- phenomenologically inspired structural psychopathology and that of narrative psychopathology - whose purpose is to complement mainstream diagnostic approach based on 'ticking boxes'. I try to identify the shortcomings of these two methodologies, in particular the confirmation bias that can cause selective inattention to anything that does not fit into the expected structure or narrative. I highlight the heuristic importance of these 'fragments' that are in danger of remaining on the fringes of the clinician's attention who is too focused on 'making ends meet,' showing how in certain psychopathological conditions - e.g. early schizophrenia and borderline personality disorder, marked by fragmentation - inattention to fragments can impede understanding and treatment. I argue for the importance in psychiatry of an 'emergentist' logic of discovery, of a kind of psychopathological knowledge 'co-produced' with patients, and of fragment-oriented listening in order not to lose the richness of patients' own accounts.

Considered by many the foremost German language literary critic of the first half of the 20 century, Walter Benjamin remains a star in our contemporary constellation of cultural criticism. His broad range of reference coupled with his dazzling linguistic versatility and radical understanding of technological transformation and its relation to society, continue to offer insights that help us respond better to the 21 century's disorienting pace of innovation and change. Also, to measure the distance we have travelled since his contributions. Here we introduce aspects of his times, life, philosophical formation, and social-historical and critical work, including his use of literary montage and concepts of history, now-time (), non-sensuous similarities, and dialectical images. Benjamin's methodology and discoveries offer penetrating tools to any psychiatry which is truly committed to understanding culture beyond the conservative or descriptive ethnographic study of tradition in order to make sense of the nature and psychopathological impact of accelerating upheavals in our era of international conflict, climate change, social media, artificial intelligence and imperfect and threatened liberal pluralism. This era demands an approach open to co-creation and co-production and we discuss the relevance, including the limitations, of Benjamin's work.

The diagnosis of hysteria, despite being fundamental in the birth of psychiatry, has currently been removed from nosography. This choice speaks of the renunciation by contemporary nosography of understanding psychopathological conditions as structural entities, with internal coherence and meaningfulness - which on the contrary should be reconsidered. Hysteria represents a mirror of social and cultural changes. The metamorphoses throughout history of hysterical symptoms reflect the changing interests of medicine (the greater legitimation of somatic symptoms over psychic ones) and, in general, mirror the increasing importance of images in the contemporary world. Despite its nosographical fragmentation, hysteria continues to be talked about. Phenomenologically, hysteria is described not as a diagnosis but as an existential position, freeing it from gender prejudices. Hysterical persons suffer from a hypo-sufficiency of the self, from a difficulty in feeling from within, which ends up hypertrophying the identity definitions coming from without: the gaze of others, socio-cultural stereotypes, gender models. Visibility therefore takes on a central role, and images become a vehicle to represent oneself - capable of attracting the attention of others and enchanting them. Different powers have been attributed to images throughout the history of thought: that of paralyzing, that of moving to action, that of underlining the contingency of experience. Hysterical persons embody images, generating with their symptoms a world of representations. However, what characterizes hysteria is not the symptom, but the use made of that symptom: it becomes a catalyst for the gaze of others, which allows one to assume an otherwise lacking identity-consistency. For this reason, hysterical persons are not only passively subject to their symptoms, but actively make use of them in interpersonal relations.

In the course of the psychiatrist-patient relationship, and especially during a psychotherapy, an image sometimes appears that is greeted by the therapist with a sense of surprise and rediscovery. Such an image has the quality of condensing many of the scattered elements of the patient's life and giving them a form that makes it possible to recognise something stable and permanent in the functioning of the patient's subjectivity. I propose to call these images, which have a valence of enlightenment, clarification and condensation of scattered elements, structuring images. I have used the term 'epiphany' to define these moments of enlightenment, which are of great help in psychiatric and psychotherapeutic work, contributing to a new construction of the history and relationships of the patient's life.

In this paper I explore Walter Benjamin's complex thoughts about the concept of experience to illuminate a central paradox when thinking about madness. This paradox concerns the need to hold together constellations of concepts that appear to be diametrically opposed. On the one hand there is the realm of the psychopathological; a psychiatric thinking of madness as mental illness that refers to suffering, loss of existence, and dysfunction. On the other hand, there is a thinking about madness as a diverse and different experience, as possibility, illumination, and difference. Benjamin's writings on experience can be particularly fertile here because he acknowledges the contradictions in experience, at certain points emphasising the loss of experience and at other points focussing on the possibilities of a new experience even within a destruction of experience. I will explore three aspects of Benjamin's reflections on experience and their relationship to an experience of psychosis; the loss of experience in modernity and the possibilities that lie within such a loss, the turn towards the object in Benjamin's account of experience, and finally the concept of the limit-experience. I conclude by considering Benjamin's idea of the dialectical image and apply this idea to the experience of madness.