Knowledge of the prevalence and the different types of risk behavior in adolescence is needed to prevent unwanted health consequences.

In general, risk behavior in adolescence is quite common. It comprises patterns such as smoking, alcohol consumption, hazardous driving, drug use, delinquency, dares, sporting risks, rebellious behavior, school-related risks, sexual intercourse as well as other socially inconspicuous behavior that nonetheless poses a risk to health (e.g. bad nutrition, lack of physical activity, or excessive sunbathing).

The different types of risk behavior are described also addressing the issues of gender differences and individual risk factors as well as protective factors. Temperament factors (novelty seeking) and peer group influences are discussed as well as genetic factors and brain maturation in adolescence.

The knowledge of adolescent risk behavior and the possible causes as well as prevention strategies is important for all professionals dealing with adolescents and young adults.

This study aims at reducing the risk for compulsory readmission in psychiatric patients by a comprehensive intervention comprising psychoeducation on warning signs, crisis cards and a continuous telephone monitoring of the patients‘ mental health status and health care utilization over a two-year period. Beyond reducing involuntary admissions, further objectives of the intervention are to reduce number and duration of inpatient stays and to result in a more cost-effective service provision.

Psychiatric inpatients suffering from schizophrenia or an affective disorder were randomly allocated to the intervention group or the control group (treatment as usual). Risk for compulsory readmission was defined by a current involuntary treatment episode or involuntary treatment within the previous 24 months. Both groups are assessed at baseline, at 12-month and 24-month follow-up. Interviewer ratings cover psychopathology (Positive and Negative Syndrome Scale, Young Mania Rating Scale, Hamilton Depression Sale, Global Assessment of Functioning), psychopathy (Hare Psychopathy Checklist Screening Version) and risk for violence (HCR 20). Treatment satisfaction, empowerment and quality of life is measured by self-report questionnaires. Health care utilization and prescription of psychotropic medication is recorded continuously in the intervention group and over a 3-month period in the control group.

Preliminary results of this ongoing study will be presented, illustrating sample characteristics and first results of the one year follow-up. Focusing on data of type, number and duration of inpatient stays, the potential of the intervention to reduce the risk for involuntary readmission to psychiatry will be discussed.

During the past 40 years there has been an increase in the number of mentally ill criminals. The purpose of this study is to analyse the correlations between the reorganisation of the psychiatric treatment system the growing number of forensic patients and the increase in serious crime, homicide and arson associated with the mentally ill.

We estimated the annual positive or negative growth rate of consumed psychiatric beds and in social and community psychiatry (explanatory variables) and in prevalence and incidence of forensic patients, homicide and arson (response variables) from 1980 to 1997 for each of the 14 Danish counties. The long-term effect was analysed in the form of between-county analysis with both single and multiple regressions.

Bed closure had no immediate effect on either the number of forensic patients or serious criminality. Over time the (negative) growth rate in number of consumed beds is significantly correlated with the (positive) growth rates for forensic patients, homicide and arson. Social and community psychiatry have little effect, if any.

We have used two sets of data firstly the number of forensic patients and, secondly the reported number of crimes associated with the mentally ill. The uniformity of the results leads us to consider that the decreasing effort invested in inpatient treatment is causing an increase in the crime rate among the mentally ill.

Forensic patients are not only offenders, but also the victims of an inadequate treatment system. Modern inpatient treatment facilities should be established.

Despite numerous advantages, the shift from hospital based to community mental health care has caused problems as well. To analyse whether or not the process of de-institutionalisation might have gone too far, studies are needed that cover general psychiatry, forensic psychiatry, and penitentiaries and analyse the interdependencies between them.

We combined epidemiological and service utilization data from three recent European studies that explored legal frameworks and practices of involuntary treatment in general mental health care, the care of mentally disordered offenders in forensic care and the care of mentally ill inmates in the European prison systems.

Time series from several EU-Member States suggest that civil detention rates remained more or less stable during the 1990s, though on rather different levels internationally. Admissions to forensic psychiatric facilities have increased during the same period. Data on the mental state (or on rates of psychiatric morbidity) in European prison populations are not available - aside from the prison suicide rate. Data from selected countries are likely to suggest that changes to the legal framework in one sector may considerably affect admission rates in others.

Much more national studies are needed to analyse the linkage between sectors and to identify inappropriate patient shifting, as this is strongly affected by the varying national health care and criminal justice systems.

Psychiatry has always had a special position among the medical disciplines. Patients were perceived by the public as potentially dangerous, psychiatrists as representatives of an uncontrolled “total” institution. The mental health reforms initiated during the 2nd half of the 20th century focussed on a “normalization” of this special position by means of a reduction of coercion to the absolute minimum and to an adaptation of the principles of treatment and care to that of all other medical specialities.

In all European countries, the prevalence of mentally disordered offenders is on the rise. As, surprisingly, the same holds good for the rates of involuntary admissions to psychiatric hospitals, a supposed transfer of coercive measures from the civil to the penal law sector seems to be unlikely. According to epidemiologic data, there is also no direct relation with the reduction of general mental hospital beds or with the sometimes insufficient provision of community services. Rather, the changed attitude of mental health professionals in dealing with a subgroup of “difficult-to-treat” patients seems to be crucial factor.

Recent data confirm an association between psychosis and violence. Not least for that reason psychiatry does have - against all affirmations - a special position among the medical disciplines. The denial of this fact by the representatives of modern community psychiatry was not able to reduce coercive measures against mental patients - rather, coercion is now applied in a hidden way, obviously insufficient so damaging the reputation of both psychiatry and its patients.

ASPD has a prevalence of 2-3% in the general population but rates in prison have been reported as 50% to 75%. ASPD is associated with significant psychiatric and medical comorbidity, high offending rates, poor psychosocial adaptation and premature death. Outcomes are poor. There is little consensus regarding the most effective intervention for the condition.

To conduct systematic literature reviews to identify randomised controlled trials for either pharmacological or psychological interventions for ASPD.

Systematic literature reviews (Cochrane reviews).

For the review on psychological interventions only 11 studies could be included with a total of 411 participants, but only five reported data separately for the subgroup of ASPD. Nine of the studies looked at participants with substance misuse problems who also suffered from ASPD. Only three types of interventions were effective (contingency management, CBT and a specific programme for those convicted for driving whilst intoxicated). These interventions showed positive results for substance misuse related outcomes but not for any others behaviours or symptoms. For the pharmacological review 10 studies were identified, anticonvulsants were the most commonly used drugs with some evidence of effectiveness on aggression, however, study quality was poor.

Despite the considerable personal and societal consequences of ASPD, very little research is carried out with regards to interventions in this patient group and subsequently the evidence base to support any interventions is extremely limited.

Alterations in gray matter volume (GMV) are a robust feature of schizophrenia. However, it is not clear to what extent these abnormalities are correlates of the genetic liability to the disorder, as opposed to environmental factors and the disorder itself.

We investigated the influence of genetic risk and illness on GMV in monozygotic (MZ) twin pairs concordant and discordant for schizophrenia.

Total and regional GMVs were measured from magnetic resonance images of 80 twins: 14 MZ pairs concordant for schizophrenia, 9 pairs discordant for schizophrenia, and 17 healthy MZ twin pairs. The three groups were matched for age, gender, handedness, level of education, parental socioeconomic status, and ethnicity.

Total GMV was smaller in twins with schizophrenia (t=-3.17, p= 0.003) and non-psychotic co-twins from discordant pairs (t=-2.66, p= 0.011) than in healthy control twins. Twin pairs concordant for schizophrenia displayed reduced regional GMV in the inferior frontal, medial frontal, and anterior cingulate gyri, the caudate, lingual gyrus and cerebellum relative to healthy twins (p< 0.05, corrected). Within discordant pairs, twins with schizophrenia had less GMV than their non-psychotic co-twins in the insula, superior/medial frontal, pre/postcentral, cingulate and superior temporal gyri, and the paracentral lobule. There were no significant differences in regional GMV between non-psychotic co-twins and healthy controls.

The presence of schizophrenia was specifically related to reduced GMV in frontal, insular, cingulate, medial parietal and temporal cortex, over and above effects of genetic risk for the disorder.

Structural brain abnormalities have consistently been found in schizophrenia, with increased familial risk for the disease associated with these abnormalities. Some brain volume changes are progressive over the course of the illness.

To investigate whether these progressive brain volume changes are mediated by genetic or disease-related factors.

We carried out a 5-year follow-up study in monozygotic (MZ) and dizygotic (DZ) twin pairs discordant for schizophrenia (DISC) and healthy comparison (HC) twin pairs using brain magnetic resonance imaging. A total of 92 participants completed the study (DISC: 9 MZ and 10 DZ; HC: 14 MZ and 13 DZ). Percentage volume changes of the whole brain and cerebral gray and white matter were estimated. Structural equation modeling was applied to estimate contributions of additive genetic and common and unique environmental factors.

Significant decreases over time in whole brain volume was found in patients with schizophrenia and their unaffected co-twins compared with control twins. Bivariate structural equation modeling using cross-trait/cross-twin correlations revealed significant additive genetic influences on the correlations between schizophrenia liability and progressive whole brain (66%; 95% confidence interval [CI], 51%-100%), frontal lobe (76%; 95% CI, 54%-100%), and temporal lobe (79%; CI, 56%-100%) volume change.

The progressive brain volume loss found in patients with schizophrenia and their unaffected co-twins is at least partly attributable to genetic factors related to the illness.

Altered neurocognitive function in schizophrenia could reflect both genetic and illness-specific effects.

To use functional magnetic resonance imaging to discriminate between the influences of the genetic risk for schizophrenia and environmental factors on the neural substrate of verbal fluency, a candidate schizophrenia endophenotype using a case control twin design.

We studied 23 monozygotic twin pairs: 13 pairs discordant for schizophrenia and 10 pairs of healthy volunteer twins. Groups were matched for age, gender, handedness, level of education, parental socio-economic status, and ethnicity. Behavioural performance and regional brain activation during a phonological verbal fluency task were assessed.

Relative to healthy control twins, both patients and their non-psychotic co-twins produced fewer correct responses and showed less activation in the medial temporal region and inferior frontal gyrus. Twins with schizophrenia showed greater activation than both their non-psychotic co-twins and controls in right lateral temporal cortex, reflecting reduced deactivation during word generation while their non-psychotic co-twins showed greater activation in the left temporal cortex.

Both genetic vulnerability to schizophrenia and schizophrenia were associated with impaired verbal fluency performance, reduced engagement of the medial temporal region and dorsal inferior frontal gyrus. Schizophrenia was specifically associated with an additional reduction in deactivation in the right temporal cortex.

It is unknown if the positive effects of intensive early intervention programmes are sustainable over time. Duration of untreated psychosis (DUP) is associated with outcome of schizophrenia, and it has been proved that DUP can be shortened. Randomized clinical trials have tested possibilities for interventions in high risk groups.

We conducted a single-blinded randomized controlled trial of two years of specialized assertive early intervention programme (OPUS) versus standard treatment. A total of 547 first-episode patients with first episode psychosis or schizotypal disorder were included in the trial and reinterviewed after one, two and five years. OPUS treatment consisted of ACT with family involvement and social skills training.

At five-year follow-up, the positive effect on psychotic and negative symptoms of the treatment seen after two years had disappeared. A significantly smaller percentage of patients from the experimental group were living in supported housing and were hospitalized fewer days during the five-year period. Among patients with schizotypal disorder, the proportion who had a transition to psychosis after one year was 8.1 vs. 28.0 percent for patients randomized to OPUS vs. standard treatment, respectively. At two-year follow-up the figures were 28.1 vs. 44.0. Duration of untreated psychosis (DUP) median was 48 weeks. Longer DUP was independently associated with more psychotic symptoms at entry and at one-year and two-year follow-up.

Due to previous findings, we have started a new trial in which we will randomize 400 patients to two years versus five years of specialized assertive treatment.