Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.

The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.

We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.

We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

Growing evidence points to the conclusion that biological factors do predispose some individuals towards violent behavior. Contemporary research suggests that serotonin is a neurotransmitter associated with expressed aggression, challenging the concept of a person's knowledge of right or wrong and the free will to choose between the two.

Thorough research of the main databases (Medline, Embase, Psychinfo), and web search engines such as Goggle, Lycos for relevant studies, agencies and organizations, interested in neurotransmitter, serotonin (5-HT), aggression, hostility, violence and violent behaviour issues.

The neurotransmitter serotonin (5-HT) has been implicated in the modulation of aggression in animals and humans. the 5-HT system seems to be involved in either the performance or the termination of aggressive behaviours. So although an association with serotonin and aggression appears to be present, it isn't clear the way of this association or the expression of the interplay of the genes with the individuals’ environment. Genes and environment appears to be in a dynamic interplay that concludes in the observed behaviour.

A longstanding dogma that aggression and serotonergic activity are inversely related has to be abandoned in light of many new findings. Trait and state aggression are differentially regulated by the 5-HT system and different 5-HT receptors seem to be involved. We are still far from understanding the complex role played by the serotonergic system in the modulation of a complex set of behaviors like aggression.

Aim of this study is to review recent studies and examine the physiology of glutamate and its receptors, pathophysiology of NMDA, effects of stress on glial cells and glutamate neurotransmission and explore the antidepressant properties of NMDA antagonists.

Review of recent pharmacological, imaging and genetic studies.

Increasing evidence supports a tight relationship between stress, the glutamatergic system and depression. Extracellular glutamate concentrations are increased in several brain regions including prefrontal cortex and hippocampus after exposure to stress. Interactions between glutamate and other neurotransmitters are discussed, as are possible mechanisms by which such altered receptor activity might result in the clinical expression of depression.

A variety of NMDA antagonists, group I metabotropic glutamate receptor antagonists, as well as positive modulators of AMPA receptors, demonstrate efficacy in various preclinical models

It seems that a breakthrough in the therapy of depression will require going beyond monoamine-based theory of depression. Evidence indicates that the glutaminergic system might be a promising target fir novel antidepressant therapy.

Psychiatry is considered a specialty not having a lot to do with medical emergencies. Psychiatrists are being asked to contribute to medical treatment or diagnosis after the completion of diagnostic procedures by physicians, often concluded in a diagnosis by exclusion. Having said that, emergency psychiatric issues often arise in usual clinical practice.

Thorough research of the main medical databases, and web search engines for relevant studies. We scrutinize them independently, before reaching consensus about appropriateness.

There are several books, articles and guidelines that go beyond the psychiatric emergencies of mentally ill patients, aiming to provide guidelines for the providers of emergency treatment in settings that access to psychiatric treatment is limited due to obstacle of time or distance.

Although general in concept and not particularly concerned with the accuracy of psychiatric diagnosis and the description of symptoms and signs of psychopathology, there are general guidelines well described that a qualified nurse, social worker or an ambulance worker could apply. We have an obligation to disseminate knowledge about dealing with psychiatric emergencies especially to health services at remote areas. Publication of treatment guidelines that are easy to apply, could be the next step in recognition, early intervention and appropriate referral in challenging psychiatric situations at the members states of European Union.

Depression is a very common condition in the elderly, underdiagnosed and often an emerging public health issue, especially in developed countries where population is aging.

The participants (103 patients) age 55 years or more, with diagnosis of Schizophrenia and other psychotic disorders, Mood disorders and Mental disorders due to general medical condition. The depressive status of the participants was determined clinically, using the GDS and the Cornell scale for depression in dementia when MMSE was > 15.

Of the 103 inpatients, 87 had MMSE score less than 24 and were included in the analysis. 23.1% had been clinically diagnosed as suffering from depression and taking antidepressants although 53.8% had CDS>6 and 57.3% had Cornell score >11 both indicative of depression. It appeared that clinicians were able to detect mainly severe major depression with mean CDS score=10.50, (sd = 1.5) and mean Cornell score=18 (sd = 4.3).

In our sample of an elderly long term inpatient population with primary diagnosis of serious mental disorder, depression was under diagnosed and undertreated. Only severe major depression was detected.

It appears that psychometric scales like Geriatric Depression Scale (GDS) and Cornell Scale for Depression in Dementia (CSDD) are valuable instruments for the detection of depression in elderly populations. As depression is very good in hiding or camouphlage its’ symptoms as part of other disorders, regular use of psychometric scales could prove to be an easy way to detect early signs of depression and treat accordingly.

In spite of the absence of validation by treatment guidelines, the practice of polypharmacy in psychiatry continues to increase. This cross-sectional study tries to describe polypharmacy rates in a psychiatric ward of a general hospital.

Participants (51 patients) were selected from inpatients in the General University Psychiatric Hospital “Papageorgiou”. The study was conducted from July to September 2011. Patients had to be hospitalized for at least 3 weeks in order to be included. The statistical program SPSS was used in the analysis.

Our sample consists of 51 patients, of average age 45.4 years (SD = 16,3), males 39,2%, with average starting age of disease 35.8 years (SD = 16,1), 78,4% voluntary hospitalized, with the diagnosis of schizophrenic disorder in 41.2%, bipolar disorder in 19.6% and depression in 39.2%. 29.4% of patients were working before being hospitalized and 7.8% had history of substance use. Their treatment included more than one antipsychotic in 2% of patients, more than one antidepressant in 4% and a benzodiazepine in 33.3%. At the moment of discharge from hospital, the rates of polypharmacy showed no statistically significant difference compared to the ones at admission. The only exception concerned the use of the long-acting formulations which rose to 7.8%.

Most patients hospitalized in the psychiatric department of the University General Hospital was suffering from mood disorders and had short admission time. These factors led to a decreased need of using multiple kinds of medications. A larger sample of patients is necessary to confirm the presented points.

Behavioral disorders, such as agitation and disability in daily skills, include symptoms of disturbed perception, thought content, mood or behavior that frequently occur in patients with dementia. These behavioral disturbances rather than cognitive disorders are the main reason why caregivers place patients in a nursing home.

The participants (103 patients) age 55 years or more had diagnosis of Schizophrenia and other psychotic disorders, Mood disorders and Mental disorders due to a general medical condition (DSM IV-TR criteria) from the psychogeriatric units of the psychiatric hospital of Attica. They were all assessed using the Neuropsychiatric Inventory (NPI) and Katz Instrumental Activities Scale (KATZ) to evaluate agitation, irritability and daily skills functionality.

Of the sample of 103 Greek long term inpatients, 32% had clinical manifestation of aggression, 43.7% had severe daily skills dysfunction (with KATZ score 1–2), 19.4% moderate (KATZ score 3–4) and 36.9% had no dysfunction. NPI detected agitation in 55.3% of the sample and irritability in 49.5%.

Behavioral disturbances, agitation and disability in daily skills are common among older hospitalized patients, and psychometric scales like NPI and KATZ are valuable instruments that could prove to be an easy way to detect early signs of behavioral manifestations and exacerbation of a variety of mental disorders in elderly populations. They should be implemented in the usual clinical practice.

People with severe mental disorders have worse physical health compared with the general population. Metabolic aspects such as obesity, diabetes, hypertension, dyslipidaemia, smoking and antipsychotic medication increase the risk of metabolic syndrome (MetS) and cardiovascular disease. Epidemiological studies have consistently shown excess CVD mortality in patients with schizophrenia, bipolar disorder and depression.

The participants (103 patients) age 55 years or more, had diagnosis of Schizophrenia and other psychotic disorders, Mood disorders and Mental disorders due to a general medical condition(DSM IV-TR criteria). Metabolic syndrome was estimated using the ATP III definition.

Framingham risk score was calculated using algorithms developed by Wilson for subjects aged 30 years and older.

Overall prevalence of MetS was 34%. (37.1% men, 62,9% women). Among patients with MetS 74.3% had schizophrenia, 8.6.% Mood disorder and 17.1% Mental disorders due to a general medical condition. In our sample 18.8% of patients with MetS were receiving FGAs, 78.1% SGAs and 3.1% combination of FGAs and SGAs but this difference wasn’t statistically significant.

Low risk (FRS < = 14) had 68% of participants (21.4% men and 78.6% women). Moderate risk (FRS > 15) had 32% of participants (66.7% men, 33.3% women).

The results indicate that patients with schizophrenia have higher probability of having MetS, therefore, clinicians should appropriately monitor the risk factors and intervene as required.

Cognitive impairment and loss of functionality are key characteristics of dementia and also highly prevalent among patients with serious mental illness. Our study reports on the prevalence of dementia and the relationship between cognitive decline, behavioral and social functioning disturbances, lifestyle/ physical health parameters and the pharmaceutical approaches, in an elderly population of the psychiatric hospital of Attica.

103 patients, aged 55 years or more, with diagnosis of Schizophrenia/other psychotic disorders, Mood disorders, and mental disorders due to a general medical condition (DSM-IV-TR) participated. Dementia was also defined according to DSM-IV-TR. Data collection was through their medical records and scales (Mini Mental State Examination, Clock Drawing Test, Global Deterioration Scale, Katz Index of Independence in Activities of Daily Living, Neuropsychiatric Inventory). All variables were statistically analyzed using the SPSS.

Of the sample of 103 participants, 35.9% men, 64.1% women (mean age of 71), 60.2% had Schizophrenia, 7.8% Mood disorder, 32% Mental disorders due to a general medical condition. Dementia was diagnosed in 42 patients. 43,7% had severe daily skills dysfunction. Only 12,6% had no concomitant physical illness. Although they all had cognitive impairment, only 1/3 were treated with cognitive enhancers.

Long term mental disorder and long term hospitalization lead to severe deterioration of both cognitive function and daily skills abilities. Along with early screening for dementia, psychogeriatric patients need specific therapeutic approaches, promotion of favourable physical profile and amelioration of the consequences of the long term medication in their fragile health.

Psyhiatrists who work in hospitals and treat patients who show aggression present particular challenges. The course and treatment of serious psychiatric disorders can be complicated because of the comorbidity with substance abuse. The objective of the present study is the drug treatment of aggression among in-patients with serious mental disorder.

The participants (423 patients) were randomly screened among the in-patients of the 9 acute departments of PHA (Psyhiatric Hospital of Attica). For the statistical analysis, the program SPSS was used.

The participants (423 patients): average age 45.9 years old (sd = 13.1), 60.8% men, 63.7% involuntary admitted, disorder onset: 28.4 years (sd = 12.1), diagnosis of Schizophrenia 72.1%, Bipolar disorder 16.8%, Depression 11.1% with substance abuse in 18.7%, and reason of admission: auto/hetero- agression 24.3%, relapse of the disease 46.1%, interruption of drug therapy 27%. 67,5% showed aggression at the admission, 25.6% were administered more than one antipsychotic drug at the admission, along with benzodiazepines in 53.7%. During their hospitalization, aggression was reduced to 22.9%, with verbal aggression first in line with 14.4%, and 41.9% of the patients were administered more than one antipsychotic drug. The SGAs dominated and were administered in combination with stabilizers, antidepressants and benzodiazepines.

There are few documented points to guide daily practice, and it seems that case reports, advices from other colleagues and/or personal experience may influence in an important way the therapy of psychiatric patients who show aggressive behavior.

There is evidence that supports the increased risk of developing psychosis or psychotic like symptoms in vulnerable populations after use of cannabis. Cannabis’ main psychoactive component, Δ9-tetrahydrocannabinol (THC), induces acute psychotic effects and cognitive impairment. But there is also evidence to suggest that molecules in the cannabis plant could have an antipsychotic affect.

In this review we are trying to explore the possibilities of cannabis use as a therapeutic agent in mental disorders.

Thorough research of the main databases, and web search engines for relevant studies, using appropriate keywords. We scrutinize them independently, before reaching consensus about appropriateness.

In animal models repeated treatment with cannabis constituent cannabidiol CBD or the atypical antipsychotic clozapine attenuates or reverses the schizophrenia-like behavioral disruption.

In humans there are data that CBD counteracts psychotic symptoms and cognitive impairment associated with cannabis use. Also CBD may lower the risk for developing cannabis use associated psychosis. There are opposite effects of CBD and THC on brain activity patterns in key regions implicated in the pathophysiology of schizophrenia, such as the striatum, hippocampus and prefrontal cortex.

The possible mechanism of action of GBD is not fully clarified, as it may involve anti-inflammatory or neuroprotective properties. These initial clinical studies with CBD treatment of psychotic symptoms argument the potential of CBD as an effective antipsychotic compound. Mechanisms responsible for these effects need to be further investigated.

The authors have not supplied their declaration of competing interest.

For an inmate incarcerated for life we could acknowledge factors contributing to the desire to commit suicide, as social isolation, insensitive discipline, lack of privacy, constant threat of violence, fear, guilt, hopelessness, and depression are prominent in the life imprisonment.

To discuss the ethical issues of prevention suicide in inmates incarcerated for life.

We performed thorough research of the main medical databases, and web search engines for relevant studies, articles and opinions and reviewed them independently.

Prevalence of mental illness is high among inmates and several common stressors typically herald an inmate's suicide. Suicide is often the single most common cause of death in correctional settings. Even though some suicide victims have consulted a mental health service-provider before their suicide, the majority of suicide victims were not mentally ill. The paradox, particularly for life sentence inmates is that we are trying to persuade an inmate to live within a disciplinary environment, which has as side effect the increase of suicidality of the inmates.

Prisons’ inability to protect the health and safety of inmates could raise ethical issues. We have obligation to adequate suicide prevention for all inmates, and we should be more broad minded as the will to die in mentally healthy individuals is beside an free will expression, a sign of serious lack of support and humane living conditions. We should be vigilant not to use the prevention of suicide programs as another way to increase punishment of life long imprisonment.

The author has not supplied his declaration of competing interest.

In psychiatric clinical practice compulsory admission to hospital is the last option of the overall care provided to mentally ill patients, justified in terms of civil and human rights because of issues of protection for patients’ and society members’ life and health. Usually treating psychiatrists believe that issues of compulsory admission are without doubt associated with the permission, or even obligation, to apply compulsory treatment in a routine daily base.

In this review, we are exploring issues around the implementation of compulsory treatment.

Thorough research of the main databases and web search engines for relevant studies, agencies and organizations, interested in compulsory treatment issues.

Research shows ambiguous views. Conservatives argue that delay of any substantial, even enforced, and well documented treatment, would result in delay of treatment and excess use of other potentially more enforced methods. Using laws and legislation patients’ rights are guarded but we also have the obligation to treat patients. On the other hand, liberals express totally opposite views. Capacity (or incapacity) is not ‘all or nothing’ but specific to decision and should be respected, with the exception to emergency treatment need.

The capacity of decision-making of the mentally ill patient, whether or not being compulsory admitted, should be assessed in a more holistic and systematic approach and become part of the standard practice, followed by dissemination of these decisions to all relevant parties. Restore decisional autonomy should be one of the main goals of any therapeutic intervention.

The author has not supplied his declaration of competing interest.

The plant that has as active ingredient nicotine was chewed or smoked for many years from American natives, for its therapeutic properties. Nowadays after the extensive negative attitude towards smoking, the main provider of nicotine, researchers are now pointing out the therapeutic possibilities of nicotine in mood disorders, as a substance that is acting in the acetylcholine receptors in the brain.

In this review we are trying to explore the possibilities of nicotine use as a therapeutic agent.

We did a detailed research of the main medical databases, and web search engines for relevant studies. We scrutinize them independently, before reaching consensus about appropriateness for inclusion in the study.

Diadermal administration of nicotine has a positive effect in depressive disorder in 3–8 days, an effect that in one study was reversed after cessation of nicotine. Patients with depression and/or healthy subjects show improvement of attention and working memory after diadermal use of nicotine. Research is not conclusive in the sustainability of these positive affects as other researchers emphasize their short effect in mood.

Nicotine presents as part of novel and promising therapeutic agents with complex interactions with other neurotransmitters in the brain. Before condemning nicotine along with smoking we should acknowledge the potential use of nicotine as a therapeutic compound since research shows that some of these positive effects appear not only to smokers after abstinence but also to non-smokers.

The authors have not supplied their declaration of competing interest.