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Concept: Moral treatment


Objective To investigate the association between in utero exposure to antidepressants and risk of psychiatric disorders.Design Population based cohort study.Setting Danish national registers.Participants 905 383 liveborn singletons born during 1998-2012 in Denmark and followed from birth until July 2014, death, emigration, or date of first psychiatric diagnosis, whichever came first. The children were followed for a maximum of 16.5 years and contributed 8.1×10(6) person years at risk.Exposures for observational studies Children were categorised into four groups according to maternal antidepressant use within two years before and during pregnancy: unexposed, antidepressant discontinuation (use before but not during pregnancy), antidepressant continuation (use both before and during pregnancy), and new user (use only during pregnancy).Main outcome measure First psychiatric diagnosis in children, defined as first day of inpatient or outpatient treatment for psychiatric disorders. Hazard ratios of psychiatric disorders were estimated using Cox regression models.Results Overall, psychiatric disorders were diagnosed in 32 400 children. The adjusted 15 year cumulative incidence of psychiatric disorders was 8.0% (95% confidence interval 7.9% to 8.2%) in the unexposed group, 11.5% (10.3% to 12.9%) in the antidepressant discontinuation group, 13.6% (11.3% to 16.3%) in the continuation group, and 14.5% (10.5% to 19.8%) in the new user group. The antidepressant continuation group had an increased risk of psychiatric disorders (hazard ratio 1.27, 1.17 to 1.38), compared with the discontinuation group.Conclusions In utero exposure to antidepressants was associated with increased risk of psychiatric disorders. The association may be attributable to the severity of underlying maternal disorders in combination with antidepressant exposure in utero. The findings suggest that focusing solely on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive.

Concepts: Moral treatment, Psychology, Psychiatric hospital, Cross-cultural psychiatry, Mental health, Psychiatry, Psychiatric medication, Mental disorder



Digital footprints, the automatically accumulated by-products of our technology-saturated lives, offer an exciting opportunity for psychiatric research. The commercial sector has already embraced the electronic trails of customers as an enabling tool for guiding consumer behaviour, and analogous efforts are ongoing to monitor and improve the mental health of psychiatric patients. The untargeted collection of digital footprints that may or may not be health orientated comprises a large untapped information resource for epidemiological scale research into psychiatric disorders. Real-time monitoring of mood, sleep and physical and social activity in a substantial portion of the affected population in a naturalistic setting is unprecedented in psychiatry. We propose that digital footprints can provide these measurements from real world setting unobtrusively and in a longitudinal fashion. In this perspective article, we outline the concept of digital footprints and the services and devices that create them, and present examples where digital footprints have been successfully used in research. We then critically discuss the opportunities and fundamental challenges associated digital footprints in psychiatric research, such as collecting data from different sources, analysis, ethical and research design challenges.Molecular Psychiatry advance online publication, 6 December 2016; doi:10.1038/mp.2016.224.

Concepts: Moral treatment, Psychiatric hospital, Psychiatric medication, Mental health professional, Mental health, Psychology, Mental disorder, Psychiatry


In 1798, Philippe Pinel presented one of the first nosologies for psychiatric disorders, “Nosographie philosophique ou la méthode de l'analyse appliquée a la médecine."1His emphasis on psychological and physical conditions as the basis of mental illness provided a distinct departure from prior reliance on such etiologies such as demonic possession. Establishing classification schema was a much more profound innovation than a simple academic reordering of psychiatric phenomena-under Pinel’s leadership at the famed Pitié-Salpêtrière hospital, it also led to a radical reformation of clinical interventions, moving away from pseudoscientific practices toward psychologically based interventions. Much of this work influenced his successors in psychiatric taxonomy including Emil Kraeplin and others, ultimately forming the basis of the DSM.2Although the DSM has been subsequently celebrated and maligned, it has been instrumental in both our conceptualization and treatment approach to psychiatric disorders. Indeed, there has been extensive effort to validate these conditions using factor analytic approaches to confirm that such conditions represent cohesive biologically based disorders, which has presented challenges.3.

Concepts: Medicine, Mental health, Clinical psychology, Mental disorder, Moral treatment, Psychology, Greek loanwords, Psychiatry


Dementia and psychiatric disorders are common in assisted living facilities (ALFs) and have suboptimal rates of recognition and treatment. Therefore, we aimed to obtain a direct estimate of the prevalence of cognitive impairment and especially dementia among residents of ALFs in western Slovakia and their rates of primary recognition and adequate treatment.

Concepts: Assisted living, Psychology, Moral treatment, Mental health, Mental disorder, Psychiatry


Substance use disorder is highly prevalent in people with psychiatric disorders, and known to impede the psychiatric treatment. Some studies show increased rates of service use, while others show a decrease. These conflicting results are further hampered by a lack of large-scale studies. The aim of this study was to investigate the association between substance use disorder and psychiatric service use in psychiatric patients.

Concepts: Moral treatment, Psychiatric hospital, Cross-cultural psychiatry, Psychiatric medication, Mental health, Mental illness, Psychiatry, Mental disorder


Children of patients with psychiatric disorders are at higher risk to develop a psychiatric illness. In addition, phases of crisis and hospitalization of the parent are often traumatizing to the children, especially during childhood. Although a specific offer to face these issues is compulsory in some countries, such is not the case in Switzerland. In this paper we describe the implementation of a special offer for children of parents with mental illness (Famille +) in the service of general psychiatry at the Department of psychiatry of the Lausanne University hospital in Switzerland. We will also discuss the development and implementation of the Joint Crisis Plan, a collaborative tool where psychiatric patients and clinicians define the strategies that should be applied in case of crisis, which strengthens the empowerment of patients and their participation to decisions about their treatment.

Concepts: Moral treatment, Cross-cultural psychiatry, Psychiatric medication, Mental health, Hospital, Psychiatric hospital, Mental disorder, Psychiatry


Despite a limited empirical literature, parental mental illness is often cited as a major risk factor for violence against children. However, mental illness that is adequately treated would not be expected to lead to increased violence risk. This study compared incidents of violence toward children perpetrated by parents who were newly discharged from inpatient psychiatric treatment with violence perpetrated by other parents in the same communities to determine whether parents with treated mental illness had an elevated risk of child abuse perpetration.

Concepts: Psychosis, Moral treatment, Psychiatric hospital, Psychiatric medication, Mental health, Child abuse, Psychiatry, Mental disorder


People who have been convicted of a crime due to a severe mental disorder and continue to be dangerous as a result of this disorder may be placed in a forensic psychiatric facility for improvement and safeguarding according to § 63 and § 64 of the German Criminal Code (StGB). In Germany, approximately 9000 patients are treated in clinics for forensic psychiatry and psychotherapy on the basis of § 63 of the StGB and in withdrawal centers on the basis of § 64 StGB. The laws for treatment of patients in forensic commitment are passed by the individual States, with the result that even the basic conditions differ in the individual States. While minimum requirements have already been published for the preparation of expert opinions on liability and legal prognosis, consensus standards for the treatment in forensic psychiatry have not yet been published. Against this background, in 2014 the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) commissioned an interdisciplinary task force to develop professional standards for treatment in forensic psychiatry. Legal, ethical, structural, therapeutic and prognostic standards for forensic psychiatric treatment should be described according to the current state of science. After 3 years of work the results of the interdisciplinary working group were presented in early 2017 and approved by the board of the DGPPN. The standards for the treatment in the forensic psychiatric commitment aim to initiate a discussion in order to standardize the treatment conditions and to establish evidence-based recommendations.

Concepts: Moral treatment, Psychology, Germany, Mental health, Psychotherapy, Psychiatric hospital, Mental disorder, Psychiatry


Repetitive skin manipulation is the key symptom in skin picking disorder (SPD), or acne excoriée des jeunes filles Brocq. The diagnostic and statistical manual of mental disorders (DSM-5) has recognized SPD as an independent disease, namely an obsessive-compulsive disorder. Thus, psychiatric treatment is indicated. Therefore, in a large cohort of SPD, we asked whether dermatologists' treatment strategy includes routine referrals to psychiatry. In addition, we describe epidemiological data, treatments and follow up.

Concepts: Moral treatment, Body dysmorphic disorder, Psychiatric hospital, Epidemiology, Psychiatry, Medicine, Mental disorder