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Concept: Moral treatment

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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

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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

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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

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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

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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

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High levels of psychiatric morbidity in prisoners have important implications for services. Assessing Needs for Psychiatric Treatment in Prisoners is an evaluation of representative samples of prisoners in a male and a female prison in London. This paper reports on the prevalence of mental disorders. In a companion paper, we describe how this translates into mental health treatment needs and the extent to which they have been met.

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

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The Psychiatry Enquête turned 40 years old last year. The S3 guideline “Psychosocial therapies for severe mental illness” is considered to be the last milestone of the reform to date. This paper highlights new impulses resulting from the S3 guideline for psychiatric care and provides an outlook on the update, expected in 2017. Many of the interventions reported in the S3 guideline are now supported by a broader evidence base.

Concepts: Moral treatment, Psychiatric hospital, Psychiatric medication, Mental health, Psychiatry, Mental illness, Medicine, Mental disorder

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Although studies of co-occurring psychiatric disorders among methamphetamine (MA)-dependent persons have been conducted in treatment programs, none have examined them in service settings used to sustain long-term recovery, such as sober living houses (SLHs).

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

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In the history of psychiatry, “schizophrenia” has often been portrayed as the discipline’s pars pro toto, which prototypically represents mental illness as such and which draws together the fundamental questions concerning psychiatric epistemology and practice. Taking a conceptual history approach, this essay examines how “schizophrenia” is represented in psychiatric discourse and what aspects of its representation account for the pars pro toto status. Three such aspects are identified: a pragmatic, an existential and a justificatory aspect. Following up these aspects in present day psychiatric discourse, it is concluded that “schizophrenia” is losing its special status as the representations of psychiatry and of mental illness have changed and become more diverse. Tentative conclusions regarding current debates about the abolition of “schizophrenia” are drawn.

Concepts: Psychosis, Mental health, Moral treatment, Psychology, Psychotherapy, Greek loanwords, Psychiatry, Mental disorder