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BACKGROUND: Artificial Intelligence is ever-expanding and large-language models are increasingly shaping teaching and learning experiences. ChatGPT is a prominent recent example of this technology and has generated much debate around the benefits and disadvantages of chatbots in educational domains. AIM: This study seeks to demonstrate the possible use-cases of ChatGPT in supporting educational methods specific to social psychiatry. METHODS: Through interactions with ChatGPT 3.5, we asked this technology to list six ways in which it could aid social psychiatry teaching. Subsequently, we requested that ChatGPT perform one of the tasks it identified in its responses. FINDINGS: ChatGPT highlighted several roles it could fulfil in educational settings, including as an information provider, a tool for debates and discussions, a facilitator of self-directed learning and a content-creator for course materials. For the latter scenario, based on another prompt, ChatGPT generated a hypothetical case vignette for a topic relevant to social psychiatry. CONCLUSIONS: Based on our experiences, ChatGPT can be an effective teaching tool, offering opportunities for active and case-based learning for students and instructors in social psychiatry. However, in their current form, chatbots have several limitations that must be considered, including misinformation and inherent biases, although these may only be temporary in nature as these technologies continue to advance. Accordingly, we argue that large-language models can support social psychiatry education with appropriate caution and encourage educators to become attuned to their potential through further detailed research in this area.

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Introducing the Federal Commission for Quality Assurance in Medical Assessment Abstract. As at January 1, 2022, the Federal Council has established the Federal Commission for Quality Assurance in Medical Evaluation. This will supervise accreditation as an evaluation institution, manage the procedure for the preparation of expert opinions and the results of medical reports, and make public recommendations. This article describes the composition and tasks of the commission. In addition, it presents the existing quality assurance measures and possible new directions in this area.

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BACKGROUND: According to a landmark decision by the Swiss Federal Supreme Court, people with a substance use disorder (SUD) are now eligible for disability benefits if their disorder impairs their ability to work. Alcohol use disorder (AUD) is one of the most common SUDs in Switzerland and is associated with high societal and economic costs. This study aimed to gain an in-depth understanding of the views of professional stakeholder groups regarding AUD and their opinions on the new legal precedent. METHODS: Swiss social insurance lawyers, insurance medical experts, and addiction-specialist therapists (N = 79) answered an online questionnaire. Due to violations of the assumption of normality, non-parametric tests are reported in most cases. RESULTS: Therapists held significantly higher regard for patients with AUD than both lawyers and insurance medical experts. All three groups strongly supported a disease view of AUD but agreed significantly less that it was a disease like cancer, suggesting that AUDs might be seen as at least partially self-inflicted. Overall, moralist views of AUD received considerably less support than the disease view, with lawyers agreeing with moralist views more than therapists. All groups were well-informed and largely supportive about the new legal precedent. When asked about stipulating participation in medical treatment to mitigate damages associated with a claim, attending therapy was supported the most amongst the groups (80% of participants felt this was somewhat or fully appropriate), followed by a reduction in drinking quantity (58%), and abstinence (18%). In all three groups, we identified associations between certain views and opinions on AUD and support for the new legal precedent. CONCLUSIONS: Whilst there were differences between the stakeholder groups in their regard for and views of AUD, all three adopted a clear harm-reduction approach with respect to measures to mitigate damages associated with the insurance disability claim. A possible connection of this stance with the Swiss national drug policy in recent years is discussed together with limitations of the study and practical implications of the findings.

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Akin to many jurisdictions, Switzerland has a dual system of sanctions comprising sentences and measures. To order a therapeutic measure per Article 59 or 63 of the Swiss Criminal Code, the presence of a "severe mental disorder" must be determined. Before the new legal precedent, this required a medical diagnosis according to recognised classification systems like the ICD or DSM. The court then decided if a disorder was "severe" in the legal sense, thereby requiring such a therapeutic measure. However, in two 2019 rulings, the Swiss Federal Supreme Court concluded that a severe mental disorder could legally exist without a diagnosis according to the ICD or DSM, if it is based on offence- and risk-relevant personality-related factors amenable to risk-reducing therapy. We examine the details and context of the rulings, alongside their wider dangers. Specifically, we outline how undue influence could be exerted by non-ICD/DSM diagnostic systems, which were developed within individual theoretical schools of thought and lack empirical validation, like in these two court cases. Such non-manual diagnoses could make the presence of a severe mental disorder dependent upon whether an expert witness employs a particular diagnostic system, which would undermine principles of legality. Moreover, the Court's requirement that the disorder is based on personality-related risk factors amenable to risk-reducing therapy is problematic because research has highlighted the low effectiveness of treatment provided independently of a psychiatric disorder. Finally, broadening entry criteria may increase the number of offenders who require psychiatric treatment, thus endangering the quality of care for those with ICD/DSM-based diagnoses that are known to respond well to treatment (e.g. schizophrenia). In short, fulfilling the Court's request that any non-manual diagnoses are based on personality-related risk factors that are amenable to risk-reducing therapy is not possible for such non-manual diagnoses. Using unvalidated diagnoses could also render the system susceptible to ethical issues and hypothetical misuse, which may adversely affect society's most vulnerable people. To counter these dangers, we suggest that in order to be admissible in court, any diagnostic system must mandatorily fulfil sufficient scientific standards.

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BACKGROUND: Benzodiazepines are commonly prescribed in prisons amidst the controversies surrounding their potential role in causing behavioral disinhibition and aggressive behavior and their association with use and trafficking of illicit and addictive substances. The present study aimed to (1) ascertain the relationship between benzodiazepine prescription (including their dosage and duration of use) and aggressive behavior and behavioral disinhibition in prison and (2) investigate whether there was an association between benzodiazepine prescription, (including their dosage and duration of use) and using and trafficking illicit and addictive substances during imprisonment. METHODS: Data were extracted from the electronic database of an "open" Swiss prison (n = 1206, 1379 measures) over a 5-year period (2010-2015). Measures included benzodiazepine prescription, duration of benzodiazepine use and mean dosage, and punishable behaviors (physical and verbal aggression, disinhibited but not directly aggressive behaviors, property damage or theft, substance-related offenses, and rule transgression). We assessed the relationship between benzodiazepine prescription and punishable behaviors after propensity score matching. Logistic regressions were also used to test the relationship of benzodiazepine use duration and dosage with punishable behaviors among participants who received benzodiazepines. RESULTS: After propensity score matching, benzodiazepine prescription was not significantly associated with any punishable behavior. Among detained persons who took benzodiazepines, there was no significant association of dosage and duration of use with offenses involving illicit or addictive substance use or trafficking. CONCLUSIONS: Our study did not empirically support the occurrence of increased aggressive or disinhibited behaviors or increased risk of substance abuse in detained persons who received benzodiazepines in prison. This suggests a need to reconsider restrictions in prescribing benzodiazepines in the prison setting.

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BACKGROUND: In the context of the current US opioid crisis and the compelling fact that a quarter to a third of all those addicted to heroin pass through its prisons and jails each year, the care of incarcerated opioid-using individuals (OUI) needs to be improved. AIMS: Little has been published on the effectiveness or outcomes of heroin-assisted treatment (HAT), a treatment option for severely dependent OUI delivered in a prison setting. The aim of this study was therefore to evaluate such treatment since its implementation. The primary objective was to investigate whether heroin-assisted treatment was associated with severe detrimental health outcomes. The secondary objective was to compare the heroin-assisted treatment group with the general prison population in terms of occupational functioning. DESIGN: Retrospective cohort study SETTING: An open prison with 120 places SUBJECTS: Data on 1885 male prisoners with a total of 2239 imprisonment periods between 2000 and 2015 was available. Ninety-seven inmates in heroin-assisted treatment were compared with 1788 inmates from the general prison population (reference group). MEASUREMENTS: Mortality, medical complications (including overdoses), and work performance (days worked, sick days, and monthly wages earned). FINDINGS: Inmates receiving HAT were on average 1 year younger (33.8 vs. 34.9 years), had longer prison stays (7.3 vs. 3.0 months), were more often of Swiss nationality (68.0% vs. 28.9%), and had committed more drug- and property-related offenses (49.5% vs. 23.2% and 63.9% vs. 38.3%, respectively) compared to the reference group. No serious heroin-related medical complication occurred during the 15-year window of observation among inmates with heroin-assisted treatment. Their work performance was comparable to that of the reference group. CONCLUSIONS: This study shows that heroin-assisted treatment can be a valuable treatment option for severely dependent OUI during imprisonment, can be delivered safely by prison health staff over extended periods of time, and allows OUI in treatment to achieve work performance rates comparable to that of the general prison population.

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BACKGROUND: Opioid agonist treatment (OAT) is an important pillar in the treatment of individuals using opioids and its continuation during imprisonment is recommended. Despite this knowledge access to and continuation of OAT is still limited in many countries. The forced discontinuation during pre-trial detention can cause severe withdrawal symptoms, which in turn may significantly impair the defendant's ability to exercise granted procedural participation rights. Furthermore, it can be argued that forced discontinuation of a desired treatment represents a form of a compulsory intervention. AIMS: The present study was developed against the backdrop of a recent ruling by the European Court of Human Rights (Wenner vs. Germany). It intended to examine how defense lawyers dealing with detained persons using opioids view and assess the accessibility of OAT in pre-trial detention as well as during imprisonment in different parts of Switzerland. METHODS: Using a qualitative approach, we interviewed 11 defense lawyers from three different cantons of Switzerland with multiple years of experience in providing legal representation to more than 220 defendants using heroin. The interviews were analyzed with QSR NVIVO 11 for Windows. A qualitative content analysis approach was used to evaluate findings. RESULTS: Defenders who had been exposed to the opioid crisis during the course of their legal career had adopted a positive attitude towards OAT and associated it with a stabilizing influence on their clients, an improvement in criminal prognosis, and a reduction in recidivism. They were generally of the opinion that access to OAT had improved, however identified a considerable variance in different penitentiaries, which were mediated by attitudes of staff and authorities. Based on the assessments of the defense lawyers, it can be estimated that the initiation of OAT especially during pre-trial detention is challenging. The predominant aim of OAT in a variety of Swiss prisons still seems to focus on a discontinuation, mediated by a forced reduction of medication. Some of the interventions reported are not in line with the principle of equivalence and strongly contrast the recommendations of the Council of Europe.

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Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is associated with risk-taking behaviors, poor self-control, and interpersonal difficulties. Affected individuals have an increased probability of involvement with the criminal justice system, contributing to a higher rate of arrest, and imprisonment compared with the general population; they are also inadequately treated once sentenced. Because prison staff play a central role in the identification of inmates with mental disorders, they could well be key to improving provision of care. There is however little knowledge of the conceptions, perceptions, and attitudes of prison staff toward ADHD. Such information could help to identify starting points for awareness training and further implementation of specific ADHD treatment. To bridge this gap, we undertook a study based on a qualitatively-driven mixed methods design, combining qualitative data collection in the form of narrative interviews with 19 prison staff from a Swiss correctional facility with quantitative data collection in the form of a survey that included the Attitudes toward Prisoners scale. The interviews were analyzed with QSR NVIVO 11 and a qualitative content analysis approach was used to evaluate findings. Prison staff were generally aware of ADHD and its symptomology, believing it to a be "real," but "fashionable" disorder and favoring hereditary-genetic or biological explanatory models for its development. They viewed inmates with ADHD rather negatively, as complicating correctional efforts, and perceived them as sticking out, as tying up more resources and as frequently being involved in confrontations. Our findings suggest that difficulties in pragmatic aspects of communication and language comprehension may be perceived "as not listening or following instructions," creating additional tensions. Consequently, inmates with ADHD are more often exposed to disciplinary sanctions, such as solitary confinement-an intervention deemed "necessary" by staff. Therefore, staff training on ADHD might need to cover evidence on adverse effects. Non-pharmacological interventions for treatment were preferred and considered to be highly efficacious. Skepticism toward pharmacological treatment prevailed, even when benefits from stimulant medication were described. Interestingly, this skepticism was not the result of negative experiences with the misuse and diversion of stimulants. Acceptance of multimodal treatment among prison staff may require customized strategies.

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Objective: To evaluate perceived needs and difficulties related to instruments for assessing work ability in individuals with mental disorders. Method: We conducted an online survey of 104 German-speaking medico-legal experts (forensic psychiatric and psychology experts, insurance physicians) and therapists. Results: The large majority of respondents reported they would welcome a standardized, structured instrument for the assessment of work ability. High predictiveness, inter-rater agreement, comprehensibility for laymen, and symptom validity were desired in roughly equal measure as the main characteristic of such an instrument. More women than men, and more medico-legal experts than therapists, considered symptom validation as always necessary. Pain, personality, and affective disorders were perceived to be the most difficult disorders in the context of work ability assessments. Conclusion: Our survey documents professionals' wish for a structured assessment of work ability in both medico-legal and therapeutic settings.

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While forensic psychiatry is of increasing importance in mental health care, limited available evidence shows that attitudes toward the discipline are contradictory and that knowledge about it seems to be limited in medical students. We aimed to shed light on this subject by analyzing medical students' central attitudes toward and their association with knowledge about forensic psychiatry as well as with socio-demographic and education-specific predictor variables. We recruited N = 1345 medical students from 45 universities with a German language curriculum across four European countries (Germany, Switzerland, Austria and Hungary) by using an innovative approach, namely snowball sampling via Facebook. Students completed an online questionnaire, and data were analyzed descriptively and multivariably by linear mixed effects models and multinomial regression. The results showed overall neutral to positive attitudes toward forensic psychiatry, with indifferent attitudes toward the treatment of sex offenders, and forensic psychiatrists' expertise in the media. Whereas medical students knew about the term 'forensic psychiatry', they showed a lack of specific medico-legal knowledge. Multivariable models on predictor variables revealed statistically significant findings with, however, small estimates and variance explanation. Therefore, further research is required along with the development of a refined assessment instrument for medical students to explore both attitudes and knowledge in forensic psychiatry.

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Psychiatry as a medical discipline is becoming increasingly important due to the high and increasing worldwide burden associated with mental disorders. Surprisingly, however, there is a lack of young academics choosing psychiatry as a career. Previous evidence on medical students' perspectives is abundant but has methodological shortcomings. Therefore, by attempting to avoid previous shortcomings, we aimed to contribute to a better understanding of the predictors of the following three outcome variables: current medical students' attitudes toward psychiatry, interest in psychiatry, and estimated likelihood of working in psychiatry. The sample consisted of N = 1,356 medical students at 45 medical schools in Germany and Austria as well as regions of Switzerland and Hungary with a German language curriculum. We used snowball sampling via Facebook with a link to an online questionnaire as recruitment procedure. Snowball sampling is based on referrals made among people. This questionnaire included a German version of the Attitudes Toward Psychiatry Scale (ATP-30-G) and further variables related to outcomes and potential predictors in terms of sociodemography (e.g., gender) or medical training (e.g., curriculum-related experience with psychiatry). Data were analyzed by linear mixed models and further regression models. On average, students had a positive attitude to and high general interest in, but low professional preference for, psychiatry. A neutral attitude to psychiatry was partly related to the discipline itself, psychiatrists, or psychiatric patients. Female gender and previous experience with psychiatry, particularly curriculum-related and personal experience, were important predictors of all outcomes. Students in the first years of medical training were more interested in pursuing psychiatry as a career. Furthermore, the country of the medical school was related to the outcomes. However, statistical models explained only a small proportion of variance. The findings indicate that particularly curriculum-related experience is important for determining attitudes toward psychiatry, interest in the subject and self-predicted professional career choice. We therefore encourage the provision of opportunities for clinical experience by psychiatrists. However, further predictor variables need to be considered in future studies.

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OBJECTIVE: To examine, in a non-clinical sample, the association of psychopathology, personality, sociodemographic information, and psychosocial indicators of non-occupational functioning with the duration of absence from work in the past 12 months. METHOD: A longitudinal community cohort of 591 adults from Switzerland was analyzed using multilevel ordered logistic regression, with several alternative models as robustness checks. Psychopathology was assessed using the total score (Global Severity Index) of the Symptom Check List-90 Revised. RESULTS: The highest psychopathology levels were associated with absences of 3 or more week duration, largely independently of age. Extraversion and being divorced, widowed or separated also corresponded with longer absences from work in some analyses. No effect of sex was found. Most effects tested were not statistically significant and estimates showed large uncertainty. CONCLUSION: Although tentative, our results suggest a possible influence of psychopathology on work participation. It may thus be desirable in insurance-medical appraisals of work ability to include instruments for measuring psychopathology.

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OBJECTIVE: To compare the time trends of Google search interest in methamphetamine and criminal offences related to this drug. METHODS: Google Trends data for the search term "meth" was compared to methamphetamine-related crime statistics (incl. use, possession, and dealing) in Switzerland, Germany, and Austria for the years 2004-2016. Google data was availably monthly. Crime data was available yearly, and monthly values were imputed. RESULTS: On the country level, internet search trends for "meth" roughly paralleled relevant criminal activity. State-level data, which was available for Austria, showed more heterogeneity. Cross-correlations for yearly data almost always peaked at a lag time of 0 and coefficients were mostly between 0.7 and 1.0 on the country level, and between 0.5 to 1.0 on the state level. Monthly cross-correlations based on imputed values were substantially lower, ranging from 0 to 0.6. CONCLUSIONS: These results encourage the further evaluation by law enforcement authorities of Google search activity as a possible predictor of methamphetamine-related crime. However, several limitations, in particular the crude temporal resolution of available crime data, precluded a detailed assessment of the relationship between internet search trends and the development of methamphetamine-related crime in central Europe.

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AIM: Occupational capacity evaluations have previously been subject to criticism for lacking in quality and consistency. To the authors' knowledge, there is no clear consensus on the best way to formally assess functioning within capacity evaluations. In this review we investigated different instruments that are used to assess functioning in occupational capacity evaluations. METHODS: Systematic review of the literature. RESULTS: Though several instruments that assess functional capacity were found in our search, a specific validated instrument assessing occupational capacity as part of a larger psychiatric evaluation was not found. The limitations of the existing instruments on assessing functional capacity are discussed. CONCLUSION: Medical experts relying on instruments to conduct functional capacity evaluations should be cognizant of their limitations. The findings call for the development and use of an instrument specifically designed to assess the functional and occupational capacity of psychiatric patients, which is also likely to improve the quality of these reports.

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Limited knowledge of the German language represents a serious barrier for migrants into Switzerland to communicate successfully in a variety of health care settings, which may result not just in delayed access to treatment and poorer outcome, but also in difficulties judging eligibility for health and other social benefits. Especially when conducting disability and other occupational capacity evaluations, clinicians of all medical fields, but particularly psychiatrists, are required to obtain abundant information to allow them to perform a thorough mental health examination and to form a differentiated view of an evaluee's work capacity. Within a clinical context different translation and interpreting strategies are in use, and each strategy has its advantages and disadvantages. This mini-review describes the legal and modal aspects as well as the clinical-practical implications of the use of such interpreting services during disability evaluations.

Des connaissances linguistiques insuffisantes et des difficultés de communication constituent un défi majeur pour les migrants dans différents domaines de la santé. Elles peuvent notamment entraîner des difficultés à identifier les conditions d'octroi des prestations des assurances sociales. Pour déterminer une atteinte à la santé et évaluer la capacité de travail dans la procédure AI, les cliniciens, et en particulier les psychiatres, doivent développer une compréhension aussi différenciée que possible des données anamnestiques et du bilan psychopathologique. Différentes approches de traduction et d'interprétation sont donc utilisées dans le contexte clinique. Cette mini-review éclaire les aspects cliniques, formels et juridiques du recours à des interprètes dans les examens médicaux d'incapacité de travail (de longue durée) lorsque les compétences linguistiques des personnes expertisées sont insuffisantes.

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