Not all individuals treated for major depressive disorder (MDD) achieve recovery. This observational study examined the recovery rates in MDD patients and the patient characteristics associated with achieving recovery in a naturalistic clinical setting. Recovery was defined as having both clinical and functional remission. Data for this post hoc analysis were taken from a 24-week prospective, observational study that involved 1,549 MDD patients. Clinical remission was assessed using the 16-item Quick Inventory of Depressive Symptomatology Self-Report and functional remission through the Sheehan Disability Scale and no days of reduced productivity in the previous week. Generalized estimating equation regression models were used to examine the baseline factors associated with recovery during follow-up. Clinical and functional remission was achieved in 70.6% and 56.1% of the MDD patients, respectively. MDD patients who achieved recovery (52.1%) were significantly less likely to have impaired levels of functioning, concurrent medical or psychiatric conditions, low levels of education, or nonadherence to therapy at follow-up. The level of functioning during the index episode seems to be a better predictor of recovery than symptom severity. Therefore, the level of functioning should be considered while determining recovery from depression.

A substantial group of forensic psychiatric patients require (life)long forensic psychiatric care. Instead of aiming at re-entry into society, treatment in long-term forensic psychiatric care (LFPC) is principally aimed at medical and psychiatric care and optimising quality of life (QoL). To assess QoL in LFPC, the influence of both the mental disorder and the restrictive context should be considered. Therefore, a new instrument was developed: the Forensic inpatient QoL questionnaire (FQL). The FQL is based on the results of concept-mapping with patients and staff within LFPC. The main purpose of this study is to evaluate the psychometric properties of the FQL. One hundred and sixty-three FQLs, filled out by 98 male long-term forensic psychiatric patients, were included for testing reliability and content validity. For testing construct validity, 53 patients additionally completed the World Health Organisation Quality of Life-Brief version and 50 of them the Affect Balance Scale. Outcomes indicate that the FQL has good psychometric properties. Fifteen of the 16 FQL domains showed adequate to good reliability (Cronbach's α range .69–.91) and 9 domains met the criteria for homogeneity. Content validity was demonstrated by exploratory factor analysis, which revealed a three-factor structure: social well-being, physical well-being and leave. Construct validity was supported by 59% correctly hypothesised inter- and intrascale Pearson's correlation coefficients. Good psychometric properties and its clinical-based development make the FQL a valid and useful instrument for QoL assessment in LFPC. The FQL could therefore contribute to evidence-based and more advanced treatment programmes in LFPC.

There is growing evidence that there is a relationship between a psychotic disorder and violent behavior. Diagnostic comorbidity of a psychotic disorder with substance abuse, a personality disorder or psychopathy increases the likelihood of violence. The aim of this review is to examine the literature about the relationship between a psychotic disorder and violence, and about comorbidity of a psychotic disorder with substance abuse, a personality disorder and/or psychopathy. A search of www.PubMed.com and www.PsychInfo.com for the period 1990–2006 yielded 1942 articles. Ultimately, however, only 73 articles remained after eliminating those on irrelevant topics. Results showed that the roles of substance abuse, the presence of a personality disorder, or a high score on the revised psychopathy checklist are confirmed as important risk factors by many authors. This review revealed a high degree of agreement that possible comorbidity in schizophrenic offenders should be mentioned routinely in scientific research as it has an essential effect on the development of the offender's illness.

This study has shown that the FQL-SV is a psychometrically valid abbreviation of the FQL and can therefore be used to monitor or assess QoL in forensic psychiatric care. However, when certain domains should be targeted in treatment, the FQL (full version) can assist both the patient and the clinician to get a more complete view of the individualized targets they should be aiming at in order to improve QoL.

The Italian forensic psychiatric system underwent drastic reforms. The newly developed facilities are inspired by psychiatric community services, embracing a recovery-oriented approach. Needs and quality of life are broader concepts that consider the more rehabilitative and humanitarian aspects of treatment. In one of the new Italian forensic psychiatric services, this cross-sectional study aimed to investigate the needs and quality of life of forensic psychiatric patients. A second aim was to validate the Italian version of the Forensic inpatient Quality of Life questionnaire Short Version (FQL-SV). Overall, 42 forensic psychiatric patients were assessed using the Forensic version of the Camberwell Assessment of Need (CANFOR), the Historical-Clinical-Risk-Management-20 (HCR-20), the FQL-SV, and the World Health Organization Quality of Life (WHOQoL-Bref). Patients reported significantly fewer needs, whether met or unmet, than their treating clinicians. The general level of agreement between patients and clinicians on specific needs was low Kappa values were < .40 for 64% of the total needs and 46% of the unmet needs. Risk factors according to the HCR-20 mean scores were 13.1, 4.6, and 6.4 for the historical, clinical and risk management subscale. Quality of life was moderate to high for 74% of the patients. Our results showed that lower numbers of needs, whether reported by patients or clinicians, were associated with a better quality of life. The Italian FQL-SV had a Cronbach's alpha of 0.86 and correlated as expected with the WHOQoL-Bref. The FQL-SV is a valid and reliable tool, justifying its use for routinely assessing QoL in Italian forensic psychiatric services. This study enhances our understanding of needs and quality of life of forensic psychiatric patients and how their assessment could have an additional value for recoveryoriented treatment in forensic psychiatry. Although the detained status of forensic patients imposes real limits on the capacity for autonomy and choice, incorporating the patient's perspective on decision-making processes, in relation to aspects of treatment, care, and daily life, may have benefits such as a better treatment adherence or therapeutic alliance. Future research should clarify how routinely assessing needs and quality of life can contribute to the recovery of these forensic psychiatric patients.