Приведены современные данные об этиологии, патогенезе, исходах при неиммунной водянке плода. Предложены варианты дифференцированного подхода к ведению патологии в зависимости от причины.

The management of pregnant women with premature rupture of membranes does not lose its relevance since one third of all preterm births begin just with amniorrhea. Despite the fact that the management tactics is presented in normative documents, the world literature describes cases of outpatient management. This paper gives an account of a case of successful completion of pregnancy due to outpatient management, which is an allowable variant during careful follow-up and examination if the status of a pregnant woman and her fetus is stable, allowing the prevention of severe infectious complications associated with hospital flora contamination.

Evidence-based future community violence risk assessment is a crucial issue in psychiatry. It is a cornerstone of safeguarding the rights of persons with mental health issues. Authors aimed to analyse the modern methods of risk assessment in psychiatry and the current practice and legal framework. Authors undertook a scoped review of the literature with search terms related to future community violence risk prediction for mentally disordered offenders in Latvian, English, German, and Russian languages. Main difficulties in future community violence risk assessment are demonstrated via Latvia’s court decisions analysis. Marked differences were identified: there are no standardized methods available/registered in Latvia, therefore risks assessment is performed via clinical assessment only. In Germany, the risk assessment is performed via structured evidence – based risk assessment tools and clinical assessment; nevertheless, the choice of the assessment tool remains challenging.

IntroductionA well-established principle is that informed consent is an obligatory requirement for any medical intervention; a patient’s decision-making capacity to consent is a requirement for legally valid consent. Some individuals may be unable to give valid informed consent due to their limited mental capacity. In such cases, laws permit substitute decision-making and involvement of the patient as far as possible (Art.6, Oviedo Convention). National laws of European countries allow persons with mental health problems to be deprived of their liberty and undergo involuntary treatment, namely treatment without a patient’s informed consent, in certain circumstances. Procedural safeguards must be secured, and a court must review its lawfulness (FRA, 2012). The legality of involuntary treatment is highly debated by various audiences (CRPD committee, CoE bodies). In Latvia and other countries, the requirement to assess a person’s decision-making capacity in the application of involuntary treatment is not required.ObjectivesThis study was conducted to reveal the role of a person’s decision-making capacity to consent to the treatment of mental disorders in cases where involuntary treatment was approved by courts.MethodsA retrospective case law study method was applied. Anonymised decisions of Latvian courts at www.manas.tiesas.lv in cases of involuntary treatment in Latvian adult psychiatric hospitals since 2010 were collected and analysed. The content of decisions concerning persons’ decision-making capacity and applicable legal regulations were studied.ResultsThe case law revealed that the decision-making capacity had not been addressed regularly and in detail. Latvian law does not require an assessment of capacity, and as a result, the courts do also not require any data. Some elements of decision-making abilities, such as the limited ability to comprehend or process information, are mentioned in the decisions of courts.ConclusionsThere is a need to address the significance of decision-making capacity in the application of patients’ rights law in clinical and legal settings when involuntary treatment is suggested or applied. There is a need to amend the laws justifying the limitations of patients’ rights, particularly concerning involuntary treatment.AcknowledgementsThis paper has been prepared within the research project “Towards a human rights approach for mental health patients with a limited capacity: A legal, ethical and clinical perspective”, No. lzp-2020/1-0397 and the project “Strengthening of the capacity of doctoral studies at the University of Latvia within the framework of the new doctoral model, identification No.8.2.2.0/20/I/006”Disclosure of InterestNone Declared

IntroductionTourette’s syndrome (ST) is a neuropsychiatric disorder that presents with combination of motor and vocal tics for at least one year time.Only few cases of comorbidity with psychotic disorder has been described.ObjectivesWe present a case report of a patient with ST, obsessive compulsive disorder, posttraumatic stress disorder that resulted in chronic schizophrenia-like psychosis, and family hystory of tics and psychosis.MethodsA case – based family study, literature review and statistic data analysis.ResultsThe patient (male, born in 1997 otherwise healthy)presented at the age of 6 with spitting.He subsequently progressed with severe motor tics, vocalizations, coprolalia, impulsivity, destructivity, repetitive motor rituals.No treatment showed to be efficacious and safe. He dropped out of the school, the family has to move to the rural area; his social withdrawal was intensified by psychotrauma (assaulted by police officer due to seemingly disorderly conduct). At the age of late adolescence he started to make fantastic statements. Later on he admitted having visual and audial hallucinations and responding to them; the Kandinsky–Clérambault syndrome was detected. Symptoms and exitement are partially controlled by diazepam and clozapine; the patient needs assistance in all routines of self – care.The patient’s mother has a mild form of motor tics; her mother developed persistent delusions in her late thirties (without disorders of perception and social disfunction).ConclusionsThe study demonstrantes genetic interconnecting between TS, tics and psychosis; hyperactivity in the dopaminergic system of the brain may be involved in all three disorders. National statistics of TS have to be reviewed and improved.DisclosureNo significant relationships.