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PubMed1993

Nonemergent forcible medication in an acute hospital.

Nonemergent forcible medication is a controversial procedure that has received somewhat less study in acute hospitals and in states where a simple in-house "treatment-driven" clinical review procedure is followed. We reviewed the charts of all patients so medicated by the New Jersey "Rennie" process on a large general acute adult psychiatric service, finding 43 (3%) of 1420 admitted patients so treated. Compared with a population of next-admitted individuals, these "Rennie" patients more frequently had previously required extended emergent forcible medication, had significantly longer hospitalizations (70 versus 26 days), not accounted for by the duration of treatment refusal, but improved with treatment so that almost all were discharged directly back to the community. Rennie patients appeared more likely to be diagnosed with schizophrenia and were significantly more likely to have a known history of assault, threatened assault, or property damage, but significantly less likely to have a known history of suicide threat or attempt. They were also significantly less likely to have a principal or secondary diagnosis of personality disorder or substance use disorder.

Adult↗
PubMed2004

Confirmatory factor analysis of the psychopathy checklist: screening version in offenders with axis I disorders.

One hundred forty-nine inpatients within a maximum security psychiatric facility were assessed with the Psychopathy Checklist: Screening Version (PCL:SV; S. D. Hart, D. N. Cox, & R. D. Hare, 1995). Within the total sample, 68% had a psychotic disorder and 30% met criteria for psychopathy. Using confirmatory factor analysis, the authors tested the 2-factor PCL:SV model of psychopathy and recent 3- and 4-factor models. Results indicated good fit for each model, with the 4-factor model showing best overall fit. Structural equation modeling was used to determine which psychopathy factors predicted 6-month follow-up of inpatient aggression. The 2-, 3-, and 4-factor models, respectively, accounted for 16%.27%. and 3l% of the variance in aggression.

Adult↗
PubMed1999

A cost analysis of untoward incidents in a medium secure unit.

All untoward incidents perpetrated by 36 patients--residents in a medium-secure hospital--over a period of six months were examined using a prospective design. Demographic and psychiatric details of patients involved in incidents were compared with those of patients not involved in incidents. Financial costs associated with incidents were calculated. A minority of patients were found to be responsible for the majority of incidents. Patients detained under criminal sections of the Mental Health Act 1983 were involved in disproportionately more incidents than their civil section counterparts. The female patients involved in untoward incidents all had a diagnosis of personality disorder and were over-represented in the number of incidents. However, most of the financial burden of untoward incidents was incurred by those incidents perpetrated by male patients. Likewise, although patients detained under the legal category of psychopathic disorder were involved in a higher number of incidents, higher costs were associated with incidents perpetrated by patients detained under the category of mental illness.

Antisocial Personality Disorder↗
PubMed1985

[Analysis of a patient population of the neurologic-psychiatric admission department of a central prison hospital].

This article represents an attempt to analyse the multivarious and problematic groups of neurological and psychiatric inpatients admitted to a central hospital for prisoners in Baden-Württemberg. This special ward for such patients is unique in its character in the entire Federal Republic of Germany. Patients are differentiated according to diagnosis, length of stay, duration of imprisonment, reason for referral, number of patients referred, and kind of treatment. The four most strongly represented groups of diagnosis consist of the patients with psychogenic reactions, drug addiction, endogenous psychoses and psychopathies. These differ from one another according to treatment regimen, reasons for referral, and mode of hospitalisation. Statistics are given reflecting the problems of non-German, mentally abnormal prisoners and of their suicidal or para-suicidal actions.

Alcoholism↗
PubMed2000

Insight and symptom change in schizophrenia and other disorders.

OBJECTIVE: This study sought to evaluate levels of insight and change in insight in subjects with schizophrenia and other major psychiatric disorders. This study also evaluated the relationship of insight to acute psychopathology. METHOD: One-hundred and eighty-seven subjects consecutively admitted to an acute care psychiatric unit and who met DSM-III-R criteria were evaluated by the Insight and Treatment Attitudes Questionnaire and Brief Psychiatric Rating Scale on admission and discharge. Relationships of insight to diagnosis, involuntary commitment status and change in insight were evaluated with analysis of variance and post hoc Tukey's Standardized Range test. Relationships of change in insight and symptoms were evaluated with analysis of covariance (ANCOVA) and correlation. RESULTS: Insight deficits were more prevalent in schizophrenia, a mixed group of other psychosis and bipolar disorder as compared with major depressive and schizoaffective disorder. Committed patients had lower insight. Insight improved across diagnoses during hospital care in both voluntary and committed patients. Significant relationships between improved symptoms and improved insight were obtained in the bipolar, schizophrenia and major depressive groups. CONCLUSION: Insight deficits are prevalent in schizophrenia and bipolar disorder. Many patients show improved insight as their acute symptoms improve. Some aspects of insight are state related during exacerbation of illness in patients with schizophrenia and bipolar disorder.

Acute Disease↗
PubMed2002

A cross-sectional study of psychosocial and criminal factors associated with arrest in mentally ill female detainees.

In this study, the relationship was examined among clinical, criminal, and sociodemographic characteristics and the severity of the criminal charge of mentally ill female detainees admitted to the women's psychiatric unit at a large urban jail. In a cross-sectional study, 96 randomly selected female detainees were interviewed by one of two trained interviewers using the Structured Clinical Interview for DSM (SCID)-IV, the Addiction Severity Index, the Global Assessment of Functioning Scale (GAF), and the Medical Outcomes Study 36-Item Short-Form Health Survey. Criminal offense categories were based on the Federal Bureau of Investigation's Uniform Crime Reporting Program. Altogether, 48 percent of the detainees had been charged with committing at least one Part I crime; 27 percent were charged with committing a violent crime against persons. Lower GAF score and previous conviction(s) for a serious crime were associated with current arrest for a Part I crime. The data also suggest that a lower GAF score may be associated with a current charge of committing a violent crime, and placement on probation or parole before the current arrest may be protective against this charge. Mentally ill women who are more functionally impaired may be at higher risk of being arrested and charged with committing more serious and more violent crimes than those with lesser impairment.

Adult↗
PubMed2006

Structured Assessment of Correctional Adaptation (SACA): a measure of the impact of incarceration on the mentally ill in a therapeutic setting.

Clinicians have observed that psychiatric patients with correctional histories evidence attitudes and behaviors that seem adaptive in penal environments but are maladaptive in mental health settings. This study sought to assess the reliability and concurrent validity of a rating scale designed to measure correctional adaptation using a sample of 64 patients from a state psychiatric hospital. Scale ratings were obtained through structured interviews, whereas predictor variables were gleaned from chart review and self-report. The scale demonstrated good interrater reliability (ICC = .83) and acceptable internal consistency (alpha= .67). Of the variables evaluated, two were significantly correlated with Structured Assessment of Correctional Adaptation (SACA) total scores, total months sentenced to prison or jail (r = .26), and frequency of disciplinary tickets while in prison or jail (r = .31). Stepwise regression analyses revealed only the latter variable significantly predicted SACA score (R = .31), F(1, 58) = 6.27, p < .05. Clinical implications of these findings, the scale, and the construct of correctional adaptation are discussed.

Adaptation, Psychological↗
PubMed2001

A specialized crisis response site as a core element of police-based diversion programs.

Transporting an individual in psychiatric crisis to an emergency department is often frustrating for both law enforcement and mental health professionals. To facilitate collaboration between police and mental heath professionals in crisis cases, some communities have developed prebooking diversion programs that rely on specialized crisis response sites where police can drop off individuals in psychiatric crisis and return to their regular patrol duties. These programs identify detainees with mental disorders and work with diversion staff, community-based providers, and the courts to produce a mental health disposition in lieu of jail. This paper describes three of the diversion programs participating in the Substance Abuse and Mental Health Services Administration jail diversion knowledge development application initiative that demonstrate the importance of specialized crisis response sites. The three programs are in Memphis, Tennessee; Montgomery County, Pennsylvania; and Multnomah County, Oregon. The authors describe important principles in the operation of these programs: being a highly visible, single point of entry; having a no-refusal policy and streamlined intake for police cases; establishing legal foundations to detain certain individuals; ensuring innovative, intensive cross-training; and linking clients to community services.

Antisocial Personality Disorder↗
PubMed2006

A comparison of offenders with intellectual disability across three levels of security.

BACKGROUND: A number of authors have described, with disparate results, the prevalence of people with intellectual disability and their characteristics, in a range of offender cohorts defined by service use. These have included high security, a range of criminal justice services and community services. There is a need for research comparing cohorts of offenders with intellectual disabilities across different settings. AIM AND HYPOTHESIS: To conduct such a comparison and test the hypothesis that severity of characteristics measured will be highest in highest levels of residential security. METHOD: A clinical-record-based comparison a offenders with intellectual disability in high security (n = 73), medium/low security (n = 70), and a community service (n = 69). RESULTS: Groups were similar in age and tested IQ levels. Early psychiatric service contact had been more likely in the lower security groups. In line with the hypothesis, more complex presentations, in particular comorbid personality disorder, was more likely in the highest security group. Both fatal and non-fatal interpersonal violence convictions were significantly related to group, with more in the high security group sustaining a conviction both at the index offence and prior to that. Over 50% of all groups had at least one conviction for a sexual offence. A regression model accounting for 78% of the variance was made up largely of disposal variables (Mental Health Act status and probation) and indications of antisocial traits (criminal damage, lifetime conviction for murder and ICD-10 personality disorder classification). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The authors show that context of sampling affects most relationships between intellectual disability (ID) and offending when the methods for measuring ID are held constant. The results also present several questions on the relationship between risk, services available in an area and referral to higher security.

Adult↗
PubMed1995

State psychiatric hospital patients with past arrests for violent crimes.

OBJECTIVE: This study examined associations between four types of major psychopathology--schizophrenia, schizoaffective disorder, and bipolar and unipolar affective disorders--and history of violent crime. The effects of demographic variables, substance abuse, psychosis, and paranoia on history of violent crime were also determined. METHODS: Diagnostic assessments using the Schedule for Affective Disorders and Schizophrenia and Research Diagnostic Criteria identified 172 state hospital inpatients with the four diagnoses of interest, as well as those with co-existing substance use disorders. Based on arrest records, patients were categorized according to the most violent crime for which they had been arrested. RESULTS: Patients with schizoaffective disorder were significantly more likely than those in the other diagnostic groups to have been arrested for a violent crime. Similar results were found for psychotic patients compared with nonpsychotic patients, patients who had paranoid schizophrenia compared with patients who had schizophrenia without paranoid features, and patients who had co-existing substance abuse compared with those with no history of substance abuse. Patients from racial minority groups and male patients were also more likely than white patients and female patients to have been arrested for a violent crime. CONCLUSIONS: Demographic features, a diagnosis of schizoaffective disorder, psychosis, paranoid symptoms, and substance abuse may all be associated with violent behavior.

Adolescent↗
PubMed2001

Measuring communication and social skills in a high security forensic setting using the behavioural status index.

Assessing patient functioning in the areas of communication and social skills is a core area of practice within psychiatric nursing. Difficulties within these areas can often represent the root of a number of presenting problems. Objective assessment can be difficult without a validated assessment schema. The Behavioural Status Index (BSI) offers such a system of baseline assessment and longitudinal monitoring as a basis for treatment, further specialised assessment, or measurement of outcome during and after interventions. This paper introduces some basic theory and describes the function and purpose of the BSI. This is followed by data analysis for the BSI communications and social skills sub-scale. Data were collected, using a repeated measures method by primary nurses, from a sample of 503 individual patients in two high security mental health hospitals. Results are reported for descriptive statistics, and factor analysis; and differences between the independent groups of Mental Health Act 1983 classification, ward dependency and gender. Data trends are indicative of clinically interesting relationships. A distinct factorial structure emerged suggesting groupings of assertive-interpersonal, non-verbal, social-perceptive and para-linguistic behaviours. Results are reported to be underpinning current European studies.

Adult↗
PubMed1982

[The "Baxström Affair". An example of criticism on psychiatry in the USA (author's transl)].

UNLABELLED: Until the year 1966 the prison administration of New York, supported by relevant laws, transferred prisoners who showed symptoms of psychic disorder during execution of a sentence to the Dannemora Clinic which belonged to the prison. The treatment was carried out by house physicians (general practitioners) who were subject to special directions. J. K. Baxström initiated a lawsuit against this procedure and was finally proven right by the Supreme Court of the USA; the necessity of a thorough medical examination of facts, a hearing in front of a judge, and the approval of the transfer were confirmed to apply also to mentally ill prisoners. The sociologists Streatman and Cocozza carried out an investigation of 967 ex-convicts of the Dannemora Clinic (1966-1974). RESULT: Psychiatrists had shown an arbitrary and comtemptuous behavior in these cases. Diagnostic, therapy, and prognosis had been insufficient or mistaken in this marginal group. Further examination showed, however, that no psychiatrist had been involved in the transfer to the Dannemora Clinic either in planning, consultation, or execution of the transfer. Is so far the reproaches lack any factual grounds. The "Baxström affair", which is frequently taken up by the media, turned out to be an example of ideologically determined "criticism on psychiatry" with doubtful methods.

Antisocial Personality Disorder↗
PubMed1988

The right to refuse treatment: an uncertain future.

Right to refuse treatment decisions have seldom considered many potential consequences. This discussion will explore some of these possible consequences and their potential effect upon patients, psychiatry, and society.

Antisocial Personality Disorder↗
PubMed2006

Do community treatment orders for mental illness reduce readmission to hospital? An epidemiological study.

BACKGROUND: It has been suggested that community treatment orders (CTOs) will prevent readmission to hospital, but controlled studies have been inconclusive. We aimed to test the hypothesis that hospital discharges made subject to CTOs are associated with a reduced risk of readmission. The use of such a measure is likely to change after its introduction as clinicians acquire familiarity with it, and we also tested the hypothesis that the characteristics of patients subject to CTOs changed over time in the first decade of their use in Victoria, Australia. METHOD: A database from Victoria, Australia (total population 4.8 million) was used. Cox proportional hazard models compared the hazard ratios of readmission to hospital before the end of the study period (1992-2000) for 16,216 discharges subject to a CTO and 112,211 not subject to a CTO. RESULTS: Community treatment orders used on discharge from a first admission to hospital were associated with a higher risk of readmission, but CTOs following subsequent admissions were associated with lower readmission risk. The risk also declined over the study period. CONCLUSIONS: The effect of using a CTO depends on the patient's history. At a population level their introduction may not reduce readmission to hospital. Their impact may change over time. DECLARATION OF INTEREST: None.

Adult↗