Reconviction of special (high security) hospital patients with personality disorder: its relationship with route of discharge and time at risk

2000 ◽  
Vol 10 (2) ◽  
pp. 88-99 ◽  
Author(s):  
Elizabeth Jamieson ◽  
Sophie Davison ◽  
Pamela J. Taylor
Keyword(s):  
At Risk ◽  
Personality Disorder ◽  
High Security ◽  
Hospital Patients

Effectiveness of Paliperidone Depot in Seriously Violent Men With Comorbid Schizophrenia and Dissocial Personality Disorder in a Uk High-Security Hospital

2016 ◽  
Vol 33 (S1) ◽  
pp. S462-S462
Author(s):  
A.M. Mortlock ◽  
F. Larkin ◽  
C. Ross ◽  
S. Sengupta ◽  
M. Das
Keyword(s):  
Personality Disorder ◽  
Treatment Resistance ◽  
Clinical Effectiveness ◽  
Service Evaluation ◽  
Personality Pathology ◽  
Psychological Therapies ◽  
High Security ◽  
Symptom Domains ◽  
Hospital Patients ◽  
Competing Interest

IntroductionHigh-security hospital patients are often complex in presentation characterised by treatment resistance, medication non-concordance and history of violence. Paliperidone is licensed as both an oral and depot antipsychotic for the treatment of schizophrenia. Whilst there is data for the effectiveness of paliperidone palmitate (PP), there are no studies involving patients in forensic settings or those with comorbid personality disorder.ObjectiveTo determine the effects of PP on violence, aggression and personality pathology.AimTo evaluate the clinical effectiveness of PP.MethodsThis was a retrospective service evaluation involving 11 patients. Medical records and interviews with the treating psychiatrist were used to formulate clinical global impression (CGI) and to identify incidents of violence. The effect on personality symptom domains; cognitive-perceptual, impulsive-behavioural dyscontrol and affective dysregulation was ascertained, as well as engagement with occupational and psychological therapies.ResultsSix patients were being prescribed PP. All 6 showed improvement in the CGI score with benefits in the symptom domains. Two patients demonstrated a reduction in violence risk and 2 remained incident-free. There was improvement in engagement with therapies. Benefits were also seen in aspects of personality for those who had discontinued PP.ConclusionsThis pragmatic study of a small but complex patient group demonstrated that PP was effective in reducing symptoms of schizophrenia. Additionally and for the first time, it was shown that PP was also effective in reducing violence as well as improving personality pathology dimensions in a comorbid patient. This could have significant implications for management of high-security patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Effectiveness of paliperidone depot injection in seriously violent men with comorbid schizophrenia and dissocial personality disorder in a UK high-security hospital

2017 ◽  
Vol 7 (5) ◽  
pp. 169-179 ◽  
Author(s):  
Anna-Marie Mortlock ◽  
Fintan Larkin ◽  
Callum C. Ross ◽  
Nitin Gupta ◽  
Samrat Sengupta ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Treatment Resistance ◽  
Similar Efficacy ◽  
Service Evaluation ◽  
Metabolic Parameters ◽  
Psychological Therapies ◽  
High Security ◽  
Symptom Domains ◽  
Hospital Patients ◽  
Depot Injection

Background: High-security hospital patients are often complex in presentation and are characterized by treatment resistance, medication nonadherence and history of violence. Paliperidone is licensed both as an oral and depot antipsychotic medication in the treatment of schizophrenia. Clinical trials have shown that paliperidone depot is well tolerated with similar efficacy to risperidone depot but with additional practical advantages. Whilst data exist for the effectiveness of paliperidone palmitate (PP), there are no studies involving patients in forensic settings or those with comorbid personality disorder. Our aim was to evaluate the effectiveness of PP on violence, aggression and personality disorder symptoms. Methods: This project was a retrospective service evaluation involving 11 patients, carried out in a high-security hospital. A combination of patient records and interviews with the treating consultant psychiatrist were used to ascertain a Clinical Global Impression (CGI) score, the effect of PP on specific personality disorder symptom domains (cognitive-perceptual, impulsive-behavioural dyscontrol and affective dysregulation) and incidents of violence and aggression. Engagement with occupational and psychological therapies was also evaluated. Metabolic parameters were reviewed. Results: A total of 6 out of 11 patients continued on PP, most of whom had schizophrenia and dissocial personality disorder with histories of violence. All showed improvement in the CGI score with associated benefits in the three personality symptom domains. Overall, two patients demonstrated a reduction in the risk of violence. There was improvement in engagement with occupational therapy and psychological work. No significant effects on metabolic parameters were noted although hyperprolactinaemia, albeit asymptomatic, was consistently recorded. Conclusions: This pragmatic service evaluation of a small but complex patient group demonstrated, for the first time, that PP was effective in reducing violence as well as improving personality pathology across all dimensions: a finding which could have significant implications for management of such high-security patients.

Route of discharge for special (high-security) hospital patients with personality disorder

1999 ◽  
Vol 175 (3) ◽  
pp. 224-227 ◽  
Author(s):  
Sophie Davison ◽  
Elizabeth Jamieson ◽  
Pamela J. Taylor
Keyword(s):  
Personality Disorder ◽  
Hospital Discharge ◽  
Psychiatric Hospitals ◽  
Considerable Proportion ◽  
High Security ◽  
Hospital Patients ◽  
Special Hospital

BackgroundA considerable proportion of patients with personality disorder are discharged directly to the community from special (high-security) hospitals.AimsTo examine whether patients with personality disorder discharged directly to the community are more likely to be re-convicted than those transferred to psychiatric hospitals of lesser security.MethodRe-conviction data for a f ive-to nine-year follow-up were collected for a four-year (1988–1991) special hospital discharge cohort of patients with personality disorder.ResultsIndividuals discharged directly to the community were not significantly more likely to be re-convicted than those transferred to less secure psychiatric hospitals. However, patients discharged to the community without formal conditions of supervision were more likely to be re-convicted than those discharged to the community with conditions or those transferred to other psychiatric hospitals.ConclusionsFormal supervision after discharge may be more important than actual destination in influencing the likelihood of re-conviction.

The voice of detainees in a high security setting on services for people with personality disorder

2002 ◽  
Vol 12 (4) ◽  
pp. 254-268 ◽  
Author(s):  
Sue Ryan ◽  
Estelle Moore ◽  
Pamela J Taylor ◽  
Eric Wilkinson ◽  
Tony Lingiah ◽  
...  
Keyword(s):  
Personality Disorder ◽  
High Security ◽  
The Voice

scholarly journals An audit into the use of psychotropic medications in patients with autism spectrum disorder in a high security psychiatric hospital

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S68-S68
Author(s):  
Elliott Carthy ◽  
David Murphy
Keyword(s):  
Autism Spectrum Disorder ◽  
Personality Disorder ◽  
Psychiatric Hospital ◽  
Autism Spectrum ◽  
Psychotropic Medications ◽  
Spectrum Disorder ◽  
Psychotic Symptoms ◽  
High Security ◽  
Psychotropic Medicines ◽  
Appropriate Prescribing

AimsAutism Spectrum Disorder (ASD) is a common neurodevelopmental disorder associated with difficulties in social communication and language development, preoccupations, a need for routine, sensory sensitivities and emotional dysregulation. People with autism who have violently offended may be prescribed psychotropic medications to treat comorbidities, or off-license to manage aggressive or challenging behaviours. However, the evidence base for their use remains scarce.MethodThis was a retrospective audit at Broadmoor Hospital, a high security psychiatric hospital in the United Kingdom, into the safe and appropriate prescribing of psychotropic medicines in those with an ASD compared to guidance from the National Institute for Health and Care Excellence (CG142): “Autism spectrum disorder in adults: diagnosis and management”. This first cycle was undertaken during May and June 2020 and included all patients with a confirmed or equivocal diagnosis of ASD in the preceding five years.ResultA total of 22 participants were included in this study. Of these, 17 participants had a confirmed diagnosis of ASD and five participants had a suspected diagnosis of ASD, but without formal confirmation with neurocognitive testing. A total of 13 (76.5%) participants with confirmed ASD were prescribed antipsychotic medication, nine of whom had an established comorbid mental disorder with psychotic symptoms. Of the remaining four, three had a diagnosis of a personality disorder. Three participants in this study had a confirmed diagnosis of ASD without any additional comorbid mental health diagnoses. No patients were prescribed psychotropic medicines for the core symptoms of ASD. The specific documentation of off-license use of antipsychotic medicines in those without a diagnosis of a psychotic disorder was poor. This was not recorded in any such participant in the preceding 12 months.ConclusionThis audit highlighted that dual diagnoses of ASD alongside non-affective psychosis and personality disorder are over-represented in this high security setting. The NICE clinical guidelines CG142 guidelines state that “antipsychotic medications should only be used for behaviour that challenges if …. the risk to the person or others is very severe”. By definition, all patients admitted to high security are deemed to be a grave and imminent risk to the public. Psychotropic medicines may therefore be clinically indicated at a much earlier stage than in community patients, instigated alongside appropriate psychosocial interventions and treatment of comorbid conditions. It may be that catered guidelines need to be formulated to support the safe and appropriate prescribing of psychotropic medicine in forensic settings.

1. How can we know if someone is a psychopath or is at risk of becoming one?

2019 ◽  
pp. 4-20
Author(s):  
Essi Viding
Keyword(s):  
At Risk ◽  
Information Processing ◽  
Personality Disorder ◽  
General Population ◽  
Antisocial Personality Disorder ◽  
Psychopathic Traits ◽  
Psychopathic Personality ◽  
Antisocial Personality ◽  
Psychopathy Checklist ◽  
The Difference

What are individuals with psychopathy like and what are their defining features? ‘How can we know if someone is a psychopath or is at risk of becoming one?’ considers two case studies to give an idea of the developmental course of criminal psychopathy and what psychopathic personality traits look like. It discusses the Psychopathy Checklist, developed by Robert Hare in the 1980s, and explains the difference between antisocial personality disorder, sociopathy, and psychopathy. Research has shown that whether we look at criminal psychopaths, individuals with high levels of psychopathic traits in the general population, or children who are at risk of developing psychopathy, similar patterns of brain function and information processing are seen.

scholarly journals Psychotherapy patients: are they “the worried well”?

1996 ◽  
Vol 20 (3) ◽  
pp. 153-156 ◽  
Author(s):  
Peter Amies
Keyword(s):  
At Risk ◽  
Personality Disorder ◽  
High Frequency ◽  
Psychiatric Symptoms ◽  
Minimum Amount ◽  
Completed Suicide

Patients waiting for psychotherapy show high levels of morbidity and distress from psychiatric symptoms and a high frequency of personality disorder diagnoses. They constitute a group at risk of completed suicide. Local NHS provision is less than half the minimum amount of treatment needed.

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