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.

Service users’ initial hopes, expectations and experiences of a high security psychologically informed planned environment (PIPE)

2014 ◽  
Vol 16 (3) ◽  
pp. 216-227 ◽  
Author(s):  
Alice L. Bennett
Keyword(s):  
Personality Disorder ◽  
Thematic Analysis ◽  
Design Methodology ◽  
Structured Interview ◽  
Referral Process ◽  
Service Users ◽  
Content Type ◽  
High Security ◽  
Practical Implications

Purpose – The purpose of this paper is to explore service-users’ hopes and expectations of a psychologically informed planned environment (PIPE) located in the high-security prison estate. Design/methodology/approach – A semi-structured interview was used to explore the hopes and expectations of five male Category A PIPE prisoners. Interviews were transcribed verbatim and thematic analysis was used to analyse the data. Findings – Analysis resulted in two overall themes: “Progression” and “Being Part of a Community”. Relevant sub-themes were considered to portray processes within these two wider themes. Practical implications – In applying these findings to practice, this study provides evidence that places value on the current referral process which ascertains prisoners’ motivations to attend the PIPE. Originality/value – This is the first known study that explores service-users’ hopes and expectations of the pilot PIPE service. The PIPEs are included within the recently introduced Offender Personality Disorder Pathway.

scholarly journals Audit of Statutory Urgent Treatment at a High Security Hospital

2014 ◽  
Vol 1 (17) ◽  
pp. 66
Author(s):  
Andy Bickle ◽  
Tarek Abdelrazek ◽  
Anne Aboaja ◽  
Kim Page
Keyword(s):  
Mental Health ◽  
Personality Disorder ◽  
Large Hospital ◽  
Code Of Practice ◽  
Mental Health Act ◽  
High Security ◽  
Wide Range ◽  
Audit Period ◽  
The Subject ◽  
Severe Personality Disorder

<p>The aim of the audit which is the subject of this article was to measure the use of statutory urgent treatment at one of England’s three high security hospitals (Rampton Hospital) against the standards set out in the Code of Practice (2008) and by the Mental Health Act Commission. Rampton Hospital is a large hospital which averaged around 400 beds during the audit period and has a catchment area of approximately one third of England. The hospital accommodates patients who suffer from a wide range of mental disorders, having directorates for mental illness, learning disability, personality disorder, women and (from 2004) ‘Dangerous and Severe Personality Disorder’. All patients are detained under the Mental Health Act 1983. It was submitted that the proper use of statutory urgent treatment is important to Rampton Hospital as an institution which accommodates patients presenting with the highest security needs owing to their risk to others.</p>

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.

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