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.

scholarly journals Patients in Broadmoor Hospital from the South Western region: an audit of transfer procedures

1991 ◽  
Vol 15 (2) ◽  
pp. 81-84 ◽  
Author(s):  
Jeanette Smith ◽  
Martin Donovan ◽  
Harvey Gordon
Keyword(s):  
Psychiatric Hospitals ◽  
Home Office ◽  
Mentally Disordered ◽  
The Public ◽  
Maximum Security ◽  
Hospital Patients ◽  
Male Patients ◽  
Transfer Procedures ◽  
Special Hospital ◽  
Special Hospitals

Broadmoor Hospital is one of the three special hospitals covering England and Wales. It provides approximately 500 beds for mentally disordered patients who on account of their dangerous, violent or criminal propensities constitute a grave and immediate danger to the public, requiring treatment in conditions of special security (Section 4, National Health Service Act, 1977). It is generally recognised, however, that there are patients in special hospitals no longer requiring treatment in conditions of maximum security. These patients could probably be more appropriately cared for elsewhere if the facilities existed in general psychiatric hospitals or the community. However, special hospital consultants frequently encounter significant obstacles when attempting to transfer patients to local hospitals. Dell (1980) highlighted this problem, suggesting that 16% of special hospital patients were waiting to leave, following the agreement of the DHSS and the Home Office to their transfer. This delay appeared to be due to hospitals not wanting to accept patients who might prove to be difficult or dangerous. At the time of this current study (March 1990) these difficulties in transferring patients were particularly relevant as two of the special hospitals, Broadmoor and Ashworth (Park Lane and Moss Side) were full for male patients and therefore closed to male admissions, despite a continuing demand for beds.

How many high security beds are needed? Implications from an audit of one region's Special Hospital patients

1994 ◽  
Vol 5 (3) ◽  
pp. 487-499 ◽  
Author(s):  
Kevin Murray ◽  
Shauna Rudge ◽  
Sarah Lack ◽  
Robert Dolan
Keyword(s):  
High Security ◽  
Hospital Patients ◽  
Special Hospital

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.

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

2017 ◽  
pp. 50-55
Author(s):  
Duc Luu Ngo ◽  
Tu The Nguyen ◽  
Manh Hung Ho ◽  
Thanh Thai Le
Keyword(s):  
Clinical Features ◽  
University Hospital ◽  
Female Ratio ◽  
Tube Obstruction ◽  
Level Ii ◽  
Study Results ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

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