scholarly journals Involuntary out-patient commitment and reduction of violent behaviour in persons with severe mental illness

2000 ◽  
Vol 176 (4) ◽  
pp. 324-331 ◽  
Author(s):  
Jeffrey W. Swanson ◽  
Marvin S. Swartz ◽  
H. Ryan Wagner ◽  
Barbara J. Burns ◽  
Randy Borum ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Substance Misuse ◽  
Randomised Trial ◽  
Case Manager ◽  
Court Order ◽  
Violent Behaviour ◽  
History Of ◽  
Hospital Recidivism ◽  
Poor Outcomes

BackgroundViolent behaviour among persons with severe mental illness (SMI) causes public concern and is associated with illness relapse, hospital recidivism and poor outcomes in community-based treatment.AimsTo test whether involuntary out-patient commitment (OPC) may help to reduce the incidence of violence among persons with SMI.MethodOne-year randomised trial of the effectiveness of OPC in 262 subjects with psychotic or major mood disorders and a history of hospital recidivism. Involuntarily hospitalised subjects awaiting OPC were randomly assigned to release or court-ordered treatment after discharge. Those with a recent history of serious assault remained under OPC until expiry of the court order (up to 90 days); then OPC orders were renewed at clinical/court discretion. Control subjects had no OPC. Four-monthly follow-up interviews with subject, case manager and collateral informant took place and service records were collected.ResultsA significantly lower incidence of violent behaviour occurred in subjects with ⩾6 months' OPC. Lowest risk of violence was associated with extended OPC combined with regular out-patient services, adherence to prescribed medications and no substance misuse.ConclusionsOPC may significantly reduce risk of violent behaviour in persons with SMI, in part by improving adherence to medications while diminishing substance misuse.

scholarly journals Severe mental illness and substance misuse

BMJ ◽  
1999 ◽  
Vol 318 (7177) ◽  
pp. 137-138 ◽  
Author(s):  
T. Weaver ◽  
A. Renton ◽  
G. Stimson ◽  
P. Tyrer
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Substance Misuse

scholarly journals Changes in diagnoses before admission to a specialist medium secure unit

2012 ◽  
Vol 36 (11) ◽  
pp. 404-408 ◽  
Author(s):  
Amrith Shetty ◽  
Dilum Jayawickrama ◽  
Pamela J. Taylor
Keyword(s):  
Substance Misuse ◽  
Service Providers ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
Psychotic Illness ◽  
Violent Behaviour ◽  
Medium Security ◽  
History Of ◽  
Secure Unit ◽  
Study Participants

Aims and methodThere is evidence that changing diagnoses may be an important factor preceding homicide, but there is little literature on diagnostic antecedents to admission to specialist secure units after violent behaviour. Our aim was to establish the frequency of a history of changing diagnoses in patients in a UK specialist unit, and to explore the characteristics of these patients.ResultsIn total, 38 of 42 study participants had prior contact with psychiatric services. Just over 40% (16 of the 38) had had their diagnosis changed three or more times. All those who had major changes in their diagnosis had received a diagnosis of a psychotic illness at some point prior to the secure unit admission, but then had it withdrawn, only to be restored after prolonged assessment in the secure unit. Personality disorder and substance misuse comorbidity was common in this group; however, non-psychotic diagnoses were seen as more important than psychotic diagnoses by general services.Clinical implicationsChanges in diagnosis between first presentation to psychiatric services and admission to a medium-security unit were more common than would be expected from reports in the general literature. They are a testimony to the difficulties experienced by service providers in delivering a consistent service. This needs to be studied further.

scholarly journals Psychosocial Treatment Programs for People With Both Severe Mental Illness and Substance Misuse

2007 ◽  
Vol 34 (2) ◽  
pp. 226-228 ◽  
Author(s):  
M. Cleary ◽  
G. E. Hunt ◽  
S. Matheson ◽  
N. Siegfried ◽  
G. Walter
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Substance Misuse ◽  
Psychosocial Treatment ◽  
Treatment Programs

“Dangerous relationships”: Family dynamics among members with severe mental illness. about a case

2017 ◽  
Vol 41 (S1) ◽  
pp. S687-S687
Author(s):  
G. Hernande. Santillan ◽  
E. Martin Ballesteros
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Family Of Origin ◽  
Self Care ◽  
Delusional Disorder ◽  
Her Family ◽  
Long Time ◽  
History Of ◽  
Competing Interest ◽  
To Come

A 51-year-old woman from a Mediterranean location with a history of a brother diagnosed with schizophrenia, moved thirty years ago, away from her family of origin, when marrying a man suffering from severe untreated OCD, who in turn, has two brothers, both with OCD, and a nephew with OCD. She says that her husband is very unsociable, spends most of the day at work and comes home at night to clean for a long time until he does not see lint on the floor or a crumb on the table literally. They have a fifteen-year-old son, with needy materials, very attached to the mother and very little to the father. The patient consults, motivated by a former sister-in-law and a friend, because they have noticed deterioration in their self-care and tendency to isolation, which the patient explains because in the last year she has noticed exacerbation of the comments by her neighbours and even unknown people that tell her “look how dirty, your husband has to come after work to clean your house, and makes noise.” The companions are also concerned that the child has had school and social problems and admits hearing the same as his mother. Now, What possible diagnoses do we propose in this patient: Folie a deux, delusional disorder, paraphrenia, other? (Figure 1)Disclosure of interestThe authors have not supplied their declaration of competing interest.

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