Homicide associated with psychotic illness: What global temporal trends tell us about the association between mental illness and violence

Available evidence suggests that persons with serious forms of mental illness are 4–10 times more likely to commit homicide as compared to non-affected members of the general population. The relationship between homicide and psychotic illness has now been subject to longitudinal investigation in six different populations across eight studies covering time periods over the last six decades. With the exception of one study, these investigations demonstrate that homicide associated with psychotic illness appears relatively stable through time and, in most populations, is not related to factors that contribute to the rise and fall of total population homicide (TPH) rates. This suggests that illness and treatment factors are of most importance if we are to reduce the prevalence of this tragic illness complication.

The neurochemical pathology of schizophrenia: post-mortem studies from dopamine to parvalbumin

Research in Peter Riederer’s lab in Vienna in the late 1970’s came from a strong tradition in post-mortem neurochemical studies, at that time a relatively niche approach in neuroscience research. He was also early to recognise the value of post-mortem brain tissue in elucidating pharmacological mechanisms of neuropsychiatric treatments. I was fortunate to have Peter Riederer as a mentor in my early post-doctoral career; his generous support and the opportunities to use post-mortem brain tissue provided an invaluable grounding on which much of my future research was based. In this paper, I shall provide a brief overview of one trajectory of my research into the neurobiology of schizophrenia that started in the Riederer lab in Vienna investigating dopamine and the D2 receptor. Subsequent research to understand findings of increased dopamine resulted in the identification of reduced GABAergic innervation, culminating in the finding of a deficit in the parvalbumin-containing subtype of GABAergic neurons. Most recent work has been studying how changes in DNA methylation of the parvalbumin gene may relate to these findings in psychotic illness and its animal models.

Closing the circle: a key collaborative opportunity for general practice and psychiatry

Two of the authors were general practitioners (GPs) in the 1980s, when there was much interest in consultation, stimulated by the psychoanalyst Michael Balint. Around one in five psychiatrists worked in consultation liaison in general practice at that time, but in the 1990s this was stopped to increase the focus on psychosis. However, the Royal College of Psychiatrists and Royal College of General Practitioners have a strong history of collaboration, and many psychiatrists, nurses and GPs trained together in the national Trailblazers programme, focusing on service delivery in all areas of mental health. Recent proposals for mental health community collaborative networks from the NHS provide an opportunity for psychiatrists to work with GPs and a range of other professionals once more, for complex non-psychotic illness that cannot be helped by Improving Access to Psychological Therapies services. The circle is closing for GPs like us, who were working in the 1980s.

518Trajectories of offending in people with psychotic illness and other mental disorders: a population study

Background Trajectory analysis has been used to study long-term patterns of offending and identify offending groups. Only few studies have explored patterns in people with psychotic illness and these were restricted to adult offenders. This study examines offending trajectories, and identifies risk factors, for people aged 10-26 with psychotic illness (PI) and other mental disorders (OMD) compared to those with no mental disorders (NMD). Methods This is a whole-population record-linkage study of 184,147 people born in Western Australia (WA) 1983-1991 using data from WA psychiatric case register, WA corrective services and other state-wide registers. Group-based trajectory modelling was used to identify offending trajectories. Results Four offender groups were identified for each mental health status (MHS) group: MHS groups had similar offending patterns, however PI had a lower proportion of individuals in the G1 group and later offending onset in the G3 group. Gender, indigenous status, substance use, childhood victimisation and parental offending were risk factors associated with group membership; for PI, childhood victimisation and parental offending were only significant in the G4 group. Conclusions Overall offending patterns and risk factors were similar for all MHS groups, however, some differences were observed for PI. Key messages To reduce offending in this population, interventions need to occur at an early age.

Comparison of mouse models reveals a molecular distinction between psychotic illness in PWS and schizophrenia

Prader-Willi Syndrome (PWS) is a neurodevelopmental disorder caused by mutations affecting paternal chromosome 15q11-q13, and characterized by hypotonia, hyperphagia, impaired cognition, and behavioural problems. Psychotic illness is a challenging problem for individuals with PWS and has different rates of prevalence in distinct PWS genotypes. Previously, we demonstrated behavioural and cognitive endophenotypes of relevance to psychiatric illness in a mouse model for one of the associated PWS genotypes, namely PWS-IC, in which deletion of the imprinting centre leads to loss of paternally imprinted gene expression and over-expression of Ube3a. Here we examine the broader gene expression changes that are specific to the psychiatric endophenotypes seen in this model. To do this we compared the brain transcriptomic profile of the PWS-IC mouse to the PWS-cr model that carries a deletion of the PWS minimal critical interval spanning the snoRNA Snord116 and Ipw. Firstly, we examined the same behavioural and cognitive endophenotypes of relevance to psychiatric illness in the PWS-cr mice. Unlike the PWS-IC mice, PWS-cr exhibit no differences in locomotor activity, sensory-motor gating, and attention. RNA-seq analysis of neonatal whole brain tissue revealed a greater number of transcriptional changes between PWS-IC and wild-type littermates than between PWS-cr and wild-type littermates. Moreover, the differentially expressed genes in the PWS-IC brain were enriched for GWAS variants of episodes of psychotic illness but, interestingly, not schizophrenia. These data illustrate the molecular pathways that may underpin psychotic illness in PWS and have implications for potential therapeutic interventions.

Assessment of the Challenges Experienced by Nurses Caring for Patients Diagnosed with Psychotic Disorders in Neuro-Psychiatric Hospitals, from South-West, Nigeria

These challenges are personal, and relationships. The goal of this study was therefore to identify the challenges faced by the nurses. The study adopted quantitative research design using descriptive methods. The sample size was determined by using the Cochran formula. A self-structured questionnaire was used to collect the data from the respondents. The findings on personal challenge revealed that 423 (95.9%) of the respondents have sufficient willingness to care, 374 (84.8%) revealed that respondents have emotional intelligence, 405 (91.8%) claimed they are able to care for patients with psychotic illness effectively in spite of challenges, furthermore 431 (97.7%) claimed to have positive attitude towards those diagnosed with psychotic disorders. Also, findings on relationship challenges revealed that 423 (95.9%) ability to establish adequate relationships with psychotic patients 441 (100.0%) claimed to have sufficient communication skills, 416 (94.3%) reported that relationships are vital in mental health nursing care. The study therefore concluded that despite the challenges experienced by the nurses, results indicate that they were still able to adequately care for their patients.

A qualitative study exploring personal recovery meaning and the potential influence of clinical recovery status on this meaning 20 years after a first-episode psychosis

Purpose Long-term data on recovery conceptualisation in psychotic illness are needed to support mental health services to organise themselves according to recovery-oriented frameworks. To our knowledge, no previous research has investigated how first-episode psychosis (FEP) service users (sampled across psychotic illness type) perceive recovery beyond 5 years after diagnosis. We aimed to explore personal recovery meaning with individuals 20 years after their FEP and examine the potential influence of clinical recovery status on how they defined recovery (i.e. personal recovery). Methods Twenty participants were purposefully sampled from an epidemiologically representative FEP incidence cohort. At 20-year follow-up, semi-structured interviews were conducted with 10 cohort members who met full ‘functional recovery criteria’ (Clinically Recovered Group) and 10 who did not (Not Clinically Recovered Group). A thematic analysis was performed to develop shared themes and group-specific sub-themes to capture agreement and divergence between groups. Results Five shared themes were produced: pursuing balance in conflict, generating meaning in life, experiencing a dynamic personal relationship with time, redressing inequality while managing added challenges/vulnerability, and directing life from resilience to flourishing. The five group-specific sub-themes developed illuminate differences in the meaning ascribed to personal recovery by each group. Conclusion Findings emphasise the role of time in how personal recovery is conceptualised by service users and identify ways clinical recovery may influence personal recovery meaning in FEP at mid-later life. Mental health services failing to consider temporal changes in meaning-making and discounting clinical recovery risk ignoring key factors affecting personal recovery.

The impact of COVID-19 on an inpatient mother and baby unit: a service evaluation

AimsUnique challenges have been faced by women in the perinatal period during the COVID-19 pandemic and the impact of this is compounded for women suffering from mental illness. This service evaluation looked at different aspects of the treatment pathway on a specialist inpatient psychiatric Mother and Baby Unit during the pandemic to identify what changes occurred.MethodData were collected for all admissions to the unit between January 2019 and October 2020, with the beginning of the pandemic being defined as on or after 1st March 2020. Information was collected retrospectively from electronic clinical notes on ethnicity, length of stay, diagnosis, mental health act use and restrictive practice, medication, psychology, occupational therapy and social services involvement.ResultThere were 114 admissions to the MBU during the study period. 4 were parenting assessments rather than acute psychiatric admissions and were excluded from the analysis, giving a sample of 110 women. 58% (62/110) were classed as “pre-pandemic” and 43.6% (48/110) were “during pandemic”. 95.45% (105/110) of women were postpartum 4.55% (5/110) were pregnant. Mean length of stay was shorter during the pandemic at 44 days, compared to 61 pre-pandemic. There was greater use of the mental health act during the pandemic: only 43.75% of patients were informal throughout admission, compared to 70.97% pre-pandemic. Mean duration of detention was shorter at 25 days (32 pre-pandemic). Psychotic illness made up a greater proportion of diagnoses during the pandemic: 56% (27/48) compared to 44% (27/62) pre-pandemic. The next most common diagnostic group was mood and anxiety disorders, which made up 29% (14/48) of diagnoses during the pandemic, but 43% (27/62) pre-pandemic. Outcomes as measured using the Health of the Nation Outcome Scale showed a mean improvement between admission and discharge of 6.65, compared to 5.15 pre-pandemic. HONOS scores were higher on admission during the pandemic (12.83, vs 10.88), suggesting a higher level of acuity.ConclusionDuring the COVID-19 pandemic on this Mother and Baby Unit, length of stay was shorter, a greater proportion of patients were detained under the mental health act (although length of detention was shorter) and psychotic illness was more prevalent. This study demonstrates that there were differences in this perinatal inpatient population during the pandemic and this may be a reflection on the wider impact of COVID-19 on perinatal mental health.