Impact of compulsory community treatment on admission rates: survival analysis using linked mental health and offender databases.
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BACKGROUND: There is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates. AIMS: To examine whether community treatment orders (CTOs) reduce admission rates, using a two-stage design of matching and multivariate analyses to take into account socio-demographic factors, clinical factors, case complexity and previous psychiatric and forensic history. METHOD: Survival analysis of CTO cases and controls from three linked Western Australian databases of health service use, involuntary treatment and forensic history. We used two control groups: one matched on demographic characteristics, diagnosis, past psychiatric history and treatment setting, and consecutive controls matched on date of discharge from in-patient care. RESULTS: We matched 265 CTO cases with 265 matched controls and 224 consecutive controls (total n=754). The CTO group had a significantly higher readmission rate: 72% v. 65% and 59% for the matched and consecutive controls (log-rank chi(2)=4.7, P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates. CONCLUSIONS: Community treatment orders alone do not reduce admissions. (+info)
Detecting symptom- and test-coached simulators with the test of memory malingering.
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The ability of the Test of Memory Malingering (TOMM; Tombaugh, 1996) to detect feigned-memory impairment was explored. The TOMM was administered to three groups: (a) a control group instructed to perform optimally, (b) a symptom-coached group instructed to feign memory problems after being educated about traumatic brain injury symptomatology, and (c) a test-coached group instructed to feign memory problems after being educated about test-taking strategies to avoid detection. The recommended cutoff scores (Tombaugh, 1996) on Trial 2 and the Retention Trial produced overall classification accuracy rates of 96%, with high levels of sensitivity and specificity. Although the symptom-coached group performed more poorly on the TOMM relative to the test-coached group, the test was equally sensitive in detecting suboptimal effort across the different coaching paradigms. (+info)
Frequency of brain injury in a forensic psychiatric population.
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OBJECTIVE: Over the last years, a growing number of studies involving individual patients and/or populations have demonstrated that Traumatic Brain Injuries (TBI) determine innumerable psychiatric symptoms, including significant alterations which may influence diagnoses, prognosis and treatment, not to mention clear psychosocial implications (both legal and those related to social security). The objectives of this study were 1) to detect the existence of TBI in a forensic psychiatric population before the occurrence of the wrongs; 2) To verify whether or not those injuries had been identified by the experts at the psychiatric institution. METHOD: 3,323 records of patients examined by forensic experts at the Forensic Psychiatric Institute Dr. Mauricio Cardoso in Porto Alegre were analyzed; the records covered the period between 1995 and 1999. RESULTS: in the studied population, there were 133 cases of TBI prior to the wrongs, 39 of which were mild, and 94, moderate or severe. Out of the total number of TBI cases found, 111 cases were not taken into account, many of them having motoric, cognitive, psychic and sensori perception alterations. CONCLUSION: the significant number of patients that had had TBI before having committed a wrong - a fact that had not been considered by the experts (neurologists and psychiatrists) at the institution - is a strong indicator of how little attention is paid to the consequences of these injuries. Considering the relevance of the psychosocial aspects, new studies should be conducted in psychiatric populations to increase the knowledge about the consequences of these injuries. (+info)
Increased deep sleep in a medication-free, detoxified female offender with schizophrenia, alcoholism and a history of attempted homicide: case report.
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BACKGROUND: Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Both schizophrenia and alcoholism are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep, the physiologically significant, refreshing part of the sleep. Antisocial behaviour with severe aggression, on the contrary, has been reported to associate with increased deep sleep reflecting either specific brain pathology or a delay in the normal development of sleep patterns. The authors are not aware of previous sleep studies in patients with both schizophrenia and antisocial personality disorder. CASE PRESENTATION: The aim of the present case-study was to characterize the sleep architecture of a violent, medication-free and detoxified female offender with schizophrenia, alcoholism and features of antisocial personality disorder using polysomnography. The controls consisted of three healthy, age-matched women with no history of physical violence. The offender's sleep architecture was otherwise very typical for patients with schizophrenia and/or alcoholism, but an extremely high amount of deep sleep was observed in her sleep recording. CONCLUSIONS: The finding strengthens the view that severe aggression is related to an abnormal sleep pattern with increased deep sleep. The authors were able to observe this phenomenon in an antisocially behaving, violent female offender with schizophrenia and alcohol dependence, the latter disorders previously reported to be associated with low levels of slow wave sleep. New studies are, however, needed to confirm and explain this preliminary finding. (+info)
And how is it over there, across the ocean?
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In late February 1989, at the invitation of the Soviet Government, a Department of State-led U.S. Delegation visited the Soviet Union in an effort to assess recent changes in Soviet psychiatry, particularly those affecting human rights and the forensic system. As an outgrowth of the largely positive Soviet response to the U.S. Delegation's visit and its report, a Soviet Delegation spent time in the U.S. on a professional visit. The following report describes the impressions of the organization of psychiatric assistance in the United States as observed by Dr. Yegorov, one member of the Soviet Delegation. (+info)
Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries.
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OBJECTIVE: To establish whether reinstitutionalisation is occurring in mental health care and, if so, with what variations between western European countries. DESIGN: Comparison of data on changes in service provision. SETTING: Six European countries with different traditions of mental health care that have all experienced deinstitutionalisation since the 1970s--England, Germany, Italy, the Netherlands, Spain, and Sweden. OUTCOME MEASURES: Changes in the number of forensic hospital beds, involuntary hospital admissions, places in supported housing, general psychiatric hospital beds, and general prison population between 1990-1 and 2002-3. RESULTS: Forensic beds and places in supported housing have increased in all countries, whereas changes in involuntary hospital admissions have been inconsistent. The number of psychiatric hospital beds has been reduced in five countries, but only in two countries does this reduction outweigh the number of additional places in forensic institutions and supported housing. The general prison population has substantially increased in all countries. CONCLUSIONS: Reinstitutionalisation is taking place in European countries with different traditions of health care, although with significant variation between the six countries studied. The precise reasons for the phenomenon remain unclear. General attitudes to risk containment in a society, as indicated by the size of the prison population, may be more important than changing morbidity and new methods of mental healthcare delivery. (+info)
Randomised controlled trials relevant to aggressive and violent people, 1955-2000: a survey.
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BACKGROUND: Randomised trials remain the gold standard for evaluating health interventions. This applies to the criminal justice system as well as to health. AIMS: To identify and survey randomised trials relevant to forensic mental health services. METHOD: We searched 29 electronic bibliographic databases and acquired randomised trials involving sex offenders, arsonists or people clearly and actively aggressive, or abusive of children or spouse. Two researchers reliably extracted data. RESULTS: Of 409 studies found, we able to acquire 300 for further inspection. They all involved particularly violent people (total n=28 669), mostly adult men; the mean study size was 197 (median 52, mode 60, range 1-1200).In these randomised trials over 700 interventions were evaluated and short-term outcomes were recorded on 345 different scales. CONCLUSIONS: Wider collaboration, rationalising treatments and simplifying outcomes could further strengthen the tradition of trialling in forensic psychiatry. Systematic reviews of these studies are overdue. (+info)
Performance of forensic and non-forensic adult psychiatric inpatients on the Test of Memory Malingering.
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This study compared performance on the Test of Memory Malingering (TOMM [Tombaugh, T. N. (1996). Test of Memory Malingering (TOMM). New York: Multi Health Systems]) between a Forensic Psychiatric group and a Non-forensic Psychiatric group of 20 men each. It was hypothesized that the Forensic group would perform less well on the TOMM due to greater secondary gain for that population. The Forensic group (age, M=32.65 years; 16/20 were minorities) was composed of inpatients from a forensic psychiatric facility who had been referred for pre-trial evaluations. The Psychiatric group (age, M=41.00 years; 15/20 were Caucasian) were chosen from an inpatient psychiatric facility and had no pending legal involvement. As hypothesized, the Psychiatric group performed significantly better than the Forensic group on all TOMM trials. A TOMM score of below 45 on Trial 2 or the Retention Trial is consistent with probable response bias. Only one member of the Psychiatric group (the same individual) met this criterion, whereas seven members of the Forensic group met this criterion. The TOMM identified patients with pending legal charges as more likely to exert less effort than those with no obvious secondary gain. (+info)