Difference between forensic patients with schizophrenia spectrum disorders in Italy and other European countries: Results of the EU-VIORMED project

Barriers to discharge: A retrospective study of factors associated with stays of longer than 2 years in a French secure hospital unit

BACKGROUND

Extended stays in specialist secure hospital units raise ethical concerns. While this topic has been investigated in various countries, there has been little research on it in France.

AIMS

We aimed to study the length of stay of patients in the Henri Colin unit, a secure hospital unit in the Paris area and test relationships between length of stay and sociodemographic, clinical and legal features.

METHODS

In this records-based retrospective study, we included all 60 inpatients on a census day just prior to the pandemic. We chose a 2-year threshold to define long stay status.

RESULTS

Mean length of stay was just in the long-stay range (756.7 days, SD 1071.2). Over a quarter (17, 28%) of the patients had been hospitalised for more than 2 years and 5 (8%) patients for more than 5 years. In multivariate analysis, legal status and need for seclusion during stay were significantly associated with long-stay status. These results are consistent with international literature, especially as they show the significant interplay between legal and medical aspects in the patients' care pathway.

CONCLUSION

As the first such study in a specialist medium security hospital unit in France, this study adds to the international evidence on the complexities surrounding extended stays in secure units and underscores the importance of addressing both clinical and legal aspects in the treatment of patients with mental disorders in these settings.

A comparison of patient ratings and staff ratings of disability using the World Health Organisation Disability Assessment Schedule in individuals with psychotic spectrum disorders who are forensic psychiatric inpatients

BACKGROUND

Psychosocial rehabilitation in forensic psychiatric services requires sound measurement of patient and staff perceptions of psychosocial function. The recommended World Health Organisation Disability Assessment Schedule 2.0 (WHODAS), designed for this, has not been examined with offender patients.

AIMS

To examine patient and staff WHODAS ratings of secure hospital inpatients with psychosis, any differences between them and explore associations with other clinical factors.

METHODS

Seventy-three patients self-rated on the WHODAS after 3 months as inpatients. An occupational therapist interviewed the patient's primary nurse and care team at about the same time (staff ratings). Scores were calculated according to the WHODAS manual. WHODAS scores and interview-rated symptom severity, cognitive measures, daily antipsychotic dose and duration of care were compared.

RESULTS

Patient ratings indicated less disability than staff ratings for total score and for the domains of understanding and communicating, getting along and life activities. Self-care and participation ratings were similar. Patients were more likely to rate themselves as disabled in getting around (mobility). Only one-fifth of patient- and staff- ratings (16, 22%) were similar, while for nearly a third of the patients (23, 32%) self-ratings were higher than staff ratings. More severe positive symptoms were associated with higher self-rated WHODAS disability after accounting for treatment duration, negative symptoms, cognitive score and antipsychotic dose. No variable accounted for the staff/patient differences in ratings.

CONCLUSION

Our mean WHODAS score findings echoed those in other patient samples-of patient underestimation of disability, linked to severity of symptoms. In this study using the WHODAS for the first time in a forensic mental health secure inpatient service, however, we found that, by comparing individuals, half of the patients reported equivalent or greater disability than did staff. Future research should focus on elucidating from patients what contributes to their self-ratings. Understanding their thought processes in rating may enhance rehabilitation planning.

Homicide perpetrators with psychotic illness found not criminally responsible in Turkiye and Russia: An international comparison

OBJECTIVE

The primary objective was to conduct a comparative analysis of homicide cases and their perpetrators with psychotic illnesses in samples from Turkiye and Russia to elucidate contextual similarities and differences, and providing novel perspectives to enhance international research in this field.

METHOD

This cross-national retrospective study, conducted at forensic psychiatric centers in Istanbul, Turkiye, and Chuvashia, Russia, involved individuals with psychotic illnesses (ICD-10 F20-F29) who were deemed criminally non-responsible for index homicide offenses between December 2012 and December 2022. The sample included 92 Turkish patients and 29 Russian patients who were compared for background, clinical characteristics, and each homicidal act.

RESULTS

Binary analyses revealed that Russian subjects were more educated, had more lifetime suicide attempts, longer illness duration, had acquaintances as victims more frequently, higher rates of blunt traumatic homicides, higher rates of intoxication with alcohol or substances, and lower rates of experiencing delusions at the time of the index homicide compared to their Turkish counterparts. Multivariate analyses indicated that more years of education, a greater frequency of lifetime suicide attempts, higher prevalence of intoxication and a lower rate of delusions at the time of the homicide were associated with belonging to the Russian group.

CONCLUSION

Despite several similarities, the remarkable differences between the two samples underscore the importance of international research in enhancing our understanding of mental health, homicidal offense and offender characteristics in the sociocultural context.