Prisoners at ultra-high-risk for psychosis: a cross-sectional study

The full spectrum of clinical stages of psychosis among mentally ill prisoners in New South Wales (NSW), Australia

Research on the association between psychosis and criminal offending has typically focused on violent offenders with chronic psychotic illness. This stages of psychosis in prison (SOPP) study used a clinical staging approach to identify adult men referred to prison mental health services who had an at-risk mental state (ARMS), first episode of psychosis (FEP) or an established psychotic illness. Of the 105 participants included, 6% were determined to have FEP, 6% met ARMS criteria and the remainder had an established psychotic illness. Compared to a prison control sample, individuals on the psychosis spectrum were found to have higher levels of social disadvantage and other co-occurring mental health and substance use problems but were not more likely to have committed a violent offence. These findings support the notion that risk of criminal justice contact and complex illness burden exist across the full spectrum of psychotic illness.

Psychiatric risk and resilience: Plasticity genes and positive mental health

OBJECTIVE

The at-risk mental state (ARMS) for psychosis has long played a key role in diathesis-stress models of schizophrenia. More recent studies, however, have called for extending the boundaries of the ARMS construct beyond attenuated psychosis in nonhelp-seeking samples to include not only other vulnerability indicators but also protective factors related to genotype, mental health, personality, and cognition.

METHOD

Accordingly, we assessed in a sample of 100 college students, the ARMS construct with the Brief Prodromal Questionnaire (PQ-B) for psychosis, in conjunction with measures of positive mental health, childhood adversity, psychiatric symptoms, personality traits, social cognition, and genetic variables derived from assays of the serotonin transporter (5-HTTLPR) and the brain-derived neurotrophic factor (BDNF).

RESULTS

Higher PQ-B scores correlated positively with vulnerability indicators of childhood adversity and heightened levels of a wide variety of psychiatric symptoms but correlated negatively with protective factors of better overall mental health, social cognition as well as with a distinct NEO profile marked by reduced neuroticism and elevated agreeableness and conscientiousness. Multivariate analyses indicated that a composite ARMS measure comprised of PQ-B scores plus anxiety and depression symptoms revealed significant genotype differences, with lowest risk and highest resilience for allelic carriers of 5-HTTLPR-short and BDNF Met polymorphisms.

CONCLUSIONS

Results provided support for extending the ARMS construct, pointing to important contributions of personality, social cognition, and genes that support neural plasticity in mitigating vulnerability and enhancing resilience and well-being.

[Assessment of mental states at risk of psychotic transition in a sample of young male prisoners in Tunisia]

BACKGROUND

Prevalence of psychotic disorders in a prison population is higher than in the general population. Recent research has shown that early intervention is feasible in prison settings, and that approximately 5% of screened prisoners have met ultra-high-risk (UHR) for psychosis criteria. We aimed to identify the prevalence of the UHR states for developing psychosis in a group of newly incarcerated men in the Jendouba Civil Prison and to analyze the association between UHR states and socio-demographic data and substance use.

METHOD

We carried-out a cross-sectional study among 120 prisoners. Every prisoner was interviewed using the Comprehensive Assessment of At-Risk Mental States (CAARMS). The Social and Occupational Functioning Assessment Scale (SOFAS) was used to assess the participant's level of functioning.

RESULTS

We found a prevalence of subjects meeting the UHR criteria of 21.3%. UHR subjects had significantly more psychiatric family history (P=0.035), personal history of suicide attempt(s) (0.035) and self-injury (P=0.013) compared to non-UHR subjects. Clinical self-evaluation found significantly more depression and anxiety in the UHR group (P=0.020 and P=0.035, respectively). In addition, social and occupational functioning was significantly more impaired in the UHR group (P=0.007). UHR subjects used significantly more cannabis in lifetime (P=0.015) as well as in the past year (P=0.022) and had a significantly higher frequency of cannabis use (P=0.01) compared to non-UHRs.

CONCLUSION

Prison mental health teams face the challenge of identifying prisoners who need mental health services and providing early care to this vulnerable group; this challenge may offer a unique opportunity for intervention among a population that might not otherwise have had access to it.

Psychosis risk screening in different populations using the Prodromal Questionnaire: A systematic review

AIM

Diagnosing individuals at ultra high risk (UHR) for psychosis can improve early access to treatment, and a two-stage model utilizing self-report screening followed by a clinical interview can be accurate and efficient. However, it is currently unclear which screening cut-offs to adopt with different populations.

METHODS

A systematic review of diagnostic accuracy studies evaluating the Prodromal Questionnaire (PQ) as a preliminary screener for UHR and psychosis was conducted to examine screening effectiveness in different contexts. MedLine, PsycInfo, SCOPUS and ProQuest Dissertations and Abstracts databases were electronically searched, along with a review screen and citation search of key papers. Findings were summarized in a narrative synthesis.

RESULTS

In total, 14 diagnostic accuracy studies and 45 studies using the PQ as a screening tool for UHR and psychosis were included. In all settings, the 3 different versions of the PQ were all found to accurately identify UHR and full psychosis. Higher cut-off points were required in non-help-seeking samples, relative to general help-seeking populations, which in turn were higher than those needed in samples highly enriched with UHR participants.

CONCLUSION

The findings support the use of the PQ as a preliminary screening tool for UHR in different settings; however, higher thresholds in lower UHR-prevalence populations are necessary to minimize false positives. Including the distress criteria, rather than just number of symptoms, may improve screening effectiveness. Different thresholds may be appropriate in different contexts depending on the importance of sensitivity vs specificity. Protocol registration: CRD42016033004.

One-fourth of the prisoners are underweight in Northern Ethiopia: a cross-sectional study

BACKGROUND

Despite the fact that prisoners are exposed to different health problems, prison health problems are often overlooked by researchers and no previous study has investigated nutritional problems of prisoners in Ethiopia.

METHODS

Cross-sectional data were collected from 809 prisoners from nine major prison setups in the Tigray region of Ethiopia. A proportional stratified sampling technique was used to select the total number of participants needed from each prison site. The outcome of this study was underweight defined as body mass index (BMI) of less than 18.5 kg/m². Multivariable binary logistic regression was performed to identify determinants of underweight at a p-value of less than 0.05.

RESULTS

The prevalence of underweight was 25.2% (95% CI; 22.3%- 28.3%). Khat Chewing (OR = 2.08; 95% CI = 1.17, 3.70) and longer duration of incarceration (OR = 1.07; 95% CI = 1.01, 1.14) were associated with a significantly increased risk of underweight. Additionally, previous incarceration (OR = 1.54; 95% CI = 0.99, 2.42) was a relevant determinant of underweight with a borderline significance. In contrast, family support (OR = 0.61; 95% CI = 0.43, 0.85) and farmer occupation (OR = 0.59; 95% CI = 0.36, 0.98) compared to those who were unemployed were important protective determinants significantly associated with lower risk of underweight.

CONCLUSION

In summary, the burden of underweight was higher among prisoners in Tigray region who had respiratory tract infections. The study has enhanced our understanding of the determinants of underweight in the prison population. We strongly recommend that nutritional support, such as therapeutic feeding programs for severely or moderately underweight prisoners, and environmental health interventions of the prison setups should be urgently implemented to correct the uncovered nutritional problem and its associated factors for improving the health status of prisoners.