Treatment for female patients with eating disorders in the largest medical prison in Japan

Recidivism among prisoners with severe mental disorders

Introduction

Mental disorders are common among prison inmates, with a high rate of recidivism found among those with severe mental disorders. In Japan, the number of inmates with mental disorders has been increasing with the increasing rate of recidivism. Prisoners need an uninterrupted connection to post-release support to prevent them from being incarcerated again. This study identified inmates diagnosed with mental disorders whose recidivism had recently increased to investigate recidivism among inmates with severe mental disorders and the risk factors for reincarceration.

Methods

This study included 148 prisoners released from the Medical Correction Center in East Japan. Clinical diagnoses were coded using the World Health Organization's International Classification of Diseases, Tenth Revision. Risk factors focusing on the central eight items were categorized, and recidivism within 3 years of release was investigated.

Result

Overall, the recidivism rate was 29.7%, with the risk of recidivism increasing by 170% in inmates with multiple incarcerations. A diagnosis of intellectual disability increased the risk of recidivism by 176%. Patients with schizophrenia were consistently less likely to recidivate than patients with other disorders.

Conclusion

Intellectual disability was identified as a risk factor for recidivism, as was multiple incarcerations. These prisoners may not be connected to medical and social services and thus may not be receiving appropriate assistance. Patients with schizophrenia might be more likely to be connected to medical care and receive support after release. Further research should be conducted using these findings to prevent recidivism among inmates with mental disorders.

Shoplifting Behavior Among Patients With an Eating Disorder at a Medical Correctional Center in Japan: A Cross-Sectional Study

PURPOSE

In Japan, the incarceration of patients with eating disorders (EDs) owing to repeated shoplifting has become a social issue. This study examined the shoplifting behavior of inmates with EDs at our medical correctional center, with the objective of delineating their characteristics, identifying an adequate treatment plan, and preventing recidivism.

METHODS

The participants consisted of 32 incarcerated patients with EDs (22 females, 10 males) charged with shoplifting, from a medical correctional center in East Japan. A cross-sectional study was employed. Data were collected by retrieving the patients' medical records and through individual interviews conducted by psychiatrists.

RESULTS

The food-specific shoplifting ED group (those who had never shoplifted anything other than food) had a core pathology of the binge-purge type of anorexia nervosa with juvenile onset (p = 0.044). Furthermore, they demonstrated an average gap of 8 years between the onset of ED and their first shoplifting episode. The non-specific shoplifting ED group (those who shoplifted food and other items) typically shoplifted before the onset of ED (p = 0.001). They experienced the onset of ED after incarceration (p = 0.004) and had comorbid disorders (p = 0.024). The food-specific group required a psychosocial approach focusing on maintaining healthy body weight and mental stability, whereas the non-specific group required multiple forms of support for substance abuse and behavioral addiction, as well as interventions to reduce impulsive behavior.

CONCLUSION

Early intervention is necessary to improve the prognosis of patients with EDs and shoplifting behavior.

At the heart of the matter: Cardiovascular health challenges among incarcerated women

Many factors appear to contribute to an increased risk for cardiovascular disease (CVD) among incarcerated women. Imprisonment is associated with a bodyweight gain and an increased prevalence of overweight and obesity. Inadequate physical activity and unhealthy nutrition further contribute to this positive energy balance. Classical CVD risk factors are common, including hypertension, diabetes mellitus, metabolic syndrome, and smoking. Moreover, imprisonment is associated with an increased incidence of mental health issues, such as depression and anxiety, with coping mechanisms, including substance abuse, being frequently adopted. Specific attitudes in the correctional environment, including hunger strikes, bullying, abuse and solitary confinement, are effectors of cardiovascular and mental ill-health. Furthermore, the plethora of psychological stressors induces an accelerated aging process, paired with CVD risk. Communicable diseases, mainly human immunodeficiency virus, opportunistic infections and inadequate sunlight exposure increase cardiovascular dysregulation. Health care needs associated with the female sex are not always met, adding to the frustration and compromised well-being. All these factors act independently and cumulatively, increasing CVD risk among incarcerated women.

High prevalence of shoplifting in patients with eating disorders

PURPOSE

Shoplifting, prevalent in patients diagnosed with bulimia nervosa (BN), is a serious behavioral problem in eating disorder (ED) patients. However, little is known about its overall presence, etiology, and consequences. This study aimed to determine whether shoplifting occurs before or after the onset of ED and to investigate the prevalence and correlates of shoplifting in ED patients.

METHODS

This was a cross-sectional study of 284 treatment-seeking female patients aged 13-45 with EDs [171 anorexia nervosa (AN); 113 BN]. Shoplifting, impulsive behaviors (self-injury, suicide attempt, sexual promiscuity, alcohol, and illicit drug use), depression, self-esteem, and clinical features of EDs were assessed with an interview.

RESULTS

Lifetime shoplifting prevalence was 28.5% (81/284) with 70.4% (57/81) occurring before ED onset. Multivariate logistic regression analysis revealed that depression [odds ratio (OR), 2.63; 95% confidence interval (CI), 1.24-5.60], alcohol abuse (OR, 3.91; 95% CI 1.34-11.38), illicit substance use (OR, 14.42; 95% CI, 1.65-125.86), and self-esteem (OR, 0.90; 95% CI; 0.82-0.99) were associated with lifetime shoplifting, while illness duration, BN, and ED symptom severity were not.

CONCLUSIONS

Shoplifting is common in ED patients and precedes ED onset in most patients with a shoplifting history, although the causal relationship between shoplifting and EDs remains inconclusive. Shoplifting may be associated with impulsive behaviors (e.g., alcohol and illicit drug use), depression, and low self-esteem, but not with ED severity. Future research should focus on the unrecognized role of shoplifting as a marker to identify patients at risk of impulsive behaviors and consider treatment options.

LEVEL OF EVIDENCE

Level V, observational cross-sectional descriptive study.