Clinical specificity of prison inmates with severe mental disorders. A case-control study

Housing Orientations and Needs of Above-Average Length of Stay Hospitalized Psychiatric Patients

A small number of severely and persistently mentally ill in-patients awaiting residential or long-stay facilities represent an obstacle to the efficient utilization of acute care beds. These facilities are costly and currently reputed to be contrary to recovery principles. In 2013, all acute psychiatric care wards in Montreal identified 194 in-patients who could be discharged to residential or long-term nursing care facilities. Program clinical professionals of regional residential facilities sent adapted standardized questionnaires to ward staff. Evaluators also collected the residential preferences of both staff and patients, and then made their own assessments. The 194 in-patients were mostly middle-aged single men. Over 80% had a psychosis diagnosis and half had judicial constraints. The staff evaluated that 71.1% could be discharged from hospital within 24 h. Of these, 55% could be referred to group resources with continuous 24 h, 7 days a week staff presence, 32% could be transferred to apartments with 7-day continuous or non-continuous staff presence, 12% could be transferred to institutional care and only 2% could be moved to an apartment of their own. Evaluator and ward staff residential preferences were highly similar, but differed with patient preferences, half of whom prefer their own apartment. Discrepancy between staff evaluations and patient preferences were higher for longer stay patients with more severe symptoms and comorbidity of personality disorders.

Adaptation of the Texas Implementation Medication Algorithm for Bipolar Disorder in Adult Female Offenders

Use of medication algorithms in the correctional setting may facilitate clinical decision making, improve consistency of care, and reduce polypharmacy. The objective of the present study was to evaluate effectiveness of algorithm (Texas Implementation of Medication Algorithm [TIMA])-driven treatment of bipolar disorder (BD) compared with Treatment as Usual (TAU) in the correctional environment. A total of 61 women inmates with BD were randomized to TIMA (n = 30) or TAU (n = 31) and treated over a 12-week period. The outcome measures included measures of BD symptoms, comorbid symptomatology, quality of life, and psychotropic medication utilization. In comparison with TAU, TIMA-driven treatment reduced polypharmacy, decreased overall psychotropic medication utilization, and significantly decreased use of specific classes of psychotropic medication (antipsychotics and antidepressants). This pilot study confirmed the feasibility and benefits of algorithm-driven treatment of BD in the correctional setting, primarily by enhancing appropriate use of evidence-based treatment.

Clinical characteristics and service use of incarcerated males with severe mental disorders: a comparative case-control study with patients found not criminally responsible

Since the drop in the bed capacity of civil psychiatric hospitals, an increase in the bed capacity of forensic psychiatric care and prison units has been reported in the United States and Europe. However, in Canada, a decrease in the number of people with severe mental illness (SMI) during the last two decades in penitentiaries has been reported. At the same time, an increase in individuals found not criminally responsible on account of mental disorder (NCRMD) was observed in forensic hospitals. The aim of this study is to compare incarcerated severely mentally ill (I-SMI) individuals with forensic-hospitalized SMI individuals in terms of their clinical profiles and service use in the province of Quebec (Canada). A case-control study design was selected using a sample of 44 I-SMI individuals and 59 forensic-hospitalized SMI individuals. Important findings include the following: I-SMI persons had less schooling; they more often reported suicide attempts and violent and non-violent crimes; and they had a higher level of comorbidity involving Cluster B personality disorders and substance-use disorders. Forensic-hospitalized SMI persons were more likely to have been receiving psychiatric follow-up before hospitalization. The final logistic regression model showed that lifetime suicide attempts, non-violent crimes, and psychopathic traits were higher among I-SMI individuals than among forensic-hospitalized SMI individuals. In contrast, receiving regular psychiatric follow-up was associated with forensic-hospitalized SMI individuals. Differences in psychopathological characteristics and the use of mental health services were found for I-SMI persons. More research is needed to determine which new initiatives might be efficacious in addressing the mental health needs of I-SMI individuals.

Algorithm-driven pharmacological management of bipolar disorder in Connecticut prisons

The objective of this study was to assess adaptation of the Texas Implementation of Medication Algorithm (TIMA) for bipolar disorder (BD) in the Connecticut Department of Correction. A nonrandomized sample of 20 males and 20 females, with diagnoses of BD Type I or II, was enrolled in the study. Two TIMA-trained psychiatrists treated the participants over a 12-week period following the TIMA protocol. The primary outcome measure was the Bipolar Disorder Symptom Scale. Secondary outcome measures evaluated global clinical status, comorbid symptomatology, and quality of life. Significant improvement was seen with the primary and secondary outcome measures (p < .001). Subanalyses showed differences in outcomes based on gender and whether a manic or depression algorithm was used. Antidepressant and antipsychotic medication use decreased, with increase in anticonvulsant and anxiolytic medication usage. This pilot study confirmed the effectiveness and benefits of TIMA for BD adaptation in the correctional setting.

Clinical and sociodemographic profiles of male inmates with severe mental illness: a comparison with voluntarily and involuntarily hospitalized patients

OBJECTIVE

To identify the clinical specificity of men with severe mental illness (aged 18 to 40 years) by legal status.

METHOD

Our study compared 85 inmates with 66 involuntarily hospitalized patients (IHPs) and 50 voluntarily hospitalized patients (VHPs) with at least one Axis I diagnosis of psychosis or major affective disorder. Sociodemographics, medical information, and criminal history were drawn from interviews, medical records, and official criminal records. We used the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders to determine Axis I disorders and antisocial personality disorder (ASPD). Psychopathy was measured with the Psychopathy Checklist--Revised.

RESULTS

We found that inmates had a lower level of schooling (P = 0.001), were more likely to have been in an intimate relationship (P < 0.001), and were less likely to have a psychiatric hospitalization history (P < 0.001), compared with hospitalized patients. Inmates were also more likely to meet criteria for delusional disorders or psychosis not otherwise specified (P < 0.001) and major depression (P = 0.001). IHPs were more likely to meet schizophrenia spectrum disorder criteria (P < 0.001). Inmates had a higher level of comorbidity involving ASPD (P < 0.001), psychopathy (P < 0.001), and substance misuse (P < 0.001). IHPs showed an intermediate level between inmates and VHPs for these comorbid disorders. VHPs had the lowest level of comorbidity with Axis I psychiatric diagnosis.

CONCLUSION

Our clinical specificity hypothesis was supported: different psychopathological characteristics and social functioning profiles were identified by legal status. Specific integrated treatments should be considered for inmates and IHPs.

Psychiatric morbidity in murder and attempted murder crime convicts: A Turkey study

In the present, the morbidity of psychiatric disorders of homicide/attempted homicide crime convicts imprisoned in Turkey, Sivas maximum security prison was investigated. Seventy imprisoned homicide/attempted homicide crime convicts included in this study. Sociodemographic information form, structured clinical interview for DSM-IV Axis-I disorders and structured clinical interview for DSM-III-R personality disorders applied to the participants. Most commonly diagnosed disorders among those convicts were current Axis-I disorders, depressive disorders (7.1%) and anxiety disorders (5.7%). Among Axis-I disorders, the most diagnosed one was the substance use disorders (45.7%). The most diagnosed Axis-II disorder was found as to be antisocial personality disorder (48.6%). The rate of convicts who were diagnosed as having both Axis-I and Axis-II disorders was 51.4%. The most prevalently accompanying lifetime Axis-I disorders to antisocial personality disorder with respect to Axis-I, and Axis-II comorbidity was substance use disorders. As a result, it was thought that the substance use disorders and antisocial personality disorder among the homicide/attempted homicide crime convicts were the most prevalent lifetime psychiatric disorders.

History of arrest, incarceration and victimization in community-based severely mentally ill

This study examined history of arrest and victimization in an urban community sample of severely mentally ill adults. Adults (n = 308) were consented and interviewed in one of four short-term residential treatment facilities in San Francisco. Nearly three quarters (71.4%) had been arrested at some time in their lives, 28.2% of whom had been arrested in the past 6 months. Substance use and homelessness were associated with history of arrest, while gender and ethnicity were not, although African Americans were more likely to have spent longer time in jail or prison. One quarter (25.6%) reported victimization. Being female (OR 2.02, 95% CI 1.2-3.5, p = 0.032) and homeless (OR 2.1, 95% CI 1.2-3.8, p = 0.013) were associated with reporting victimization. Severe mental illness, in particular in combination with substance abuse and homelessness, is associated with higher prevalence of both arrest and victimization history. Healthcare providers should solicit histories to include these events in order to understand and provide optimal care and case management services.

CANTAB explicit memory is less impaired in addicted schizophrenia patients

It has been suggested that in order to sustain the lifestyle of substance abuse, addicted schizophrenia patients would have less negative symptoms, better social skills, and less cognitive impairments. Mounting evidence supports the first two assumptions, but data lack regarding cognition in dual diagnosis schizophrenia. Seventy-six schizophrenia outpatients (DSM-IV) were divided into two groups: with (n = 44) and without (n = 32) a substance use disorder. Motor speed and visuo-spatial explicit memory were investigated using CANTAB. As expected, dual diagnosis patients showed a better cognitive performance. Our results suggest either that substance abuse relieves the cognitive deficits of schizophrenia or that the patients with less cognitive deficits are more prone to substance abuse.

Auricular acupuncture in prison psychiatric units: a pilot study

OBJECTIVE

The study explores whether auricular acupuncture can be a viable treatment form for inmates in prison psychiatric units.

METHOD

Inmates in a prison psychiatric unit and in a support unit for violent behavior were offered group treatment with auricular acupuncture three times a week over a period of 9 months. Another prison psychiatric unit served as a control group.

RESULTS

Twenty-two inmates received treatment, and 11 inmates received treatment for over 8 weeks. Cortisol levels were higher for inmates in the support unit than for the other two groups. Inmates treated at least 25 times were prescribed fewer psycholeptic drugs than controls. Perceived autonomy increased for treated inmates in the psychiatric unit. Inmates treated for over 8 weeks experienced improved inner harmony and calm and better clarity over future plans.

CONCLUSION

Acupuncture is a non-verbal form of treatment appropriate for prison psychiatric units. The treatment facilitates contact and complements other psycho-social treatment forms.

[Abuse of psychoactive drugs and social adjustment of psychotic patients]

OBJECTIVE

Is the abuse of psychoactive drugs in psychotic patients linked to social adjustment?

METHOD

Fifty-five psychotic men from a detention centre or a psychiatric hospital were assessed with the Social Adjustment Scale (SAS-II) and a French version of the Phillips Rating Scale of Premorbid Adjustment in Schizophrenia.

RESULTS

In psychotic patients, the abuse of psychoactive drugs is linked to some indicators of social adjustment and premorbid sexual adaptation.

CONCLUSION

Differences were found in some aspects of social functioning, but it is difficult to establish an overall assessment of social adjustment.

[Multidimensional aspect of proposed hypotheses accounting for the prevalence of mental disorders in prisons]

OBJECTIVE

This paper summarizes the hypotheses accounting for the prevalence of mental disorder in prison. The hypotheses about the migration of prisoners, the criminalization of individuals with mental disorders, and the clinical specificity of subjects with mental disorders are introduced and discussed. A new hypothesis is proposed to account for the prevalence of mental disorder in prison, stating that the first instances of case management, either legal or medical, affect subsequent case management.

DISCUSSION

The 4 aspects (political, administrative, individual, and cognitive) of the hypotheses enable the development of a multidimensional approach to account for the prevalence of mental disorder in prison.