Schizophrenia in a high-security hospital: long-term forensic, clinical, administrative &amp; social outcomes

Darjee, Rajan; Øfstegaard, Marianne; Thomson, Lindsay

doi:10.1080/14789949.2017.1308537

Cited by 6 publications

(6 citation statements)

References 43 publications

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“…High security institutions are commonplace among international mental health systems and provide specialist care for patients with enduring psychiatric problems in combination with a high risk of further violence. Research indicate that patients in high security settings in western countries were predominantly Caucasian male, between 28 and 38 years old on average (1)(2)(3)(4)(5)(6)(7)(8). Judicially, index offenses are presented in a diverse manner across studies, making comparisons difficult.…”

Section: Introductionmentioning

confidence: 99%

High Security Settings in Flanders: An Analysis of Discharged and Long-Term Forensic Psychiatric Patients

Jeandarme

Goktas²,

Boucké³

et al. 2022

Front. Psychiatry

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BackgroundTwo Forensic Psychiatric Centres (FPC) were implemented the last decade in Flanders in Ghent (2014) and Antwerp (2017). FPCs are forensic institutions for forensic psychiatric patients with a high recidivism risk and a high security need. The objective of FPCs is to create a care process with sufficient flow (from high to lower forms of security), and transitions (from specialized forensic care to regular psychiatric care).AimsTo examine the characteristics of the high security population in FPCs, treatment length, number of discharges, and discharge locations and to determine the profile of long-term patients within an FPC.MethodsA retrospective file study of an admission cohort of 654 patients admitted to FPC Ghent or FPC Antwerp was conducted. Sociodemographic, clinical, judicial and risk characteristics were analyzed. Bivariate analyses were used to test the difference between two groups: the group that was discharged to a lower security level vs. the group of long-term patients.ResultsMost patients had psychosis and personality disorders, while comorbidity was also high. Judicial histories were extensive, with many sexual index offenses. During a 6-year follow-up period, the number of referrals back to prison was low. Nearly a third of the population was discharged to a setting with a lower security level. Long-term patients typically presented with more personality disorders, higher psychopathy traits and higher risk scores and were more frequently subjected to coercive measures during treatment.ConclusionsThe Flemish FPC population is characterized by a high proportion of sex offenders as well as a high proportion of personality-disordered patients. It is this last group, and the group with elevated psychopathy traits, who remain for longer than expected and is difficult to resocialize. This study further highlights the need for clear criteria to assess the conditions of these long-term patients in Flanders.

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Section: Introductionmentioning

confidence: 99%

High Security Settings in Flanders: An Analysis of Discharged and Long-Term Forensic Psychiatric Patients

Jeandarme

Goktas²,

Boucké³

et al. 2022

Front. Psychiatry

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“…On the other hand, many people with cognitive limitations/intellectual disabilities are coerced into committing illicit acts. However, those diagnosed with intellectual disability totaled only 13.3% of the group, while 80% were diagnosed with schizophrenia, an unexpectedly high number of crimes involving third parties (Darjee et al, 2017; Oliveira et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…Some penal systems worldwide do not even consider the possibility of holding an individual in this situation (Abdalla-Filho, 2006). The Anglo-Saxon forensic system is cautious in analyzing the degree and risk of the dangerousness of the crime itself (Abdalla-Filho, 2003; Darjee et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Prolonged Institutionalization in Mentally Ill People with and Without a History of Violence and Legal Involvement: A Cross-Sectional Study

Oliveira

Fraga

Silva

et al. 2021

Int J Offender Ther Comp Criminol

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This is a cross-sectional study carried out on 34 individuals hospitalized for a long period in the Federal District, in Brazil. To evaluate factors related to prolonged institutionalization in mental patients with history of violence and criminal records. Individuals found were assorted into two groups: with and without criminal records. We analyzed 56 items by reviewing medical records and health records. Demographic and social data, history of violence, criminal involvement, medical history, substance use, and other aspects related to long hospitalizations, by reviewing medical and health records. We found a profile of male individuals: single, male, with an average age of 47.6 years, low education, and little professional qualification from correctional facilities or long-term psychiatric clinics and hospitals. Most men had a history of aggressive behavior, a leading psychiatric diagnosis of psychosis, and an issue with polypharmacy. Two factors showed statistical significance and were highly related to longer institutionalizations: polypharmacy and records of hospitalization for violent behavior. Further studies with these populations are needed to increase knowledge on the subject. They can help health care systems to improve and provide broad, humanized and quality assistance with multi-professional teams, aiming to reduce prolonged hospitalizations.

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“…Most men in high-secure hospitals have schizophrenia and there is no reluctance to use clozapine. 5 , 6 The benefits of clozapine over alternative antipsychotics include improved symptom control and function, as well as reduced violence. 7 However, clozapine may not be used within license when there is a history of neutropenia from any cause.…”

Section: Introductionmentioning

confidence: 99%

Clozapine re-challenge and initiation following neutropenia: a review and case series of 14 patients in a high-secure forensic hospital

Silva

Higgins

Hammer

et al. 2021

Therapeutic Advances in Psychopharmacology

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Objective: Clozapine remains the most effective intervention for treatment resistant schizophrenia; however, its use is prohibited following neutropenias. We review neutrophil biology as applied to clozapine and describe the strategies to initiate clozapine following neutropenia used in a case series of 14 consecutive patients rechallenged in a United Kingdom (UK) high-secure psychiatric hospital. We examine outcomes including the use of seclusion and transfer. Methods: A case series of 14 male patients with treatment resistant schizophrenia treated with clozapine despite previous episodes of neutropenia between 2006 and 2015 is presented. Data were collected during 2015 and 2019. Using this routinely collected clinical data, we describe the patient characteristics, causes of neutropenia, the strategies used for rechallenging with clozapine and clinical outcomes. Results: Previous neutropenias were the result of benign ethnic neutropenia, clozapine, other medications and autoimmune-related. Our risk mitigation strategies included: granulocyte-colony stimulating factor (G-CSF), lithium and watch-and-wait. There were no serious adverse events; at follow up half of the patient’s had improved sufficiently to transfer them to conditions of lesser security. There were dramatic reductions in the use of seclusion. Conclusion: Even in this extreme group, clozapine can be safely and effectively re/initiated following neutropenias, resulting in marked benefits for patients. This requires careful planning based on an understanding of neutrophil biology and the aetiology of the specific episode of neutropenia.

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Schizophrenia in a high-security hospital: long-term forensic, clinical, administrative & social outcomes

Cited by 6 publications

References 43 publications

High Security Settings in Flanders: An Analysis of Discharged and Long-Term Forensic Psychiatric Patients

High Security Settings in Flanders: An Analysis of Discharged and Long-Term Forensic Psychiatric Patients

Factors Associated with Prolonged Institutionalization in Mentally Ill People with and Without a History of Violence and Legal Involvement: A Cross-Sectional Study

Clozapine re-challenge and initiation following neutropenia: a review and case series of 14 patients in a high-secure forensic hospital

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