The treatment and security needs of patients in special hospitals: views of referring and accepting teams

Sayal, Kapil; Maden, Anthony

doi:10.1002/cbm.503

Cited by 5 publications

(7 citation statements)

References 9 publications

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“…CONSULTANT FORENSIC CLINICAL PSYCHOLOGIST -SERVICE LEAD quality of life flexible care, and therefore have more therapeutic impact on patients than is possible within the constraints of high-secure detention. Sayal and Maden (2002) also comment that the suggested figure of 20-30% of high-security patients that could be managed in a medium-secure setting is not based on objective criteria. They believe that the figure may be closer to nine per cent.…”

Section: Adrian G Westmentioning

confidence: 99%

Secure settings and the scope for recovery: service users' perspectives on a new tier of care

Barsky¹,

West²

2007

The British Journal of Forensic Practice

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This research attempts to explore in‐patient perspectives on the long‐stay, medium‐secure hospital wards in which they are based. Semi‐structured interviews focused on the care provided by the hospital in comparison with the high‐secure hospitals from which the participants had been transferred. Questions focused on the participants' perceptions of recovery and the scope for it at both sites.The data suggests that participants identify increased scope for recovery at the long‐stay, medium‐secure facility, and that this is promoted by increased flexibility due to less emphasis on security. Important factors discussed by participants were increased access to a range of activities, graded access into the community, the different atmosphere in the hospital sites and the differences in potential for developing trusting relationships with staff and fellow in‐patients.

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Section: Adrian G Westmentioning

confidence: 99%

Secure settings and the scope for recovery: service users' perspectives on a new tier of care

Barsky¹,

West²

2007

The British Journal of Forensic Practice

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“…Low risk of bias studies found a significantly lower TRS prevalence (28.4%, 95% CI 23.9-33.0) 7 , 16 , 25 , 26 , 32 , 33 , 36 , 38 - 40 , 48 , 50 , 53 , 54 , 57 , 58 , 60 , 62 , 66 , 67 , 69 , 71 than high risk of bias studies (44.35%, 95% CI 38.29-50·50) 8 , 27 - 31 , 34 , 35 , 37 , 41 - 47 , 49 , 51 , 52 , 55 , 56 , 59 , 61 , 63 - 65 , 68 , 70 (Q = 17.1, p < 0.0001). The results for individual scores and subgroup analyses across studies for each criterion and total scores are shown in , respectively.…”

Section: Resultsmentioning

confidence: 95%

“…This methodological feature may explain the unexpected finding that studies which considered intolerability-related treatment failure as TRS 25 - 27 , 29 , 31 , 34 , 35 , 40 , 41 , 47 , 53 , 57 , 64 , 65 , 69 reported a lower TRS prevalence than those that did not. 7 , 8 , 16 , 28 , 30 , 32 , 33 , 36 - 39 , 42 - 46 , 48 - 52 , 54 - 56 , 58 - 63 , 66 - 68 , 70 , 71 …”

Section: Discussionmentioning

confidence: 99%

“…Several limitations should be considered when interpreting these results. First, although we excluded studies whose definitions of TRS were based on clozapine use or included patients who were not in remission, we did not require detailed TRS criteria, and only 21 studies 7 , 8 , 16 , 25 , 31 , 38 , 39 , 41 , 46 , 49 , 50 , 52 - 54 , 57 , 59 , 62 - 64 , 68 , 69 were designed to determine TRS prevalence. Second, we identified seven standardized but heterogeneous TRS criteria, 1 , 2 , 4 , 6 , 75 - 77 which likely explains the wide-ranging prevalences in addition to differences in treatment setting, populations, etc.…”

Section: Discussionmentioning

confidence: 99%

“… 16 , 48 , 61 , 70 Two studies confirmed medication adherence by enrolling patients who had been hospitalized. 28 , 52 One study examined medication adherence by analyzing the dose/serum ratio of antipsychotic treatment, finding a median (interquartile range) of 0.53 in 65 of 108 treatment-resistant patients, although data on serum concentration from previous trials were not available. 63 Only one study 34 addressed pseudo-resistance via a 4-week prospective trial, finding that 12 (36.4%) of 33 putative TRS patients had pseudo-resistance.…”

Section: Discussionmentioning

confidence: 99%

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Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates

Diniz,

Fonseca,

Rocha

et al. 2023

Brazilian Journal of Psychiatry

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Objectives: To determine the prevalence and correlates of treatment-resistant schizophrenia (TRS) through a systematic review and meta-analysis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, an electronic search was performed in PubMed and Embase through May 17, 2022. All study designs that assessed a minimum of 20 schizophrenia-spectrum patients and provided data on TRS prevalence or allowed its calculation were included. Estimates were produced using a random-effects model meta-analysis. Results: The TRS prevalence across 50 studies (n = 29,390) was 36.7% (95%CI 33.1-40.5, p < 0.0001). The prevalence ranged from 22% (95%CI 18.4-25.8) in first-episode to 39.5% (95%CI 32.2-47.0) in multiple-episode samples (Q = 18.27, p < 0.0001). Primary treatment resistance, defined as no response from the first episode, was 23.6% (95%CI 20.5-26.8) vs. 9.3% (95%CI 6.8-12.2) for later-onset/secondary (≥ 6 months after initial treatment response). Longer illness duration and recruitment from long-term hospitals or clozapine clinics were associated with higher prevalence estimates. In meta-regression analyses, older age and poor functioning predicted greater TRS. When including only studies with lower bias risk, the TRS prevalence was 28.4%. Conclusion: Different study designs and recruitment strategies accounted for most of the observed heterogeneity in TRS prevalence rates. The results point to early-onset and later-onset TRS as two separate disease pathways requiring clinical attention. Registration number: PROSPERO CRD42018092033.

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The Security Needs Assessment Profile: A Multidimensional Approach to Measuring Security Needs

Collins

Davies

2005

International Journal of Forensic Mental Health

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Although levels of security in UK forensic psychiatric services are generally accepted as being divided into high, medium and low security there are few detailed descriptors beyond those of high security. The lack of clear definitions of security poses problems for researchers, clinicians and patients. Developments in forensic care increasingly demand that patients should receive care under conditions of security that are no greater than necessary to manage the risks they present. This is not a simple proposition; a number of complex areas have to be addressed by clinicians when defining a patient's individual needs for security. In an attempt to provide a more comprehensive description of patients' security needs the authors developed the Security Needs Assessment Profile (S.N.A.P). This instrument builds on the three traditional dimensions of security: physical, procedural and relational. Each dimension is sub-divided into a number of items, 22 overall. Each item was described on a four-point scale, each point being carefully defined to provide reference points for users. This article briefly outlines the background, instrument development, instrument structure, sample and results. Initial results indicate that the instrument can distinguish between patients who require different levels of security. An emerging component structure is also described. A preliminary version of the instrument is described for use in forensic settings.

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The treatment and security needs of patients in special hospitals: views of referring and accepting teams

Cited by 5 publications

References 9 publications

Secure settings and the scope for recovery: service users' perspectives on a new tier of care

Secure settings and the scope for recovery: service users' perspectives on a new tier of care

Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates

The Security Needs Assessment Profile: A Multidimensional Approach to Measuring Security Needs

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