Treatment resistance and prolonged length of stay among schizophrenia inpatients in forensic institutions.

Gosek, Paweł; Kotowska, Justyna; Rowińska-Garbień, Elżbieta; Bartczak, Dariusz; Heitzman, Janusz

doi:10.1016/j.psychres.2021.113771

Cited by 16 publications

(10 citation statements)

References 23 publications

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“…Older age was another factor associated with longer LoS in our cohort. The majority of our sample consisted of men (87.3%), which is similar to other European states ( 10 , 31 – 33 ). We found that male sex was associated with LoS, replicating previous results ( 9 , 14 ), while others found no association ( 11 ).…”

Section: Discussionsupporting

confidence: 73%

“…Higher antipsychotic doses may indicate treatment resistance in cases where clozapine is contraindicated. The impact of combined treatment with antipsychotics on LoS has been previously demonstrated ( 31 ). The findings from our hospital indicate that psychotic symptoms are the main drivers of assaultive behavior among inpatients with psychosis; therefore, successfully targeting symptoms is essential for violence prevention ( 35 ).…”

Section: Discussionmentioning

confidence: 89%

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Factors Affecting Length of Inpatient Forensic Stay: Retrospective Study From Czechia

2022

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ObjectivesThe length of forensic stay (LoS) is a subject to country-specific legal and service systems. Therefore, the identification of common factors targetable by treatment is at the forefront of forensic psychiatric research. In this study, we present the first reports of forensic characteristics of patients from the Czechia.MethodsWe conducted a retrospective analysis of data from 260 inpatients discharged from the Bohnice Hospital (Prague) and obtained a set of sociodemographic and clinical variables as well as the Health of the Nation Outcome Scale (HoNOS) and HoNOS-secure scores.ResultsThe following variables were identified as significantly associated with a longer LoS: older age, length of previous psychiatric hospitalization, olanzapine equivalent, clozapine treatment, psychosocial dysfunction, psychotic or paraphilic disorder diagnosis, and sexual offense. A shorter LoS was associated with being in a relationship, being employed before hospitalization, receiving personal support, and committing an index offense under the influence of substance. While the HoNOS score and HoNOS symptom subscale predicted a longer LoS, the HoNOS-secure subscale predicted a shorter stay.ConclusionIn the European context, our hospital has a relatively low LoS. The results are consistent with findings linking psychotic disorders and paraphilia with a longer LoS in forensic treatment. Higher doses of antipsychotic medication or clozapine prescriptions were associated with a longer LoS. The results show a high level of unmet needs in this population, highlighting the importance of the availability of follow-up service.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 89%

Factors Affecting Length of Inpatient Forensic Stay: Retrospective Study From Czechia

2022

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“…Recent research showed an increase in case complexity, whereby substance use disorders, personality disorders, and neurological disorders have become more prevalent among individuals in forensic care (Penney et al., 2019), which offers a potential explanation for longer stays. Studies have found that duration of hospitalization may be influenced by factors amenable to psychiatric treatment, such as substance use, persistent psychotic symptoms, duration of mental disorder, diagnosis, treatment with multiple antipsychotic medications, seclusion, and institutional behavior (e.g., Andreasson et al., 2014; Davoren et al., 2015; Eckert et al., 2017; Gosek et al., 2021). This literature suggests that clinical factors may play an especially important role in forensic detention decisions.…”

Section: Introductionmentioning

confidence: 99%

“…treatment, such as substance use, persistent psychotic symptoms, duration of mental disorder, diagnosis, treatment with multiple antipsychotic medications, seclusion, and institutional behavior (e.g., Andreasson et al, 2014;Davoren et al, 2015;Eckert et al, 2017;Gosek et al, 2021). This literature suggests that clinical factors may play an especially important role in forensic detention decisions.…”

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confidence: 99%

The influence of changes in clinical factors on high‐security forensic custody dispositions

Hilton

Ham

Kim

2022

Behavioral Sci & The Law

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The demand for forensic psychiatric beds is increasing, while many individuals are "stuck" in the system. Index offense severity and other legal considerations are associated with longer forensic stays but factors amenable to change such as symptoms of mental illness and aggression may also influence forensic decisions. We examined forensic review board decisions over time among 89 men admitted to a high-security forensic hospital. Almost half received a disposition to remain at their first hearing. Overall, dispositions were not associated with violence risk. The odds of a disposition to remain were higher for men with more in-hospital assaults and higher scores on a measure of clinical factors. Dispositions changed over time and this change was sensitive to clinical factors. We conclude that decisions were consistent with a cascading system of loosening security over time. Further longitudinal research following large samples through the forensic system is recommended.

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“…Since 2000, research activities in forensic psychiatry have focused on risk assessment, systems differences, preventing reoffending, quality of care, and the quality of life of forensic patients (Connell et al., 2019; Davoren et al., 2015; de Girolamo et al., 2019; Gosek et al., 2020, 2021; Kirchebner et al., 2020; Sampson et al., 2016). Forensic psychiatric treatment is not intended to be a punishment for criminal behaviour, and there are limitations to directly comparing length of stay in treatment and carceral settings, but, when considering the rationale for inpatient compulsory treatment and deprivation of liberty, it is clinically and ethically important to take into account the proportionality of the period of liberty deprivation (Heitzman et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

Longer than prison? A comparison of length of stay in a medium security hospital and prison for perpetrators of violent crimes other than homicide or attempted homicide

Gosek

Kotowska

Rowińska-Garbień³

et al. 2021

Criminal Behav Ment Health

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Background Concerns have been raised that people detained in secure hospitals after a criminal act spend longer in a locked institution than people sent to prison for similar offending, but research evidence is scarce and conflicting. Aims To compare the length of secure hospitalisation of people convicted of crimes for which flexible sentencing is allowed with length of time in prison for people serving a prison sentence for similar crimes who were not found mentally ill. Methods A records‐based, retrospective study was conducted comparing length of stay of all inpatients in one medium security hospital in Poland, hospitalised between 2014 and 2018, who had been convicted of any interpersonal crime other than homicide or attempted homicide, and data on all sentenced prisoners in Poland on 09.05.2018 convicted of a similar range of offences. Homicide was excluded because, in Poland, it usually attracts a fixed sentence–a life sentence until the 1970s and currently a 25‐year imprisonment–so disrupting comparisons. Results Eighty‐two patients completed their secure hospital stay within the study period or were still hospitalised at the census point 09.05.2018, only 10 of them women. Male patients convicted of stalking or similar threatening offence or ‘mistreatment’ spent, on average, almost twice as long confined to hospital than men sentenced to imprisonment spent in prison (28.8 months, respectively). By contrast, men hospitalised after sex offences were confined for over three years less than those sentenced to prison. Only bodily harm offences attracted comparable lengths of stay in hospital and prison. Conclusions Our findings confirm significant disparities in length of time spent in a closed institution after offences of serious interpersonal violence, according to whether that institution was prison or hospital, but not all in the same direction. Next steps should explore reasons for this and relative longer‐term outcomes.

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Treatment resistance and prolonged length of stay among schizophrenia inpatients in forensic institutions.

Cited by 16 publications

References 23 publications

Factors Affecting Length of Inpatient Forensic Stay: Retrospective Study From Czechia

Factors Affecting Length of Inpatient Forensic Stay: Retrospective Study From Czechia

The influence of changes in clinical factors on high‐security forensic custody dispositions

Longer than prison? A comparison of length of stay in a medium security hospital and prison for perpetrators of violent crimes other than homicide or attempted homicide

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