Simon Gibbon

Forensic mental health

1. Introduction: The Criminal Justice System and Mental Health Legislation 2. Mental Disorder and Offending 3. Entering the Forensic Mental Health System 4. Forensic Mental Health Services 5. The Multidisciplinary Team 6. Risk Assessment 7. Treatments in Prison and Probation Services 8. Treatments in Mental Health Settings 9. Leaving the System, Patients Rights and Advocacy

A comparison of the family and childhood backgrounds of hospitalised offenders with schizophrenia or personality disorder

BACKGROUNDnPrevious studies have demonstrated high levels of childhood adversity and familial criminality in offender patients with schizophrenia and/or personality disorder, but few have directly compared these groups.nnnAIMSnTo compare the parenting histories of offender patients with schizophrenia with those with personality disorder. We hypothesised that rates of family criminality and experiences of disrupted parenting would be higher in the personality disorder group than the schizophrenia group.nnnMETHODnA retrospective case-control methodology compared the family background and childhood experiences of patients with either schizophrenia or personality disorder (n = 3088) admitted to any of the English high-security hospitals.nnnRESULTSnCompared with those with schizophrenia, patients with personality disorder had experienced higher rates of family criminality, parental separation, and multiple changes of caregiver and institutional care. There was no significant difference in the prevalence of family psychiatric history between the groups.nnnDISCUSSIONnAlthough our hypotheses were sustained, we were impressed that rates of disruption to parenting were high in the schizophrenia group as well as in the personality disorder group. Less than a third of the personality disorder group had survived childhood without a change in parenting, but this was true for about half of the schizophrenia group, too. Family work tailored for people with schizophrenia is needed, even though within personality disorder services, a greater demand for disorder-sensitive family work is likely to be encountered.

Incidents of hostage-taking in an English high-secure hospital

Serious adverse incidents in secure psychiatric hospitals are infrequent but significant events. The frequency and characteristics of escape, absconsion, homicide and suicide in English high-secure hospitals have been described, but no research has been dedicated to hostage-taking. In this study, we collected details about all hostage-taking incidents in one high-secure hospital, Rampton Hospital, over a 25-year period (1984–2009). We identified four incidents. All were perpetrated by male patients. In two cases, the victims were female staff and in the other two cases, the victims were male patients. All incidents were planned; two involved the use of a weapon. None of the incidents was driven by acute symptoms of mental illness. None resulted in serious injury or in prosecution. Three patients had a history of hostage-taking. Whilst hostage-taking is a serious event, it is extremely rare and appears to be successfully managed in a highly structured and well-staffed environment.

S08-01 - Cochrane reviews of pharmacological and psychological interventions for antisocial personality disorder (ASPD)

Introduction ASPD has a prevalence of 2-3% in the general population but rates in prison have been reported as 50% to 75%. ASPD is associated with significant psychiatric and medical comorbidity, high offending rates, poor psychosocial adaptation and premature death. Outcomes are poor. There is little consensus regarding the most effective intervention for the condition. Aims and objectives To conduct systematic literature reviews to identify randomised controlled trials for either pharmacological or psychological interventions for ASPD. Methods Systematic literature reviews (Cochrane reviews). Results For the review on psychological interventions only 11 studies could be included with a total of 411 participants, but only five reported data separately for the subgroup of ASPD. Nine of the studies looked at participants with substance misuse problems who also suffered from ASPD. Only three types of interventions were effective (contingency management, CBT and a specific programme for those convicted for driving whilst intoxicated). These interventions showed positive results for substance misuse related outcomes but not for any others behaviours or symptoms. For the pharmacological review 10 studies were identified, anticonvulsants were the most commonly used drugs with some evidence of effectiveness on aggression, however, study quality was poor. Conclusions Despite the considerable personal and societal consequences of ASPD, very little research is carried out with regards to interventions in this patient group and subsequently the evidence base to support any interventions is extremely limited.

Recording adverse drug reactions in a forensic psychiatry unit: How can we improve standards?

Adverse drug reactions (ADRs) are increasingly recognised as an important cause of morbidity and mortality. Psychiatric patients, and especially those in forensic units, may be at increased risk of ADRs. Detection and documentation of previous ADRs are essential in reducing the risk of future ADRs. A baseline audit was undertaken, and subsequently the recording of ADRs on the drug cards of patients in a forensic psychiatry unit was re‐audited. Poor levels of documentation of ADRs were found. Following the baseline audit, a number of simple measures were undertaken which improved performance at re‐audit.

Evaluación práctica del trastorno de la personalidad

Resumen Aunque la evaluacion de cualquier trastorno es esencial para informar al medico de cual es el tratamiento mas conveniente y el pronostico probable, muchos psiquiatras no efectuan de modo apropiado la evaluacion de un trastorno de la personalidad. En el presente articulo se revisan los diferentes metodos de evaluacion y se sostiene que cualquier interpretacion juiciosa de los datos adquiridos necesita la informacion de unos conocimientos adecuados sobre la estructura de la personalidad. Una formacion sistematica con un instrumento semiestructurado proporciona de forma optima estos conocimientos. Si dicha formacion se ofreciera sistematicamente durante los anos de estudio de la especialidad de psiquiatria, el ejercicio de esta profesion mejoraria considerablemente.