11 Forensic issues in adult attendees to a specialist tourette syndrome service

Abstract

Objective To examine the frequency of forensic issues in patients attending a Tourette’s syndrome (TS) clinic in relation to comorbid conditions and other possible risk factors. Method Clinical notes of 223 attenders over the age of 17 to the Tourette syndrome clinic at St George’s Hospital were analysed. The information recorded for each patient included diagnoses (including co-morbidities), illicit drug usage, forensic history, family history of criminality. For the purposes of this study ‘forensic issues’ included any formal interactions with the police, including cautions. Results Of the 223 patients, 71% were male, 39 had forensic Issues (17.5%) of which 8 had received prison sentences, including 2 suspended sentences. Tic severity was not recorded in a uniform way for all patients, but 79% were rated on a clinicians’ global impression, as severe in 19% of forensic cases v 10% of controls (NS). Comorbid conditions were more prevalent in the presence of forensic issues: Oppositional Defiant Disorder (ODD) (31% v 13% *significant), Conduct Disorder diagnosed as a child (CD) (18% v 2% *), Attention Deficit Hyperactivity Disorder (ADHD) (67% v 41% *), Obsessive Compulsive Disorder (40% v 27% NS) and depression (26% v 22% NS). Personality disorder was recorded in only 5/223 (2.2%) patients as a whole and was almost certainly clinically under-ascertained. Substance misuse was seen in 59% of the forensic group v 22% of controls * including cannabis (n=54), MDMA (21), cocaine (18), amphetamine (10), prescription drugs (4), LSD (3), “acid” (3), ketamine (2), “mushrooms” (2), solvents (1). Those receiving prison sentences all had multiple co-morbidities. A family forensic history was seen in 21% v 11% of controls (NS). Conclusion These data showed that 17.5% of this predominantly male patient group had had forensic issues. It is difficult to assess the significance of this figure as there could be important psychosocial factors that have not been included in the analysis and in some cases police involvement was in a phase of life earlier than the clinical assessment. We included a wide range of seriousness of offences/alleged offences. We found significantly increased ODD and CD (childhood diagnoses), ADHD and substance misuse in the forensic group but not a significantly higher proportion of severe tic disorders. In common with the general forensic literature, these are risk factors that could be actively addressed in the younger age group eg parenting programmes, CBT for impulsivity and multisystemic therapy.