Forensic Psychiatric Ward Research Articles

Gender differences in a forensic psychiatric ward: A retrospective study

IntroductionThe criminality associated with psychiatric disorders has been extensively studied with some studies showing a greater risk of violence in these patients. The gender differences in the general psychiatric population and can have an impact in the characteristics of a forensic population.ObjectivesThe authors aim to study the gender differences regarding diagnosis, type of crime and other characteristics in a forensic ward population.MethodsA retrospective study was designed, including patients admitted in the Forensic ward of Coimbra Hospital and University Center between 2018 and 2020.ResultsOur study included 110 patients, 19 women and 91 men. Although psychotic disorders were the most common in both groups, particularly schizophrenia, mood disorders were significantly more common in women, with a risk of 7,768. This was explained by a greater prevalence of depressive episodes in women. These were associated with a particular type of crime, infanticide, that was not found in the men group. This might contribute to a greater prevalence of violent crimes in women. There was a chance of committing crimes against the offspring of 24 in women. The use of psychoactive substances was significantly greater in men, with a chance of 12,906.ConclusionsConsidering that mood disorders are more common in women, these findings are easy to understand. The predominance of female perpetrators in infanticide is well described in the literature and can be associated with peripartum depression and gender roles. In this sample substance abuse was more common in man, like it’s seen in the general population.DisclosureNo significant relationships.

Tidier. e-sport; a recovery oriented intervention in forensic psychiatry

IntroductionRecently video gaming, have attracted considerable attention for its possible beneficial therapeutic effects, the possibility for testing behavior in safe artificial environments and as a tool for professionals and patients to build specific competencies for the everyday life. Also, a substantial amount of research suggests that videogaming might improve the participants social and cognitive skills and emotional regulation. There is little or no evidence that videogaming increases long term aggression or leads to physical aggression. At a medium secure forensic psychiatric in-patient ward, the patients and staff engage in weekly E – Sport sessions (primarily counterstrike) to further the recovery process.ObjectivesTo provide a standardized description of how E-sport is organized and used in the recovery process among forensic psychiatric patients.MethodsThe Template for Intervention Description and Replication (TIDieR) checklist and guide is widely used to in health research to describe interventions in clinical trials and other health research contexts. By use of TIDieR we describe a newly developed E-sport intervention, in which staff members and patients in a medium secure forensic psychiatric ward engage in weekly E-Sport sessions (primarily counterstrike) to improve patient–staff relationship.ResultsThe E-sport intervention is detailed by use of the 12 TIDieR items and practical experiences and insights will be described.ConclusionsThis standardized and detailed description of how is used in a recovery-oriented process in forensic psychiatry can be used for future studies that wishes to implement the intervention or for research studies replicating the treatment.Conflict of interestNo significant relationships.

Occupational therapy for a client with depression and avoidant personality disorder in the forensic psychiatric ward in Japan:

Occupational therapy for a client with depression and avoidant personality disorder in the forensic psychiatric ward in Japan:

Occupational therapy for patients with schizophrenia who resist treatment in a forensic psychiatric ward in Japan

Occupational therapy for patients with schizophrenia who resist treatment in a forensic psychiatric ward in Japan

Violence rate dropped during a shift to individualized patient-oriented care in a high security forensic psychiatric ward

BackgroundContextual variables such as staff characteristics, treatment programs, assessment routines and administrative structures are found to influence patient violence rates in psychiatric forensic wards. The possible effects of current developments in treatment philosophy emphasizing patientsˈ perspective and treatment involvement upon violence rate have not yet been examined. The aim of this paper is to analyse associations between such developments and the occurrence of violent incidents among patients in a high security forensic psychiatric ward.MethodsDuring a 17-year period with stable ward conditions, incidents of violence were systematically collected together with diagnostic, risk assessment and demographic patient characteristics. Changes in care- and organizational related variables such as nursing staff characteristics, treatment and management routines were collected. Multilevel modelling was applied to estimate the relationship between these variables and changes in violent incidents.ResultsA substantial decline in the occurrence of violent incidents paralleled with changes in the ward during the middle phase of the study period. Most of the changes, such as implementation of new treatment and care routines and an increased proportion of female staff and higher education levels, were significantly related to a decrease in the occurrence of violent incidents in the ward.ConclusionsFindings in this study suggest that an increase in individualized, patient-oriented care strategies, delivered by well-educated nursing staff with an equally balanced gender distribution contribute to a low level of violence.

Employment-Related Factors of Forensic Psychiatric Outpatients with Psychotic Disorders.

PurposeEmployment is important for forensic psychiatric patients with psychotic disorders, in terms of reduction in symptoms, improving the quality of life, and preventing re-offenses. However, few detailed studies on employment status in such patients exist. We aimed to determine the employment rate among forensic psychiatric outpatients with psychotic disorders and identify the factors associated with employment.Patients and methodsThe study population comprised 406 patients with psychotic disorders who completed a forensic outpatient treatment order, were aged <65 years at discharge from a forensic psychiatric ward and provided written informed consent. Psychotic disorders were defined as psychiatric disorders classified into F2 in the International Statistical Classification of Diseases and Related Health Problems, 10th edition. Demographic data were collected from the medical records of the inpatient treatment period. Prognostic data during the outpatient treatment order period was provided by the reintegration coordinators responsible for coordinating the patients’ social environment during this period. Exploratory univariate and multivariable logistic regression analyses identified the factors associated with employment.ResultsThe mean age at discharge was 44.4±10.8 years. The mean follow-up period was 2.69±1.01 years. There were 4.6 times more men (n=334) than women (n=72). During the outpatient treatment order period, 56 of 406 participants achieved employment (13.8%). Participants who committed serious crime, including homicide, arson, robbery, and sexual assault, had a lower employment rate compared to participants who committed bodily injury crimes (multivariable odds ratio, 0.421; 95% confidence interval, 0.220–0.807). History of substance use and living with family after discharge from a forensic psychiatric ward positively contributed to employment.ConclusionThe employment rate among forensic psychiatric outpatients with psychotic disorders was low and was similar to that reported in previous studies on general psychiatric patients with schizophrenia. Furthermore, serious criminal behavior negatively impacted employment.

Mortality and suicide rates in patients discharged from forensic psychiatric wards in Japan

BackgroundJapanese forensic mental health services for patients with psychiatric disorders under the Medical Treatment and Supervision Act was initiated in 2005; however, the prognosis of those patients is not well-known, particularly regarding mortality and suicide. This study aimed to evaluate the all-cause mortality and suicide rate in forensic psychiatric outpatients who had been discharged from forensic psychiatric wards in Japan. MethodsParticipants included 966 patients who had been discharged from forensic psychiatric wards. Data were collected from July 15, 2005 to July 15, 2018 at 29 of the 33 forensic psychiatric wards in Japan. Only the patients who provided written informed consent were included. We and collaborators at each forensic psychiatric ward identified demographic data of participants from the medical records for the inpatient treatment period. The reintegration coordinators, who belonged to the Ministry of Justice, investigated the prognosis of the participants during the outpatient treatment order period. We then connected demographic data and participants’ prognosis for analysis. The crude rates (CRs) and standardized mortality ratios (SMRs) were calculated to analyze all-cause mortality and suicide rates. Univariate analysis was performed to examine the factors associated with all-cause mortality and suicide rates using the Cox proportional hazards ratio model. ResultsThe participants included 3.3 times as many men (n=739) compared to women (n=227), and their combined mean age was 47.3 (SD=12.9). The most common primary psychiatric diagnosis was psychotic disorders (81.3%). The mean follow-up period was 790.2 days (SD=369.6). The total observation period was 2091.2 person-years. The CR for all-cause death was 812.9 per 100,000 person-years (95% CI [426.5, 1199.4]), while the SMR for all-cause death was 2.2 (95% CI [1.3, 3.5]). The CR for completed suicide was 478.2 per 100,000 person-years (95% CI [181.8, 774.6]). The suicide SMR was 17.9 (95% CI [8.6, 32.9]) overall, 7.7 (95% CI [2.5, 18.0]) for men, and 79.4 (95% CI [25.8, 185.2]) for women. Univariate analysis showed that women had higher completed suicide risk than men (hazard ratio=3.599, 95% CI [1.041, 12.445]). ConclusionThe all-cause mortality and completed suicide rates were higher in participants than observed in the general population consistent with the results of previous international studies.

‘The Art of Understanding in Forensic Psychiatric Care’ – From a Caring Science Perspective Based on a Lifeworld Approach

Patients in forensic psychiatric clinics are a vulnerable and exposed patient group due to suffering from a severe mental disorder, having committed a crime and being cared for against their will in an institutional environment with a high level of security. The art of understanding in forensic psychiatric care is discussed from a caring science perspective, based on a lifeworld approach. The aim is to contribute knowledge that can support staff, who daily meet patients on forensic psychiatric wards, in applying a caring attitude.

Rhythm2Recovery: A Model of Practice Combining Rhythmic Music with Cognitive Reflection for Social and Emotional Health within Trauma Recovery

Rhythm pervades life in almost every context, from the smallest pulsating atom to the epic scale of our expanding universe. In our behaviour we are creatures of rhythm, following, initiating, and embedding patterns from the moment we are born, and within our physical anatomy rhythm is ever present, from our beating heart, through the rise and fall of our lungs and across the firing of our neurons. Healing traditions across all cultures invoke the rhythms of music, and the latest research from the field of neuro‐biology into the way this element impacts the brain, reinforces this traditional knowledge and provides a new understanding of the real potential for rhythmic music to be utilised in therapy. This article details the use of rhythmic music in combination with cognitive behavioural therapy as a model for practitioners working with those recovering from trauma, and the supporting evidence validating this approach. Since 2003 this model has been utilised in diverse settings from behavioural centres for young people at risk to refugee trauma centres, forensic psychiatric wards in prisons, and child and adult mental health services. Currently over 4,000 professionals across 20 different countries have completed training in this model. Consistent feedback has highlighted the value of this model in engaging clients not readily engaged in ‘talk‐based’ therapies, increasing social connection, and reducing psychological distress. The benefits of playing music socially with others, and of rhythmic music specifically, include increased levels of social integration, improvements in affect, mood stabilisation, reductions in anxiety and depression, and increases in self‐esteem. When combined with exercises that draw attention and initiate reflection on important life issues, such as improving relationships and overcoming adversity, this has the added benefit of utilising the whole brain and embedding learning at a deeper level.

CAPS judiciário: Opção necessária para uma justiça saudável

O presente artigo apresenta as bases teóricas para a extensão do serviço substitutivo de atenção em saúde mental para o “louco infrator”. Propõe-se a criação de um novo modelo de Centro de Atenção Psicossocial que atenda aos usuários internos em hospitais de custódia, manicômios judiciários ou alas de tratamento psiquiátrico de presídios. Com um enfoque argumentativo, são dadas as diretrizes e os parâmetros de implementação do ora denominado Centro de Atenção Psicossocial Judiciário (CAPSj). São apresentadas as razões para sua criação, o funcionamento e a estrutura; são refutadas as críticas à ideia e discorre-se sobre o impacto positivo ao sistema prisional e à sociedade.

Zusammenhänge des Stationsklimas mit objektiven Rahmenbedingungen psychiatrischer Stationen

Investigate inter-relations of objective conditions and a ward's social climate. Staff and patients on 104 wards filled in the short Essen Climate Evaluation Schema (EssenCES). Assessments were related to setting variables (like open vs. closed wards, forensic vs. general psychiatric wards, ward size, staffing). Setting variables and climate characteristics are strongly associated. The EssenCES, originally catered for forensic settings, proved to be useful to characterize general psychiatric wards. A number of suggestions regarding relevant setting conditions are clearly confirmed (like staffing level; open vs. closed wards). Remarkably, staff experience a higher level of Safety on forensic than on general psychiatric wards. Patients' Cohesion and Therapeutic Hold are rated higher on general psychiatric wards. Heterogeneity of patients (vs. specialization of wards) is not positively related to climate characteristics; staff experiences less Safety on non-specialized wards.

Identification of a new psychoactive substance in seized material: the synthetic opioid N-phenyl-N-[1-(2-phenethyl)piperidin-4-yl]prop-2-enamide (Acrylfentanyl).

Among the new psychoactive substances (NPS) that have recently emerged on the market, many of the new synthetic opioids have shown to be particularly harmful. A new synthetic analogue of fentanyl, N‐phenyl‐N‐[1‐(2‐phenethyl)piperidin‐4‐yl]prop‐2‐enamide (acrylfentanyl), was identified in powder from a seized capsule found at a forensic psychiatric ward in Denmark. Gas chromatography with mass spectrometry (GC‐MS) identified a precursor to synthetic fentanyls, N‐phenyl‐1‐(2‐phenylethyl)piperidin‐4‐amine; however, the precursor 1‐(2‐phenethyl)piperidin‐4‐one, was not detected. Analysis of the electron impact mass spectrum of the main, unknown chromatographic peak (GC) tentatively identified an acryloyl analogue of fentanyl. Further analyses by quadrupole time‐of‐flight high resolution mass spectrometry (QTOF‐MS), matrix‐assisted laser ionization Orbitrap mass spectrometry (MALDI‐Orbitrap‐MS), nuclear magnetic resonance spectroscopy (NMR), and infra‐red spectroscopy (IR) confirmed the presence of acrylfentanyl (also known as acryloylfentanyl). Quantitative analysis with liquid chromatography and triple quadrupole mass spectrometry (LC‐MS/MS) determined the content of acrylfentanyl in the powder, equal to 88.3 mass‐% acrylfentanyl hydrochloride. An impurity observed by NMR was identified as triethylamine hydrochloride. Acrylfentanyl is sold on the Internet as a ‘research chemical’. Like other synthetic fentanyls, such as acetylfentanyl, it poses a serious risk of fatal intoxication. Copyright © 2016 The Authors. Drug Testing and Analysis Published by John Wiley & Sons Ltd.

Predictive accuracy of the Historical-Clinical-Risk Management-20 for violence in forensic psychiatric wards in Japan.

Most structured assessment tools for assessing risk of violence were developed in Western countries, and evidence for their effectiveness is not well established in Asian countries. Our aim was to examine the predictive accuracy of the Historical-Clinical-Risk Management-20 (HCR-20) for violence in forensic mental health inpatient units in Japan. A retrospective record study was conducted with a complete 2008-2013 cohort of forensic psychiatric inpatients at the National Center Hospital of Neurology and Psychiatry, Tokyo. Forensic psychiatrists were trained in use of the HCR-20 and asked to complete it as part of their admission assessment. The completed forms were then retained by the researchers and not used in clinical practice; for this, clinicians relied solely on national legally required guidelines. Violent outcomes were determined at 3 and 6 months after the assessment. Receiver operating characteristic analysis was used to calculate the predictive accuracy of the HCR-20 for violence. Area under the curve analyses suggested that the HCR-20 total score is a good predictor of violence in this cohort, with the clinical and risk sub-scales showing good predictive accuracy, but the historical sub-scale not doing so. Area under the curve figures were similar at 3 months and at 6 months. Our results are consistent with studies previously conducted in Western countries. This suggests that the HCR-20 is an effective tool for supporting risk of violence assessment in Japanese forensic psychiatric wards. Its widespread use in clinical practice could enhance safety and would certainly promote transparency in risk-related decision-making. Copyright © 2016 John Wiley & Sons, Ltd.

Assessment of the needs and clinical parameters in patients with mental disorders residing in forensic psychiatry wards with varying degrees of security.

Aim of the studyThe aim of the study was to compare patients treated in court psychiatric wards with both low and medium security in terms of the needs, the severity of psychopathological symptoms, subjective assessment of quality of life and satisfaction with treatment.Subject or material and methodsThe research was conducted at the Regional Mental Hospital in Lubiąż. The study involve patients interned at two Low Security Forensic Psychiatric Wards (n=50) and one Medium Security Forensic Ward (n=43). The study included 93 male patients. The study used the following research tools: Camberwell Needs Assessment Scale for Forensic Patients (CANFOR), sociodemographic and clinical data questionnaire, BPRS, CAT, MANSA.ResultsPatients at the medium security ward reported greater overall needs (mean 3,86 vs. 2,96, p= 0,037) and a greater number of unmet needs (mean 1,51 vs. 0,80, p=0,009) . Overall severity of psychopathology (mean 2,41 vs. 1,93 p&lt;0,001), including deficits and positive symptoms, was higher among patients of the low security ward.DiscussionResults proves that medical care in the wards with low and medium security is at a similar level. Qualification of people sent to medium security wards does not depend on their mental health but on the nature of the act they had committed, which in this case is more serious than for those directed to low security wards.ConclusionsThe services provided in the forensic psychiatric wards, and especially in the group of patients in medium security wards, do not sufficiently met the needs of patients.

Caring potentials in the shadows of power, correction, and discipline—Forensic psychiatric care in the light of the work of Michel Foucault

The aim of this article is to shed light on contemporary forensic psychiatric care through a philosophical examination of the empirical results from two lifeworld phenomenological studies from the perspective of patients and carers, by using the French philosopher Michel Foucault's historical–philosophical work. Both empirical studies were conducted in a forensic psychiatric setting. The essential results of the two empirical studies were reexamined in a phenomenological meaning analysis to form a new general structure in accordance with the methodological principles of Reflective Lifeworld Research. This general structure shows how the caring on the forensic psychiatric wards appears to be contradictory, in that it is characterized by an unreflective (non-)caring attitude and contributes to an inconsistent and insecure existence. The caring appears to have a corrective approach and thus lacks a clear caring structure, a basic caring approach that patients in forensic psychiatric services have a great need of. To gain a greater understanding of forensic psychiatric caring, the new empirical results were further examined in the light of Foucault's historical–philosophical work. The philosophical examination is presented in terms of the three meaning constituents: Caring as correction and discipline, The existence of power, and Structures and culture in care. The philosophical examination illustrates new meaning nuances of the corrective and disciplinary nature of forensic psychiatric care, its power, and how this is materialized in caring, and what this does to the patients. The examination reveals embedded difficulties in forensic psychiatric care and highlights a need to revisit the aim of such care.

Stress levels of psychiatric nursing staff

During a total of 30 shifts, the arousal levels of 10 psychiatric nurses were assessed while working on a (forensic) psychiatric admissions ward. Arousal was assessed by means of a small device (wristband) by which the Skin Conductance Level (SCL) of the participating nurses was monitored. Each nurse was assessed during a full day, evening, and night shift. In the distribution of the SCL over the hours of the day, several elevations of the arousal levels were clearly visible during specific events. Additionally, an association was found between the neuroticism level of the staff members and their arousal level during their work.

Why do girls freak out? Exploring female rage among adolescents admitted to adolescent forensic psychiatric inpatient care

Objective: To explore the characteristics of girls displaying frequent aggressive behaviors on an adolescent forensic psychiatric ward. Materials and methods: On an adolescent forensic ward, demographics, family, treatment, crime and victimization histories, diagnoses, and symptoms of all adolescents are collected in a cumulative database. Regarding these, girls displaying excessive aggressive behaviors were compared with other girls, all the boys, and boys displaying frequent aggressive behaviors. Their case histories were further qualitatively explored to find characteristics associated with female violence in the literature. Results: The studied girls were the most severely ill among adolescents admitted, and had suffered most the unfortunate backgrounds with parental mental disorders, poor parental management, early caregiver disruption, community disorganization, lack of social support, and being victims of sexual abuse. They displayed a wide range of psychiatric symptoms on different symptom dimensions. Conclusion: Treatment cannot focus solely on aggression management. Extensive psychiatric needs have to be met.

To be Strategically Struggling against Resignation: The Lived Experience of Being Cared for in Forensic Psychiatric Care

To be referred to care in forensic psychiatric services can be seen as one of the most comprehensive encroachments society can impose upon a person's life, as it entails a limitation of the individual's freedom with no time limit. This study focuses upon patients’ experiences of their life situation in forensic psychiatric wards. Using a Reflective Lifeworld Research approach founded in phenomenology, we analysed 11 qualitative interviews with patients cared for on a maximum security unit in a Swedish forensic psychiatric service. Results show how forensic psychiatric care can be non-caring with only moments of good care, from the patient's perspective. By using different strategies, the patients attempt to adapt to the demands of the caregivers in order to gain privileges. At the same time the patients are lacking meaningful and close relationships and long to get away from the system of forensic care. Being cared for entails struggling against an approaching overwhelming sense of resignation.

Patient Autonomy versus Risk Management: A Case Study of Change in a High Security Forensic Psychiatric Ward

Increased attention to the civil rights of general psychiatric patients has been an issue for over 30 years. Similar processes in forensic settings have been slower, because of safety and security needs. This paper explores the development of patient autonomy, as well as rates of violence and escape incidents, in a Norwegian high-security forensic psychiatric ward over an 18-year period. A historical documentary method was applied using quantitative and qualitative data. Multiple sources were analyzed, including focus group interviews among current and former staff, reviewing of official documents and staff notes, and examination of records of violent incidents and escapes. Several indicators of increased patient autonomy were found. These were paralleled by more dynamic and individualized routines for treatment and managing risk, new laws, and changed staff characteristics over the study period. Violent incidents decreased, and frequency of escape has remained low. We conclude that maintaining security is compatible with increased patient autonomy and a more normalized everyday life in forensic settings. We infer that changes in patient-staff interactions, related to implementation of relational and dynamic security, may have influenced the process toward increased patient autonomy.

P03-358 Clozapine may be the answer: a case report of elevated serum creatine kinase in the absence of NMS

ObjectivesTo highlight significant increase in serum creatine kinase(CK) without occurrence of Neuroleptic Malignant Syndrome (NMS), during treatment with atypical antipsychotics (Olanzapine and/or Quetiapine) in a patient with paranoid schizophrenia and the absence of recurrence on treatment with Clozapine.MethodsClinical biochemistry data was collected at regular intervals to monitor the relevant changes in serum CK levels,of a patient with paranoid schizophrenia who was an inpatient in our low secure forensic psychiatric ward in 2008-09. We also did a literature search in Pubmed and Google with the key words ‘Increase in serum Creatine Kinase’ and ‘antipsychotics’.ResultsOur patient developed a significant increase in serum CK levels with Olanzapine and also Quetiapine without the occurence of NMS. The CK levels came back to normal on stopping these medications.Following this he was initiated on Clozapine and has remained stable for almost a year without a significant increase in serum CKlevels. There have been previous case reports on the use of Clozapine in patients with significant increase in CK secondary to other antipsychotics, without recurrence in elevation of creatine kinase.ConclusionsClinicians should be aware that Clozapine can be considered as a treatment option in patients presenting with (non NMS) significant increase in CK due to other antipsychotics. Clozapine has been known to cause Neuroleptic Malignant Syndrome and previous literature suggests Clozapine-induced NMS may present with fewer extrapyramidal side effects and a lower rise in Creatine Kinase levels.