Forensic Psychiatry Unit Research Articles

EPA-0183 - Factors related to the duration of the hospitalization by schizophrenic patients under compulsory treatment

Aims Patients with criminal history and without criminal responsibility under compulsory treatment at the forensic psychiatry unit of Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases are included in the study and the relationship of various parameters like sociodemographic and clinic features and forensic histories are compared with the duration of the hospitalization (1,2). Method One-hundred five schizophrenic patients are included to the study. Patients were divided into three different groups according to the duration of hospitalization. Each group included 35 patients: 1. Group: 2–6 months, 2. Group: 1–3 years, 3. Group: more than 3 years of time. An Interview Form of the Unit Identifying Sociodemographic Properties, Disease and Criminal Characteristics of the Patients, Positive and Negative Syndrome Scale (PANSS), Scale for Assessment of Three Components of Insight, Calgary Depression Scale for Schizophrenia and the Perceived Social Support Scale of the Family were applied. Results Our data indicated that to be convicted before, to be under compulsory treatment before, severity of the criminal act and the level of insight seem to associate with duration of hospitalization of schizophrenic subjects under compulsory treatment. Besides parameters like the age of onset of schizophrenia, being under guardianship and the frequency of visitors were statistically different among the groups. Conclusion Our data underlines the importance of the level of insight, which plays a crucial role at the length of hospitalization for patients with schizophrenia in forensic units.

A 4-year review of psychiatrists’ participation in prosecutorial workshops on criminal capacity

<p><strong>Objective.</strong> The objective was to review psychiatric involvement in seven prosecutorial workshops on criminal capacity between 2004 and 2009. The aim was to evaluate the changing role of the psychiatrists in the workshops in order to identify areas in forensic psychiatry where prosecutors have a specific need for training, and to identify more suitable methods of training.</p><p><strong>Method.</strong> The workshop programmes, copies of presentations, the number of attending prosecutors at each workshop, informal personal notes from the presenters, suggestions from meetings in preparation for workshops and formatted feedback reports were reviewed. Information from a total of seven workshops was reviewed and interpreted by 2 psychiatrists from Weskoppies Hospital Forensic Psychiatry Unit (WHFPU). <strong></strong></p><p><strong>Results.</strong> The psychiatrists’ involvement increased over the years. Problematic topics that were identified include non-pathological criminal incapacity, child psychiatry and the different roles of the psychiatrist and the psychologist in court. Exposure to practical aspects, interactive workshops with case presentations, discussion groups and audience participation seemed to be the preferred method of training. Attitudes of prosecutors towards psychiatry improved with increased knowledge and understanding of the field, and overall the training was rated as relevant and enriching.</p><p><strong>Conclusion.</strong> Psychiatrists can offer valuable training opportunities to legal professionals about the major mental illnesses and how they can affect criminal capacity, but evaluation of the training should be an ongoing process to address changing needs. Training sessions provide an opportunity for reciprocal sensitisation between the different fields. The ultimate goal is to work towards improved association between the criminal justice and mental health systems.</p>

A Follow-up Interview of Patients Eight Years after Discharge from a Maximum Security Forensic Psychiatry Unit in Norway

Research on the fate of patients after discharge from maximum security psychiatric care is scarce. Nonetheless, results indicate that readmission and reconviction rates are unacceptably high. Our research aimed to address three main issues: (1) to report findings from an eight-year follow-up of 125 patients discharged from a maximum security forensic unit (MSU) and to compare the results with studies from other countries; (2) to explore the feasibility and usefulness of face-to-face interviews (N= 38) as compared to using the traditional register-based follow-up method; and (3) to explore differences in psychosocial functioning from discharge to follow-up as a correlate of outcome. Findings replicated results from other research concerning rates of readmission, reconviction, and the strong association between substance abuse and the likelihood of being readmitted to the MSU. Despite methodological limitations, the face-to-face interview appeared to enhance access to significant clinical and psychosocial information. When compared with official records, patients’ self-report was reliable for violent crime, not reliable concerning petty crime, and significantly more accurate for crimes pertaining to illegal drugs. Being readmitted to the MSU predicted decreased GAF-score values (OR =−12.89), and living with family predicted increased GAF-score values (OR = 19.20) in the multivariate linear regression analysis.

Patients Admitted to a Maximum Security Forensic Psychiatry Unit in Norway: A Case File Analysis of Demographic, Psychosocial, Clinical and Criminal Characteristics

Every year, 25 to 30 patients are admitted to the maximum security unit at Ullevål University Hospital in Oslo, Norway. The unit has 25 beds and covers a catchment area of some 2.4 million inhabitants. The main scope of this study was to monitor and analyze demographic, psychosocial, clinical, and criminal characteristics of the patient population, with a special focus on possible associations between psychosocial conditions, mental illness, substance abuse, violence, and criminality. Three independent raters scrutinized hospital case files from index hospitalization of all patients (N = 125) that had been admitted during a 4-year period. A codebook specially developed for this research was used, and the scoring was subsequently determined by consensus between the raters. Being exposed to physical or sexual abuse in childhood was associated with the father being mentally ill (multivariate logistic regression, OR = 19.4, 95% CI = 3.4–111). Having a history of violence was associated with previous conviction (OR = 2.6, 95% CI = 1.01–6.8). Homicide was associated with personality disorder (OR = 19.0, 95% CI = 1.9–187.0) and having previously been admitted to a psychiatric institution (OR = 9.9, 95% CI = 2.5–39.4). Our findings are discussed in relation to methodological flaws and other research in the area.

Perpetrators of homicide with schizophrenia: sociodemographic characteristics and clinical factors in the eastern region of Turkey

In this study, we aimed to describe the social and clinical characteristics and offense details in a sample of people with schizophrenia convicted of homicide in the eastern region of Turkey. This study was performed in Elazig Mental Hospital between November 2004 and May 2007. We included 43 men and 6 women with schizophrenia convicted of homicide who were hospitalized in the forensic psychiatry unit for compulsory treatment. Preset data recording forms were used. The first part of the forms contained questions regarding the age, sex, marital status, residence, educational status, and occupation of the patients. The second part of the forms included questions about some clinical features of patients with schizophrenia: the presence of schizophrenia in any family member, duration of the disease, subtype of schizophrenia, previous contact with mental health services, types of antipsychotics (first and last drug used), and adherence to antipsychotic medication. The third part of the forms dealt with alcohol-substance abuse and features of the victim (sex of the victim and whether the victim was a stranger, partner, or an ex-partner in the family or an acquaintance). The mean ± SD age of our patients was 36.98 ± 10.07 years, and 55.1% of the patients were unmarried. In our sample, 42.9% of the patients were primary school graduates and 75.5% were unemployed. Of the perpetrators, 14.3% never had contact with mental health services. However, 85.7% of patients had previous contact with mental health services. We found that 85.7% of the patients were paranoid subtype and 85.7% were not using their medication regularly and that treatment compliance was considerably low. We found that haloperidol and trifluoperazine were the most preferred antipsychotic drugs, particularly being the first drugs used during treatment (haloperidol, 71.4%; trifluoperazine, 10.2%) and the last antipsychotics used before the offence (haloperidol, 46.9%; trifluoperazine, 20.4%). In 38.8% of cases, schizophrenia was present in the first-degree relatives. We also found that 69.4% of victims were one of the family members. In our sample, 24.5% of patients were using alcohol and 4.1% were using cannabis. It is plausible that rendering more effective communication might allow earlier intervention for unrecognized and possibly unrecognizable risk factors of homicidal acts in people with schizophrenia.

The homicide phenomenon: The role of mental ilness

Background and Aims:The homicide phenomenon is a complex phenomenon that enhances Man complexity. This study aims to contribute to a better understanding of this phenomenon and its protagonists.Methods:Data were collected from clinical records of a Forensic Psychiatry Unit (Magalhaes Lemos Hospital) using a specific clinical protocol, being selected those with “homicide or homicide attempt” as the motive for evaluation.Results and Discussion:The sample was mainly formed by men (94.4%M vs. 5.6%F), with an average age of 37.78 years-old (sd +- 13.63), mostly single (n=25; 53.2%) and unemployed (n=24; 44.4%). The majority of the individuals were detained in a prisional facility (n=35; 64.8%). Thirteen of the victims were first degree relatives to the murderers. Homicide was consumed in 29 cases and in 25 of them it was a failed attempt. Twelve individuals (22.2%) were under suspicion of drug abuse (mainly alcohol) at the moment of the crime. The murderers percentage with psychiatric surveillance was 40.7% (n=22); 90.7% (n=49) had a psychiatric diagnosis and 27.8% (n=15) had a Psychotic Disorder. There were found a significant number of individuals with mental retardation and personality disorder. The conclusion of psychiatric forensic evaluation was “criminal responsibility” in thirty individuals (55.6%). Twenty individuals were considered “not criminally responsible” and psychiatric treatment and security measures were proposed.Conclusions:The homicide act of the individuals proposed for Forensic Psychiatric evaluation seems to be an isolated phenomenon that appears mostly in individuals with mental illness, often those having alcohol abuse or dependence.

The Insanity Defense in Iraq

Iraq, as the cradle of civilization, was the place where the first statute was ever written and the first mental health legislation made. Ironically, however, at this time there is no identified legislation of any kind of mental health law. Insanity defenses are used freely but there is no officially identified test for insanity, although M'Naghten tests seem to be used the most. The judge usually gives the psychiatrist the prerogative of deciding on the insanity issue directly. Typically, the judge—and sometimes the defense—calls for the evaluation by a forensic psychiatrist. This article reviews the demographics, psychiatric diagnosis, and management of patients in Iraq's sole forensic psychiatry unit. The majority of defendants stay a relatively short period of time—generally less than five years—in the forensic psychiatry unit and leave without a specific safeguard to prevent relapse and re-offending. Most of the “insane” offenders were found to be schizophrenics, males, and younger than 30 years of a...

An Audit of a Specialist Old Age Psychiatry Liaison Service to a Medium and a High Secure Forensic Psychiatry Unit

The elderly prison population is increasing and there is a significant amount of unidentified psychiatric morbidity among elderly prisoners. A sizeable number of elderly subjects are referred to regional forensic units. These units are able to provide advice but are reluctant to admit frail, physically ill and vulnerable elderly into their unit because the ward environment is considered inappropriate for them. A sizeable number of inpatients in medium and high secure units are elderly. This paper is an exploratory audit of referrals from a medium and high secure forensic psychiatry unit to a specialist consultation-only liaison old age psychiatry service, which was specifically developed to service the forensic unit. The demographic and clinical characteristics of the patients seen by this specialist service were similar to elderly inpatients in medium and high secure units. All referrals were judged to be appropriate and new management advice was provided in all cases. Main reasons for referral included diagnostic advice, placement advice and treatment advice. Establishing a diagnosis of dementia was considered important because Alzheimer's disease and Lewy body dementia can be treated with cholinesterase inhibitors. Placement advice was the most difficult to provide because of paucity of residential and nursing homes able and willing to accept patients with a forensic history. There is a need for a comprehensive model of specialist forensic old age psychiatry service at a regional or supraregional level. A consensus needs to be reached on the exact configuration of such a service.

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.

Devolution of clinical governance mechanisms to units and teams

The subject matter of Gralton et al 's paper ([2000][1], this issue) is quite important: the devolution of clinical governance arrangements to a forensic psychiatry unit, which is part of a larger trust. The arrangements described are also unique, in that they involve a large number of members of

Factors associated with homicide recidivism in a 13-year sample of homicide offenders in Finland.

Data on persons known to have committed homicide during a 13-year period were studied to determine factors associated with increased risk of repeating homicide. Between 1981 and 1993, a total of 1,649 homicides were committed in Finland. In 1,089 cases (66 percent), the offenders received an exhaustive forensic psychiatric examination. Data from reports of these examinations were analyzed to determine whether mental disorder and other factors were associated with homicide recidivism. Thirty-six homicide recidivists were identified. Twenty-four were alcoholics, 23 had a personality disorder, in most cases combined with alcoholism, four had schizophrenia, and two had major depression. Homicidal behavior was ten times more likely in men who had committed a previous homicide than in the general male population. Alcoholism increased the odds ratio of additional homicidal behavior in male homicide offenders about 13 times, and schizophrenia increased the odds ratio more than 25 times. During their first year after release from prison, male homicide offenders were about 250 times more likely to commit homicide than members of the general male population. The data suggest that mentally abnormal offenders are overrepresented among homicide recidivists in Finland. The risk of repeat homicide appears to be very high during the first year after release from prison.

Dementia and crime: A forensic psychiatry unit study in israel

AbstractThe psychiatric files of the 57 consecutive defendants aged 60+ referred by court for psychiatric examination at the Forensic Psychiatry Unit at the Y. Abarbanel Mental Health Center in the period 1982–1992 were retrospectively evaluated. The objectives were as follows: (a) to compare some assessment aspects of dementia patients with those of psychotics and personality disorders; (b) to compare how the questions of competency to stand trial, legal responsibility and competency to be sentenced were differentially approached. Of the 57 elderly patients surveyed, 17 (30%) suffered from dementia, 14 (25%) from a functional psychosis and 16 (28%) from a personality disorder. These three groups of psychiatric patients were found to be quite similar regarding the demographic and criminal variables studied. However, dementia patients occupied an intermediate position between the psychotics and personality disorders when assessment characteristics, psychiatric and legal recommendations to the court were considered.

Application of the Megargee MMPI Typology to a Forensic Psychiatric Population

Generalizability of a previously established MMPI-based classification system that was developed using a criminal population (Megargee & Bohn, 1979) was investigated using a sample of 151 patients in a forensic psychiatry unit. Comparison of Megargee and Bohn's (1977) prisoners and the forensic sample indicated significantly different proportions occurring for three of the ten groups with significantly higher proportion of the forensic sample occurring in the five more elevated profile types. Comparison of the three most common groups revealed a significant difference on the Beck Hopelessness Scale. These findings are taken to support the applicability of the Magargee system to a hospitalized population.

Management of mentally ill offenders in South Africa: The assessment and rehabilitation program in Cape Town

Forensic psychiatry services in South Africa are centred at the larger psychiatric hospitals; five of these centres are located in the teaching hospital departments of psychiatry at university medical schools. Psychiatric consultative services in general are more available in the larger cities, and thus each hospital with a forensic service serves a large rural area in addition to its immediate urban surroundings. These areas are fortunately almost identical to those delineated by the provincial judicial divisions of the Supreme Court of South Africa. South Africa must be considered as still developing in the psychiatric field in comparison with other medical specialities. One of the contributory factors is the low number of psychiatrists and other mental health professionals available to the population. However, it is obvious that if the judiciary is to operate efficiently, forensic psychiatry services to the courts and prisons must be available, efficient and adequate. A realisation of this has led to rapid expansions. South Africa has a population of approximately 28 million, which is cared for by 14,000 medical practitioners of all specialities. The Specialist Register of Psychiatrists of the S.A. Medical and Dental Council lists 120 practising members. Only 47 of these are in full-time hospital appointments. The operation and experiences of the Forensic Psychiatry Unit in Cape Town illustrates the management of the mentally ill offender. This service is provided to the Department of Justice for the entire Western Cape, parts of the Cape Province and occasionally South West Africa. The unit is situated within Valkenberg Hospital, a teaching hospital within the University of Cape Town/Groote Schuur Hospital complex. The service is involved with the total assessment of court referrals as well as the treatment, management and rehabilitation of the mentally ill offenders in graded facilities ranging from a Maximum Security Ward to a rural training centre within a farming community. Valkenberg Hospital provides services to a population of 2 million and has seven psychiatrists in total together with medical officers and psychiatrists-intraining. Only one psychiatrist is involved full-time with the Forensic Psychiatry Unit. One group of professionals remains responsible for all phases of assessment and rehabilitation.