General Psychiatric Hospital Research Articles

Verbal Intelligence and Criminal Offending Among Men With Schizophrenia

There are well-documented associations between low verbal IQ and criminal offending and between low verbal IQ and early-onset persistent offending among males in the general population. This study was designed to test whether similar associations could be observed in a sample of 219 men with schizophrenia and schizoaffective disorder. The participants were recruited at discharge from forensic and general psychiatric hospitals in four sites in Canada, Finland, Germany and Sweden. In the weeks preceding discharge, information was collected from participants, family members, staff, and official records. The results demonstrated that low verbal IQ was not associated with the risk of criminal offending, nor with the numbers of offences, but with the age at first non-violent offence. Low verbal IQ was associated with lengthy stays in hospital that may have limited further criminal offending.

Die Bewertung tagesklinischer Behandlung durch die Patienten - Aspekte der Behandlungserfahrungen und erlebte Veränderungen

At the end of their treatment, 48 patients, having attended the day clinic of a general psychiatric hospital, evaluated important aspects of their therapy. These evaluations were analysed. In resulting with the norm sample of the inpatient experience questionnaire (SEB), more positive values were obtained for all the scales. The scales "experiences of relationship to individual therapist" and "experiences of relationship to the therapeutic team" yielded the highest values for patient satisfaction. We found that the categories of "general documentation about change through treatment" within the Psy-BaDo are relevant for patients attending a day clinic treatment. There is evidence for a large improvement with respect to all categories. Highest changes were reported for the subjects "understanding of the individual illness", "body symptoms" and "psychological well-being". Smaller changes were reported for the subjects "private relationships", "relationships in job" and "social problems". Compared to the patients, the therapists' estimate of the changes were lower. On an individual basis, the assessments of the patient and therapist agreed well. Sociodemographic characteristics and other criteria of the illness and therapy were not well associated with the scales of the SEB and the categories of Psy-BaDo. Only the duration of symptoms and the frequency of previous inpatient therapies were clearly associated with the categories of Psy-BaDo. The data, derived from standardized questionnaires, enable comparisons to be made between different institutions and provide evidence for a very positive evaluation of the investigated treatment.

Preventing Suicidal Behaviour in a General Hospital Psychiatric Service: Priorities for Programming

General hospital psychiatric services are able to provide leadership and coordinate the development of suicide prevention programs for individuals serviced in general hospital settings. We completed this literature review to suggest priorities for programming. Our procedure was to update the review by Gunnell and Frankel that guided priorities for Health of the Nation, the national suicide prevention strategy in the UK. We completed a search, using the terms suicide prevention and control, of all English-language research and clinical trials conducted between January 1, 1994, and May 1, 2004. We identified 82 papers. Of these, 48 were excluded and the remaining 34 were grouped by secondary care setting categories. We found no articles on screening tools for predicting risk of suicide, 16 articles on interventions for individuals with suicidal behaviour, 14 articles on the treatment of major psychiatric disorders, 1 article and 1 published abstract on discharge from hospital, and 2 articles on reducing access to means. Based on a review of each category, we make several program and policy recommendations, including regularly updating clinical assessment skills, using guidelines for assessment of patients following a suicide attempt, assessing the risk of suicide 24 to 48 hours before discharge from hospital, and incorporating education about reducing access to means into routine psychiatric care.

Psychiatric Assessment and Consultation

Psychiatric Assessment and Consultation

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Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsJohn DenfordJohn Denford, psychiatrist and psychoanalyst. Early life: medical education and country general practice in Dunedin, New Zealand. Later training in London, England. Experience in general psychiatric and psychotherapeutic hospitals in London and Dunedin. Particular interests: inpatient psychotherapy, group teaching arid therapy, psychotherapy in general practice and hospital practice. Consultant psychotherapist, Shenley Hospital, and The Cassel hospital, Richmond, where later, Medical Director, Medical Coordinator, Medical Foundation for the Care of Torture Victims, for two years after leaving the N.H.S, Trustee, Refugee Therapy Centre.

Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries

Objective To establish whether reinstitutionalisation is occurring in mental health care and, if so, with what variations between western European countries.Design Comparison of data on changes in service provision.Setting Six...

Crime and schizophrenia

The authors sought to identify opportunities for interventions to prevent offending among men with schizophrenic disorders by tracking their histories of offending and admissions to hospital. The study examined 232 men with schizophrenic disorders discharged from forensic and general psychiatric hospitals. Data were collected from participants, family members and official records. The results found that 77.8 per cent of the forensic patients had previously been admitted to general psychiatric services; 24.3 per cent of the general psychiatric patients had a criminal record. Offences had been committed by 39.8 per cent of the forensic patients and 10.8 per cent of the general psychiatric patients before their first admission to general psychiatry.

Preventing crime by people with schizophrenic disorders: the role of psychiatric services.

Knowledge of when and how to implement treatments to prevent criminal offending among people with schizophrenia is urgently needed. To identify opportunities for interventions to prevent offending among men with schizophrenic disorders by tracking their histories of offending and admissions to hospital. We examined 232 men with schizophrenic disorders discharged from forensic and general psychiatric hospitals. Data were collected from participants, family members and official records. More than three-quarters (77.8%) of the forensic patients had previously been admitted to general psychiatric services; 24.3% of the general psychiatric patients had a criminal record. Offences had been committed by 39.8% of the forensic patients and 10.8% of the general psychiatric patients before their first admission to general psychiatry, and after their first admission these 59 patients committed 195 non-violent and 59 violent offences. Subsequently, 49 of them committed serious violent offences that led to forensic hospital admission. The offenders were distinguished by a pervasive and stable pattern of antisocial behaviour evident from at least mid-adolescence. General psychiatry requires resources in order to prevent criminal offending among a subgroup of patients with schizophrenic disorders.

Influencing factors on file-up stress of family caregivers with a family member having a chronic mental illness

The purpose of this study was to identify the factors influencing file-up family stress in the family with a family member having a chronic mental illness. Data was collected by questionnaires from 365 families with a member having a chronic mental illness, in an outpatient clinic of a General Hospital and Government Psychiatric Hospital in Seoul. The data was analyzed using descriptive statistics, pearson correlation coefficients, and stepwise multiple regression. The score of file-up stress showed a significantly negative correlation with the score of level of hardiness (r=-.31, p=.00), family support (r=-.13, p=.00), family cohesion (r=-.25, p=.00), and sense of coherence (r=-.26, p=.00). The most powerful predictor of file-up stress was family hardiness and the variance was 11.1%. A combination of hardiness, family support, and sense of coherence account for 14.8 % of the variance in file-up stress of the family with a member having a chronic mental illness. This study suggests that family support, hardiness, cohesion, and sense of coherence are significant influencing factors on file-up stress in the family with a member having a chronic mental illness.

Unidades de internação psiquiátrica em hospital geral: espaços de cuidados e a atuação da equipe de enfermagem

Este artigo constitui-se numa revisão sobre Unidades de Internação Psiquiátrica em Hospital Geral. São descritas experiências de implantação de Enfermarias de Psiquiatria, pontuando questões sobre a tolerância com o doente mental no hospital geral e a atuação da equipe de enfermagem. Foi feita uma leitura aleatória de trabalhos, artigos, dissertações e teses produzidas no Brasil, nos últimos dez anos. A análise dessas experiências tem por base a Reforma Psiquiátrica, os conceitos de "transição paradigmática", o campo de atenção psicossocial e reflexões sobre a atuação do enfermeiro. Acredita-se que esses equipamentos sejam iniciativas voltadas para a criação de espaços de inclusão do doente mental na sociedade e geradores de propostas transformadoras da enfermagem em saúde mental, mediante a construção de práticas profissionais éticas, terapêuticas, flexíveis e comprometidas com o cuidado de subjetividades.

Urbanisation as a risk indicator for psychiatric admission.

This study examines the independent effect of urbanisation on the risk for admission irrespective of age, sex and marital status. Logit analysis was performed on a dataset containing all first admissions to Dutch general psychiatric hospitals and psychiatric teaching clinics in 1991. Unmarried people and people living in urbanised municipalities have an increased risk of admission in all diagnostic groups analysed. People over 45 have an increased risk of admission for affective psychosis and organic psychosis. Women have an increased risk of affective psychosis. A high level of urbanisation increases the risk of admission in the diagnosis groups studied. However, being unmarried is a higher risk factor.

Proceedings of the 20th Annual Conference of the Japanese Association for Adolescent Psychotherapy, 16 November 2002, Tokyo, Japan

Proceedings of the 20th Annual Conference of the Japanese Association for Adolescent Psychotherapy, 16 November 2002, Tokyo, Japan

The antecedents of aggressive behavior among men with schizophrenia: a prospective investigation of patients in community treatment.

The association between psychotic symptoms and violence is unclear, due in part to methodological features of investigations that have examined this question, and in part to the fact that the association likely differs by disorder and treatment conditions. Using data from The Comparative Study of the Prevention of Crime and Violence by Mentally Ill Persons, we examined 128 men with schizophrenia or schizoaffective disorder discharged from general and forensic psychiatric hospitals in Canada, Finland, Germany, and Sweden. The association between symptoms and aggressive behavior was studied during two 6 month periods when the patients lived in the community. Severe positive and negative symptoms of psychosis, depression, and anxiety were measured at the beginning of each of the 6 month periods. In addition, at the beginning of the second 6 month period changes in symptoms in the previous period were indexed. Aggressive behavior was measured in each 6 month period by reports from patients and from collaterals. During the first 6 months post-discharge, after controlling for the presence of antisocial personality disorder or PCL score and past diagnoses of alcohol/drug abuse/dependence, the presence of a severe positive symptom significantly increased the risk of aggressive behavior. During the second 6 month period, after controlling for antisocial personality disorder or PCL score and self-reported alcohol/drug use, the presence of a severe positive symptom, a TCO symptom, and an increase in TCO symptoms significantly increased the risk of aggressive behavior. Neither depot medications nor obligatory community treatment reduced the risk of aggressive behavior after controlling for the presence of a severe positive symptom and/or TCO symptoms. These findings suggest that, among men with schizophrenia being treated in the community, the presence of severe psychotic symptoms and the development of TCO symptoms are antecedents of aggressive behavior.

Assessment and Aftercare for Deliberate Self-Harm Patients Provided by a General Hospital Psychiatric Service

We report on a sample of 135 deliberate self-harm (DSH) patients who were assessed by a general hospital DSH service, and on those who were offered aftercare by, or telephone open access to, the service. Patients' satisfaction with assessment and treatment, and their outcome were investigated at follow-up 12-20 months later. Four-fifths of patients reported the assessment following DSH to have been helpful and the assessor sympathetic. Thirty-three (24%) of the 135 patients assessed were offered treatment by the DSH service but 13 declined or failed to attend. Of the 20 who engaged in treatment, 17 (94%) were satisfied with their care. Open access to the DSH service by telephone was offered to 53 (39%) patients, nine (22%) of whom reported at follow-up that they had used this facility. A specialist DSH service can effectively assess and treat patients following DSH. It is important that the service is accessible and acceptable to patients.

A preliminary investigation into patterns of aggression in an Australian forensic psychiatric hospital

The aggressive behaviour of psychiatric inpatients has profound consequences for patients, staff, ward atmosphere and psychiatric hospitals in general. Considerable international research exists, primarily conducted in general psychiatric hospitals, on the prevalence and determinants of aggression. Conclusions drawn from this research contribute valuable information about the clinical and demographic characteristics of aggressive patients. There is little Australian research available, however, that contributes directly to aggression management and minimization strategies for local facilities. Furthermore, no published research on aggression in an Australian forensic psychiatric hospital exists. Australian research is required because of the clear influence of situational and cultural contributors to aggression. The aim of this project was to review retrospectively documented incidents of aggression that occurred during the first year of operation of the Thomas Embling Hospital, a forensic psychiatric hospital in Victoria, Australia. Results showed that aggression was prevalent although most likely there was an underestimate of verbal and physical aggression. Acute wards recorded almost 90% of incidents. Proportionately, males and females were similar in both the frequency and type of aggression. Males tended to be aggressive towards males and females were aggressive towards females. Variations in the patterns of physical aggression across wards were found. These variations may have been a consequence of differences in aggression management strategies, particularly the tendency to use restraint and seclusion. The use of seclusion to contain actual or potentially aggressive patients may contribute to more frequent aggression and injury to staff since the staff were more frequently the victims of physical aggression during restraint than by direct assault.

On the admittance of forensic patients to general psychiatric wards

In Germany, due to an increasing number of "hospital order sentences," the capacities of forensic hospitals are exhausted. In the late 1990s,general psychiatric hospitals admitted a remarkable number of mentally disturbed offenders. In this study,data of 140 patients treated in general psychiatric hospitals in the German lower Rhine region are presented. These patients clearly differ from those treated in forensic hospitals. Approximately 60% of them suffer from schizophrenic psychosis. Only a few reveal a long antisocial background, a severe personality disorder, or a sexual offence as an index crime. Though the staff in the general psychiatric units often complain about the circumstances of patients' admittance to the hospitals, in about half of the cases they do not agree with a transferring of their patients to a forensic hospital. The results of this study are discussed in regard to general questions of organizing forensic psychiatric treatment.

Diabetes Mellitus en 93 enfermos esquizofrénicos crónicos

Aims: In an exploratory research of the prevalence of hyperglycaemia or Diabetes Mellitus, type 2, among chronic schizophrenic patients in a chronic ward of a general psychiatric hospital, all patients with the diagnosis of schizophrenia or schizoaffective disorders were asked to cooperate in the study. Methods: Hyperglycaemia or DM, type 2, in the non-fasting patients was diagnosed in accordance with the NHG-guidelines (1999). 93 out of the 99 schizophrenic or schizoaffective patients actually participated in the research. Results: Hyperglycaemia was diagnosed in 11 of the 93 patients, of which only 1 was previously known. The prevalence of hyperglycaemia at the age of 20-49 years was significantly higher than in the general population (15,2% vs 5,7%, OR = 2.959. CI = 1.230-7.119, p < 0.05). The general prevalence of DM, type 2, was significantly raised in comparison to the general population (7,5% vs 1,9%, OR = 4.288, CI = 1.979-9.289, p < 0.001). In spite of a significantly raised prevalence of obesitas in the study population (20% vs 8%, OR = 2.953. CI = 1.698. p < 0.001). no relation with the raised prevalence of hyperglycaemia or DM, type 2, was found, neither was a relation found between diabetic disturbance and the prescribed antipsychotic medication. Conclusions: In an exploratory study of 93 chronic schizophrenic inpatients a significantly raised prevalence of hyperglycaemia and diabetes mellitus type 2 was found, which could not be explained by the raised prevalence of overweight. In contrast to case reports and some recent studies, no relation was found between diabetic disturbance and the prescribed antipsychotic medication. Whether this contrast results from differences in study population or other methodological differences, is a question for further research. This study has three major limitations. One is that the impact of inactivity, one well-known risk factor of diabetes mellitus type 2, was not assessed. The second limitation is the selection of the study population: only chronic, schizophrenic impatients were included in this study. The thrid limitation is the difficulty in assessing the effect of chronic, often decade-long antipsychotic regime of different antipsychotic medication in different dosages on glucose homeostasis. Further research are needed to help to elucidate these questions.

Current Status of Human Issues in Horticulture in Korea

As the level of urbanization has increased, many people in Korea have begun to recognize the beneficial effects of plants in our immediate surroundings and involvement in horticultural activities. Today, an increasing number of Koreans attempt to improve the quality of life and enhance educational effectiveness through horticultural activities. Kindergarten, elementary, middle, and high schools have initiated garden-based programs. Some universities include courses focusing on horticulture applications to human well-being in their regular graduate programs or in their social education curricula. A few general hospitals, psychiatric hospitals, and rehabilitation centers have begun applying horticulture as a means of treatment. Most of the research articles in Korea on various aspects of human issues in horticulture have been published since the foundation of two academic societies, the Korean Horticultural Therapy Association and the Korean Society for Plants, People, and Environment. These articles are primarily focused on the areas of school gardening, healing gardens, and psychological or physiological effects of horticultural activities. For the future development of human issues in horticulture in Korea, several areas need to be enhanced including: interdisciplinary studies of horticulture and social education; development of different skills, techniques,and scales to validate the effects of horticultural therapy, healing gardens, and gardening as a teaching tool in public education; and an organization empowered to certify horticultural therapists.

Determinants of multiple psychotropic drug use in patients with mild intellectual disabilities or borderline intellectual functioning and psychiatric or behavioral disorders

Prevalence rates of psychotropic drug use in people with intellectual disabilities are high and pharmacotherapy is often attempted with multiple drugs. The presence of disruptive behavior is an important factor associated with the use of psychotropic drugs in this population. We wanted to gain insight into prevalence and determinants of multiple psychotropic drug use among patients with mild intellectual disabilities or borderline intellectual functioning with psychiatric or behavioral disorders. Therefore, data on psychotropics and possible determinants of use were retrospectively collected during 1992–1997 in a specialized closed ward of a Dutch general psychiatric hospital. We defined multiple drug use as concomitant prescription (regular or as needed) of a combination of benzodiazepines/tranquilizers/antipsychotics/anticonvulsants/anti-depressants. Multiple drug use, seen in 48% of the patients, was associated with a long duration of stay, psychosis, aggressive, bizarre, attention-seeking behavior and involuntary measures. We conclude that it is likely that difficulties in the management of socially disruptive behavior are often countered by multiple drug prescription.

Neurologic and psychiatric symptoms following chronic phenytoin intoxication

Reported (ir)reversibility of neurological and psychiatric symptoms induced by Phenytoin intoxication is being discussed by means of a case report concerning a 40-year old man who sets fire to his house during a psychosis. Observation after admission to a general psychiatric hospital, following a short period of detention, leads to diagnosing neurological and psychiatric symptoms due to chronic Phenytoin intoxication. Discontinuation of Phenytoin supply induces partial remission of the symptoms. Literature on the subject is being revised.