Prison Psychosis Research Articles

Prison vs. hospital for offenders with psychosis; effects on reoffending

ABSTRACTWith research showing a high prevalence of psychosis in prisons, its effective management is essential for clinical and criminal outcomes. In a matched sample of released prisoners and discharged patients with psychosis (124 pairs) we investigated whether group participation (prison vs. hospital) affected the likelihood of reoffending as well as time to reoffending. Statistical analysis was completed using multilevel logistic regression and multilevel survival analysis. We found that prison cases were more likely to commit any offence within a given period of time (1, 2 or 3 years). Moreover, at any particular time 3 times as many patients with psychosis released from prisons reoffended proportionally to their matched controls discharged from hospitals (HR = 2.92, 95% CI = 1.99, 4.29, P < 0.001). In conclusion, release from prison carries higher risk of a future offending and reduced time to reoffending among offenders with psychosis. Notwithstanding limitations inherent in observational study designs, we advocate that in addition to clinical need and the humanitarian argument, offenders with psychosis should be treated in secure hospitals to reduce future recidivism.

Samuel Beckett's ‘Psychology Notes’ and The Unnamable

This essay reexamines Samuel Beckett's The Unnamable by treating his ‘Psychology Notes’ as part of the genetic dossier for this text. By developing a parallel between The Unnamable and ‘textbook’ psychoanalysis in terms of a shared obsession with abjection, the essay will demonstrate that some of the symptoms and obsessions suffered by the unnamable voice (‘prison psychosis’, ‘coprosymbolism’ and ‘genital discharge’) are traceable to the Notes. At the same time, the commitment to cure, control and explanation in psychoanalysis is resisted, and Beckett's text ultimately stages a failed talking cure. The genetic identification of these intertextual connections is enhanced by the availability of the Beckett Digital Manuscript Project (BDMP). Using the same scholarly tool, the essay also examines some of the variations between the English and the French versions of the text, in order to shed further light on the significance of the Notes to the manuscript corpus of L'Innommable/The Unnamable.

Treatment of psychosis in prisons and violent recidivism.

BackgroundViolence among released prisoners with psychosis is an important public health problem. It is unclear whether treatment in prison can influence criminal behaviour subsequent to release.AimsTo investigate whether treatment in prison can delay time to reoffending.MethodOur sample consisted of 1717 adult prisoners in England and Wales convicted of a serious violent or sexual offence. We used Cox regression to investigate the effects of treatment received in prison on associations between mental illness and time to first reconviction following release.ResultsPrisoners with current symptoms of schizophrenia reoffended quicker following release. Nevertheless, treatment with medication significantly delayed time to violence (18% reduction). Treatment for substance dependence delayed violent and non-violent reoffending among prisoners with drug-induced psychosis.ConclusionsIdentifying prisoners with psychosis and administering treatment in prison have important protective effects against reoffending. Repeated screening with improved accuracy in identification is necessary to prevent cases being missed.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Prisoners at ultra-high-risk for psychosis: a cross-sectional study.

The definition of ultra-high risk (UHR) for psychosis was derived from community-based help-seeking populations. Prisoners have high rates of psychosis and other severe mental health (MH) problems. They also have high rates of risk factors for psychiatric morbidity and yet they are among the populations who are less likely to seek help in the community. Despite a policy of equivalence of care for individuals in prison there are no early intervention services for psychosis in prisons in the UK. This was a study exploring feasibility of introducing such a service into a local London prison. This paper discusses the differences in MH profile of prisoners who met criteria for at-risk mental state compared with those who did not. A two-stage procedure was used. Participants in a local London prison were routinely screened in the first week of arrival in prison with the Prodrome Questionnaire - Brief Version (PQ-B; Loewy et al. 2011). Those that screened positive as well as a small sample of those who screened negative underwent a further semi-structured assessment to see whether they met criteria for UHR state. Data on self-harm and suicide attempt, family psychiatric history, and anxiety and depression was also collected. A total of 891 prisoners were screened, 44% of whom screened positive. A total of 354 underwent second stage assessment, 60 of whom had screened negative. Four groups were identified: those that had no MH problems, a group experiencing First Episode Psychosis, those at UHR of psychosis and a group with other MH problems. The UHR state and Psychotic groups had very similar MH profiles of symptoms and distress. Prisoners with no MH problems were at the other end of the spectrum with few symptoms and little distress. The Other group fell in between this group and the psychotic spectrum group in terms of symptomology and distress. This study is the first to examine risk for psychosis in an adult male prison population. We identified a broad spectrum of MH disorder for which there is little current service provision in prisons. Screening early in the custodial process has the potential to identify unmet MH need and has implications for keeping individuals safe in custody. A long-term strategic approach is required to address MH need in prisons.

Imprisonment, alcohol dependence and risk of delusional disorder: A cross-sectional study

BackgroundCompared to the general population, an excess of psychotic illnesses, major depression and dependence disorders among prisoners has been reported. However, the impact of prison on detainees’ psychopathology has rarely been studied. ObjectiveTo determine the mental disorders liable to develop or regress on entry into prison and over time. MethodTwo samples of French prisoners detained in local prisons were interviewed using the same methodology. The first sample consisted of 267 new arrivals. The second was a random sample of 450 prisoners. Diagnoses were assessed using a thorough methodology: each prisoner was interviewed for approximately 2hours by two clinicians. One of the clinicians used a structured clinical interview, which generates DSM IV diagnoses (MINI plus v 5.0); the second completed the procedure with an open clinical interview. The final DSM IV diagnoses were obtained as a consensus between the two approaches. Multilevel logistic regressions were used to take into account potential confounders. ResultsPrevalence rates of mental disorders were substantially higher in prison even for the sample of newcomers (major depression disorder: 24.7%, substance dependence: 17.6% and schizophrenia: 4.1%). Alcohol dependence disorder was significantly more frequent in the sample of newcomers (OR 1.84 [1.01–3.51]). No significant difference was evidenced between samples for substance dependence disorder. Psychotic disorders were significantly less frequent at entry into prison, particularly delusional disorder (OR 0.29 [0.08–0.98]). ConclusionThis study shows the contrasted potential effects of prison on psychopathology: alcohol dependence disorders were significantly more frequent for the newcomers, while the frequency of delusional disorders was lower. This evidence is arguing in favour of the validity of the old concept: prison psychosis. Moreover, prisoners should receive relevant help from clinicians to cope with these disorders.

Diagnoses of Personality Disorders Between 1879 and 1929 in the Largest Croatian Psychiatric Hospital

To study demographic characteristics, comorbidities, and diagnoses of patients admitted for personality disorders to Psychiatric Hospital Vrapče between 1879 and 1929. Data were collected from the archives of Vrapče Psychiatric Hospital for a 50-year period from November 1879 to December 1929. The ratio between the number of patients with personality disorder and the number of all admitted patients was determined. We used 3 systems of definitions of personality disorder: for cases before 1923, we used Prichard’s concept of moral insanity and unpublished definitions of one of the hospital managers at that time; for cases after 1923, we used Schneider’s classification of psychopathic personalities and unpublished definitions of one of the hospital managers at that time. The total number of admissions during the study period was 18 960, 141 (0.74%) of which were for a personality disorder. Of the admitted patients, 85.8% were men and 59.7% were single. The average age was 29.7 } 9.5 years. Most of them (61.7%) were sent to the hospital by courts or police, and the median length of stay was 92 days (interquartile range, 92.0 - 127.5 days). The first patient with a personality disorder was admitted in 1889 with a diagnosis of moral insanity. Until 1920, only 3 terms were used for personality disorder: moral insanity, psychopathic inferiority, and psychopathy. The term was subdivided only after that year. Of the 141 patients admitted for personality disorder, 34 (24.1%) were discharged with comorbid disorders, mainly substance abuse. The most common single comorbid diagnosis was Ganser syndrome (prison psychosis). Archives of the Vrapče Psychiatric Hospital contain reliable data about the earliest nomenclature of personality disorders, the increase in the prevalence of personality disorders, and further subdivision of the term personality disorder. Nomenclature for these disorders used at the Vrapče Psychiatric Hospital was consistent with that used in clinical practice in other parts of the world at the time.

Prison psychosis or simulation: a case report

Prison psychosis or simulation: a case report

Psychosis in prisons and the community

Psychosis in prisons and the community

Psychosis in the Community and in Prisons: A Report From the British National Survey of Psychiatric Morbidity

Reports of increased rates of psychosis in prisons could be due to sampling and ascertainment differences. The authors compared two samples of subjects 16-64 years of age: those from the general population of residents in Great Britain and prisoners in England and Wales. A random sample of remanded and sentenced male and female prisoners (N=3,142) and a two-phase, cross-sectional random sample of household residents (N=10,108) were assessed with structured questionnaires and the semistructured Schedules for Clinical Assessment in Neuropsychiatry. The weighted prevalence of probable functional psychosis in the past year was 4.5 per thousand (95% CI=3.1 to 5.8) in the household survey. In the prison survey, the weighted prevalence was over 10 times greater: 52 per thousand (95% CI=45 to 60). One in four prisoners with a psychotic disorder had psychotic symptoms attributed to toxic or withdrawal effects of psychoactive substances. The proportion of subjects with specific types of hallucinations or delusions did not differ between prison and household psychosis cases. This large study using standardized comparisons showed that the prevalence of psychosis in prisons is substantially higher than in the community and is deserving of greater attention to treatment and prevention. Apart from a minority of prisoners with symptoms attributable to psychoactive substances, the clinical symptom profile of psychosis is the same in both settings. Longitudinal research is needed to better understand these prevalence differences.

PSYCHOSES OCCURRING AMONG PSYCHOPATHIC PERSONALITIES IN ASSOCIATION WITH INELASTIC SITUATIONS OVERSEAS

The present study is concerned with a group of 50 psychotic patients with psychopathic personalities, encountered in New Guinea and the Philippines during World War II. The heredity, environmental background, personality development, and psychopathology were investigated. Fifty psychopaths not considered to be psychotic were used as a control group. Among the 50 patients the family setting was characteristically insecure. Enuresis, nail biting, temper tantrums, and sleepwalking were common. The scholastic performance and school adjustment were poor. The work record was characterized by frequent shifts in jobs, periods of unemployment, and difficulty in getting along with fellow workers and employers. Difficulties in developing and maintaining satisfactory interpersonal relationships were also common. Over two-thirds of the patients had a record of from one to 30 military or civilian arrests. Sexual life was marked by promiscuity and poor marital adjustment. In 6 there was a history of homosexuality. Of the 24 who had been married, 14 were divorced or separated. In 24 cases there was evidence of a previous neurotic or psychotic illness. Twenty-two were alcoholic. Five were addicted to drugs. During the psychosis the commonest psychopathological features were excessive motor activity, depression, auditory and visual hallucinations, paranoid delusions, disorganization of thinking, bizarre behavior, and defective judgment. In 22 cases suicidal preoccupations were found. Ten had made suicidal attempts. The dynamic factors and type of reaction were similar to those found in prison psychosis.

Alcoholism and hallucinosis

Alcoholics who develop psychotic episodes while incarcerated, manifest hallucinations very frequently (39 of 50 cases) although they have been abstinent for periods varying from six months to 10 years. This is in contrast to nonalcoholics who develop prison psychoses. It is probable, therefore, that hallucinosis associated with alcoholism is related to the underlying constitution and personality rather than specifically to the alcohol.

Prognosis of hebephrenia

Alcoholics who develop psychotic episodes while incarcerated, manifest hallucinations very frequently (39 of 50 cases) although they have been abstinent for periods varying from six months to 10 years. This is in contrast to nonalcoholics who develop prison psychoses. It is probable, therefore, that hallucinosis associated with alcoholism is related to the underlying constitution and personality rather than specifically to the alcohol.

Symptoms and previous personality in prison psychoses

1. Prison psychoses have a common etiology in the sense that they are a reaction to a common environment. 2. Fifty cases of prison psychoses were studied after recovery with respect to the relation of the previous personality to the symptoms shown during the psychotic episode. Where suitable, the Humm-Wadsworth Temperament Scale was administered. 3. In 46 of the cases, a definite relationship could be found between the psychotic symptoms and the previous personality as shown by the previous history or the temperament scale or both. 4. The form of prison psychosis is dependent upon the previous personality and constitution.

Auditory hallucinations in prison psychosis

One hundred cases of prison psychosis with auditory hallucinations have been investigated as to the content of their hallucinations.

The Development of Psychoses in Prison

When undertaking a description and classification of mental disorders occurring in prison, the investigator gets very little assistance from most of the literature available on the subject. Although German studies date back to Delbruch of Halle Prison, in 1852, not a great deal has been written on the topic. Those who have written have differed greatly in their description and classification due, largely, to the different types of prisoners coming under their care.Some have had large numbers of murderers and desperate criminals with long sentences. Others almost exclusively have had short term prisoners, such as come to jails and workhouses. Adler,' alone, of American investigators, has given us a classification and description of prison types which includes those contentious and paranoid prisoners usually referred to as suffering from Prison Psychoses. Other American students have been more interested in other phases, of the subject. Glueck2 dissected and classified the admissions to Sing Sing and pointed out the needs of the state for the proper segregation, custody and treatment of the various types. Fernald3 defined most clearly the position of the mental defective among criminals. White4 has given us individual studies of disorders developing under imprisonment before, during and after trial. The emphasis of all these, however, has not been upon the psychosis developing after commitment, as has the work of the German writers. Because material in the studies available is not comparable, there is little agreement among investigators upon the questions of predisposing causes, exciting factors, course or final outcome of the disorders found among prisoners. The gradual evolutionin prison management, with the removal of the more severe forms of punishment, probably has modified the material and influenced more recent classifications.

Observations on the Prison Psychoses

From time to time in convict prisons examples are seen of certain morbid mental states which are described as distinct disease forms under the name of “prison psychoses.” These states may be defined as special types of mental reactions developing upon conflicts which arise as the result of imprisonment, and possibly from the shock attending the criminal act, trial and conviction. They have been the subject of much inquiry, but, on account of the variation in the material which was available and in the conditions under which the studies were pursued, some confusion of thought appears to exist as to what may or may not be regarded as belonging to this class of disorder, and whether, in fact, the classification is not redundant. The sole justification for the use of the term “true prison psychosis” lies in the ability to establish the disorder as a separate entity, lest the name should be applied to conditions which are adequately described under other titles, as has been the case with shell-shock and “barbed-wire” disease.

A PROBLEMATICAL CASE

The simulation of mental disease is rare, but cases of suspected or alleged malingering are met with, especially in medico-legal work associated with capital crimes. It is a rather common fallacy among the laity and the general medical profession that feigned insanity is of fairly frequent occurrence. Actual instances, however, are unusual and some psychiatrists may never see a single case. The difficulties of simulation, alone, would seem to preclude, in most cases, the possibility of malingering. One will readily admit that neurotic symptoms may be assumed, those of a subjective nature, the evidence of existence of which depends largely upon the statement of the patient. Even such instances are less frequent than commonly believed. Single symptoms may be simulated or exaggerated, in the traumatic neuroses existing physical abnormalities may be falsely ascribed to the injury, suggestible hysterical individuals may imitate others and, as found in military life, a mentally diseased person may endeavor to simulate recovery in order to resume active duty. Insanity, however, as a prolonged departure from the patient’s usual mode of thinking, acting and feeling is quite a different proposition. When the intensity of the excitement, the unceasing, restless activity, the prolonged period of sleeplessness and other characteristic signs of a manic condition, the deep and lasting depression with the diagnostic facies of a depressed state, the mannerisms, absolute change of personality, emotional deterioration or fixed delusions of a pr2ecox, or the physical evidences of an organic condition, are considered, it seems doubtful that any of these could even be momentarily assumed without prompt detection by experienced psychiatrists. Among the so-called prison psychoses, however, there are certain reactive disturbances of which the mode of onset, the symp-

Insanity in American prisons and the prison psychosis.

Discusses the need for better care of the insane criminals. Though insanity may be fully developed in certain cases, at the time of commitment of crime, but due to lack of proper mental examination the mental deficiency is overlooked and commitment is made to a correctional institute instead of a hospital for insane or an institution for anti social defectives. The classification of and statistics pertaining to criminal insanity and mental defects in criminals has been worked out in Eastern states of America, which has been reported. Gives a brief summary of the report of the committee, responsible for the mental survey of the prisoners in the Illinois State Penitentiary at Joliet. Suggests that confining of insane in prisons should be avoided, better facilities like hospitals and others should be provided. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Book Review The History of the Prison Psychoses . By Drs. Paul Nitsche (Dresden) and Karl Williams, (Heidelberg). Authorized translation by Francis M. Barnes, Jr., M.D., and Bernard Glueck, M.D., Senior Assistant Physicians, etc., Government Hospital for the Insane, Washington, D. C. New York Journal Nervous and Mental Disease Publishing Co. pp. 84. 1912.

Book Review The History of the Prison Psychoses . By Drs. Paul Nitsche (Dresden) and Karl Williams, (Heidelberg). Authorized translation by Francis M. Barnes, Jr., M.D., and Bernard Glueck, M.D., Senior Assistant Physicians, etc., Government Hospital for the Insane, Washington, D. C. New York Journal Nervous and Mental Disease Publishing Co. pp. 84. 1912.

The History of the Prison Psychoses.

The excellent historical review of the prison psychoses, of which this is a translation, covers the period from the pioneer publication of Delbrück down to the present. It cannot fail to attract the attention of penologists and psychiatrists throughout the country, as the important relation of crime to the psyche is daily becoming more evident. Dr. William A. White in the introduction to this monograph states as his opinion that "the present volume should serve a distinct purpose in helping to fix attention on those concepts and methods that make for a better understanding of the criminal and for more intelligent methods of dealing with the many difficult problems that surround him." While this monograph is purely historical in content, its perusal by state's attorneys and judges might lead to some practical reforms.