Psychiatric Contact Research Articles

African-Caribbean men remanded to Brixton prison. Psychiatric and forensic characteristics and outcome of final court appearance

BACKGROUND African-Caribbean men are over-represented in psychiatric and forensic services and in the prison population. A failure of community services to engage mentally ill African-Caribbean men and their presentation through the criminal justice system culminates in a repeated pattern of forensic service and criminal justice system contact. METHOD We carried out a cross-sectional survey during a one-year period of a sample of potentially mentally ill men remanded to HMP Brixton in south London. Men were interviewed to establish their place of birth, first language, socio-demographic profile, ethnicity, psychiatric diagnosis, levels of alcohol and substance misuse, criminality, violence involved in their index offence, past psychiatric and forensic contacts and outcome of court appearance. RESULTS Two hundred and seventy-seven men were interviewed. In comparison with White men, African-Caribbean men were more often diagnosed as having schizophrenia and were more often sent to hospital under a mental health act order. African-Caribbean men were remanded in custody despite more stable housing conditions and more favourable indices of lifetime criminality, substance misuse and violence. CONCLUSIONS Community services, including diversion schemes, should be especially sensitive to African-Caribbean men with schizophrenia who 'fall out of care', who are not diverted back into care and are therefore unnecessarily remanded.

Probabilistic models to analyze psychiatric contacts

To present three probabilistic models (Poisson, negative binomial, Waring) to analyze the distribution of the number of contacts of patients followed using a psychiatric case register. Longitudinal to obtain the distribution of the number of contacts (during 91 days following that of the first contact) observed on patients followed using the South-Verona Psychiatric Case Register during the period 1/1/79-31/12/91. There were a total number of 6913 contacts on 3454 subjects. The chi-square test for the goodness of fit yields a significant result both for the Poisson distribution (3580 with 6 degrees of freedom, p < 0.001) and for the negative binomial distribution (65.47 with 18 degrees of freedom, p < 0.001); on the other hand a non significant result was obtained for the Waring distribution (25.31 with 19 degrees of freedom, p = 0.151). The Poisson distribution gave a very poor fit for the distribution of contacts. The negative binomial distribution could be employed to analyze the pattern of contacts when the right tail of the distribution is not important. The Waring distribution is the best of the three presented. Moreover, the variance of the Waring distribution can be decomposed in three components: a random component, a component which accounts for endogenous factors and another component which accounts for esogenous factors. Therefore the Waring distribution is useful when one wants to make comparisons between psychiatric case registers of the same country or of different countries.

Serious criminal offending and mental disorder. Case linkage study.

A relationship exists between mental disorder and offending behaviours but the nature and extent of the association remains in doubt. Those convicted in the higher courts of Victoria between 1993 and 1995 had their psychiatric history explored by case linkage to a register listing virtually all contacts with the public psychiatric services. Prior psychiatric contact was found in 25% of offenders, but the personality disorder and substance misuse accounted for much of this relationship. Schizophrenia and affective disorders were also over-represented, particularly those with coexisting substance misuse. The increased offending in schizophrenia and affective illness is modest and may often be mediated by coexisting substance misuse. The risk of a serious crime being committed by someone with a major mental illness is small and does not justify subjecting them, as a group, to either increased institutional containment or greater coercion.

Psychiatric Contacts Among Youths Aged 13 Through 24 Years Who Have Made Serious Suicide Attempts

To compare the history of psychiatric contacts among young people who have made medically serious suicide attempts and control subjects. Using a case-control design, the authors contrasted 129 young people who made serious suicide attempts with 153 randomly selected community controls on a series of measures of lifetime, prior year, and prior month contacts with psychiatric services. Of those who made serious suicide attempts, 78.3% had a lifetime history of contact with health services for psychiatric reasons, 72.1% reported contact within the year preceding the suicide attempt 58.9% reported contact within the month preceding the suicide attempt, and 29.5% had a lifetime history of psychiatric hospital admission. Within the year preceding the suicide attempt, 21.7% had been admitted to a psychiatric hospital and 67.4% had outpatient consultations for psychiatric problems. Multiple logistic regression suggested that the best psychiatric service predictors of risk of serious suicide attempt were admission within the preceding year (p < .005) and outpatient consultation within the preceding month (p < .0001). Young people making serious suicide attempts had vastly elevated rates of a range of psychiatric contacts including hospital admissions and outpatient consultations. These findings imply that the development of improved treatment and management strategies for young people with psychiatric morbidity may be a very effective approach to reducing youthful suicidal behaviors.

Criminal Mutilation of the Human Body in Sweden—A Thirty-Year Medico-Legal and Forensic Psychiatric Study

During the 30-year period 1961-1990, a total of 22 deaths with criminal multilation/dismemberment of the human body were registered in Sweden. The multilations occurred in time clusters, mostly during the summer and winter periods, and increased during the three decades, with incidence rates of 0.05, 0.1, and 0.125 per million inhabitants and year, respectively. Multilation was noted 6.6 times more often in large urban areas than in the rest of Sweden. Defensive mutilation, in order to get rid of the corpse or make its identity more difficult, was noted in ten instances, aggressive mutilation following outrageous overkilling in four, offensive mutilation (lust murder) in seven, and necromanic multilation in one instance. In the last-mentioned case the cause of death was natural, while all deaths in the first three groups were homicidal, or homicide was strongly suspected. All perpetrators were males, in six instances assisted by other persons. In more than half of the cases the perpetrator's occupation was associated with application of anatomical knowledge, e.g., butcher, physician, veterinary assistant, or hunter. The perpetrators of the defensive and aggressive mutilations were mostly disorganized, i.e., alcoholics or drug users with previous psychiatric contacts and criminal histories, while the lust murderers were mostly organized, with a history of violent crimes (including the "serial killing" type), drug abuse and mental disorders with anxiety and schizophrenia, in that order to a diminishing degree. There were differences in mode of mutilation, depending on whether the mutilation was carried out by a layman, a butcher, or a physician. In only one case was the perpetrator convicted for the mutilation act itself; in the remaining instances the manslaughter, as a more serious crime, assimilated the mutilation. When the mutilation made it impossible to establish the cause of death, the perpetrators, despite strong circumstantial evidence indicating murder, were acquitted.

African-Caribbean men remanded to Brixton Prison. Psychiatric and forensic characteristics and outcome of final court appearance.

African-Caribbean men are over-represented in psychiatric and forensic services and in the prison population. A failure of community services to engage mentally ill African-Caribbean men and their presentation through the criminal justice system culminates in a repeated pattern of forensic service and criminal justice system contact. We carried out a cross-sectional survey during a one-year period of a sample of potentially mentally ill men remanded to HMP Brixton in south London. Men were interviewed to establish their place of birth, first language, socio-demographic profile, ethnicity, psychiatric diagnosis, levels of alcohol and substance misuse, criminality, violence involved in their index offence, past psychiatric and forensic contacts and outcome of court appearance. Two hundred and seventy-seven men were interviewed. In comparison with White men, African-Caribbean men were more often diagnosed as having schizophrenia and were more often sent to hospital under a mental health act order. African-Caribbean men were remanded in custody despite more stable housing conditions and more favourable indices of lifetime criminality, substance misuse and violence. Community services, including diversion schemes, should be especially sensitive to African-Caribbean men with schizophrenia who 'fall out of care', who are not diverted back into care and are therefore unnecessarily remanded.

Sudden death in psychiatric patients.

The present study investigated histories of prior psychiatric treatment in cases of sudden death reported to the coroner. A matching survey linked the register of deaths reported to the coroner with a comprehensive statewide psychiatric case register covering both in-patient and community-based services. Sudden death was five times higher in people with histories of psychiatric contact. Suicide accounted for part of this excess mortality but deaths from natural causes and accidents were also elevated. Schizophrenic and affective disorders had similar suicide rates. Comorbid substance misuse doubled the risk of sudden death in affective and schizophrenic disorders. The rates of sudden death are sufficiently elevated to raise questions about current priorities in mental health care. There is a need both for greater attention to suicide risk, most notably among young people with schizophrenia, to the early detection of cardiovascular disorders and to the vigorous management of comorbid substance misuse.

Unplanned first contact as a predictor of future intensive use of mental health services.

The scheduled appointment system, widely used in most mental health services, has never been evaluated. This study attempts such an evaluation within a community-based mental health service that permits unplanned access to specialist care, by comparing further service use of first-episode patients who come unannounced to seek psychiatric care with that of patients with a planned (scheduled) initial appointment. All patients with first lifetime psychiatric contact who contacted psychiatric services reporting to the South-Verona Psychiatric Case Register between 1 January 1982 and 31 December 1989 (n = 1261) were identified. A total of 1056 patients entered the study and were followed for 2 years. Poisson regression with the generalised estimating equation (GEE) method (to take into account both overdispersion of contacts between subjects and correlation between contacts within subjects) was used to evaluate the effects of the type of first-ever contact (defined as planned or unplanned according to whether or not a regular appointment was previously arranged) and of other selected variables, including sociodemographic characteristics, on the annual rate of planned and unplanned care in the follow-up period. Thirty-six percent of first-ever contacts were unplanned. Patients who began with unplanned contact, as compared with others, were more often widowed, separated or divorced, unemployed and with a diagnosis of schizophrenia or organic psychosis. Moreover, they had, in the following 2 years, significantly higher rates of both unplanned and planned community care, as well as more in-patient care (higher admission rate and a longer mean length of stay). These results at follow-up were confirmed when the rates for the type of first-ever contact were adjusted for all other clinical and sociodemographic variables at initial contact. Step-down Poisson multiple regression analysis showed that the rates of both unplanned and planned contacts in the follow-up period were significantly and independently associated with: type of first-ever contact, diagnosis and type of service first contacted. Unplanned cases at initial contact require particular attention and are confirmed as at risk for placing higher demands on mental health services in the following 2 years. The results of the present study may also have implications for other, non-psychiatric health services.

Telepsychiatry: an island pilot project.

A telemedicine link was established in 1996 between the island of Inishmore and the department of psychiatry in University College Hospital, Galway. The link was mainly used to facilitate emergency consultations between patients on the island and the duty psychiatrist, always at the request of the island's general practitioner. Nine patients were referred for assessment in this manner over eight months. Three patients had their first psychiatric contact and assessment through the video-link, and were followed up as outpatients via the link to eventual resolution of the episode of illness and discharge at the outpatient clinic. Our experience has been that videoconferencing systems are acceptable and satisfactory for patients and staff alike.

Psychiatric Morbidity Differences in Male and Female Adolescent Inpatients With Alcohol Use Disorders

Objective: To examine gender differences in demography, cooccurrence of Diagnostic Statistical Manual (third edition, revised; DSM-III-R) axis I disorders and axis II personality disorders, and self-reported psychological distress in adolescent psychiatric inpatients with alcohol use disorders. Method: A consecutive series of 61 adolescent inpatients (36 boys and 25 girls) with either alcohol abuse or dependence were reliably assessed with structured diagnostic interviews for DSM-III-R Axis I and Axis II personality disorders. Results: Boys and girls did not differ in age, ethnicity, socioeconomic status, global functioning, age at first psychiatric contact, or number of hospitalizations. Girls were more likely to meet criteria for oppositional defiant disorder, eating disorders, and additional drug use disorders. Girls were also more likely than boys to meet criteria for at least one personality disorder and borderline personality Contrary to gender patterns in the general population, the proportion of girls and boys with affective disorders and conduct disorders did not differ significantly. Conclusions: Relatively few gender differences were found in adolescent inpatient alcohol abusers even where they would be expected, based on non substance-abuse general population gender patterns. When observed, gender differences were in the direction of greater psychiatric disturbance among girls. Some of the gender patterns observed among alcohol abusing adolescents are at odds with gender differences observed in non substance-abuse samples.

Folie a famille — the need for family perspectives in psychiatry

AbstractA case of folie a famille is described. The presenting symptom bearer was a child thus necessitating psychiatric contact with his family. This prevented the folie a famille from remaining covert as may have occurred had an adult presented in a similar manner. The possibility is raised that folie a plusieurs has a higher incidence than previously believed. Criticism is made of the tendency of adult psychiatry and its diagnostic systems to focus purely upon the individual. The investigation, formulation and management of the case using the family is outlined.

Gender-specific decline and seasonality of births in operationally defined schizophrenics in italy

All clinical records of schizophrenic patients included in the period 1979–1995 in the South Verona Psychiatric Case Register were reviewed and diagnoses operationally defined according to ICD-10 criteria using OPCRIT 3.1. Among the 335 scrutinized, 205 patients met the ICD-10 criteria for paranoid or undiiferentiated schizophrenia. No seasonality of birth was found in these patients using a log-linear equiprobability model. The incidence and seasonality of birth were then analysed on the subsample of 106 patients born in 1947–1974 for whom corresponding data for the Verona general population were available. Schizophrenic males displayed a significant excess of birth in November–January with respect to the Verona population ( χ 2 = 10.93, p = 0.012). The time series of the incidence of schizophrenia by cohort of birth 1947–1974 had a linearly decreasing trend, steeper in males than in females. The significant increase in age at first ever psychiatric contact, observed in both males and females throughout the period considered, cannot completely account for the gender-specific decline of birth of schizophrenics.

‘Graduates’

The term 'graduate' (hereafter without quotation marks) has been used to describe the following groups of patients:1) All those patients with enduring psychiatric illness who have graduated to old age (usually defined as age over 65 years);2) 'Patients who entered hospitals for the mentally ill before modern methods of treatment were available and have grown old in them after many years there.'3) Specifically, long-stay patients with schizophrenia over the age of 65 years who came into continuous psychiatric contact well before that age.

Serious overdosers admitted to a general hospital: Comparison with nonoverdose self-injuries and medically ill patients with suicidal ideation

There are few psychiatric studies of serious self-injury patients admitted to general hospitals. In order to better characterize patients whose overdoses are serious enough to require hospitalization on a toxicology service, we describe 207 consecutively admitted, serious overdose patients (OD), all of whom were psychiatrically evaluated. They were compared with 53 nonoverdose self-injury cases (NO) and 79 medical/surgical patients with suicidal ideation (SI) who were routinely referred for consultation during the same 2-year period. All data were contemporaneously compiled into a computerized database and analyzed. The attempters (OD and NO) were younger than the ideation patients (SI). The OD group was predominantly female (60%) and the NO and SI groups were predominantly male (72%). More OD cases were separated and more SI cases were widowed. Similar to previous reports, prior psychiatric contact was high in all groups. DSM-III-R diagnoses of depression, adjustment disorders, and substance abuse were most common in each group, without group differences. Only borderline personality disorder distinguished the groups, and the OD group had significantly more borderline patients. There were no seasonal differences for admission dates between groups. SI cases had longer hospital lengths of stay and were least likely to require further psychiatric care after discharge from the general hospital. Attempter groups were more similar to each other than the ideation patients. Clinicians should maintain a high index of suspicion for Axis I disorders in suicidal general hospital patients, though female borderline patients are particularly associated with the serious overdose method.

Prevention of relapse and recurrence of depression: newer versus older antidepressants

In a 17- to 19-year follow-up study it was shown that patients admitted to the Maudsley Hospital, London (whose index episode marked their first psychiatric contact) had a 50% chance of readmission during their lifetime; those with previous admissions had a similar chance of readmission within three years. Less than one-fifth of the patients had remained well, and over one-third suffered severe chronic distress and handicap or had died unnaturally (Lee &amp; Murray, 1988). Similar gloomy pictures were reported in a 15-year follow-up study of patients in London and Sydney (Kilohet al, 1988) and an 11-year follow-up study of patients in Montreal (Lehmannet al, 1988). As a result of such findings, much emphasis is now put on the importance of continuation and maintenance treatment of depression.

Conduct disorder, substance use disorders, and coexisting conduct and substance use disorders in adolescent inpatients.

The authors examined the association between conduct disorder and substance use disorders in adolescent inpatients. Structured diagnostic interviews were given to 165 adolescent inpatients to assess the presence of DSM-III-R axis I disorders and personality disorders from axis II. Patients with conduct disorder (N = 25), substance use disorders (N = 24), and coexisting conduct and substance use disorders (N = 54) were compared to determine whether additional axis I and axis II disorders presented at significantly different rates. The groups with conduct disorder and coexisting conduct and substance use disorders had a higher proportion of male subjects than the group with substance use disorders alone. Patients with conduct disorder had an earlier age at first psychiatric contact and were diagnosed significantly more often with attention deficit hyperactivity disorder than the other two groups. Borderline personality disorder was diagnosed more frequently in the patients with substance use and coexisting conduct and substance use disorders than in the patients with conduct disorder. These differential co-occurrence patterns were observed for both male and female subjects. Conduct disorder and substance use disorders have high comorbidity rates with other psychiatric disorders in adolescent inpatients. The additional psychiatric comparison group (patients with coexisting conduct and substance use disorders) allowed for finer distinctions regarding psychiatric comorbidity. The validity of subtyping conduct disorder on the basis of the presence of a coexisting substance use disorder is suggested; conduct disorder patients without a coexisting substance use disorder are more likely to have attention deficit hyperactivity disorder.

Neurosyphilis with psychiatric manifestations - a forgotten condition?

AbstractWe report on a patient with neurosyphilis with psychiatric manifestations. A point to notice in this case is the time elapsed (one year) between the first psychiatric contact and the final diagnosis. The case reported here suggests that neurosyphilis may have become a ‘forgotten disease’.

Suicides by burning in England and Wales.

The aim was to examine suicides by burning (SBB) occurring in England and Wales. The method was a retrospective case note examination of death certificates, coroners inquest notes and GP notes for all SBBs registered in 1991 by OPCS in England and Wales, and an examination of SBB statistics from 1979-1992. In 24% of cases the incident involved others either as intended or actual victims or as witnesses, and three distinct groups (Asian-born women, schizophrenics, and homicide-suicides) were over-represented. The majority were not in contact with current psychiatric services, and 43% had never had contact with psychiatric services. There was no trend in SBB compared to other suicides in 1979-1992. While SBB may be associated with Asian-born women, homicide-suicide and schizophrenia, the majority of cases did not have these characteristics, and the overall psychiatric contact rate was similar to suicide by unspecified means.

Mental and somatic health and social adjustment in ordinary school children during childhood and adolescence related to central nervous functions as expressed by a complex reaction time.

A cohort of ordinary Swedish children were followed up from school entry through childhood and adolescence and checked retrospectively from birth to the age of 6 years regarding psychiatric and physical health and contact with the social welfare authorities. The children were allocated to different risk groups at age 7 on the basis of their psycho-physical development expressed as complex reaction time (CRT). It was previously shown that many of the slow CRT children have problems in psychomotor and language development at school, and that many leave compulsory school with poor achievements in Swedish and gymnastics as continuing signs of their developmental delay. This study shows that slow CRT children have an increased prevalence of child psychiatric problems. At an early age there were symptoms of aggression, hyperactivity and withdrawal in conjunction with developmental delay. During adolescence, depression, maladjustment and psycho-somatic disorders were prominent features, often in association with developmental delay, dyslexia and poor motoric skill. These children could have a disadvantage at school and in society and they felt themselves "handicapped" and were stressed by feelings of limited future possibilities. In adolescence, many of them were in need of help, especially financial aid from the social welfare services. The findings stress that a slow cognitive processing ability seen as a slow CRT must be considered a handicap of importance and a risk-factor in the society of today, with primary or secondary psychic and social manifestations often in a multifactorial setting of biological co-morbidity and family problems. In contrast, an advanced CNS development with a fast CRT may be seen as a protective factor.

Mortality among patients with psychiatric illness. A ten-year case register study in an area with a community-based system of care.

Most studies which showed an excess mortality in psychiatric patients have been conducted on hospitalised samples. This was a case register study. All South Verona patients with an ICD diagnosis who had psychiatric contacts with specialist services in 1982-1991 were included. Mortality was studied in relation to sex, age, diagnosis, pattern of care and interval from registration. Standardised Mortality Rates (SMRs) and Poisson regression analysis were calculated. The overall SMR was 1.63 (95% Cl = 1.5-1.8), which is the lowest value reported so far. Mortality was higher among men (SMR = 2.24; 95% Cl = 1.9-2.6), among patients who were admitted to hospital (SMR = 2.23; 95% Cl = 1.9-2.6), among younger age groups (SMR = 8.82; 95% Cl = 4.9-14.6) and in the first year after registration (SMR = 2.32; 95% CL = 1.8-2.9). Higher mortality was found in patients with a diagnosis of alcohol and drug dependence (SMR = 3.87; 95% Cl = 3.0-4.9). The SMR for suicide was 17.41. Using a Poisson regression model, diagnosis, pattern of care and interval from registration were all found to be significantly associated with mortality. When all these variables were entered together in the model, each maintained its predictive role. The overall mortality of psychiatric patients treated in a community-based system of care was higher than expected, but lower than the mortality reported in other psychiatric settings. The highest mortality risk was found in the first year after registration.