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Psychosis in high-security and general psychiatric services: Report from the UK700 and Special Hospitals' Treatment Resistant Schizophrenia groups

  • Elizabeth Walsh (a1), Morven Leese (a1), Pamela Taylor (a1), Ingrid Johnston (a1), Tom Burns (a2), Francis Creed (a3), Anna Higgit (a4) and Robin Murray (a5)...

Abstract

Background

Serious violence is an unusual but significant correlate of psychosis, and leads to the need for specialist secure psychiatric services. Most such service users have previously used general psychiatric services.

Aims

To examine diagnostic and socio-demographic differences between high-security psychiatric service users from their peers in community services.

Method

Two groups of patients with psychosis were compared: a national sample of high-security hospital residents, and a sample of patients in contact with general psychiatric services.

Results

Schizophrenia was the almost invariable diagnosis for all special hospital patients. White patients in the community sample were significantly more likely to have affective components to their illness compared with African–Caribbean patients; unlike those in special hospitals. There was a small excess in the proportion of African–Caribbean patients in the special hospital group, controlling for diagnosis, gender and locality. Men were overrepresented in this group.

Conclusions

Among patients with psychosis, having a diagnosis of schizophrenia and being male increase the likelihood of special hospital admission. Suggestions that ethnic minority patients are much more likely to have engaged in serious violence and need high-security placement were not borne out.

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Copyright

Corresponding author

Dr Elizabeth Walsh, Section of Forensic Mental Health, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK

Footnotes

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Declaration of interest

Funding is detailed in the Acknowledgements.

Footnotes

References

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Arseneault, L., Moffitt, T. E., Caspi, A., et al (2000) Mental disorders and violence in a total birth cohort: results from the Dunedin study. Archives of General Psychiatry, 57, 979986.
Binder, R. L. & McNeil, D. E. (1990) The relationship of gender to violent behaviour in acutely disturbed psychiatric patients. Journal of Clinical Psychiatry, 51, 110114.
Brennan, P., Mednick, S. A. & Hodgins, S. (2000) Major mental disorders and criminal violence in a Danish birth cohort. Archives of General Psychiatry, 57, 494500.
Burns, T., Creed, F., Fahy, T., et al for the UK700 Group (1999) Intensive versus standard case management for severe psychotic illness: a randomised trial. Lancet, 353, 21852189.
Carr-Hill, R. A., Hardman, G., Martin, S., et al (1994) A Formula for Distributing NHS Revenues Based on Small Area use of Hospital Beds. York: Centre for Health Economics, University of York.
Coid, J. W., Nadji, K., Gault, S., et al (2000) Ethnic differences in admissions to secure forensic psychiatry services. British Journal of Psychiatry, 177, 241247.
Cope, R. & Ndegwa, D. (1990) Ethnic differences in admissions to a regional secure unit. Journal of Forensic Psychiatry, 1, 365378.
Cote, G. & Hodgins, S. (1992) The prevalence of major mental disorders among homicide offenders. International Journal of Law and Psychiatry, 15, 8999.
Eronen, M., Hakola, P. & Tiihonen, J. (1996) Mental disorders and homicidal behaviour in Finland. Archives of General Psychiatry, 53, 497501.
Glover, G. R., Robin, E., Emami, J., et al (1998) A needs index for mental health care. Social Psychiatry and Psychiatric Epidemiology, 33, 8996.
Harrison, G. (1990) Searching for the causes of schizophrenia: the role of migrant studies. Schizophrenia Bulletin, 16, 663671.
Hodgins, S. (1992) Mental disorder, intellectual deficiency and crime. Archives of General Psychiatry, 49, 476483.
Hodgins, S., Mednick, S. A., Brennan, P. A., et al (1996) Mental disorder and crime: evidence from a Danish birth cohort. Archives of General Psychiatry, 54, 489496.
Jarman, B. (1984) Underprivileged areas: validation and distribution scores. BMJ, 298, 15871592.
Jones, G. & Berry, M. (1986) Regional secure units; the emerging picture. In Current Issues in Clinical Psychology IV (ed. Edwards, G.), pp. 2442. London: Plenum.
Kirov, G. & Murray, R. M. (1999) Ethnic differences in the presentation of bipolar affective disorder. European Psychiatry, 14, 199204.
Link, B. G. & Stueve, A. (1995) Evidence bearing on mental illnessasa possible cause of violent behaviour. Epidemiologic Reviews, 17, 172181.
Maden, A., Friendship, C., McClintock, T., et al (1999) Outcome of admission to a medium secure psychiatric unit. 2. Role of ethnic origin. British Journal of Psychiatry, 175, 317321.
McGuffin, P., Farmer, A. E. & Harvey, I. (1991) A polydiagnostic application of operational criteria in psychotic illness. Archives of General Psychiatry, 48, 5055.
McMiller, P., Johnstone, E. C., Lang, F. H., et al (2000) Differences between patients with schizophrenia within and without a high security psychiatric hospital. Acta Psychiatrica Scandinavica, 102, 1218.
Monahan, J. (1993) Causes of violence. In Drugs and Violence in America (ed. Commission, USS). Washington, DC: US Government Printing Office.
STATA (1995) STATA Statistical Software release 5.0. College Station, TX: STATA Corporation.
Strakowski, S. M., Flaum, M., Amador, X., et al (1996) Racial differences in the diagnosis of psychosis. Schizophrenia Research, 21, 117124.
Steadman, H. J., Monahan, J., Robbins, P. C., et al (1993) From dangerousness to risk assessment: implications for appropriate research strategies. In Mental Disorder and Crime (ed. Hodgins, S.), pp. 3961. London: Sage.
Swanson, J. W., Holzer, C. E., Ganju, V. K., et al (1990) Violence and psychiatric disorder in the community: evidence from the epidemiologic catchment area surveys. Hospital and Community Psychiatry, 41, 761770.
Taylor, P. J. (1985) Motives for offending among violent and psychotic men. British Journal of Psychiatry, 147, 491498.
Taylor, P. J., Leese, M., Williams, D., et al (1998) Mental disorder and violence. A special (high security) hospital study. British Journal of Psychiatry, 172, 218226.
Tiihonen, J., Isohanni, M., Räsänen, P., et al (1997) Specific major mental disorders and criminality: a 26-year prospective study of the 1966 Finland birth cohort. American Journal of Psychiatry, 154, 840845.
Van Os, J., Castle, D. J., Takei, N., et al (1996) Psychotic illness in ethnic minorities: clarification from the 1991 census. Psychological Medicine, 26, 203208.
Wessely, S., Castle, D., Der, G., et al (1991) Schizophrenia and Afro-Caribbeans. A case control study. British Journal of Psychiatry, 159, 795801.
World Health Organization (1992) The ICD–10 Classification of Mental and behavioural Disorders. Geneva: WHO.
World Health Organization (1994) The ICD–10 Classification of Mental and behavioural Disorders: Diagnostic Criteria for Research. Geneva: WHO.

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Psychosis in high-security and general psychiatric services: Report from the UK700 and Special Hospitals' Treatment Resistant Schizophrenia groups

  • Elizabeth Walsh (a1), Morven Leese (a1), Pamela Taylor (a1), Ingrid Johnston (a1), Tom Burns (a2), Francis Creed (a3), Anna Higgit (a4) and Robin Murray (a5)...
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