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Comorbidity of post traumatic stress disorder and paranoid schizophrenia: a comparison of offender and non-offender patients
- Author:
- SARKAR Jaydip
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), December 2005, pp.660-670.
- Publisher:
- Taylor and Francis
This study describes rates of trauma and posttraumatic stress disorder (PTSD) in forensic and non-forensic psychiatric patients, with a primary diagnosis of paranoid schizophrenia. Twenty-seven disordered offender patients (forensic) were compared with 28 non-offender (general) psychiatric inpatients. Ninety-three percent of the entire group reported previous trauma, with the forensic group reporting higher rates of physical and sexual abuse. The forensic patients had also experienced more multiple traumas then the general psychiatric patients, although the result was non-significant. There was no difference between the groups with regard to the age of the earliest trauma experienced. PTSD was common, with rates of 27% for current, and 40% lifetime diagnosis in the whole group. Forensic patients had higher rates of both current (33% v 21%) and lifetime (52% v 29%) PTSD. Very few patients had received a working diagnosis of PTSD, or were receiving trauma focussed psychological therapy. Possible reasons for high rates of trauma and PTSD, and implications for treatment are discussed.
Forensic issues in adolescents with developmental disabilities
- Authors:
- GRALTON Ernest, ed.
- Publisher:
- Jessica Kingsley
- Publication year:
- 2011
- Pagination:
- 287p.
- Place of publication:
- London
The book provides a comprehensive account of forensic issues in adolescents with a wide range of developmental disabilities, including autism spectrum disorders, acquired brain injury, developmental traumatology, and complex comorbidities. It examines the processes involved in working with this client group in forensic settings, and explores the ways in which their needs differ from those of other young people who engage in high risk behaviour or offending. The book covers assessment, intervention and treatment options for adolescents with developmental disabilities. It describes the obstacles, challenges and opportunities to consider when working with this population, and the role played by various professionals, including those working in forensic psychiatry and psychology, occupational therapy, physiotherapy, education, art psychotherapy and social work. The book also outlines the issues to consider when working in secure and community settings as well as the legal aspects of working with this client group, and the complex issues surrounding risk assessment. It is likely to be of interest to a wide range of professionals working with adolescents with developmental disabilities.
A demographic study of the Orchard Clinic: Scotland's first medium secure unit
- Authors:
- GOW Rona L., et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 21(1), February 2010, pp.139-155.
- Publisher:
- Taylor and Francis
Forensic services in Scotland are evolving, based on similar developments previously in England and Wales. The Orchard Clinic in Edinburgh opened in November 2000 and was the first medium secure unit in Scotland. It was designed to serve a general population of 1.5 million, covering south-east Scotland, with 50 beds split between 2 rehabilitation wards and 1 acute ward. This paper describes all patients admitted to the unit in the first 5 years of its operation, considering antecedents to their admission, patient characteristics and progress through the system. In total 219 admissions were collected and analysed. The majority of patients were single adult males, aged 40 or under, who had a primary diagnosis of paranoid schizophrenia with a co-morbid diagnoses of personality disorder or substance misuse. The average length of admission was 285 days. In order to benchmark against established services a comparison is made with earlier studies of forensic populations in Scotland and elsewhere in the UK.
Personality disorders, psychopathy and other mental disorders: co-morbidity among patients at English and Scottish high-security hospitals
- Authors:
- BLACKBURN Ronald, et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 14(1), April 2003, pp.111-137.
- Publisher:
- Taylor and Francis
Mental health legislation in Britain has traditionally encouraged distinction between personality disordered and mentally ill offenders, but research on co-morbidity indicates that few patients exhibit an Axis I or an Axis II disorder in isolation. This study compared male high-security hospital patients in the English Mental Health Act categories of psychopathic disorder (n= 54) and mental illness n = 61) and the Scottish legal category of mental disorder (n= 60), using structured instruments to assess personality disorders, psychopathy and Axis I disorders. The mental illness and psychopathic disorder categories were not differentiated by personality disorders,psychopathy,or AxisI disorders,except for more lifetime drug abuse and more lifetime and current psychosis among the mentally ill. A majority of patients with mental disorder under Scottish legislation also exhibited personality disorders. Grouping by primary clinical diagnosis of personality disorder or mental illness produced few differences on Axis I or Axis II, and overall there was a relatively strong correlation between the presence of an AxisI and an AxisII disorder. Legal and clinical attempts to separate personality disordered and mentally ill offenders maybe ill-conceived because Axis I and Axis II disorders tend to coexist.
Forensic rehabilitation in Asperger syndrome: a case report
- Authors:
- KELBRICK Marlene, RADLEY Jane
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 4(1/2), 2013, pp.60-64.
- Publisher:
- Emerald
Purpose – People with Asperger syndrome are at increased risk of co-morbid mental health problems. The core features underlying autism are likely to play an important role in offending behaviour amongst this population. Forensic rehabilitation includes a multidisciplinary approach and combination of therapeutic interventions. However there is limited evidence in the literature of what constitutes effective treatment within this setting, and how the process of rehabilitation is experienced by patients. The purpose of this paper is to describe a case of Asperger syndrome with co-morbid psychosis and offending behaviour and the process of forensic rehabilitation. Design/methodology/approach – The authors briefly review the literature related to Asperger syndrome, offending in this population and co-morbidity. The authors then describe and reflect on a case of a young man with Asperger syndrome, sexual offending and the process of forensic rehabilitation, and offer an insight from the patient's perspective. Findings – Co-morbid mental illness, when detected early, can be successfully managed with limited additional disability. The process of forensic rehabilitation includes a multidisciplinary approach. Therapeutic interventions specifically aimed at addressing core features of autism, risk and offence-related factors are effective in promoting recovery amongst those with autism and offending behaviour. Originality/value – The paper highlights how core features of autism can lead to offending behaviour, the importance of early recognition and treatment of co-morbidity, and the process of forensic rehabilitation and recovery. Also included are quotes from the patient's perspective on what it is like to have Asperger syndrome, and what has been the key learning from the rehabilitation process. (Publisher abstract)
MIDAS: a new service for the mentally ill with comorbid drug and alcohol misuse
- Authors:
- BAYNEY R., ST. JOHN-SMITH P., CONHYE A.
- Journal article citation:
- Psychiatric Bulletin, 26(7), July 2002, pp.251-254.
- Publisher:
- Royal College of Psychiatrists
Describe the work and patient characteristics of one of the first combined mental illness and drug and alcohol services (MIDAS) in the UK. Examines MIDAS as an assertive community service, for individuals receiving long-term community care. Results found patients with bipolar affective disorder and personality disorders were more likely to use the service than patients with unipolar disorder or schizophrenia. Despite the use of an assertive service, there was difficulty engaging patients with schizophrenia and comorbid drug use.