Search results for ‘Subject term:"personality disorders"’ Sort:
Results 1 - 10 of 62
Patients with personality disorders and intellectual disability - closer to personality disorders or intellectual disability? A three-way comparison
- Authors:
- ALEXANDER Regi T., et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 23(4), August 2012, pp.435-451.
- Publisher:
- Taylor and Francis
Within secure intellectual disability services, the prevalence of personality disorders is around 50%. This study aimed to examine how patients with both intellectual disability and a personality disorder differ from those with an intellectual disability alone or those with a personality disorder alone. It involved retrospective case-note analysis relating to a sample of 362 patients discharged from secure hospital services in the UK between 1992 and 2001. The article describes the methodology and data analysis, and presents the results. It reports that the findings suggest that within the secure hospital system, those with intellectual disability alone and personality disorder alone were strikingly distinct, while those with both intellectual disability and personality disorders appeared to follow a path closer to those with intellectual disability in terms of outcomes. The authors discuss the differences and similarities between patients and the implications of the findings.
Rehabilitating antisocial personalities: treatment through self-governance strategies
- Author:
- McRAE Leon
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 24(1), 2013, pp.48-70.
- Publisher:
- Taylor and Francis
It is widely assumed that offenders with antisocial personality disorder (ASPD) reject psychotherapeutic intervention, suggesting that they may be better managed in the criminal justice system. On the other hand NICE guidelines recommend that those who are treatment seeking should be considered for admission to specialist psychiatric hospitals. The argument is that offenders with ASPD can be rehabilitated, if they are motivated. However little is known about why offenders with ASPD seek treatment or what effect subsequent treatment has on their self-understanding. This paper draws on the findings of a qualitative study examining the experiences of sentenced male offenders admitted to a specialist personality disorder ward within the medium secure estate and the medical practitioners who treat them. The data are analysed with reference to Michel Foucault’s work on governmentality and strategy in power relations. The paper concludes that specialist treatment in the hospital setting can effect changes in the resistive offender’s self-understanding, but not if the completion of treatment results, as is commonplace, in his prison readmission.
Self harm in a dangerous and severely personality disordered population
- Author:
- MANNION Aisling
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 20(2), April 2009, pp.322-331.
- Publisher:
- Taylor and Francis
This article reports on a total of 309 incidents of self-harm recorded between October 2004 and September 2007, for a group of male patients deemed to be dangerous and severely personality disordered (DSPD), within the Peaks Unit at Rampton high security hospital. The first part of this paper describes self-harm within this group of patients, to see whether, as well as posing danger to the public, these patients also pose a risk of harm to themselves. Second, the paper investigated the antecedents of the self-harm incidents recorded. Finally, statistical analyses were conducted to assess the relationships between self-harm and patient/environmental characteristics. No significant differences were found between those who self-harmed and those that did not, although some differences were found within the self-harming group. Implications for future research and treatment are discussed.
The effects of relocation and staff changes on individuals with a personality disorder
- Author:
- COUGHLIN Louise
- Journal article citation:
- British Journal of Forensic Practice, 5(4), November 2003, pp.12-17.
- Publisher:
- Emerald
Reports on a research study which compares staff and patient perceptions of two new wards in a medium secure unit, and to compare staff and patient perceptions of the new ward with their ideal ward environment. Results obtained from the patients indicated that there were differences between perceptions of the new treatment unit and the former treatment unit. Results also indicated that there was a difference between perceptions of the new treatment unit and the ideal ward environment. Results obtained from staff could not be analysed because of a low response rate.
Patients' experience of dangerous and severe personality disorder services: qualitative interview study
- Authors:
- SINCLAIR Julia, et al
- Journal article citation:
- British Journal of Psychiatry, 200(3), March 2012, pp.252-253.
- Publisher:
- Cambridge University Press
The Dangerous and Severe Personality Disorder (DSPD) is an administrative category, not a diagnosis, and how such individuals should be managed in secure hospitals or prisons has been the subject of debate. A pilot study across four sites in the UK, the DSPD Programme, is now complete. The programme is being scaled down but the authors suggest that there is a need to learn lessons about the treatment of this difficult group. The aim of this short report is to describe the treatment pathway and environment of the DSPD units. A total of 60 participants purposely sampled across the four pilot DSPD units took part in in-depth interviews. This report is limited to the finding with potential `conceptual generalisability': namely the unanticipated finding of negative and hostile attitudes of participants being managed in hospital units compared with the prison system. The authors believe that the recent UK government policy decision to concentrate this programme in prisons may, in part, reflect the significance of these findings.
MHT insight guide: women’s secure services
- Authors:
- JACOB Caroline, LILLEY Steve
- Journal article citation:
- Mental Health Today, September 2011, pp.21-23.
- Publisher:
- Pavilion
- Place of publication:
- Hove
Partnerships in Care (PiC) is the largest independent provider of secure mental health facilities across the UK. PiC Midlands provides medium and low secure plus locked rehabilitation services across the East Midlands. Following the introduction of the national Quality, Innovation, Productivity and Prevention (QIPP) programme in 2009, PiC Midlands reviewed its model of care in terms of the aim of the programme and current psychological knowledge of the treatment of women. This article describes the design and early stages of implementation of the new staged model of care adopted by PiC Midlands. The model of care comprises 4 different stages: stabilisation; engagement and awareness; choosing change; and maintaining recovery. A shared care pathway functions across levels of security and streamlines the patient’s journey through PiC Midlands. Transitions during a patient’s recovery are often destabilising factors, and a ‘moving on’ programme for patients aims to help patients in managing transitions, such as transferring to a lower security unit or moving to the next step in the care pathway.
Adapted dialectical behaviour therapy for male offenders with learning disabilities in a high secure environment: six years on
- Authors:
- MORRISSEY Catrin, INGAMELLS Bridget
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 2(1), January 2011, pp.8-15.
- Publisher:
- Emerald
Dialectical behaviour therapy (DBT) is a comprehensive psychological treatment that was first developed for suicidal individuals with a diagnosis of borderline personality disorder. Standard DBT is an integrated model combining a range of cognitive and behavioural approaches with aspects of Eastern philosophy, including mindfulness meditation, and has several treatment modes. The model has previously successfully been used to address violence and aggression in a forensic setting. The National High Secure Learning Disability Service (NHSLDS) piloted an adapted DBT programme suitable for men with mild learning disabilities in 2004, and the programme has been developed over a period of 6 years. This paper describes the rationale for development of the programme, how the programme has evolved, the major modifications to mainstream DBT that it incorporates, and the challenges that remain. It concludes that adapted DBT is a promising approach to address self-harm and aggression in hospitalised forensic populations with learning disability and personality disorder, but much creativity and adaptation is necessary. Manualised approaches need to serve as a guidance rather than being rigidly prescriptive.
Difficulties in the pathway from high to medium secure services for personality-disordered patients
- Authors:
- TETLEY Amanda Clair, EVERSHED Sue, KRISHNAN Gopi
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 21(2), April 2010, pp.189-201.
- Publisher:
- Taylor and Francis
A significant proportion of inpatients in high secure hospitals are detained under the Mental Health Act with a diagnosis of personality disorder, and the main route of discharge to the community for these patients is through medium secure units. This study aimed to explore the difficulties encountered in the transfer process from high to medium secure services for personality disordered patients, to identify the success of referrals from high to medium secure services, to determine the delays encountered during the transition process, and to identify the success of personality disordered patients' admissions to medium secure services. Data relating to referrals to medium secure services were collated for previous and current patients from a personality disorder service and a dangerous and severe personality disorder service in the high secure Rampton Hospital. The results showed a poor success rate of referrals to medium secure units and extensive delays encountered in the transfer process, also identifying a poor success rate of patients' period of trial leave at medium secure units. The researchers concluded that these findings are consistent with reports that consultants in medium secure units are reluctant to accept personality disordered patients and that these units lack the infrastructure to treat this patient group
Social interaction related to the functioning of forensic psychiatric inpatients
- Authors:
- VAN DER HORST Ruud, et al
- Journal article citation:
- Journal of Forensic Psychology Practice, 10(4), July 2010, pp.339-359.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
The major aim of the treatment of forensic psychiatric patients is to reduce risk of future violence by means of a positive change in the factors associated with the offence. This article argues that information on patients' social network patterns and the content of their relationships provide detailed information about relational behaviour that can be an important complement of information on behaviour provided by the traditional psycho-diagnostics. A study investigated social networks in 60 patients with personality disorders in a forensic psychiatric hospital in the Netherlands. The socio-therapists working on the patient units evaluated all possible dyadic relations between patients using a specifically designed questionnaire. Positive, friendly relationships, instrumental relationships (which provide something of advantage, such as goods or protection) and influential relationships (which lead to changes in behaviour or thinking) were all considered. This data was analysed to investigate how the patient’s social relations were associated with 3 domains of their risk-related psychosocial functioning: problem awareness; impulse control; and skills. All 3 domains were found to be associated with relational patterns; impulse control, and skills showing the strongest associations. More positive relations were maintained by patients with better basic requisite life, social, and coping skills. Better skilled patients were also more instrumentally used by other patients. The results demonstrated a clear association between mental health and networks of imprisoned patients.
The clinical and risk characteristics of patients admitted to a secure hospital-based Dangerous and Severe Personality unit
- Authors:
- SHELDON Kerry, KRISHNAN Gopi
- Journal article citation:
- British Journal of Forensic Practice, 11(3), September 2009, pp.19-27.
- Publisher:
- Emerald
Four high secure units at HMP Whitemoor, HMP Frankland, Broadmoor Hospital and Rampton Hospital were set up in order to deal with patients with severe personality disorder who pose a risk to the public. This paper describes the clinical and risk characteristics of patients admitted over the first four years of operation of the Dangerous and Severe Personality Disorder NHS pilot at the Peaks Unit, Rampton Secure Hospital. There were 124 referrals, mainly from Category A and B prisons, resulting in 68 admissions. Clinically, 29% scored 30 or more on the Psychopathy Checklist. The most common personality disorders were antisocial, borderline, paranoid and narcissistic. The patients also exhibited a high risk of violent and sexual recidivism. The authors conclude that it is too soon to come to a view about the effectiveness of the treatment offered, although a primary aim of the Dangerous and Severe Personality Disorder service will be to establish the impact of treatment on the risk posed by the patients.