Patterns of Long Acting Injectable Antipsychotic Prescription During Criminal Acts in a Portuguese Psychiatric Hospital

2016 ◽  
Vol 33 (S1) ◽  
pp. S458-S458
Author(s):  
M.A. Duarte ◽  
F. Vieira ◽  
A. Ponte
Keyword(s):  
Psychiatric Inpatient ◽  
Psychiatric Hospitals ◽  
The United States ◽  
Security Measures ◽  
Court Records ◽  
Psychiatric Units ◽  
Icd 10 ◽  
History Of ◽  
Competing Interest ◽  
Long Acting

IntroductionUnder the Portuguese law, criminal offenders that are designated as non-criminal responsible – “inimputáveis”, similar those in the United States of America found “not guilty by reason of insanity”, are forced to be committed to inpatient forensic units either in psychiatric hospitals or prison hospitals for mandatory security measures.Objectives/aimsTo evaluate if patients committed in a regional forensic inpatient unit (RFIU) who had a psychiatric history preceding the crime, were under long acting injectable antipsychotic (LAIA) in during the period of the crime.MethodsDuring September/October 2015, patients committed to the RFIU in Centro Hospitalar Psiquiátrico de Lisboa were characterized using medical and court records regarding clinical and demographic variables. The type of crime and previous number of criminal acts were also accounted for.ResultsWe included 33 patients in the study. During time of the crime, 25 patients (75.8%) had history of previous psychiatric appointments, with an average of 3 commitments to the psychiatric inpatient units. The majority (n = 17; 68%) had a diagnose of “schizophrenia, schizotypal and delusional disorders” (F20–29; ICD 10) and committed “crimes against life” (n = 13; 52%). They had an average of 0.8 previous criminal acts. During the crime, 7 patients (28%) were taking LAIA. Those, 16% (n = 4) were doing an unknown antipsychotic and 12% (n = 3) were doing Haloperidol.ConclusionsDespite several studies showing the clinical and rehabilitative benefit of using LAIA early in the disease course, most of the patients in our study, who were already being followed in outpatient psychiatric units, did not benefit from them.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The reform of Italian forensic psychiatric hospitals and its impact on risk assessment and management

2018 ◽  
Author(s):  
Vittorio De Luca ◽  
Pieritalo Maria Pompili ◽  
Giovanna Paoletti ◽  
Valeria Bianchini ◽  
Federica Franchi ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Treatment Plan ◽  
Psychiatric Hospitals ◽  
Assessment Tools ◽  
Residential Home ◽  
Security Measures ◽  
Lazio Region ◽  
History Of ◽  
Forensic Psychiatric

Italy has a consolidated history of de-institutionalization, and it was the first country to completely dismantle psychiatric hospitals, in order to create small psychiatric inwards closer to the community (i.e. in general hospitals). Nevertheless, it took the nation nearly 40 years to end the process from the beginning of de-institutionalization, definitely closing all of the forensic hospitals, which was not addressed by the first Italian psychiatric reform. This paper describes the establishment of new facilities substituting old forensic hospitals, called Residences for the Execution of Security Measures (REMS), which are a paradigm shift in terms of community-based residential home, and are mainly focused on treatment and risk assessment, rather than custodial practices. The use of modern assessment tools, such as the Aggressive Incident Scale (AIS) and the Hamilton Anatomy of Risk Management (HARM), is crucial in order to point out the focus and consistent instruments of the treatment plan. A preliminary analysis of data from the first 2 years of activity, considering severely ill patients who have been treated for more than 12 months, is then described for two REMSs in the Lazio region, close to Rome. Encouraging results suggest that further research is needed in order to assess clinical elements responsible for a better outcome, and to detect follow-up measures of violence or criminal relapse after discharge.

Demographic characteristics, medical and psychiatric history of patients with prescription opioid use disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S300-S301
Author(s):  
S. Herrera ◽  
A. Riquelme ◽  
T. León ◽  
M. Babul
Keyword(s):  
Opioid Analgesics ◽  
The United States ◽  
Opioid Use Disorder ◽  
Demographic Characteristics ◽  
Prescription Opioid ◽  
Psychiatric History ◽  
Opioid Use ◽  
History Of ◽  
Competing Interest ◽  
Prescription Opioid Misuse

IntroductionOver the past two decades the prescription of opioid analgesics has increased with a subsequent escalating in prescription opioid misuse. It is estimated that 4.5 million (2.5%) of the United States of America population abuse of pain relievers; opioids are among the most commonly.In Chile there are few reports about the prevalence of opioid use disorder.ObjectivesThe aim of this study is to describe the demographic characteristics, medical and psychiatric comorbidity of patients that suffer from opioid addiction.Patients and methodsThis transversal study examined data of 7 patients with opioid use disorder (OUD; DSM-5) that consulted at the addiction unit of “Red de Salud, Pontificia Universidad Católica de Chile”, between November 2013 and October 2015. Data included: demographics, medical and psychiatric history, laboratory and imaging tests.ResultsOf all the patients, 57% were men, 25 to 67 years of age, 43% between 35-40 years; 57% were married; 57% had completed studies at university. 43% had also alcohol use disorder, 28% marijuana, 28% cocaine and 28% benzodiazepines than in most cases began before OUD. In addition; 57% had medical comorbidity among which stand out obesity (17%), osteoarthritis (17%) and chronic low back pain (17%). Eighty-three percent require hospitalization. Twenty-eight percent had abnormal liver tests and one patient had positive hepatitis B core antibody. Opioids used were: morphine(14%), codeine (43%), tramadol (42%).ConclusionThese results emphasize on the misuse of prescription opioids analgesics, the complexity of patients with OUD and the prevalence of other substance use disorder that precedes and accompany OUD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A study of deliberate self-poisoning in a Dublin hospital 1986 – 1990

1994 ◽  
Vol 11 (2) ◽  
pp. 70-72 ◽  
Author(s):  
Fergus Coakley ◽  
Catherine Hayes ◽  
John Fennell ◽  
Zachary Johnson
Keyword(s):  
Past History ◽  
Dublin Hospital ◽  
Psychiatric Inpatient ◽  
Previous History ◽  
Psychiatric Hospitals ◽  
High Rate ◽  
Medical Complication ◽  
Motivating Factors ◽  
History Of ◽  
Low Threshold

AbstractObjective: The study was undertaken to determine the current demographic and clinical features of cases of deliberate self-poisoning (DSP) presenting to an acute general hospital and to compare the findings with previous work in Ireland and elsewhere. Method: Four hundred and sixty seven consecutive admissions for DSP presenting to a Dublin hospital between 1986 and 1990 inclusive were identified retrospectively and the case notes reviewed. Data was collected on age, sex, marital status, past history, date of DSP, drugs used, motivating factors and outcome. Results: The peak age of DSP was 15-24 years. The female:male ratio was 1.5:1. There was an increased incidence of DSP in women in July and August. In 32% there was a previous history of DSP. Benzodiazepines, antidepressants and analgesics/anti-inflammatories were the commonest drugs taken. There was a significant medical complication in 10.5% of cases, but no fatalities. Twenty-five percent of patients were subsequently admitted to psychiatric inpatient care. Conclusions: DSP is an ongoing problem. The summer peak in females may be related to the parenting burden during the summer recess. The high rate of repetition suggests a significant reduction could be achieved with successful strategies for secondary prevention. The high rate of psychiatric in-patient referral may be related to a low threshold for admissions to Irish psychiatric hospitals.

DSM-5 Clinical/legal Challenges Regarding the USA's Death Penalty

2016 ◽  
Vol 33 (S1) ◽  
pp. S458-S458
Author(s):  
L. French
Keyword(s):  
Mental Retardation ◽  
Death Penalty ◽  
The United States ◽  
World Health ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
The Us ◽  
Icd 10 ◽  
The Usa ◽  
Competing Interest

IntroductionIn May 2013, the American Psychiatric Association (APA) published the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in order to bring America's clinical professionals in concert with the World Health Organization's (WHO) international classifications, notably the ICD-10-CM. This effort was met with considerable resistance and changes were delayed until November 2015. Major social-cultural differences between the United States and its European and other North American partners (Canada and Mexico) poses challenges in critical forensic areas such as the clinical/legal assessment of death qualified offenders – a status unique to the USA.Objective/aimsTo articulate the clinical/legal differences between the previous DSM's (III; III-R; IV) and the DSM-5 and how the new language provides greater ambiguity in defining the mental status requirements for Mens Rea – competence to understand one's actions.MethodsPresent the major legal issues surrounding the US death penalty and brought before the US Supreme Court including: Furman v. Georgia (1972); Greg v. Georgia (1976); Jared v. Texas (1976); Proffit v. Florida (1976); Adkins v. Virginia (2002); Roper v. Simmons (2005); Miller v. Alabama (2012): … and legislative actions such as Rosa's Law (Public Law 111-256; 2010).Results/conclusionsAdvocacy groups pushed Rosa's Law to mental retardation with – intellectual and developmental disability. This change is reflected in the DSM-5 whereby mental retardation (MR) was once relegated to axis II, is now classified under intellectual disabilities (ID) given the impression that it is a transitory (correctable) and not a fix (organ disability) clinical condition.Disclosure of interestThe author has not supplied his declaration of competing interest.

Violent incidents within psychiatric settings

2017 ◽  
Vol 41 (S1) ◽  
pp. S589-S589
Author(s):  
B. Motamedi ◽  
A. Mahmoudi ◽  
M. Motamedi
Keyword(s):  
Relative Risk ◽  
Nursing Staff ◽  
Violent Behavior ◽  
Psychiatric Inpatient ◽  
Low Grade ◽  
Psychiatric Units ◽  
Inpatient Settings ◽  
Competing Interest ◽  
Complex Relationships ◽  
Patient Mix

ObjectiveTo determine the frequency and types of aggressive and violent behaviors in acute psychiatric inpatient settings and potential interactions between staffing and patient mix and rates of the behaviours were explored.MethodsData on violent incidents were gathered prospectively in two acute psychiatric units in two general hospitals and two units in a psychiatric hospital in Isfahan, Iran. Staff recorded violent and aggressive incidents by using Morrison's hierarchy of aggressive and violent behavior. The classification ranged from level 1, inflicted serious harm to self or others requiring medical care, to level 8, exhibited low-grade hostility. They also completed weekly reports of staffing levels and patient mix. Regression analysis was used to calculate relative rates.ResultsA total of 400 violent incidents were recorded over a three-month period. Based on the scale, more than 50 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more non nursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness.ConclusionsViolent incidents within psychiatric facilities were frequent and serious, with great significance for occupational health. Some clues were found in the prediction of violence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Late Onset Schizophrenia. A Case Report

2016 ◽  
Vol 33 (S1) ◽  
pp. S530-S531
Author(s):  
J.M. Hernández Sánchez ◽  
M.C. Cancino Botello ◽  
M.F. Molina Lopez ◽  
M. Muñoz Carril ◽  
S. Arnés González ◽  
...  
Keyword(s):  
Late Onset ◽  
Clinical History ◽  
Developed Countries ◽  
Main Diagnosis ◽  
Medline Search ◽  
Wide Range ◽  
History Of ◽  
Competing Interest ◽  
Long Acting ◽  
Clinical Conditions

IntroductionThe presence of elderly people is more and more common in developed countries. Unlike other medical conditions, late onset psychosis includes organic and mental precipitants in its differential diagnosis.ObjectivesTo present a case of late onset schizophrenia.MethodsMedline search and review of the clinical history and the related literature.ResultsWe present the case of a 71-year-old woman with organic medical history of rectum adenocarcinoma in 2008 that underwent radiotherapy, chemotherapy and surgical resection with successful results. According to the psychiatric history, this patient has needed two admissions to the psychiatry ward, the first of them in 2012, (when the delusional symptoms started), due to deregulated behaviour in relation to persecutory delusions and auditory pseudo-hallucinations. In 2012, she was diagnosed with late onset schizophrenia. Blood tests (hemograme, biochemistry) and brain image were normal. Despite treatment with oral amisulpride and oral paliperidone and due to low compliance, delusional symptoms have remained. We started treatment with long-acting injectable papliperidone 75 mg/28 days having reached clinical stability.ConclusionsLate onset psychosis is due to a wide range of clinical conditions. In this case, our patient had no organic precipitants. The evolution and presentation of delusional symptoms in this patient made us think of late onset schizophrenia as main diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment with intramuscular paliperidone palmitate in schizoaffective disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S581-S581
Author(s):  
L. Maroto Martin ◽  
P. Hervías Higueras
Keyword(s):  
Schizoaffective Disorder ◽  
Complex Disease ◽  
Psychotic Disorders ◽  
Paliperidone Palmitate ◽  
Valuable Treatment ◽  
History Of ◽  
Competing Interest ◽  
One Year ◽  
Long Acting ◽  
Monthly Dose

IntroductionInjectable formulations of long acting antipsychotic are a valuable treatment option for patients with psychotic disorders. Schizoaffective Disorder (SAD) is a complex disease; the optimal treatment is not well established yet.ObjectiveAnswer the question about the effectiveness offered by intramuscular Paliperidone Palmitate in SAD versus other injectable antipsychotics. Keywords: schizoaffective disorder; paliperidone palmitate injection.MethodsA case report of a 35-year-old male diagnosed with Schizoaffective Disorder six years ago and with personal history of multiple manic decompensation after treatment discontinuation. Throughout his life he has been treated with intramuscular Risperidone 87.5 mg (50 + 37.5) every 14 days, Olanzapine flas 20 mg/day, Risperidone flas 3 mg, Amisulpride 600 mg/day, Valproic acid 1500 mg/day Clonazepam 2 mg/day and Lormetazepam 1 mg. In the last admission one year ago, he started treatment with intramuscular paliperidone palmitate up to 200 mg a month. Currently he receives a monthly dose of 100 mg and concomitant lithium 800 mg/day.DiscussionThe use of intramuscular paliperidone palmitate in SAD and its effectiveness against other injectable antipsychotic is discussed.ConclusionsThe use of intramuscular paliperidone palmitate appears to constitute an employment opportunity in the treatment of intramuscular maintenance in SAD. It could be effective in stabilizing episodes of acute exacerbation and remissions of psychotic, manic and depressive symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

15 years and counting – How are schizophrenic patients with long hospitalization time?

2016 ◽  
Vol 33 (S1) ◽  
pp. S576-S577
Author(s):  
M.A. Duarte ◽  
B. Lourenço ◽  
A. Ponte ◽  
A. Caixeiro
Keyword(s):  
Negative Symptoms ◽  
Psychiatric Hospitals ◽  
Therapeutic Approaches ◽  
Symptom Scale ◽  
Long Duration ◽  
Icd 10 ◽  
Schizophrenic Patients ◽  
The Mean ◽  
Competing Interest ◽  
Behaviour Changes

IntroductionCentro Hospitalar Psiquiátrico de Lisboa (C.H.P.L.), in Lisbon, Portugal, is the biggest psychiatric hospital in Portugal and one of the oldest still working. Along with acute inpatient clinics it has long duration inpatient units with 226 patients.Objectives/aimsCharacterize and improve the therapeutic approaches in patients committed to the long duration inpatient unit with long hospitalization times and the diagnose of schizophrenia.MethodsDuring the month of September 2015 all patients, committed before 2000 who fulfilled the diagnosis criteria ICD 10, F20.X (Schizophrenia) were characterized regarding age, gender, time of hospitalization and were evaluated using the Positive and Negative Symptom Scale (PANSS).ResultsFrom the original sample (n = 226), 31 patients were included in the study. The mean age was 64.4 years (min 50–max 91) and the majority were male (67.7%; n = 21). The mean years of hospitalization were 28.7 years (min 15–max 60). The average total PANSS score was 99.8 (positive symptoms: 25.4; negative symptoms: 29.9; general symptoms: 44.4).ConclusionsAlthough in last decades many psychiatric hospitals were closed and community approaches to treatment of the mentally ill were the direction preconized by several international organizations, some patients still “live” in the hospital. Mostly, as we found in our study, have a severe, refractory disease, sometimes with behaviour changes that unable them to be discharged. With the continuous evolution of psychopharmacological drug treatment, this paradigm may change. Meanwhile other therapeutic approaches should be used to improve the disease symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Differences between countries in adult acute psychiatric hospitalization: Clinical features and drug prescription in Spain and the United States of America

2016 ◽  
Vol 33 (S1) ◽  
pp. S113-S113 ◽  
Author(s):  
L. Gonzalez-Blanco ◽  
S. Bestene-Medina ◽  
E. Torio-Ojea ◽  
I. Abad-Acebedo ◽  
J. Rodriguez-Revuelta ◽  
...  
Keyword(s):  
Clinical Features ◽  
Psychiatric Hospitalization ◽  
Drug Prescription ◽  
The United States ◽  
Inpatient Stay ◽  
Cross Sectional ◽  
Diagnostic Categories ◽  
Psychiatric Units ◽  
Competing Interest ◽  
Comparison Table

IntroductionDiverse prescription patterns and differences in length of psychiatry inpatient stay among European and American countries have been reported [1,2].ObjectivesTo describe and compare clinical features and drug prescriptions in two Acute Psychiatric Units from Spain and USA.MethodsCross-sectional and comparative study. Sample: 73 inpatients from Reno (USA-Inpatients) and 65 from Oviedo (Spain-Inpatients) admitted to public Adult Acute Psychiatric Unit over a two-month period. Sociodemographic/clinical data and drug prescription were collected.ResultsSociodemographic/clinical comparison (Table 1) and drug prescription differences (Table 2) are shown.No significant differences in antipsychotics’ prescription except for the most frequently used [risperidone in Spain (36%)/ziprasidone in US (19.6%), Chi2 = 39.7**].Conclusions(A) Psychiatric inpatients in US are younger, have longer hospitalization, show more comorbid substance use disorder and differ from Spanish inpatients in frequency of diagnostic categories (schizophrenic disorders represent a larger proportion).(B) Inpatients in Spain usually receive polytherapy, and are more frequently treated with antidepressants and anxiolytics, especially benzodiazepines. In contrast, USA-Inpatients take lithium more often [1,2].Disclosure of interestThe authors have not supplied their declaration of competing interest.

Civil Commitment Trends in Ontario: The Effect of Legislation on Clinical Practice

1985 ◽  
Vol 30 (4) ◽  
pp. 259-264 ◽  
Author(s):  
B.A. Martin ◽  
K.D. Cheung
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Psychiatric Inpatient ◽  
Civil Commitment ◽  
Psychiatric Hospitals ◽  
The Other ◽  
Mental Health Legislation ◽  
History Of ◽  
Health Legislation ◽  
Over Time

The rationale for and history of civil commitment legislation in Ontario are reviewed The civil commitment rate in Ontario from 1926 to 1980 for provincial psychiatric hospitals, and from 1974 to 1980 for all psychiatric inpatient facilities was analyzed to detect variation in the rate over time and with relevant legislation. The findings indicate that mental health legislation has had little effect on commitment practices in Ontario. In addition, the variation in the commitment rate over the period reviewed cannot be ascribed to inconsistent application by physicians. The other variables affecting the rate are discussed in this context. The need for more descriptive studies of the major determinants of the commitment rate is emphasized.

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