Mental disorder and clinical care in people convicted of homicide: national clinical survey

BackgroundThe number of suicides in prison has increased over recent years. This is the first study to describe the clinical care of a national sample of prison suicides.AimsTo describe the clinical and social circumstances of self-inflicted deaths among prisoners.MethodA national clinical survey based on a 2-year sample of self-inflicted deaths in prisoners. Detailed clinical and social information was collected from prison governors and prison health care staff.ResultsThere were 172 self-inflicted deaths: 85 (49%; 95% CI 42–57) were of prisoners on remand; 55 (32%; 95% CI 25–39) occurred within 7 days of reception into prison. The commonest method was hanging or self-strangulation (92%; 95% CI 88–96). A total of 110 (72%; 95% CI 65–79) had a history of mental disorder. The commonest primary diagnosis was drug dependence (39, 27%; 95% CI 20–35). Eighty-nine (57%; 95% CI 49–64) had symptoms suggestive of mental disorder at reception into prison.ConclusionsSuicide prevention measures should be concentrated in the period immediately following reception into prison. Because hanging is the commonest method of suicide, removal of potential ligature points from cells should be a priority.

Download Full-text

Impact of arthritis on the perceived need and use of mental healthcare among Canadians with mental disorders: nationally representative cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-041371 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041371

Author(s):

Alyssa Howren ◽

J Antonio Aviña-Zubieta ◽

Deborah Da Costa ◽

Joseph H Puyat ◽

Hui Xie ◽

...

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Mental Disorder ◽

Clinical Care ◽

Mental Healthcare ◽

Cluster Sampling ◽

Cross Sectional ◽

Perceived Need ◽

Mental Health Support ◽

Health Support

ObjectiveTo evaluate the association between having arthritis and the perceived need for mental healthcare and use of mental health support among individuals with mental disorders.DesignA cross-sectional analysis using data from Canadian Community Health Survey—Mental Health (2012).SettingThe survey was administered across Canada’s 10 provinces using multistage cluster sampling.ParticipantsThe study sample consisted of individuals reporting depression, anxiety or bipolar disorder.Study variables and analysisThe explanatory variable was self-reported doctor-diagnosed arthritis, and outcomes were perceived need for mental healthcare and use of mental health support. We computed overall and gender-stratified multivariable binomial logistic regression models adjusted for age, gender, race/ethnicity, income and geographical region.ResultsAmong 1774 individuals with a mental disorder in the study sample, 436 (20.4%) reported having arthritis. Arthritis was associated with increased odds of having a perceived need for mental healthcare (adjusted OR (aOR) 1.71, 95% CI 1.06 to 2.77). In the gender-stratified models, this association was increased among men (aOR 2.69, 95% CI 1.32 to 5.49) but not women (aOR 1.48, 95% CI 0.78 to 2.82). Evaluation of the association between arthritis and use of mental health support resulted in an aOR of 1.50 (95% CI 0.89 to 2.51). Individuals with arthritis tended to use medications and professional services as opposed to non-professional support.ConclusionComorbid arthritis among individuals with a mental disorder was associated with an increased perceived need for mental healthcare, especially in men, underscoring the importance of understanding the role of masculinity in health seeking. Assessing the mental health of patients with arthritis continues to be essential for clinical care.

Download Full-text

Religion and psychiatry: research, prayer and clinical practice

BJPsych Advances ◽

10.1192/bja.2020.43 ◽

2020 ◽

Vol 26 (5) ◽

pp. 282-284

Author(s):

Christopher C. H. Cook

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Mental Disorder ◽

Religious Coping ◽

Clinical Care ◽

Well Being ◽

Culturally Sensitive ◽

Careful Attention

SUMMARYReligious concerns, manifested in thought and behaviour, have a complex, bidirectional and sometimes conceptually overlapping relationship with mental health and mental disorder. Psychiatry, concerning itself with what is measurable in research, and with the relief of distress in clinical practice, has a different perspective on these complex interrelationships than does theology or religion. That which is transcendent, and therefore not measurable, is often important to patients, and sometimes distress may (theologically) be a sign of human well-being. The giving of careful attention to transcendence and distress may variously be conceived of as prayer, religious coping or clinical care. Applications of research to clinical practice, addressing as they do a sensitive and controversial boundary between psychiatry and religion, must therefore be patient centred and culturally sensitive.

Download Full-text

Analysis of Suicides Reported as Adverse Events in Psychiatry Resulted in Nine Quality Improvement Initiatives

Crisis ◽

10.1027/0227-5910/a000787 ◽

2021 ◽

Author(s):

Julie Mackenhauer ◽

Jan-Henrik Winsløv ◽

Jens Holmskov ◽

Inger Brødsgaard ◽

Tina Gram Larsen ◽

...

Keyword(s):

Mental Health ◽

Quality Improvement ◽

Adverse Events ◽

Mental Disorder ◽

Suicide Attempts ◽

Clinical Care ◽

Health Facilities ◽

Risk Assessments ◽

Medical Chart Review ◽

Mental Health Facilities

Abstract. Background: The majority of persons who die by suicide have a mental disorder. Preventive strategies should include addressing social and psychological factors and the treatment of the mental disorder. Aim: We aimed to identify breaches in clinical care and identify areas for quality improvement initiatives. Method: An aggregate analysis of suicides reported as adverse events during 2012–2016 to Psychiatry, North Denmark Region was carried out. We developed an audit chart and identified items through (a) medical chart review and (b) consensus meetings in an expert panel. Results: A total of 35 cases were analyzed. Suicide risk assessments were adequately documented in the medial chart in six of 35 cases. Risk assessments emphasized suicidal ideation rather than well-known risk factors such as previous suicide attempts, substance abuse, physical illness, or job loss. Relatives were involved in four of 35 of the risk assessments. The panel suggested nine areas for quality improvement. Limitations: Most people who die by suicide are not seen in mental health facilities prior to suicide, and hence conclusions can only be generalized to these patients. Information on the gap between “Work-as-Done” and “Work-As-Imagined” was not recognized. Conclusion: Most of the risk assessments among suicides reported as adverse events to our mental health facilities were insufficient. Quality improvement initiatives focusing on training, documentation, involving relatives, communication, and data sharing must be planned to improve clinical care.

Download Full-text

Rates of mental disorder in people convicted of homicide

The British Journal of Psychiatry ◽

10.1192/bjp.188.2.143 ◽

2006 ◽

Vol 188 (2) ◽

pp. 143-147 ◽

Cited By ~ 73

Author(s):

Jenny Shaw ◽

Isabelle M. Hunt ◽

Sandra Flynn ◽

Janet Meehan ◽

Jo Robinson ◽

...

Keyword(s):

Mental Illness ◽

Mental Disorder ◽

Severe Mental Illness ◽

Mental Healthcare ◽

Psychiatric Services ◽

England And Wales ◽

History Of ◽

Clinical Survey ◽

The Relationship ◽

Diminished Responsibility

BackgroundPrevious studies of people convicted of homicide have used different definitions of mental disorder.AimsTo estimate the rate of mental disorder in people convicted of homicide; to examine the relationship between definitions, verdict and outcome in court.MethodA national clinical survey of people convicted of homicide (n=1594) in England and Wales (1996–1999). Rates of mental disorder were estimated based on: lifetime diagnosis, mental illness at the time of the offence, contact with psychiatric services, diminished responsibility verdict and hospital disposal.ResultsOf the 1594, 545 (34%) had a mental disorder: most had not attended psychiatric services; 85 (5%) had schizophrenia (lifetime); 164 (10%) had symptoms of mental illness at the time of the offence; 149 (9%) received a diminished responsibility verdict and 111 (7%) a hospital disposal – both were associated with severe mental illness and symptoms of psychosis.ConclusionsThe findings suggest an association between schizophrenia and conviction for homicide. Most perpetrators with a history of mental disorder were not acutely ill or under mental healthcare at the time of the offence. Some perpetrators receive prison sentences despite having severe mental illness.

Download Full-text

Depression, Anxiety and Stress in Women with Breech Pregnancy - "Be not Afraid": A Prospective Study

10.21203/rs.3.rs-664800/v1 ◽

2021 ◽

Author(s):

Madeleine Schauer ◽

Elisabetta Latartara ◽

Maria Alonso-Espias ◽

Emma Rossetti ◽

Pimrapat Gebert ◽

...

Keyword(s):

Risk Factors ◽

Psychological Distress ◽

Cesarean Section ◽

Mental Disorder ◽

Pregnant Women ◽

Clinical Care ◽

Breech Presentation ◽

Increased Risk ◽

Demographic Risk ◽

Demographic Risk Factors

Abstract Background: Breech presentation at term is associated with higher perinatal complications through the increased incidence of cesarean section and complications by vaginal breech birth. The decision-making process between breech delivery, trial of external cephalic version or cesarean section may lead to maternal depression, stress and anxiety. Mental disorder in itself is associated with poorer maternal and fetal outcomes, such as preterm birth, small for gestational age infants, lower birth weight and increased risk for postnatal depression. This study aims to evaluate the level of psychological distress for women with breech presentation compared to cephalic presentation. We hypothesized, that women with breech presentation have higher levels of depression, stress and anxiety than other pregnant women. Secondary objectives were to analyze potential demographic risk factors and comorbidity of psychological distress in breech pregnancy. Methods: The breech study group was formed by 379 women with breech presentation. A sample of 128 women with cephalic presentation was recruited during routine clinical care. Depression, anxiety and stress symptoms were ascertained by means of the Depression-Anxiety-Stress-Score (DASS)-21 questionnaire. Categorial data was analyzed with Chi-square or exact test, continuous data with unpaired t-test or Mann-Whitney-U-test. Demographic risk factors were identified using a binary logistic regression model.Results: Prevalence of psychological distress among women with breech was not higher compared to those of other pregnant women. Symptomatic depression, anxiety and stress affected 5.8%, 14.5% and 11.9% of women with breech, respectively. Decreasing age was identified as a risk factor for anxiety (p = 0.006). Multiparity increased risk for depression (p = 0.001), for anxiety (p = 0.026) and for perinatal stress (p = 0.010). More than 80% of women with depressive symptoms had comorbidities of psychological distress.Conclusions: Breech presentation compared to cephalic presentation was not associated with higher levels of psychological distress. However, breech pregnancies are affected by symptoms of potential mental disorder. Multiparous women and younger women may need additional support and would benefit from a standardized screening tool for the assessment of perinatal psychological distress.Clinical Trial Registration: Ethical approval (EA2/241/18) was granted by the Ethics Commission of the Charité University Hospital on the 23.01.2019 (ClinicalTrials.gov Identifier: NCT03827226)

Download Full-text

Suicide by homeless patients in England and Wales: national clinical survey

BJPsych Open ◽

10.1192/bjo.2021.2 ◽

2021 ◽

Vol 7 (2) ◽

Author(s):

Paul Culatto ◽

Lana Bojanić ◽

Louis Appleby ◽

Pauline Turnbull

Keyword(s):

Mental Health ◽

Substance Misuse ◽

Clinical Care ◽

Homeless People ◽

Total Sample ◽

Post Discharge ◽

England And Wales ◽

High Prevalence ◽

Integration Of Services ◽

Clinical Survey

Background Homelessness in England and Wales is on the rise together with the mortality rate among homeless people. Many homeless people have a mental illness, which is a risk factor for suicide. Aims This study used data from the National Confidential Inquiry into Suicide and Safety in Mental Health to examine demographic and clinical characteristics of homeless people who died by suicide and were in recent contact with mental health services. Method We have compared 514 patients (2% of the total sample) who died by suicide and who were reported as being homeless or having no fixed abode by their clinicians with patients in stable accommodation between 2000 and 2016 to identify differences in sociodemographic characteristics and clinical care. Results Our analysis suggests that homeless patients who died by suicide had more acute (alcohol: 47% v. 25%, P < 0.01, drug: 39% v. 15%, P < 0.01) and chronic (alcohol: 72% v. 44%, P > 0.01, drug: 64% v. 31%) substance misuse issues than patients in stable accommodation. Homeless patients were also more likely to die as in-patients (21% v. 10%, P < 0.01) or within 3 months of discharge (32% v. 19%, P < 0.01). Conclusions Homeless patients who died by suicide more often had known risk factors for suicide than patients in stable accommodation. As a result of the higher percentages of post-discharge and in-patient suicides in homeless patients as well as the high prevalence of substance misuse, this study recommends closer integration of services as well as awareness of risks during in-patient admission and in the weeks immediately after discharge.

Download Full-text

Special, radical, failure of reduction in psychiatry

Behavioral and Brain Sciences ◽

10.1017/s0140525x18001164 ◽

2019 ◽

Vol 42 ◽

Author(s):

Don Ross

Keyword(s):

Mental Disorder ◽

Brain Structure ◽

Causal Structure ◽

Network Models ◽

Gambling Addiction ◽

Brain Disorder ◽

Mental Processes ◽

Special Radical ◽

Intentional Relationships

AbstractUse of network models to identify causal structure typically blocks reduction across the sciences. Entanglement of mental processes with environmental and intentional relationships, as Borsboom et al. argue, makes reduction of psychology to neuroscience particularly implausible. However, in psychiatry, a mental disorder can involve no brain disorder at all, even when the former crucially depends on aspects of brain structure. Gambling addiction constitutes an example.

Download Full-text

Confronting the grey zone after severe brain injury

Emerging Topics in Life Sciences ◽

10.1042/etls20190115 ◽

2019 ◽

Vol 3 (6) ◽

pp. 707-711 ◽

Cited By ~ 1

Author(s):

Andrew Peterson ◽

Adrian M. Owen

Keyword(s):

Brain Injury ◽

Ethical Issues ◽

Vegetative State ◽

Clinical Care ◽

Grey Zone ◽

Severe Brain Injury ◽

New Methods ◽

Legal Decision Making ◽

Technological Developments ◽

The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

Download Full-text

A Questionnaire Survey of Current Rehabilitation Practices for Adults With Normal Hearing Sensitivity Who Experience Auditory Difficulties

American Journal of Audiology ◽

10.1044/2020_aja-20-00027 ◽

2020 ◽

Vol 29 (4) ◽

pp. 738-761

Author(s):

Tess K. Koerner ◽

Melissa A. Papesh ◽

Frederick J. Gallun

Keyword(s):

Hearing Aids ◽

Questionnaire Survey ◽

Patient Population ◽

Clinical Care ◽

Normal Hearing ◽

Auditory Training ◽

Training Methods ◽

Hearing Sensitivity ◽

Considerable Benefit ◽

High Level

Purpose A questionnaire survey was conducted to collect information from clinical audiologists about rehabilitation options for adult patients who report significant auditory difficulties despite having normal or near-normal hearing sensitivity. This work aimed to provide more information about what audiologists are currently doing in the clinic to manage auditory difficulties in this patient population and their views on the efficacy of recommended rehabilitation methods. Method A questionnaire survey containing multiple-choice and open-ended questions was developed and disseminated online. Invitations to participate were delivered via e-mail listservs and through business cards provided at annual audiology conferences. All responses were anonymous at the time of data collection. Results Responses were collected from 209 participants. The majority of participants reported seeing at least one normal-hearing patient per month who reported significant communication difficulties. However, few respondents indicated that their location had specific protocols for the treatment of these patients. Counseling was reported as the most frequent rehabilitation method, but results revealed that audiologists across various work settings are also successfully starting to fit patients with mild-gain hearing aids. Responses indicated that patient compliance with computer-based auditory training methods was regarded as low, with patients generally preferring device-based rehabilitation options. Conclusions Results from this questionnaire survey strongly suggest that audiologists frequently see normal-hearing patients who report auditory difficulties, but that few clinicians are equipped with established protocols for diagnosis and management. While many feel that mild-gain hearing aids provide considerable benefit for these patients, very little research has been conducted to date to support the use of hearing aids or other rehabilitation options for this unique patient population. This study reveals the critical need for additional research to establish evidence-based practice guidelines that will empower clinicians to provide a high level of clinical care and effective rehabilitation strategies to these patients.

Download Full-text