scholarly journals Long Term Metabolic and Inflammatory Effects of Second-Generation Antipsychotics: A Study in Mentally Disordered Offenders

2021 ◽  
Vol 11 (11) ◽  
pp. 1189
Author(s):  
Emilia Vassilopoulou ◽  
Dimitris Efthymiou ◽  
Evangelia Papatriantafyllou ◽  
Maria Markopoulou ◽  
Efthymia-Maria Sakellariou ◽  
...  
Keyword(s):  
Side Effects ◽  
Second Generation ◽  
Psychotic Disorders ◽  
Psychiatric Patients ◽  
Mentally Disordered Offenders ◽  
Metabolic Complications ◽  
Mentally Disordered ◽  
Increased Risk ◽  
Forensic Psychiatric

Mentally disordered offenders provided with forensic psychiatric care are often treated with second generation antipsychotic (SGA) medication and experience metabolic and inflammatory side effects. Aim: In this paper, we monitored the three-year fluctuation of selected anthropometric, biochemical, and inflammatory indices in forensic psychiatric patients receiving antipsychotic (AP) medication for more than five years, according to the type of AP. Methods: Thirty-five patients with psychotic disorders were classified into two groups based on the type of AP. Specifically: AP1, related to a lower risk, and AP2, related to an increased risk of weight gain (WG) and metabolic complications. Biochemical, hematological, anthropometric, blood pressure (BP), and medication data were retrieved from the individual medical files. Statistical analysis was performed with SPSS 23. Results: No significant differences in weight and glucose and cholesterol levels were observed, but patients taking AP2 more often needed drugs to control diabetes mellitus (DM), lipidemia, and cardiovascular disease (CVD). In those taking AP1, the mean HDL level decreased significantly over time (p < 0.05) and a higher proportion developed higher BP (52.9% of AP1 vs. 16.7% AP2). In the AP2 group the median level of C-reactive protein (CRP) (p < 0.001) and the white blood cell count (WBC) increased over the three years (p < 0.001). Conclusions: The proposed sub-classification of SGAs into AP1 and AP2, depending on their potential for metabolic and inflammatory effects, might facilitate study of their long-term side-effects but also help in personalized prevention or treatment measures to counteract these side-effects.

scholarly journals »Så de lod mig bare være …« – eksempler på veje fra psykiatrisk til retspsykiatrisk patient

2020 ◽  
Vol 107 (3) ◽  
pp. 287-306
Author(s):  
Jette Møllerhøj ◽  
Mette Brandt-Christensen ◽  
Liv Os Stølan
Keyword(s):  
Protective Factors ◽  
Health Care Professionals ◽  
Preventive Measures ◽  
Psychiatric Patients ◽  
Risk And Protective Factors ◽  
Mentally Disordered Offenders ◽  
Psychiatric Facility ◽  
Mentally Disordered ◽  
Hospital Psychiatry

AbstractThe aim of this study is to provide various perspectives on two examples in which long term psychiatric patients committed serious crimes and consequently became mentally disordered offenders. The two patients involved were found guilty, but were not punishable under Danish law and were instead sentenced to placement in a psychiatric facility. When looking at these cases from the perspective of various stakeholders, e.g., relatives, health care professionals, the patients themselves, a number of potential risk and protective factors come to light. The analysis is followed by a discussion of whether similar situations can be prevented and, if so, how. We recommend an intensified focus on risk and protective factors, as well as preventive measures, and an increased cooperation and knowledge sharing between patients, relatives, networks, hospital psychiatry and psychosocial rehabilitation units provided within municipalities.

Motivational Influences and Trajectories to Violence in the Context of Major Mental Illness

2019 ◽  
pp. 088626051987671
Author(s):  
Stephanie R. Penney ◽  
Andrew Morgan ◽  
Alexander I. F. Simpson
Keyword(s):  
Mental Illness ◽  
Developmental Trajectories ◽  
Psychiatric Patients ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
New Information ◽  
Forensic Psychiatric Patients ◽  
Not Criminally Responsible ◽  
Forensic Psychiatric ◽  
Motivational Influences

Developmental trajectories regarding the age onset of violence and offending have not routinely considered the role of major mental illness (MMI). In parallel, despite several studies investigating the relationship between MMI, violence and offending, fewer have identified motivational processes that may link illness to these outcomes in a more direct and proximal manner. This study investigates whether subtypes of forensic psychiatric patients deemed Not Criminally Responsible on account of Mental Disorder ( N = 91) can be identified based on the age onset of mental illness and offending behavior, and whether information on motivational influences for offending—elicited both from the patient directly and detailed collateral information—contributes to the clinical utility of this typology. Results indicated that most patients reported engaging in violence (51%) or antisocial behaviors (72%) prior to the onset of MMI, but that the index offense(s) resulting in forensic admission were predominantly psychotically motivated. In contrast to patients for whom the onset of MMI occurred prior to offending, patients exhibiting premorbid violence had higher levels of risk and criminogenic need; they were more likely to be diagnosed with personality and substance use disorders, and to have conventional (i.e., non-illness-related) motivations ascribed to their index offense. Findings are consistent with the existing literature regarding subgroups of mentally disordered offenders, but provide new information regarding proximal risk factors for violence through better identification of motivational processes.

Towards an EU research framework on forensic psychiatric care: Introduction, structure, activities and results of cost action Is1302

2017 ◽  
Vol 41 (S1) ◽  
pp. S584-S584
Author(s):  
L. Castelletti ◽  
F. Scarpa
Keyword(s):  
Best Practice ◽  
Psychiatric Care ◽  
Service Providers ◽  
Psychiatric Symptoms ◽  
Legal Framework ◽  
Mentally Ill Offenders ◽  
Mentally Disordered Offenders ◽  
Cost Action ◽  
Forensic Psychiatric

IntroductionForensic psychiatric care is aimed at improving mental health and reducing the risk of recidivism of mentally ill offenders. For some mentally disordered offenders long forensic psychiatric care is required. Due to different legal framework, policies and resources in member countries, treatment programs and care provided for these subjects may vary substantially across Europe.ObjectivesCOST Action IS1302, a EU project aimed at establishing a European network of researchers, clinicians and service providers about long-term forensic psychiatric care, has involved nineteen European countries for 2013 to set the basis for comparative evaluation and research on effective treatment and the development of best practice in long-term forensic psychiatry in Europe.MethodIt is constituted by three main areas of interest and research. One group works on determination of patient characteristics, looking into prevalence, duration of stay and the most determinant characteristics of long term patients. The second area of research aims at obtaining better understanding of complex external factors that influence the poor progress of patients residing for an above average time in forensic services. Third group of research focuses on knowledge about specific needs brought about by psychiatric symptoms and how these specific needs might optimize the quality of life of patients in long term forensic psychiatric care.Results/conclusionsLaunched four years ago, the action is at its last of activities. We display features, activities and data emerging from the research conducted so far.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Is There a Need for Elderly Forensic Psychiatric Services?

2005 ◽  
Vol 45 (2) ◽  
pp. 154-160 ◽  
Author(s):  
I O Nnatu ◽  
F Mahomed ◽  
A Shah
Keyword(s):  
Mental Illness ◽  
Old Age ◽  
The Elderly ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
Court Diversion ◽  
Mental Health Difficulties ◽  
Old Age Psychiatry ◽  
Forensic Psychiatric ◽  
Developed Nations

The population of the elderly in most developed nations is on the increase. Furthermore, the prevalence of mental disorder amongst elderly offenders is high. The true extent of `elderly' crime is unknown because much of it goes undetected and unreported. This leads to a failure to detect mental illness in such offenders. Court diversion schemes may improve recognition of mental illness but these schemes usually tend to deal with the more severe crimes. This may result in an overestimation of the amount of serious crime committed by the elderly and a failure to detect mental illness amongst those who commit less serious crimes. Efforts to service this hidden morbidity call for multi-agency collaboration. Improved detection and reporting of crimes is essential if mental health difficulties in the elderly are not to go unnoticed. The needs of elderly mentally-disordered offenders are complex and fall within the expertise of old age and forensic psychiatry, without being adequately met by either one. Therefore, consideration should be given to the development of a tertiary specialist forensic old-age psychiatry service.

scholarly journals Prediction of recidivism in a long-term follow-up of forensic psychiatric patients: Incremental effects of neuroimaging data

PLoS ONE ◽  
2019 ◽  
Vol 14 (5) ◽  
pp. e0217127 ◽  
Author(s):  
Carl Delfin ◽  
Hedvig Krona ◽  
Peter Andiné ◽  
Erik Ryding ◽  
Märta Wallinius ◽  
...  
Keyword(s):  
Psychiatric Patients ◽  
Prediction Of Recidivism ◽  
Forensic Psychiatric Patients ◽  
Neuroimaging Data ◽  
Long Term Follow Up ◽  
Forensic Psychiatric

Community forensic psychiatric services in England and Wales

CNS Spectrums ◽  
2020 ◽  
Vol 25 (5) ◽  
pp. 604-617
Author(s):  
Richard Latham ◽  
Hannah Kate Williams
Keyword(s):  
Research Evidence ◽  
Medical Specialty ◽  
Community Services ◽  
Mentally Disordered Offenders ◽  
Late 20Th Century ◽  
England And Wales ◽  
Mentally Disordered ◽  
Forensic Psychiatric ◽  
Criminal Legislation ◽  
The 19Th Century

Forensic psychiatry is an established medical specialty in England and Wales. Although its origins lie in the 19th century, the development of secure hospitals accelerated in the late 20th century. Services for mentally disordered offenders in the community have developed most recently and it is these services, which are the focus of this article. We have looked broadly at community services and have included criminal justice liaison and diversion services in our remit. We have also considered partnerships between health and justice agencies as well as mental health and criminal legislation. We consider the limited research evidence in relation to community forensic services and the discussion this has provoked.

scholarly journals Care of the Liver Transplant Patient

2014 ◽  
Vol 28 (4) ◽  
pp. 213-219 ◽  
Author(s):  
Mamatha Bhat ◽  
Said A Al-Busafi ◽  
Marc Deschênes ◽  
Peter Ghali
Keyword(s):  
Liver Transplant ◽  
Transplant Patient ◽  
Keywords Liver Transplantation ◽  
Metabolic Complications ◽  
Transplant Patients ◽  
Medical Issues ◽  
Metabolic Bone ◽  
Increased Risk

OBJECTIVE: To provide an approach to the care of liver transplant (LT) patients, a growing patient population with unique needs.METHODS: A literature search of PubMed for guidelines and review articles using the keywords “liver transplantation”, “long term complications” and “medical management” was conducted, resulting in 77 articles.RESULTS: As a result of being on immunosuppression, LT recipients are at increased risk of infections and must be screened regularly for metabolic complications and malignancies.DISCUSSION: Although immunosuppression is key to maintaining allograft health after transplantation, it comes with its own set of medical issues to follow. Physicians following LT recipients must be aware of the greater risk for hypertension, diabetes, dyslipidemia, renal failure, metabolic bone disease and malignancies in these patients, all of whom require regular monitoring and screening. Vaccination, quality of life, sexual function and pregnancy must be specifically addressed in transplant patients.

ETHICAL ISSUES IN FORENSIC PSYCHIATRIC RESEARCH ON MENTALLY DISORDERED OFFENDERS

Bioethics ◽  
2010 ◽  
Vol 24 (1) ◽  
pp. 35-44 ◽  
Author(s):  
CHRISTIAN MUNTHE ◽  
SUSANNA RADOVIC ◽  
HENRIK ANCKARSÄTER
Keyword(s):  
Ethical Issues ◽  
Psychiatric Research ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
Forensic Psychiatric

scholarly journals The developmental trajectory of bipolar disorder

2014 ◽  
Vol 204 (2) ◽  
pp. 122-128 ◽  
Author(s):  
Anne Duffy ◽  
Julie Horrocks ◽  
Sarah Doucette ◽  
Charles Keown-Stoneman ◽  
Shannon McCloskey ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Psychotic Disorders ◽  
Familial Risk ◽  
Childhood Anxiety ◽  
Developmental Trajectory ◽  
Developmental Approach ◽  
Increased Risk ◽  
Clinical Stages

BackgroundBipolar disorder is highly heritable and therefore longitudinal observation of children of affected parents is important to mapping the early natural history.AimsTo model the developmental trajectory of bipolar disorder based on the latest findings from an ongoing prospective study of the offspring of parents with well-characterised bipolar disorder.MethodA total of 229 offspring from families in which 1 parent had confirmed bipolar disorder and 86 control offspring were prospectively studied for up to 16 years. High-risk offspring were divided into subgroups based on the parental long-term response to lithium. Offspring were clinically assessed and DSM-IV diagnoses determined on masked consensus review using best estimate procedure. Adjusted survival analysis and generalised estimating equations were used to calculate differences in lifetime psychopathology. Multistate models were used to examine the progression through proposed clinical stages.ResultsHigh-risk offspring had an increased lifetime risk of a broad spectrum of disorders including bipolar disorder (hazard ratio (HR) = 20.89; P = 0.04), major depressive disorder (HR = 17.16; P = 0.004), anxiety (HR = 2.20; P = 0.03), sleep (HR = 28.21; P = 0.02) and substance use disorders (HR = 2.60; P = 0.05) compared with controls. However, only offspring from lithium non-responsive parents developed psychotic disorders. Childhood anxiety disorder predicted an increased risk of major mood disorder and evidence supported a progressive transition through clinical stages, from non-specific psychopathology to depressive and then manic or psychotic episodes.ConclusionsFindings underscore the importance of a developmental approach in conjunction with an appreciation of familial risk to facilitate earlier accurate diagnosis in symptomatic youth.

Long-stay forensic psychiatric inpatients in the Republic of Ireland: aggregated needs assessment

2003 ◽  
Vol 20 (4) ◽  
pp. 119-125 ◽  
Author(s):  
Conor O'Neill ◽  
Patrick Heffernan ◽  
Ray Goggins ◽  
Ciaran Corcoran ◽  
Sally Linehan ◽  
...  
Keyword(s):  
Psychiatric Patients ◽  
Psychiatric Inpatients ◽  
Multidisciplinary Teams ◽  
Mentally Disordered Offenders ◽  
Dynamic Risk Factors ◽  
Republic Of Ireland ◽  
Lengths Of Stay ◽  
Community Psychiatric ◽  
Forensic Psychiatric ◽  
The Republic

AbstractObjectives:To profile the current cohort of forensic psychiatric inpatients in the Republic of Ireland, comparing psychiatric healthcare and placement needs of long-stay patients with those more recently admitted.Method:All forensic psychiatric inpatients in the Central Mental Hospital, Dundrum on a census date were included in the study. Patients and key worker were interviewed using a standardised schedule and validated research instruments. Static and dynamic risk factors for violence including demographic, diagnostic and legal characteristics were supplemented by detailed chart review. Standardised anonymised case vignettes were presented to panels of forensic and community psychiatric multidisciplinary teams who assessed current and future treatment and placement requirements for the cohort.Results:There were 88 forensic psychiatric inpatients on the census date. Forty-three had lengths of stay over two years (17 over 20 years). Both patient groups were predominantly males with severe mental illness and histories of violent offending. The majority of the long-stay group were receiving regular parole and this group had lower levels of positive symptoms and comorbid substance misuse disorders. Significant gaps in existing rehabilitation inputs were identified. Almost half the long-stay patients were inappropriately placed. Thirty per cent of long-stay patients could be safely transferred to lower levels of security within six months and 63% within three years.Conclusions:Holding patients in conditions of excessive security impedes rehabilitation and has considerable human rights implications. Almost half of long-stay forensic psychiatric patients in Ireland are inappropriately placed. Barriers to discharge include legislative inadequacies, lack of local low-secure facilities and under-resourcing of community psychiatric services. Such barriers lead to inappropriate utilisation of limited resources and limit access to secure facilities for higher-risk mentally disordered offenders. These findings are of particular relevance in the context of proposed new insanity legislation.

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