A six-month prospective study of violent incidents was carried out in a Special Hospital (Rampton). Comparisons were made with results from earlier studies in general psychiatric hospitals. As might be expected, incidents occurred more frequently in the Special Hospital. These incidents were also more serious in nature and resulted in greater injury. Although more patients in the Special Hospital were involved in incidents, only a small number of patients accounted for the majority of these. Female patients, who comprised 25% of the Special Hospital population, were involved in 75% of the incidents. Nursing staff were three times as likely to be assaulted as patients.
This study sought to compare the long-term course and outcome of a group of special hospital discharges subdivided by their legal classification into those with psychopathic disorder or with mental illness. Serial case-note reports on 75 men and 20 women with psychopathic disorder were compared with 70 men and 19 women with mental illness (93% schizophrenia) on a number of outcome measures. The mentally ill were matched to a consecutive group with psychopathic disorder and all the patients were on restriction orders. Mortality for both men and women was twice that of the population base rate adjusted for age and the length of follow-up but there was no difference between the two groups. Both sex and the legal classification affected the course of patients after their discharge. Men with psychopathic disorder were twice as likely to be convicted and four times more likely to be imprisoned compared with mentally ill men. They were also three times more likely to obtain work and four times more likely to develop a relationship. Females generally had a more satisfactory outcome than males irrespective of the MHA classification. These results show that outcome after discharge is complex with re-offending and psychosocial adjustment being discordant. We confirm previous findings that offending is more common among men with psychopathic disorder after discharge, despite which the long-term course for many in this group was very good. We also identify men with mental illness as having a poor psychosocial outcome.
The value of lithium carbonate as an adjunctive treatment of resistant schizophrenia was tested in a 4-week clinical trial using a single-blind, randomized, consent design. Treatment and control groups were drawn from a population of detained patients in an English special (maximum security) hospital. The 2 groups were comparable in terms of age, sex, severity of symptoms, length of hospitalization and concurrent neuroleptic dosage. The addition of lithium carbonate to the treatment regimen did not result in symptomatic improvement in patients completing the treatment protocol. The ethical and practical difficulties raised by the trial are discussed.
For people with personality disorder better clinical descriptions seem essential. For people with a pure psychosis, as symptoms were usually a factor driving the index offence, treatment appears as important for public safety as for personal health.
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