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Biomedical subjects

Pamela J Taylor

Publications and source records attributed to Pamela J Taylor.

14 recordsLinked to original sources
PubMed2006

Delusional disorder and delusions: is there a risk of violence in social interactions about the core symptom?

Delusional disorders are rare, but psychoses with prominent and persistent delusions are less so. A small but significant association between psychosis and violence is often mediated by delusions in such illnesses. Traditionally, delusions have been viewed as "incorrigible", but there is evidence that they change over time. During development of a scale for measuring delusions, it was found that people who acted violently on their "most important" delusion were more likely to have modified that belief after a mild form of challenge to it. When cognitive-behaviour therapy (CBT) is used for schizophrenia, attempts to modify psychotic symptoms are generally included. Could studies of CBT provide further information about possible risks of social interactions about delusions?In the UK, 2000 people with schizophrenia have been in randomized controlled trials of CBT with a goal of symptom modification. These studies were examined for evidence of violence during the treatment. There was none. Given the period prevalence of violence among people with psychosis, this is surprising. In these studies, however, both challenge to delusions and change in them was minimal and in the context of a safe clinical relationship. Challenge to delusions may, however, occur in a variety of social situations. There are no systematic data on lay challenge to them, but it seems likely that some in the sufferer's social circle will do so vigorously. Relatives, friends, and acquaintances are the people most vulnerable to the most serious violence by someone with psychosis. Study of how people interact in these circumstances and whether their interactions are relevant to modification of delusions would be worthwhile. Could those close to a sufferer learn skills for responding to such pathological beliefs that could be protective against violence, perhaps derived from the principles of CBT?

Cognitive Behavioral Therapy↗
PubMed2006

A hypothetical clinical vignette of delusional disorder: how potential legal issues could be addressed in the United Kingdom and the United States.

One of the major difficulties in presenting an international perspective on delusional disorders and their impact on offending or violent behaviour is that no two legal systems are quite the same, and there are substantial differences between some of them; in addition, there is international variation in relevant service provision or use. We therefore invited several experts practising in forensic mental health services or the law to consider the following case and to use relevant literature, statute and case law to draw out similarities and differences in process and management of the following case. Annie Smith is not a real person; the things that happened really occurred.

Adult↗
PubMed2003

Changes in patterns of excessive alcohol consumption in 25 years of high security hospital admissions from England and Wales.

BACKGROUND: It is now generally acknowledged that alcohol abuse increases the risk of violence among people with major mental disorder. Studies in the 1980s and earlier, however, tended to report an inverse relationship between their alcohol use and violence. AIMS: A study was undertaken to test a hypothesis that among people with major mental disorder considered to pose a serious risk to others the likelihood of excessive alcohol consumption in a period leading up to a violent or dangerous act has increased over time. METHODS: Analysis was made of annual high security hospital admission cohort case register data of 1 January 1975 to 31 December 1999; alcohol use data were taken from interview and records, and problem drinking defined as consumption of alcohol in excess of 21 units per week during the 12 months prior to the index offence or act. RESULTS: There was a linear increase in the proportion of patients in five-year admission cohorts who had engaged in excessive alcohol consumption during the year prior to their index offence or act. The increase was steeper among women than men, but cut across all diagnosis and offending groups. It was strongly associated with increasing tendency to abuse illicit drugs. CONCLUSIONS: The greater proportion of patients affected by excessive alcohol consumption occurred in spite of a reduction over the same period in admission of people in the diagnostic groups most likely to be implicated in substance misuse (personality disorder). This increased trend may simply reflect similar trends in the general population, but may also be associated with a lack of services or current consensus on appropriate treatment for patients whose mental illness is complicated by excessive alcohol use. Regardless, the trend suggests a growing need for 'dual diagnosis' services within and outside high security hospital.

Adolescent↗
PubMed2003

Physical and psychiatric predictors of late whiplash syndrome.

Approximately 40% of people who sustain whiplash injuries, complain of chronic physical and psychiatric symptoms. Associations have been found between pre-accident physical symptoms and physical outcome and between pre-accident psychiatric variables and both physical and psychiatric outcome. There are no reported investigations of the association between pre-accident physical symptoms and psychiatric outcome. In this study, 33 consecutive cases of whiplash injury met inclusion criteria from a series of psychiatric reports used in civil litigation. Outcome was measured for each patient and correlated with a range of pre-accident physical and psychiatric variables using multivariate regression. There was no association between pre-accident psychiatric factors and overall outcome. Older age and a pre-accident history of musculoskeletal complaints correlated with the physical and psychiatric outcome. In whiplash injury, pre-accident psychiatric factors may have little bearing on long-term prognosis. Physical and psychiatric outcome of late whiplash syndrome is probably worse in older individuals and in patients with a pre-accident history of musculoskeletal complaints.

Adult↗
PubMed2003

Mental disorder and serious violence: the victims.

BACKGROUND: Media representation of violence by people with mental disorder tends toward images of random, serious violence to strangers. Studies of general psychiatric patients do not support this representation, but include few cases of serious or homicidal violence. This study describes the relationship of mentally disordered offenders to victims of an attack that was serious enough to result in the offender's detention in a high-security hospital. Hypotheses tested were that perpetrators of stranger violence would be more likely than those targeting people they know to be male, nonwhite, and younger and have a violence history and less likely to have psychotic features. METHOD: A clinical register and record study of all patients with an index offense of interpersonal violence who were resident in English high-security hospitals Jan. 1, 1993, to June 30, 1993, was conducted. RESULTS: Among 887 men and 88 women, 33% had attacked strangers. After adjustment for the high proportion of men in this male-dominated population, men were still more likely than women to have attacked strangers. There was no independent association between stranger victimization and perpetrator's age, ethnic group, or violence history. Stranger victimization was, however, more likely to have been committed by those with personality disorder than those with psychosis. The most serious violence and homicide were more likely to be against intimates than strangers. CONCLUSION: Among patients selected for high risk to the public, high rates of stranger victimization would be expected. The rates appeared, however, only slightly higher than in other reported patient samples and lower than in an untreated sample. The safety of people close to such patients urgently needs improvement.

Adult↗
PubMed2002

The institutionalization of a concept.

Government involvement with psychiatry creates potentially great opportunities, as hitherto neglected problems receive attention and funding. When seriously harmful behaviour is involved, however, such opportunity can be limited or lost. Parallel consideration of legal restraints on those people with serious disorder who commit harm to others seems to spill over into restraints on clinical conceptualization of the disorder, on the shape of clinical treatment programmes and even on the people who deliver treatment. Greater clarity for everyone about the individuality and variety of people with personality disorders and a propensity for serious offending will be a critical factor in avoidance of new forms of institutionalization, the dangers of which have only been hinted at in literature to date.

Commitment of Persons with Psychiatric Disorders↗
PubMed2002

Substance misuse in a high security hospital: period prevalence and an evaluation of screening.

BACKGROUND: Illicit drug misuse by people with mental disorder in the community has been associated with increased risk of violence but not tested among inpatients. AIMS: To evaluate screening for illicit drugs and determine the period prevalence of use in one high security hospital. METHOD: A records study six and 18 months after introduction of random ward urine testing was followed by a true random prospective study. A random sub-sample of these tests was checked in the laboratory. RESULTS: In the first period there were few tests and patchy recording; during the second, both improved, but testing was not random. In the third period there were 217 tests (65% of those requested) in 33 days; 116 tests requested were not carried out, of which 42 were due to patient refusals. Correlations between dipstick and laboratory results, and research and central recording of tests were high. The rate of drug detection was no higher with true randomization. The hospital's central record was confirmed as a reliable and valid research tool with respect to illicit substances. In the year 2000 the central record showed 12 definite cases of illicit substance use in 153,887 patient days, but some for test refusals. CONCLUSIONS: Random, reliable urine drug testing can be implemented, with generally good cooperation between patients and staff. Contrary to popular belief, in this setting there was little misuse. Further research might test whether current extensive preventive measures are cost effective. The methodology might be applied in less controlled settings to test inpatient violence and substance misuse associations.

Adult↗
PubMed2002

The voice of detainees in a high security setting on services for people with personality disorder.

BACKGROUND: British government Home and Health Departments have been consulting widely about service development for people with ' dangerous severe personality disorder' (DSPD). There has, however, been no consultation with service users, nor is there any user view literature in this area. METHODS: All people detained in one high security hospital under the legal classification of psychopathic disorder were eligible but those on the admission or intensive care wards were not approached. Views of service were elicited using a purpose designed semi-structured interview. The principal researcher was independent of all clinical teams. Confidentiality about patients' views was assured. AIMS: To establish views on services from one subgroup of people nominated by the government department as having 'DSPD'. RESULTS: Sixty-one of 89 agreed to interview. With security a given, about half expressed a preference for a high security hospital setting, 20% prison and 25% elsewhere, generally medium secure hospitals. Participants most valued caring, understanding and 'experience' among staff. An ideal service was considered to be one within small, domestic living units, providing group and individual therapies. Some found living with people with mental illness difficult, but some specified not wanting segregated units. Views were affected by gender and comorbidity. CONCLUSIONS: As the sample were all in hospital, the emphasis on treatment may reflect a placement bias. All but five participants, however, had had experience of both health and criminal justice services, so were well placed to talk with authority about preferences.

Antisocial Personality Disorder↗
PubMed2002

Name change among offender patients: an English high security hospital sample.

BACKGROUND: There is scant literature on change of name among psychiatric patients but a more substantial amount on the use of aliases among offenders. No one to our knowledge has explored name changes among offender patients. AIM: This study was undertaken to establish the prevalence of name change among high security hospital patients and to compare those who changed name with those who did not. HYPOTHESIS: It was hypothesized that name change would be associated with male gender, repeated offending and a diagnosis of personality disorder. METHOD: The clinical records of all patients resident in one high security hospital on 31 January 2000 were searched. As all such patients are compulsorily detained, all name changes must be recorded. Any change prior to that date was also noted, together with basic demographic and diagnostic information; supplementary data were obtained from the special hospitals' case register. RESULTS: Seventy-one patients (17%) of the resident population changed names (exclusive of a woman changing her surname on marriage). Name changing was associated with disrupted upbringing. Patients with personality disorder were more likely to change names than those with psychosis, regardless of sex, age or ethnic group. Those with psychosis were more likely to select unusual or symbolic names. CONCLUSIONS: On the evidence of previous literature, people from this serious offender patient population were more likely to change names than other psychiatric patients but less likely than non-mentally-disordered offenders. Changes by people with psychosis seemed related to their illness, whereas changes by those with personality disorder might reflect childhood disruptions in rearing patterns.

Adult↗
PubMed2002

Follow-up of serious offender patients in the community: multiple methods of tracing.

Longitudinal studies of people with mental disorder are important in understanding outcome and intervention effects but attrition rates can be high. This study aimed to evaluate use of multiple record sources to trace, over 12 years, a one-year discharge cohort of high-security hospital patients. Everyone leaving such a hospital in 1984 was traced until a census date of 31 December 1995. Data were collected from several national databases (Office for National Statistics (ONS), Home Office (HO) Offenders' Index, Police National Computer Records, the Electoral Roll) and by hand-searching responsible agency records (HO, National Health Service). Using all methods, only three of the 204 patients had no follow-up information. Home Office Mental Health Unit data were an excellent source, but only for people still under discharge restrictions (<50% after eight years). Sequential tracing of hospital placements for people never or no longer under such restrictions was laborious and also produced only group-specific yield. The best indicator of community residence was ONS information on general practitioner (GP/primary care) registration. The electoral roll was useful when other sources were exhausted. Follow-up of offenders/offender-patients has generally focused on event data, such as re-offending. People untraced by that method alone, however, are unlikely to be lost to follow-up on casting a wider records net. Using multiple records, attrition at the census was 38%, but, after certain assumptions, reduced further to 5%.

Adult↗
PubMed2002

Mental disorder and perceived threat to the public: people who do not return to community living.

BACKGROUND: In the UK, people with mental disorder thought to pose a high risk of harm to others are usually put in a high-security (special) hospital. Little is known about what happens after that. AIMS: To test a hypothesis that, under current services and laws (from the mid-1980s), no one leaving high-security hospitals remains indefinitely institutionalised. METHOD: The special hospitals' case register was used for case ascertainment and admission data; post-discharge data were collected from multiple sources on patients discharged in 1984 (census date 31.12.1995). RESULTS: In this discharge cohort (n=223), 36 (17%) did not return to the community: 17 died in special hospital and 19 continuously lived in other institutions until death or the census date. Over two-thirds of these had mental illness, were older on admission and had lived longer in special hospital than their better-rehabilitated peers. Offending history was irrelevant to this. Most post-discharge institution time was in open psychiatric hospital, or back in special hospital, not in medium secure units or prison. CONCLUSIONS: The hypothesis was not sustained, but fewer people never reached the community than before the mid-1980s. Atypical antipsychotics might reduce this number. We found no justification for a new tier of long-term medium secure units.

Adult↗