Stimulant use under a prison treatment protocol for attention-deficit/hyperactivity disorder.

Although stimulant medications are the mainstay of effective intervention for attention-deficit/ hyperactivity disorder (ADHD), their use presents a daunting scenario for psychiatry, nursing, and custody staff in correctional settings, where reported prevalence rates range from 9% to 45%. The reported rates, however, may overestimate actual prevalence in general and need for treatment in particular. Under a monitored protocol that required documentation of history, diagnosis, lack of response to nonstimulant treatment, and significant functional impairment, less than 1% of male inmates in the Massachusetts state prison system met criteria for treatment with stimulants.

A national survey of self-injurious behavior in American prisons.

Objective: This study sought information about the prevalence, epidemiology, and management of self-injurious behavior by inmates in U.S. prison systems.

Howard Zonana and the subspecialty maturation of forensic psychiatry.

The formal process of specialization and subspecialization in medicine began at the start of the 20th century. Although forensic psychiatry has long held a central place within organized psychiatry, it was not officially recognized as a subspecialty until the end of the 20th century. This milestone was achieved through the efforts of many leaders in the field, and prominent among them has been Howard Zonana, MD.

Commentary: the art of forensic report writing.

As forensic psychiatry has matured into a well-recognized subspecialty, considerable agreement about the format and content of reports has emerged. Griffith et al. now turn their attention to the art of forensic writing.

Attention deficit hyperactivity disorder in prison: a treatment protocol.

Prescribing controlled substances in correctional settings can create challenges for security, nursing, and psychiatric staff. Some inmates, including those with functionally significant attention deficit hyperactivity disorder (ADHD), however, can benefit from such treatment. This article describes the development of a protocol for the treatment of prison inmates with ADHD that attempted to address a broad range of concerns including disparate diagnostic and treatment standards among prison psychiatrists, conflicts between stakeholders, and medication misuse and substance abuse among inmates.

Commentary: the use of restraint and seclusion in correctional mental health.

In contrast to the position taken in the American Psychiatric Association's "Resource Document on The Use of Restraint and Seclusion in Correctional Mental Health Care," this commentary proposes limiting the use of mental health restraints to the stabilization of unsafe situations during the time it takes to transfer an inmate to a psychiatric hospital. Jails and prisons are inherently nontherapeutic environments and are not adequate settings for managing mental health emergencies, such as those that require the use of restraints. Correctional conditions often contribute to the onset, and impede the resolution, of the underlying mental health crisis.

A university-state-corporation partnership for providing correctional mental health services.

In September 1998 the University of Massachusetts Medical School, in partnership with a private vendor of correctional health care, began providing mental health services and other services to the Massachusetts Department of Correction. The experience with this partnership demonstrates that the involvement of a medical school with a correctional system has advantages for both. The correctional program benefits from enhanced quality of services, assistance with the recruitment and retention of skilled professionals, and expansion of training and continuing education programs.