Offenders With Personality Disorder Who Fail to Progress: A Case-Control Study Using Partial Least Squares Structural Equation Modeling Path Analysis.

Background: Offenders with personality disorder can be challenging to engage and retain in treatment. The UK Offender Personality Disorder (OPD) pathway aims to proactively and responsively identify and engage offenders with personality disorder. However, a subpopulation of offenders on the pathway have been found to not be accepted into any OPD service and therefore fail to progress.

Flip the Triangle: using quality improvement methods to embed a positive behaviour support approach on a medium secure forensic ward for men with intellectual disabilities.

Incidents of violence and aggression are serious concerns on a secure ward for people with intellectual disabilities and are often met with increases in physical and restrictive interventions. However, these interventions are usually high risk for both patients and staff and are ineffectual in promoting long-term behaviour change. This study aimed to promote positive culture change and embed the evidence-based practice of positive behaviour support by shifting focus and efforts from the use of physical and restrictive interventions to manage crises to intervening positively and proactively to prevent crises from occurring.

Quality improvement in forensic mental health: the East London forensic violence reduction collaborative.

Ward-based violence is the most significant cause of reported safety incidents at East London NHS Foundation Trust (ELFT). It impacts on patient and staff safety, well-being, clinical care and the broader hospital community in various direct and indirect ways. The contributing factors are varied and complex.

Psychological therapists' judgments of pain and treatment decisions: The impact of 'medically unexplained symptoms'.

Background: Clinical judgments of pain are influenced by patient and observer factors, and affect their treatment decisions. This study investigated the factors of a lack of a medical explanation for pain, 'medically unexplained' comorbid conditions, and ethnicity, on CBT therapists' judgments of pain and treatment.

Method: An online experimental study was conducted in which participants viewed computer-generated faces expressing pain with a brief written patient history, then estimated the severity and likely exaggeration of pain, and likelihood of pain being caused by a mental or physical health problem.

Retrograde ejaculation associated with quetiapine and treatment with low-dose imipramine.

Sexual side-effects are common among those using antipsychotic medication and may result in poor compliance and reduced quality of life. Retrograde ejaculation (RE) has been described occurring with a number of antipsychotic medications (thioridazine, risperidone, iloperidone and clozapine) but there are no guidelines regarding management of antipsychotic-associated RE. Imipramine has been suggested as a treatment for antipsychotic-associated RE in one small study of patients prescribed thioridazine and a case series of patients prescribed iloperidone.

Triage, decision-making and follow-up of patients referred to a UK forensic service: validation of the DUNDRUM toolkit.

Background: Forensic medium secure services in the UK are a scarce but essential resource providing care for those in the criminal justice system with severe mental disorder. Appropriate allocation of beds to those most in need is essential to ensure efficient use of this resource. To improve decision-making processes in a UK forensic service, an admissions panel utilized the DUNDRUM 1&2 (D1 & D2) triage instruments.

The virtual institution: cross-sectional length of stay in general adult and forensic psychiatry beds.

Background: Length of stay in psychiatric hospitals interests health service planners, economists and clinicians. At a systems level it is preferable to study general adult and forensic psychiatric beds together since these are likely to be inter-dependent. We examined whether patients were placed according to specialist need or according to their cross-sectional length of stay.

Fighting the Whole System: Dissociative Identity Disorder, Labeling Theory, and Iatrogenic Doubting.

This research examines how individuals diagnosed with dissociative identity disorder construe their experiences of being labeled with a contested diagnosis. Semistructured interviews were conducted in the United Kingdom with 5 women and 2 men diagnosed with dissociative identity disorder. A framework analysis was conducted.

Improving access to competitive employment for service users in forensic psychiatric units.

Employment has been proven to be an effective recovery tool and therapeutic intervention for those with severe and enduring mental health conditions. Aside from monetary reward, employment is a means of structuring time and provides a sense of worth and achievement, which enhances self-esteem and confidence. A social identity is developed through employment, encouraging social support and increasing social networks.

An evaluation of case formulation training and consultation with probation officers.

Background: Formulation is a core competency of mental health professionals, drawing on a variety of sources of information. In England and Wales, the current strategy for offenders with personality disorder places formulation-led management, generally by probation staff, at its core, but reliability and validity of the process remain unclear.

Aims: The first aim was to evaluate a checklist previously designed to establish quality of formulation, and the second to measure the impact of training and consultation on the ability of probation officers to formulate cases.

Local knowledge of the link between tuberculosis and HIV-1/AIDS among the Turkana of Lodwar township: implications for tuberculosis and HIV-1/AIDS prevention.

This article is extracted from a doctoral thesis that was supported by a research grant from the International Development Research Centre of Canada (IDRC)'s Ecosystem Approaches to Human Health Training Award, the Royal Anthropological Institute of Great Britain and Northern Ireland's Emslie Horniman Scholarship Fund and McGill University, Faculty of Graduate Studies and Research's Humanities and Social Sciences Research Award. This study used a broad theoretical framework encompassing an ecosystem approach to HIV-1/AIDS that partly investigated the nexus between local knowledge of tuberculosis (TB) and HIV-1/AIDS. According to the Turkana of Lodwar township, Kenya, HIV-1/AIDS and TB are largely contagious and are attributed to impersonal and natural causes.

The paradoxical use of interpreting in psychiatry.

Changes in the official status of African languages in South Africa suggested an examination of the impact of multi-lingualism on the practice of institutional psychiatry. For a range of theoretical and institutional reasons, a 'language gap' between clinician and patient can be rendered irrelevant in terms of the routine production of psychiatric texts in which 'symptoms' are described and 'cases' are constructed. In contrast to the way in which the role of interpreting is obscured in some hospital settings, it is highlighted in forensic settings.

Aetiological risk factors for personality disorders.

Background: Elucidation of aetiological processes leading to development of Axis II disorders is important in category validation and could lead to new treatments.

Aims: To establish aetiological associations between Axis II disorders and specific risk factors.

Method: Male and female subjects (n = 260) in maximum security hospitals and prisons were interviewed to determine DSM-III Axis II and lifetime Axis I diagnoses.

The Psychiatric Care Satisfaction Questionnaire: a reliability and validity study.

Patient satisfaction can be a useful marker in evaluating the quality of psychiatric care. However, this form of measurement has been hampered by the lack of attention paid to the psychometric properties of instruments devised. The Psychiatric Care Satisfaction Questionnaire (PCSQ) was developed and tests of acceptability, validity and reliability were undertaken using 52 inpatients.