Showing papers in "Psychiatric Services in 1999"
659 citations
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506 citations
TL;DR: Clinicians should pay attention to Asians' unique responses to psychotropics, especially in regard to dosage requirements and side effects, as well as on other important issues is in the early stage of development.
Abstract: One of fastest-growing population groups in recent decades, Asian Americans represent a vastly diversified and rich mixture of cultures, languages, beliefs, and practices, many of which differ widely from those of European Americans. As immigrants, Asian Americans have experienced and continue to experience various emotional and behavioral problems. However, they tend to underuse existing services except those that are culturally appropriate and linguistically compatible. Misdiagnosis frequently occurs, and the existence of culture-bound syndromes points to a lack of precise correspondence between indigenous labels and established diagnostic categories. Due to Asian traditions of viewing the body and mind as unitary rather than dualistic, patients tend to focus more on physical discomforts than emotional symptoms, leading to an overrepresentation of somatic complaints. Traditional practices and healing methods are frequently used to alleviate distress both before and after patients and their family members approach the conventional mental health care system. Help seeking typically is a family venture. Asian patients respond well to highly structured therapeutic interventions such as those used in behavioral, cognitive, and interpersonal models. When applying pharmacotherapy, clinicians should pay attention to Asians' unique responses to psychotropics, especially in regard to dosage requirements and side effects. Research in this area as well as on other important issues is in the early stage of development.
351 citations
340 citations
TL;DR: Routine screening for and assessment of substance use disorders among persons with severe mental illness has become the accepted standard of care and an integrated approach to the treatment of both disorders is generally accepted to be the most promising treatment strategy.
Abstract: OBJECTIVE: Understanding the complex diagnostic and treatment issues posed by the co-occurrence of severe mental illness and substance use disorders has become a necessary exercise in current psychiatric practice. The authors reviewed research studies from the past six years that have contributed to our knowledge about effective assessment, diagnosis, course of illness, and treatment approaches. Research on special populations, including women, persons infected with HIV, and violent patients, is highlighted. METHODS: PsycINFO, Silver Platter, and MEDLINE were used to search for English-language studies published in the United States and other countries. To augment the search, selected bibliographies were reviewed with a focus on clinical standards. Information was sought on epidemiology, screening and assessment strategies, course of illness, models of treatment delivery, and cost of care. Results and conclusions: Although estimates of the prevalence of substance use disorders vary by population, a higher...
340 citations
TL;DR: The effects of trauma on children and adolescents wear a silver ribbon and how to get help is explained.
Abstract: dissociation in children and adolescents a developmental dissociation in children and adolescents a developmental guidelines for the evaluation and treatment of dissociation in children and adolescents a developmental e.b.o.o.k dissociation in children and adolescents: a dissociation and criminal responsibility: a developmental dissociation in children and adolescents as reaction to the treatment of dissociation in sexually abused children child dissociative checklist (cdc), version 3 ce-credit adolescent ptsd and dissociative disorders trauma recovery trauma & dissociation resource list relational trauma, brain development, and dissociation child and adolescent estd chapter 2 dissociative disorder in children and adolescents dissociative behavior in early adolescence: a vol 3 chapter 7 adolescent problems asch development of dissociation and development of the self european society for trauma & dissociation, uk network mythssummary sk bb teachtrauma psychopathology, 2 nd edition chapter 14 | dissociative chapter 10 assessment of pediatric posttraumatic stress resources for the clinical treatment of dissociative responses looking at early years education and care nolia wcat1936-15211536-153xjournal of child & adolescent trauma guidelines for the evaluation and treatment of complex trauma in children and adolescents trauma center home care services boscos the effects of trauma on children and adolescents wear a silver ribbonrecommended readings: how to get help section i – adoption, attachment, foster section ii aacc-restoring the shattered self-pdf heathergingrich dissociation following traumatic medical treatment program outline complex trauma southeast institute for understanding adolescent development and child trauma developmental psychology european journal of fitness and your health nownfc children and adolescents, trauma and disasters windows post traumatic stress disorder1 symptoms of ptsd: re psychiatric annals 2 harris county, texas a passion for birds eliot porters photography boscos
311 citations
TL;DR: Faithful implementation of, and adherence to, the assertive community treatment model for persons with dual disorders was associated with superior outcomes in the substance use domain, and the findings underscore the value of measures of model fidelity.
Abstract: OBJECTIVE: The study examined the association between fidelity of programs to the assertive community treatment model and client outcomes in dual disorders programs. METHODS: Assertive community treatment programs in the New Hampshire dual disorders study were classified as low-fidelity programs (three programs) or high-fidelity programs (four programs) based on extensive longitudinal process data. The study included 87 clients with a dual diagnosis of severe mental illness and a comorbid substance use disorder. Sixty-one clients were in the high-fidelity programs, and 26 were in the low-fidelity programs. Client outcomes were examined in the domains of substance abuse, housing, psychiatric symptoms, functional status, and quality of life, based on interviews conducted every six months for three years. RESULTS: Clients in the high-fidelity assertive community treatment programs showed greater reductions in alcohol and drug use and attained higher rates of remission from substance use disorders than client...
280 citations
TL;DR: A substantial rate of violent criminal victimization among persons with severe and persistent mental illness is found, and results suggest that substance use and homelessness makecriminal victimization more likely.
Abstract: OBJECTIVE: The types and amounts of crime experienced by persons with severe mental illness were examined to better understand criminal victimization in this population. METHODS: Subjects were 331 involuntarily admitted psychiatric inpatients who were ordered by the court to outpatient commitment after discharge. Extensive interviews provided information on subjects' experience with crime in the previous four months and their perceived vulnerability to victimization, as well as on their living conditions and substance use. Medical records provided clinical data. RESULTS: The rate of nonviolent criminal victimization (22.4 percent) was similar to that in the general population (21.1 percent). The rate of violent criminal victimization was two and a half times greater than in the general population—8.2 percent versus 3.1 percent. Being an urban resident, using alcohol or drugs, having a secondary diagnosis of a personality disorder, and experiencing transient living conditions before hospitalization were si...
260 citations
TL;DR: At least two-thirds of all departments, even those with no specialized response program, rated themselves as moderately or very effective in dealing with mentally ill persons in crisis.
Abstract: Police departments in the 194 US cities with a population of 100,000 or more were surveyed in 1996 to identify strategies they used to obtain input from the mental health system about dealing with mentally ill persons A total of 174 departments responded (90 percent) Ninety-six departments had no specialized response for dealing with mentally ill persons Among the 78 departments with special programs, three basic strategies were found: a police-based specialized police response, a police-based specialized mental health response, and a mental-health-based specialized mental health response At least two-thirds of all departments, even those with no specialized response program, rated themselves as moderately or very effective in dealing with mentally ill persons in crisis
249 citations
TL;DR: Attention to three themes may help clinicians and investigators meet the challenge of treating the common mental disorders of later life: the effect of these disorders on functioning, prevention of the consequences of mental disorders, and integration of mental health care and primary health care services.
Abstract: OBJECTIVE: The prevalence and incidence of the major mental disorders of late life that are common in the community and in primary health care are reviewed. METHODS: Community-based studies in English that included older adults were identified through MEDLINE searches and were reviewed. RESULTS: As the population ages, dementia, depression, and other mental conditions of the aged will demand more attention from clinicians and investigators to minimize their effects on disability, the use of health care services, and the quality of life for older adults and caregivers. Up to 15 to 20 percent of older adults have significant depressive symptoms, and it is estimated that as many as 45 percent of persons age 85 years and older have significant cognitive impairment and dementia. Other mental-health-related conditions, such as anxiety disorders, alcohol abuse, and prescription medicine misuse, are also important considerations but have not been as well studied as depression and dementia. Because an increasing p...
248 citations
TL;DR: The study findings confirmed previous findings of a high frequency of auditory hallucinations, particularly command hallucinations to kill oneself, and paranoid ideation among inpatients with a history of abuse.
Abstract: OBJECTIVE: The relationship between three positive symptoms of schizophrenia—hallucinations, delusions and thought disorder—and childhood physical and sexual abuse among psychiatric inpatients was investigated. METHODS: From the records of 100 consecutive admissions to an acute psychiatric inpatient unit in a New Zealand general hospital, the records of the 22 patients in which a history of either physical or sexual childhood abuse was mentioned were examined for data on the frequency and content of hallucinations, delusions, and thought disorder. RESULTS: Seventeen of the 22 patients exhibited one or more of the three symptoms. Half of the symptoms for which content was recorded appeared to be related to the abuse. An analysis of the relationships between types of abuse and specific symptoms suggested that hallucinations may be more common than delusions or thought disorder among patients who have been sexually abused, particularly among those who have experienced incest, and that delusions may be more r...
TL;DR: Brief motivational interviewing may be a useful strategy for decreasing gambling among heavy gamblers who are ambivalent about entering treatment or who do not desire abstinence.
Abstract: OBJECTIVE: Although pathological gambling is an increasing problem, many mental health providers are unfamiliar with its diagnosis and treatment. To improve recognition and treatment of pathological gambling, the authors reviewed the literature on its prevalence, assessment, and treatment. METHODS: Entries in PsycLIT and MEDLINE were examined for the years 1984 to 1998. Results and discussion: The prevalence of pathological gambling seems to be increasing with the spread of legalized gambling; casinos are now operating in 27 states. Point and lifetime prevalence rates of pathological gambling are reported to be as high as 1.4 percent and 5.1 percent, respectively. The most commonly used assessment instrument is the DSM-based, 20-item South Oaks Gambling Screen. There is no standard treatment for pathological gambling. Gamblers Anonymous (GA) is the most popular intervention, and about 1,000 chapters exist in the U.S. Studies suggest that only 8 percent of GA attendees achieve a year of abstinence. Combini...
TL;DR: To identify the magnitude of the problem, diagnostic criteria should be modified and national survey data should be analyzed to provide more accurate estimates of substance abuse and dependence among baby boomers.
Abstract: Little attention has been paid to substance use disorders in the elderly population. Currently available diagnostic criteria are likely to significantly underestimate the prevalence of substance ab...
TL;DR: Running away and childhood sexual victimization provide distinct pathways into prostitution and the findings suggest that women wishing to leave prostitution may benefit from different mental health service strategies depending on which pathway to prostitution they experienced.
Abstract: OBJECTIVE: To explore the service needs of women in jail, the authors examined three pathways into prostitution: childhood sexual victimization, running away, and drug use. Studies typically have explored only one or two of these pathways, and the relationships among the three points of entry remain unclear. METHODS: Data on 1,142 female jail detainees were used to examine the effects of childhood sexual victimization, running away, and drug use on entry into prostitution and their differential effects over the life course. RESULTS: Two distinct pathways into prostitution were identified. Running away had a dramatic effect on entry into prostitution in early adolescence, but little effect later in the life course. Childhood sexual victimization, by contrast, nearly doubled the odds of entry into prostitution throughout the lives of women. Although the prevalence of drug use was significantly higher among prostitutes than among nonprostitutes, drug abuse did not explain entry into prostitution. CONCLUSIONS...
TL;DR: This cross-sectional mortality linkage study describes the prevalence of specific fatal disease and injury conditions in an adult population with serious mental illness and finds the high rate of injury deaths, especially those due to psychotropic and other medications, should concern providers.
Abstract: OBJECTIVE: This cross-sectional mortality linkage study describes the prevalence of specific fatal disease and injury conditions in an adult population with serious mental illness. The large sample of decedents and the use of multiple-cause-of-death data yield new clinical details relevant to those caring for persons with serious mental illness. METHODS: Age-adjusted frequency distributions and years of potential life lost were calculated by gender and causes of death for persons in the population of 43,274 adults served by the Massachusetts Department of Mental Health who died between 1989 and 1994. Means and frequencies of these variables were compared with those for persons in the general population of the state who did not receive departmental services and who died during the same period. RESULTS: A total of 1,890 adult decedents served by the department of mental health were identified by electronic linkage of patient and state vital records. They had a significantly higher frequency of deaths from a...
TL;DR: Six attributes of isolated settings with limited resources appear to intensify ethical dilemmas of rural mental health care: overlapping relationships, conflicting roles, and altered therapeutic boundaries between caregivers, patients, and families; challenges in preserving patient confidentiality; heightened cultural dimensions ofmental health care; "generalist" care and multidisciplinary team issues; limited resources for consultation about clinical ethics; and greater stresses experienced by rural caregivers.
Abstract: Roughly 15 million of the 62 million rural U.S. residents struggle with mental illness and substance abuse. These rural dwellers have significant health care needs but commonly experience obstacles to obtaining adequate psychiatric services. Important but little-recognized ethical dilemmas also affect rural mental health care delivery. Six attributes of isolated settings with limited resources appear to intensify these ethical dilemmas: overlapping relationships, conflicting roles, and altered therapeutic boundaries between caregivers, patients, and families; challenges in preserving patient confidentiality; heightened cultural dimensions of mental health care; "generalist" care and multidisciplinary team issues; limited resources for consultation about clinical ethics; and greater stresses experienced by rural caregivers. The authors describe these features of rural mental health care and provide vignettes illustrating dilemmas encountered in the predominantly rural and frontier states of Alaska and New ...
TL;DR: The findings highlight the importance of clinicians' work to support and strengthen family relationships, which loom large in determining the extent to which siblings are involved in the care of a brother or sister with disabilities.
Abstract: Objective: The study examined the factors associated with the involvement of siblings in the life of a brother or sister who has mental illness or mental retardation. Involvement was defined as the current provision of instrumental and emotional support as well as the expectation of future caregiving responsibility. Methods: A mailed questionnaire was used to collect data from 61 siblings of adults with serious mental illness and 119 siblings of adults with mental retardation. The sample was drawn from two ongoing longitudinal studies. Results: The two groups of siblings showed striking differences in their expectations about their responsibility for future caregiving. Almost 60 percent of the siblings of adults with mental retardation expected to assume primary caregiving responsibility in the future, but only one-third of the siblings of adults with mental illness held this expectation. For both groups, competing family responsibilities limited the involvement of siblings, whereas closeness to the family of origin led to greater sibling involvement. Conclusions: The extent of current and future involvement by siblings of adults with disabilities is a function of the demands and constraints of midlife as well as the degree of closeness with the family of origin. The findings highlight the importance of clinicians’ work to support and strengthen family relationships, which loom large in determining the extent to which siblings are involved in the care of a brother or sister with disabilities. (Psychiatric Services 50:1214‐1219, 1999) siblings are willing to take on at least partial responsibility, the cost to the public will be reduced and the continuity of family-based support will be ensured. Little is known, however, about the propensity of adult siblings to assume caregiving roles (5).
TL;DR: The mechanisms identified in this study facilitate operationalization of the concept of continuity of care by specifying its meaning through empirically derived indicators.
Abstract: OBJECTIVE: As a step toward developing a standardized measure of continuity of care for mental health services research, the study sought to identify the interpersonal processes of giving and receiving day-to-day services through which individual providers create experiences of continuity for consumers. METHODS: Ethnographic methods of field observation and open-ended interviewing were used to investigate the meaning of continuity of care. Observations were carried out at two community mental health centers and a psychiatric emergency evaluation unit in Boston. Sixteen recipients and 16 providers of services at these sites were interviewed. RESULTS: Six mechanisms of continuity were identified, labeled, defined, and described through analysis of field notes and interview transcripts: pinch hitting, trouble shooting, smoothing transitions, creating flexibility, speeding the system up, and contextualizing. The mechanisms elaborate dimensions and principles of continuity cited by other observers and also sug...
TL;DR: Research on the impact of nicotine on schizophrenia and antipsychotic medications was reviewed to determine ways to improve treatment planning for patients with schizophrenia who smoke and to evaluate smoking cessation programs for this population.
Abstract: OBJECTIVE: Research on the impact of nicotine on schizophrenia and antipsychotic medications was reviewed to determine ways to improve treatment planning for patients with schizophrenia who smoke and to evaluate smoking cessation programs for this population. METHODS: All major research databases were searched. The review focuses on reports published since 1990. RESULTS: Smoking improves processing of auditory stimuli (sensory gating) by patients with schizophrenia and may lessen negative symptoms by increasing dopamine in the nucleus accumbens and the prefrontal and frontal cortex. Use of traditional antipsychotics may result in patients' smoking more, whereas patients taking atypical antipsychotics may smoke less. Patients who smoke metabolize antipsychotics faster than nonsmoking patients. Smoking cessation programs for outpatients with schizophrenia report a success rate of about 12 percent after six months. No studies of cessation programs for chronically ill inpatients with schizophrenia have been p...
TL;DR: The associations between patient satisfaction and administrative measures of quality at the individual level support the idea that these measures address a common underlying construct, and attenuation of the associations at the hospital level suggests that neither type can stand alone as a measure of quality across institutions.
Abstract: OBJECTIVE: Although measures of consumer satisfaction are increasingly used to supplement administrative measures in assessing quality of care, little is known about the association between these two types of indicators. This study examined the association between these measures at both an individual and a hospital level. METHODS: A satisfaction questionnaire was mailed to veterans discharged during a three-month period from 121 Veterans Administration inpatient psychiatric units; 5,542 responded, for a 37 percent response rate. These data were merged with data from administrative utilization files. Random regression analysis was used to determine the association between satisfaction and administrative measures of quality for subsequent outpatient follow-up. RESULTS: At the patient level, satisfaction with several aspects of service delivery was associated with fewer readmissions and fewer days readmitted. Better alliance with inpatient staff was associated with higher administrative measures of rates of ...
TL;DR: Health care costs for patients with bipolar disorder exceed those for patients treated for depression or diabetes, and specialty mental health and substance abuse treatment costs account for this difference.
Abstract: OBJECTIVE: The study examined health care utilization and costs among patients treated for bipolar-spectrum disorders in an insured population. METHODS: Computerized data on prescriptions and on outpatient and inpatient diagnoses from a large health plan were used to identify patients treated for cyclothymia, bipolar disorder, or schizoaffective disorder. Three age- and sex-matched comparison groups consisting of general medical outpatients, patients treated for depression, and patients treated for diabetes were selected from health plan members. Utilization and cost of health services for the four groups over a six-month period were assessed using computerized accounting records. RESULTS: Total mean±SD costs for patients in the bipolar disorder group ($3,416±$6,862) were significantly higher than those in any of the comparison groups. Specialty mental health and substance abuse services accounted for 45 percent of total costs in the group with bipolar disorder (mean±SD=$1,566±$3,243), compared with 10 pe...
TL;DR: Further experience of homelessness by formerly homeless mentally ill individuals may be reduced by providing effective substance abuse treatment and by paying special attention to consumers identified by clinicians to be at particular risk for housing loss.
Abstract: OBJECTIVE: The study examined the influence of group or individual housing placement and consumer characteristics on the number of days subsequently homeless among formerly homeless mentally ill persons. METHODS: A total of 303 homeless shelter residents with severe mental illness were screened for dangerousness, 118 were randomly assigned to either independent apartment or staffed group living sites, and 110 were followed for 18 months. Study participants' sociodemographic characteristics, diagnosis, and residential preferences and the residential recommendations made by clinicians were measured at baseline. RESULTS: Overall, 76 percent of the study participants were housed at the end of the 18-month follow-up period, although 27 percent had experienced at least one episode of homelessness during the period. The number of days homeless was greater for individuals assigned to independent apartments than for those placed in staffed group homes, but only for members of minority groups. Substance abuse was t...
TL;DR: The authors suggest an adaptation of the model that attempts to minimize the impact of the cognitive and motivational deficits associated with schizophrenia, and suggest a six-month treatment protocol that contains four modules focusing on social skills and problem solving.
Abstract: Although substance abuse has reached epidemic proportions among people with schizophrenia, relatively little is known about the critical elements of effective treatment of substance abuse in this population. The authors discuss common assumptions about treatment of substance abuse and review the features of the transtheoretical model of change, which is based on the view that behavior change is a longitudinal process consisting of several stages. In this model, substance abusers must first be persuaded to reduce substance use and then be engaged in treatment before they can be taught the skills necessary to become and remain abstinent. The authors suggest an adaptation of the model that attempts to minimize the impact of the cognitive and motivational deficits associated with schizophrenia. The six-month treatment protocol contains four modules focusing on social skills and problem solving, education about the causes and dangers of substance use, motivational interviewing and goal setting for decreased su...
TL;DR: Aggressive behavior against self and others is a frequent symptom of schizophrenia in the first two years of illness and plays a major role in rehospitalization.
Abstract: OBJECTIVE: Aggressive behavior directed against self and others was examined in a sample of patients with schizophrenia during their first hospitalization and during any subsequent hospitalizations over the next two years. METHODS: The charts of 138 patients (77 men and 61 women) with a first episode of schizophrenia or schizoaffective disorder admitted to a psychiatric hospital in Weissenau, Germany, were reviewed to obtain information about four types of aggressive behavior (verbal aggression and aggression against objects, self, and others). Similar chart reviews were conducted for 83 patients (47 men and 36 women) who were rehospitalized during the next two years. The severity of the four types of behavior was rated using the Modified Overt Aggression Scale. Stepwise multiple regression was used to identify predictors of the number and duration of rehospitalizations. RESULTS: Seventy-five percent of the men and 53 percent of the women in the sample exhibited some type of aggressive behavior during the...
TL;DR: Research supports the view that treatment can decrease sex offense and protect potential victims, and any commitment to a social project substituting treatment for imprisonment of sexual aggressors must be accompanied by vigorous research.
Abstract: Objective: Recent legislation in several states providing for civil commitment and preventive detention of sexually violent persons has stirred legal, clinical, and public policy controversies. The mandate for psychiatric evaluation and treatment has an impact on public mental health systems, requiring clinicians and public administrators to direct attention to treatment options. It is a common view that no treatments work for disorders involving sexual aggression. The authors examine this assumption by reviewing research on the effectiveness of treatment for adult male sex offenders. Methods: MEDLINE was searched for key reviews and papers published during the years 1970 through 1998 that presented outcome data for sex offenders in treatment programs, individual case reports, and other clinically and theoretically important information. Results: Although rigorous research designs are difficult to achieve, studies comparing treated and untreated sex offenders have been done. Measurement of outcome is flawed, with recidivism rates underestimating actual recurrence of the pathological behavior. Outcome research suggests a reduction in recidivism of 30 percent over seven years, with comparable effectiveness for hormonal and cognitivebehavioral treatments. Institutionally based treatment is associated with poorer outcome than outpatient treatment, and the nature of the offender’s criminal record is an important prognostic factor. Conclusions: Although treatment does not eliminate sexual crime, research supports the view that treatment can decrease sex offense and protect potential victims. However, given the limitations in scientific knowledge and accuracy of outcome data, as well as the potential high human costs of prognostic uncertainty, any commitment to a social project substituting treatment for imprisonment of sexual aggressors must be accompanied by vigorous research. (Psychiatric Services 50:349‐361, 1999) Regarding treatment, a body of literature has evolved steadily over the past two decades that addresses the effectiveness of treatment programs for sex offenders, but it remains specialized and unfamiliar to many general psychiatrists (4‐7). It is commonly assumed, and even argued in support of public policy, that disorders involving aggressive sexual behaviors are unlike other mental illnesses because they are untreatable. The purpose of this paper is to examine this assumption more closely by reviewing the research on the effectiveness of treatment for sex offenders, focusing primarily on adult males.
TL;DR: To meet the public health challenges posed by geriatric depression over the next 15 years, the major priorities for research and clinical practice must include improvement in recognizing and treating depression among elderly patients seen in the general medical sector, suicide prevention among elderly Patients seen in primary care, and acceleration of response to antidepressants.
Abstract: Geriatric depression is widespread, affecting at least one of six patients treated in general medical practice and an even higher percentage in hospitals and nursing homes. Depression in later life has serious consequences, including patients' and caregivers' distress, amplification of disability associated with medical and cognitive disorders of later life, increased health care costs, and increased mortality related to suicide and medical illness. Despite the numerous pathways to late-life depression, as well as the complex medical and psychosocial context in which it occurs, it can be effectively diagnosed and treated. To meet the public health challenges posed by geriatric depression over the next 15 years, the major priorities for research and clinical practice must include improvement in recognizing and treating depression among elderly patients seen in the general medical sector, suicide prevention among elderly patients seen in primary care, and acceleration of response to antidepressants. Other major priorities include improving the early recognition of treatment resistance in late-life depression and developing strategies for improving the treatment response of such patients; finding maintenance treatments with long-term efficacy, especially for patients over age 70 and those who have required electroconvulsive therapy; and developing preventive strategies to reduce the liability to late-onset depression.
TL;DR: The comorbidity of schizophrenia and psychopathy was found to be higher among violent patients than among nonviolent patients, and was associated with earlier age of onset of illness and more arrests for both violent and nonviolent offenses.
Abstract: Objective: Although a strong association between violence and psychopathy has been demonstrated in nonpsychotic forensic populations, the relationship between psychopathy and violence among patients with schizophrenia has not been thoroughly explored. Patients with and without a history of persistent violent behavior were compared for comorbidity of psychopathy and schizophrenia or schizoaffective disorder. Methods: Violent and nonviolent patients were identified through reviews of hospital charts and records of arrests and convictions. The Psychopathy Checklist: Screening Version was administered to 51 patients, 26 violent patients and 25 matched nonviolent patients. Analysis of variance was used as the principal statistical method for comparing violent and nonviolent groups. Results: Mean psychopathy scores were higher for violent patients than nonviolent patients. Five of the violent patients (19 percent) had scores exceeding the cutoff for psychopathy, and 13 (50 percent) scored in the possible psychopathic range. All of the nonviolent patients scored below the cutoff for possible psychopathy. Higher psychopathy scores were associated with earlier age of onset of illness and more arrests for both violent and nonviolent offenses. Conclusions: The comorbidity of schizophrenia and psychopathy was found to be higher among violent patients than among nonviolent patients. Violent patients with schizophrenia who score high on measures of psychopathy may have a personality disorder that precedes the emergence of psychotic symptoms, or they may constitute a previously unclassified subtype of schizo phrenia, characterized by early symptoms of conduct disorder symptoms and persistent violent behavior. (Psychiatric Services 50:787– 792, 1999) sociation between violence and psychopathy has been well documented in nonpsychotic forensic populations (5–9).
TL;DR: Effective treatment of substance use among persons with mental illness appears to reduce arrests and incarcerations but not the frequency of nonarrest encounters, and stable housing may also reduce the likelihood and number of arrests.
Abstract: OBJECTIVE: Persons with co-occurring severe mental illness and substance use disorders were followed for three years to better understand how they are involved with the legal system and to identify factors associated with different kinds of involvement. METHODS: Data came from a three-year study of 203 persons enrolled in specialized treatment for dual disorders. Cost and utilization data were collected from multiple data sources, including police, sheriffs and deputies, officers of the court, public defenders, prosecutors, private attorneys, local and county jails, state prisons, and paid legal guardians. RESULTS: Over three years 169 participants (83 percent) had contact with the legal system, and 90 (44 percent) were arrested at least once. Participants were four times more likely to have encounters with the legal system that did not result in arrest than they were to be arrested. Costs associated with nonarrest encounters were significantly less than costs associated with arrests. Mean costs per perso...