Skip to main content
×
×
Home

Changes in diagnoses before admission to a specialist medium secure unit

  • Amrith Shetty (a1), Dilum Jayawickrama (a2) and Pamela J. Taylor (a3)
Abstract
Aims and method

There is evidence that changing diagnoses may be an important factor preceding homicide, but there is little literature on diagnostic antecedents to admission to specialist secure units after violent behaviour. Our aim was to establish the frequency of a history of changing diagnoses in patients in a UK specialist unit, and to explore the characteristics of these patients.

Results

In total, 38 of 42 study participants had prior contact with psychiatric services. Just over 40% (16 of the 38) had had their diagnosis changed three or more times. All those who had major changes in their diagnosis had received a diagnosis of a psychotic illness at some point prior to the secure unit admission, but then had it withdrawn, only to be restored after prolonged assessment in the secure unit. Personality disorder and substance misuse comorbidity was common in this group; however, non-psychotic diagnoses were seen as more important than psychotic diagnoses by general services.

Clinical implications

Changes in diagnosis between first presentation to psychiatric services and admission to a medium-security unit were more common than would be expected from reports in the general literature. They are a testimony to the difficulties experienced by service providers in delivering a consistent service. This needs to be studied further.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Changes in diagnoses before admission to a specialist medium secure unit
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Changes in diagnoses before admission to a specialist medium secure unit
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Changes in diagnoses before admission to a specialist medium secure unit
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Amrith Shetty (amrith.shetty@wales.nhs.uk)
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
1 Department of Health. Guidance on the Discharge of Mentally Disordered People and their Continuing Care in the Community. HMSO, 1994.
2 Taylor, PJ, Gunn, J. Diagnosis, medical models and formulations. In Handbook on Forensic Mental Health (eds Soothhill, K, Dolan, M, Rogers, P): 268–97. William Publishers, 2008.
3 Spokes, J. Report of the Committee of Inquiry into the Care and Aftercare of Miss Sharon Campbell. HMSO, 1988.
4 Ritchie, JH, Dick, D, Lingham, R. The Report of the Inquiry into the Care and Treatment oj Christopher Clunis. HMSO, 1994.
5 Healthcare Inspectorate Wales. Report of a Review in Respect of Ms A and the Provision of Mental Health Services, Following a Homicide Committed in October 2005. Healthcare Inspectorate Wales, 2008 (http://www.hiw.org.uk/Documents/477/cardiff%20homicide%20for%20print%20final2.pdf).
6 Melzer, D, Tom, BDT, Brugha, T, Fryers, T, Gatward, R, Grounds, A, et al. Access to medium secure psychiatric care in England and Wales: a national survey of admission assessments. J Forensic Psychiatry Psychol 2009; 15: 731.
7 NHS National Patient Safety Agency (NSPA). Defining Research. National Research Ethics Service, NPSA, 2010 (http://www.nres.nhs.uk/news-and-publications/publications/general-publications).
8 Lelliott, P, Audini, B, Duffett, R. Survey of patients form an inner-London health authority in medium secure psychiatric care. Br J Psychiatry 2001; 178: 62–6.
9 McKenna, J. In-patient characteristics in a regional secure unit. Psychiatr Bull 1996; 20: 264–8.
10 Baca-Garcia, E, Perez-Rodriguez, MM, Basurte-Villamor, I, Fernandez Del Moral, AL, Jimenez-Arriero, MA, Gonzalez De Rivera, JL, et al. Diagnostic stability of psychiatric disorders in clinical practice. Br J Psychiatry. 2007; 190: 210–6.
11 Veen, ND, Selten, J-P, Schols, D, Iaan, W, Hoek, HW, van der Tweel, I, et al. Diagnostic stability in a Dutch psychosis incidence cohort. Br J Psychiatry 2004; 185: 460–4.
12 Hall, W, Farrell, M. Comorbidity of mental disorders with substance misuse. Br J Psychiatry 1997; 171: 45.
13 Swanson, JW, Borum, R, Swartz, MS. Psychotic symptoms and disorders and the risk of violent behaviour in the community. Crim Behav Ment Health 1996; 6: 309–29.
14 Cuffel, BJ, Shumway, M, Choujian, TL, MacDonald, T. A longitudinal study of substance use and community violence in schizophrenia. J Nerv Ment Dis 1994; 182: 704–8.
15 Tiihonen, J, Isohanni, M, Rasanen, P, Koiranen, M, Moring, J. Specific major mental disorders and criminality: a 26-year prospective study of the 1966 northern Finland birth cohort. Am J Psychiatry 1997; 154: 840–5.
16 Wallace, C, Mullen, P, Burgess, P, Palmer, S, Ruschena, D, Browne, C. Serious criminal offending and mental disorder. Case linkage study. Br J Psychiatry 1998; 172: 477–84.
17 Walsh, E, Buchanan, A, Fahy, T. Violence and schizophrenia: examining the evidence. Br J Psychiatry 2002; 180: 490–5.
18 Department of Health. Safety First: Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. TSO (The Stationery Office), 2001.
19 Manning, N. DSM-IV and dangerous and severe personality disorder – an essay. Soc Sci Med 2006; 63: 1960–71.
20 Taylor, PJ. Second Expert Paper: Mental Illness and Serious Harm to Others. NHS National Programme on Forensic Mental Health Research and Development, 2007 (http://www.liv.ac.uk/fmhweb/EP%20Mental%20Illness%20and%20Serious%20Harm%20to%20Others.pdf).
21 Appleby, L. Safer services: conclusions from report of the National Confidential Inquiry. Adv Psychiatr Treat 2000; 6: 515.
22 Stone, MH. Relationship of borderline personality disorder and bipolar disorder. Am J Psychiatry 2006; 163: 1126–8.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 8 *
Loading metrics...

Abstract views

Total abstract views: 63 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 17th July 2018. This data will be updated every 24 hours.

Changes in diagnoses before admission to a specialist medium secure unit

  • Amrith Shetty (a1), Dilum Jayawickrama (a2) and Pamela J. Taylor (a3)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *