Violence after discharge from forensic units in the safe pilot study : a prospective study with matched pair design

Objective: This paper reports on a prospective naturalistic study of violent recidivism after discharge from forensic mental health. Main aims were to find predictors of violence and to test the feasibility of a matched pair design for this purpose. Methods: Patients from the Safe pilot project (n=18) and a group of controls (n=18) were matched on 10 variables, such as diagnosis, seriousness of violence, setting after discharge, and risk management plans. All the Safe pilot patients had been through repeated measurement of dynamic risk factors of violence the year before discharge to develop efficient risk management plans for use after discharge. We wanted to test whether violent recidivism during follow-up would be lower and less serious in the Safe pilot group. Results: We found no significant between-group difference concerning number of patients with violent recidivism. However, the Safe pilot patients had significantly lower rates of violence and fewer severe violent episodes. In the control group, there was a significant association between a high number of risk management plans and high rates of violence. There was a statistical trend for the opposite association in the Safe pilot group. Conclusion: We discuss this in terms of a possible gap between the development and implementation of plans. Keywords: forensic mental health, discharge, violence, matched pairpublishedVersio

Mekaniske tvangsmidler og kjønn : En retrospektiv kvantitativ undersøkelse fra en lukket akuttpsykiatrisk avdeling - årene 2004 og 2005

Denne mastergradsoppgaven i klinisk helsearbeid er en studie om tvangsmiddelbruk ved en akuttpsykiatrisk avdeling i Norge. Et av de store fagpolitiske satsningsområdene innen psykisk helsevern, er å få mer kunnskap om og redusere alle sider ved tvang psykiatriske pasienter utsettes for. Det være seg alt fra formelle tvangsinnleggelser, opplevd tvang hos pasientene og tvangsmiddelbruk. Tall fra ulike undersøkelser viser at Norge ligger stabilt høyt sammenlignet med tall fra andre europeiske land. I denne studien fremkommer det at menn oftere utsettes for en og to tvangsmiddelepisoder og blir værende i tvangsmidlene over lenger tid. Noen få kvinner har oftere gjentagende episoder og er iført tvangsmidlene i kortere perioder. Voldelig atferd mot andre er den atferden som oftest fører til bruk av mekaniske tvangsmidler

Strong associations between childhood victimization and community violence in male forensic mental health patients

Background: Childhood abuse and neglect increase the risk of both mental disorders and violent behavior. Associations between child relational adversities and violent behavior have not been extensively investigated in forensic mental health settings. We asked whether the extent of child adversities predicts the extent of violence in the community in forensic mental health patients. Methods: We included 52 male patients at a medium security forensic mental health ward, with diagnoses of predominantly paranoid schizophrenia and other schizophrenia and psychotic disorders. Seventy-five percent had comorbid substance abuse. We extracted information on six types of child adversities based on clinicians' administrations of the Historical Clinical Risk Management 20 version 3 (HCR 20) scale and summary notes in electronic patient journals. These same sources were used to extract information on war trauma and interpersonal violence in the community. We established cumulative scales for exposure to number of types of child adversities and number of incidents of community violence. Results: Physical and emotional abuse, emotional and physical neglect, and bullying were associated with higher levels of community violence. We observed a linear, significant increase in the frequency of community violence with cumulative numbers of child adversity types. Conclusions: Cumulative exposure to child adversities may be associated with higher degrees of violence in forensic mental health patients, with the most violent patients having the most extensive exposures to adversities. An enhanced focus on child adversities in risk assessment and management of violence may be considered in forensic inpatient settings.publishedVersio

Early recognition method : ‘Opening doors’ in risk management dialogue between mental health and prison services

In secured institutions, which include prison services, violence between clients or towards staff has a major impact, eliciting feelings of stress, anger and fear for those involved. In this chapter we explain how violence can be understood as a complexity of multiple factors, and why a structured risk management strategy is necessary to adequately assess and manage violence. We describe specifically the Early Recognition Method (ERM) as a step-wise forward strategy aiming to identify, formulate and manage early warning signs of violence and allows a risk management dialogue to develop between prison staff and inmates. The ERM-dialogue strategy has successfully been developed and applied in forensic psychiatry and in this chapter we explore how, in a process of innovation, the knowledge and research of the ERM-applied in forensic services, has been transferred to prison services. The ‘multivoicedness’ of the ERM is explored through the theoretical concept of the ‘Self’publishedVersio

Detection of recurrent prostate cancer with 18F-Fluciclovine PET/MRI

Objective: Simultaneous PET/MRI combines soft-tissue contrast of MRI with high molecular sensitivity of PET in one session. The aim of this prospective study was to evaluate detection rates of recurrent prostate cancer by 18F-fluciclovine PET/MRI. Methods: Patients with biochemical recurrence (BCR) or persistently detectable prostate specific antigen (PSA), were examined with simultaneous 18F-fluciclovine PET/MRI. Multiparametric MRI (mpMRI) and PET/MRI were scored on a 3-point scale (1-negative, 2-equivocal, 3-recurrence/metastasis) and detection rates (number of patients with suspicious findings divided by total number of patients) were reported. Detection rates were further stratified based on PSA level, PSA doubling time (PSAdt), primary treatment and inclusion criteria (PSA persistence, European Association of Urology (EAU) Low-Risk BCR and EAU High-Risk BCR). A detailed investigation of lesions with discrepancy between mpMRI and PET/MRI scores was performed to evaluate the incremental value of PET/MRI to mpMRI. The impact of the added PET acquisition on further follow-up and treatment was evaluated retrospectively. Results: Among patients eligible for analysis (n=84), 54 lesions were detected in 38 patients by either mpMRI or PET/MRI. Detection rates were 41.7% for mpMRI and 39.3% for PET/MRI (score 2 and 3 considered positive). There were no significant differences in detection rates for mpMRI versus PET/MRI. Disease detection rates were higher in patients with PSA≥1ng/mL than in patients with lower PSA levels but did not differ between patients with PSAdt above versus below 6 months. Detection rates in patients with primary radiation therapy were higher than in patients with primary surgery. Patients categorized as EAU Low-Risk BCR had a detection rate of 0% both for mpMRI and PET/MRI. For 15 lesions (27.8% of all lesions) there was a discrepancy between mpMRI score and PET/MRI score. Of these, 10 lesions scored as 2-equivocal by mpMRI were changed to a more definite score (n=4 score 1 and n=6 score 3) based on the added PET acquisition. Furthermore, for 4 of 10 patients with discrepancy between mpMRI and PET/MRI scores, the added PET acquisition had affected the treatment choice. Conclusion: Combined 18F-fluciclovine PET/MRI can detect lesions suspicious for recurrent prostate cancer in patients with a range of PSA levels. Combined PET/MRI may be useful to select patients for appropriate treatment, but is of limited use at low PSA values or in patients classified as EAU Low-Risk BCR, and the clinical value of 18F-fluciclovine PET/MRI in this study was too low to justify routine clinical use