Initiating Change of People With Criminal Justice Involvement Through Participation in a Drama Project: An Exploratory Study

Introduction: Innovative and interdisciplinary approaches are needed to improve mental health and psychosocial outcomes of people with criminal justice involvement and their families. Aim of the study was to assess effects of the participation in a theatre project on the mental health problems of people with criminal justice involvement and relatives. Methods: We conducted structured diagnostic interviews and in-depth qualitative interviews with five participants performing Shakespeare's Richard III in Chile. Three participants had been imprisoned prior to the project, and two were the parents of a person who died in a prison fire. Qualitative interviews followed a topic guide. Data were transcribed, and a six-phase approach for thematic analysis of the data was used. Results: Substance use disorder or major depression was identified in all the participants. Participation in the theatre project was experienced by the respondents as having a positive effect on the mental health conditions. The research registered the positive experiences of role identification, emotional expression, commitment with group processes, improved skills to socially interact, to be heard by the general public and society, and positive perceptions of the audience (including relatives). Discussion: The study raises the possibility that there may be improvements of depression and substance use problems through the participation of people with criminal justice involvement in a drama project. Wider scale research is recommended on the possible effects. The approach may be an alternative to psychotherapy and medication for some individuals

'Maybe It Is Only in Prison That I Could Change Like This' The Course of Severe Mental Illnesses During Imprisonment - A Qualitative 3-Year Follow-Up Study From Chile

Background: Severe mental illness (SMI) among imprisoned individuals is a global health concern. Quantitative research indicates on average mental health symptom improvements during imprisonment, however, it cannot reflect multifaceted factors influencing the course of SMI. This study aimed to explore the subjective course of SMI during imprisonment and to identify influencing factors. Methods: The study has a 3-year-follow-up design of imprisoned individuals in Chile. We conducted semi-structured interviews with 10 men and 9 women at follow-up who had either major depression or psychosis (severe mental illnesses) at baseline. We included individuals who deteriorated, remained stable or improved their mental health according to quantitative assessments. We explored the subjective course of their mental health condition during the follow-up period. Qualitative data was transcribed and coded using NVivo Software for quantitative content analysis. Qualitative data was also manually coded and was subsequently analyzed using the thematic analysis method with an inductive approach. We developed the final themes using the results of this analysis in combination with the inclusion criteria. Results: The mental health of 10 individuals subjectively improved, 6 experienced deteriorations, and 3 did not perceive any change. Good infrastructure, structure/occupation, intrapersonal resources (will to change, spirituality) and supportive relationships were identified as factors improving mental health. Factors deteriorating mental health were identified as bad infrastructure (e.g., no running water and bad housing conditions) and crowding, lack of psychological treatment, exposure to violence, interpersonal stress (conflictive relationships and separation from family), perceived injustice through sentencing, intrapersonal stressors and previous medical conditions. Discussion: SMI in prison can improve in a supportive environment under certain conditions. These conditions include the improvement of infrastructure (housing and healthcare), the opportunity to work or study, protection from violence during imprisonment, and to develop intrapersonal resources and family relationships. To reduce SMI in prisons the improvement of these conditions should become a priority

Substance Use During Imprisonment in Low- and Middle-Income Countries

Substance use disorders are among the most common health problems of people involved in the criminal justice system. Scaling up addiction services in prisons is a global public health and human rights challenge especially in poorly resourced countries. The aim of the present study was to systematically review the prevalence of substance use in prison populations in low- and middle-income countries (LMIC). We searched for studies reporting prevalence rates of nicotine, alcohol, illicit drug and injection drug use during imprisonment in unselected samples of imprisoned people in LMIC. Data were meta-analyzed and sources of heterogeneity examined by meta-regression. The prevalence of nicotine use during imprisonment ranged from 5% to 87% with a random-effects pooled estimate of 56% (95% CI: 45, 66) with significant geographical heterogeneity. Alcohol use varied from 1% to 76%. The pooled prevalence was 16% (95% CI: 9, 25). A quarter of the people who are imprisoned (25%, 95% CI: 17, 33; range: 0, 78) used illicit drugs during imprisonment. The prevalence of injection drug use varied from 0% to 26% with a pooled estimate of 1.6% (95% CI: 0.8, 3.0). Secondary analyses investigated lifetime substance use. The high prevalence of smoking in prison suggests that policies around smoking need careful review. Furthermore, the findings underscore the importance of timely, scalable and available treatments for alcohol and illegal drugs in people involved with the criminal justice system

Der Verlauf psychischer Erkrankungen während Haft – ein Drei-Jahres-Follow-Up aus Santiago de Chile

[Hintergrund] Psychische Erkrankungen bei inhaftierten Personen sind häufig und werden selten adäquat behandelt. Es gibt wenige Daten über den die Entwicklung psychischer Erkrankungen während Haft, insbesondere nicht aus Ländern des globalen Südens. Longitudinale Studien aus westlichen Ländern suggerieren eine Verbesserung der psychischen Symptome im Verlauf der Haft. Das Ziel dieser Studie war es, psychische Erkrankungen und Symptome drei Jahre nach der Evaluation zu Beginn der Haft zu untersuchen sowie Faktoren die mit Veränderungen der psychischen Gesundheit in einem lateinamerikanischen Gefängniskontext assoziiert sind, zu identifizieren. [Methoden] Konsekutiv aufgenommene Inhaftierte in Santiago de Chile wurden bei Haftbeginn (Baseline) sowie drei Jahre später (Follow-Up) anhand eines strukturierten Fragebogens zu soziodemographischen Daten, des Mini-International Neuropsychiatric Interview (M.I.N.I.) sowie der Symptom-Check-List-90 Revised (SCL-90-R) evaluiert. Der Global Severity Index (GSI) der SCL-90-R wurde berechnet und anhand gepaarter t-Tests verglichen. Die Prävalenz von psychischen Erkrankungen bei Baseline und Follow-Up wurde anhand des McNemar-Tests verglichen. Zur Identifikation soziodemographischer Faktoren, die mit Symptomveränderung über den Follow-Up-Zeitraum assoziiert waren, wurde eine Varianzanalyse (ANOVA) durchgeführt. [Ergebnisse] 73 (94%) von 78 Inhaftierten nahmen an der Studie teil. Die Prävalenz von schweren psychischen Erkrankungen war zum Zeitpunkt des Follow-Ups niedriger als bei Baseline: 47 (64%) bei Aufnahme vs. 23 (32%) bei Follow-Up hatten eine schwere Depression (p<0,001); 22 (30%) bei Aufnahme vs. 10 (14%) bei Follow-Up hatten eine Psychose. Der GSI verbesserte sich von 1,6 (0,84) bei Baseline auf 1,2 (0,82) bei Follow-Up (p<0,001). Depression bei Baseline (F = 9,39; η_p^2=0,137; β=-0,67; p=0,003) und Lohnarbeit oder Schulbesuch (F = 10,61; η_p^2=0,152; β=-0,71; p=0,002) waren mit einer starken Verbesserung des GSI assoziiert. Psychotische Erkrankungen bei Beginn der Haft waren mit einer weniger starken Verbesserung des GSI assoziiert (F = 12,11; η_p^2=0,17; β=0,81; p=0,001). [Zusammenfassung und Fazit] Die psychische Symptombelastung und Prävalenz psychischer Erkrankungen sinkt über den Verlauf der Haft in einem ressourcenschwachen südamerikanischen Gefängniskontext signifikant ab. Arbeits- und Bildungsangebote während Haft könnten die Verbesserung der psychischen Gesundheit unterstützen.[Background] Psychiatric disorders in prison population are common and resources for treatment and healthcare are poor. Data on the course of mental disorders during imprisonment, especially in low and middle income countries, are scarce. Longitudinal studies from high income countries suggest an improvement of mental health symptoms during the course of imprisonment. The aim of the present study was to assess mental illnesses and symptoms three years after baseline evaluation at the beginning of imprisonment and to identify factors associated with change of mental health in a Latin American prison context. [Methods] Consecutive detainees in Santiago de Chile were evaluated at the beginning of their detention (baseline) and three years (Follow-Up) later using a structured interview on sociodemographic characteristics, the Mini-International Neuropsychiatric Interview (M.I.N.I.) and the Symptom Check List-90 Revised (SCL-90-R). The Global Severity Index (GSI) of the SCL-90-R was calculated and compared using paired t-tests. The prevalence of psychiatric disorders at baseline and Follow-Up was compared using the McNemar test. Analysis of variance (ANOVA) was performed to identify socio demographic factors associated with symptom change. [Results] 73 (94%) of 78 prisoners participated in the study. The prevalence of severe psychiatric disorders was lower at the time of Follow-Up: 47 (64%) at admission vs. 23 (32%) at Follow-Up had major depression (p<0,001); 22 (30%) at admission vs. 10 (14%) at Follow-Up had psychosis. The GSI improved from 1,6 (0,84) at baseline to 1,2 (0,82) at Follow-Up (p<0,001). Depression at baseline (F = 9,39; η! "=0,137; "=-0,67; p=0,003) and working for income or school attendance (F = 10,61; η! "=0,152; "=-0,71; p=0,002) were associated with a strong improvement of the GSI. Psychotic disorders at the beginning of imprisonment were associated with a less marked improvement of the GSI (F = 12,11; η! "=0,17; "=0,81; p=0,001). [Conclusion] The burden of mental health symptoms and prevalence of mental illness decreases significantly over the course of imprisonment in a resource-poor South American prison context. Work and educational opportunities during imprisonment could help to improve mental health

Correction: Mental disorders and mental health symptoms during imprisonment: A three-year follow-up study

[This corrects the article DOI: 10.1371/journal.pone.0213711.]

Therapeutic options for CTLA-4 insufficiency.

BACKGROUND Heterozygous germline mutations in cytotoxic T lymphocyte-associated antigen-4 (CTLA4) impair the immunomodulatory function of regulatory T cells. Affected individuals are prone to life-threatening autoimmune and lymphoproliferative complications. A number of therapeutic options are currently being used with variable effectiveness. OBJECTIVE Our aim was to characterize the responsiveness of patients with CTLA-4 insufficiency to specific therapies and provide recommendations for the diagnostic workup and therapy at an organ-specific level. METHODS Clinical features, laboratory findings, and response to treatment were reviewed retrospectively in an international cohort of 173 carriers of CTLA4 mutation. Patients were followed between 2014 and 2020 for a total of 2624 months from diagnosis. Clinical manifestations were grouped on the basis of organ-specific involvement. Medication use and response were recorded and evaluated. RESULTS Among the 173 CTLA4 mutation carriers, 123 (71%) had been treated for immune complications. Abatacept, rituximab, sirolimus, and corticosteroids ameliorated disease severity, especially in cases of cytopenias and lymphocytic organ infiltration of the gut, lungs, and central nervous system. Immunoglobulin replacement was effective in prevention of infection. Only 4 of 16 patients (25%) with cytopenia who underwent splenectomy had a sustained clinical response. Cure was achieved with stem cell transplantation in 13 of 18 patients (72%). As a result of the aforementioned methods, organ-specific treatment pathways were developed. CONCLUSION Systemic immunosuppressants and abatacept may provide partial control but require ongoing administration. Allogeneic hematopoietic stem cell transplantation offers a possible cure for patients with CTLA-4 insufficiency

Therapeutic options for CTLA-4 insufficiency

BACKGROUND: Heterozygous germline mutations in cytotoxic T lymphocyte-associated antigen-4 (CTLA4) impair the immunomodulatory function of regulatory T cells. Affected individuals are prone to life-threatening autoimmune and lymphoproliferative complications. A number of therapeutic options are currently being used with variable effectiveness.OBJECTIVE: Our aim was to characterize the responsiveness of patients with CTLA-4 insufficiency to specific therapies and provide recommendations for the diagnostic workup and therapy at an organ-specific level.METHODS: Clinical features, laboratory findings, and response to treatment were reviewed retrospectively in an international cohort of 173 carriers of CTLA4 mutation. Patients were followed between 2014 and 2020 for a total of 2624 months from diagnosis. Clinical manifestations were grouped on the basis of organ-specific involvement. Medication use and response were recorded and evaluated.RESULTS: Among the 173 CTLA4 mutation carriers, 123 (71%) had been treated for immune complications. Abatacept, rituximab, sirolimus, and corticosteroids ameliorated disease severity, especially in cases of cytopenias and lymphocytic organ infiltration of the gut, lungs, and central nervous system. Immunoglobulin replacement was effective in prevention of infection. Only 4 of 16 patients (25%) with cytopenia who underwent splenectomy had a sustained clinical response. Cure was achieved with stem cell transplantation in 13 of 18 patients (72%). As a result of the aforementioned methods, organ-specific treatment pathways were developed.CONCLUSION: Systemic immunosuppressants and abatacept may provide partial control but require ongoing administration. Allogeneic hematopoietic stem cell transplantation offers a possible cure for patients with CTLA-4 insufficiency.</p