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Article
Publication date: 14 August 2017

Alice Bennett and Darren Johnson

In light of the clinical importance of understanding co-morbidity within offender populations, the purpose of this paper is to examine the prevalence and comorbidities of…

Abstract

Purpose

In light of the clinical importance of understanding co-morbidity within offender populations, the purpose of this paper is to examine the prevalence and comorbidities of clinical disorder (Axis I) and personality disorder (Axis II) within a sample of high risk, male offenders located in a high secure, prison-based personality disorder treatment service.

Design/methodology/approach

The study utilised clinical assessment data for both Axis I diagnoses (Structured Clinical Interview for DSM-IV) and Axis II diagnoses (International Personality Disorder Examination) of 115 personality disordered offenders who met the criteria for the treatment service between 2004 and 2015.

Findings

Co-morbidity between Axis I and Axis II diagnoses was high, with 81 per cent of the sample having co-morbid personality disorder and clinical disorder diagnosis. The most prevalent Axis I disorder was substance misuse, and Axis II was antisocial, borderline, and paranoid personality disorder. Following χ2 analysis, Cluster A personality disorder demonstrated co-morbidity with both mood disorder and schizophrenia/other psychotic disorder. Paranoid, schizoid, narcissistic, and avoidant personality disorder demonstrated a level of co-morbidity with Axis I disorders. There was no association found between the clinical disorders of substance use and anxiety with any personality disorder within this sample.

Practical implications

In part these results suggest that certain Axis II disorders may increase the risk of lifetime Axis I disorders.

Originality/value

The findings of no co-morbidity between the clinical disorders of substance use and anxiety with any personality disorder within sample are inconsistent to previous findings.

Details

Journal of Forensic Practice, vol. 19 no. 3
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 15 February 2013

Carla Marienfeld and Robert A. Rosenheck

The purpose of this paper is to determine if dually diagnosed (DDx) patients with severe mental illnesses such as bipolar disorder and schizophrenia are at higher risk of…

Abstract

Purpose

The purpose of this paper is to determine if dually diagnosed (DDx) patients with severe mental illnesses such as bipolar disorder and schizophrenia are at higher risk of not obtaining prescribed medication.

Design/methodology/approach

National Veterans Health Administration records from 2010 identified all DDx patients with Bipolar (BP) spectrum (n=98,894) and Schizophrenia (SZ) spectrum (n=80,654) disorders. Pharmacy records identified the total number of prescriptions dispensed per veteran for antidepressants, antipsychotics, sedative‐hypnotics and anxiolytics, mood stabilizers (anti‐convulsants), and lithium. To identify potential sociodemographic and clinical confounders, bivariate analyses compared four groups: BP and SZ with and without DDx. Analysis of covariance (ANCOVA) was used to determine the association of DDx with the number of dispensed prescriptions, and interaction analysis was used to determine whether any “dual‐diagnosis effect” was greater between BP or SZ. Further ANCOVA examined whether significant differences were accounted for by differences in outpatient mental health visits or co‐morbidities.

Findings

Among BP veterans, 33,226 (33.6 percent) were DDx, compared to 19,652 (24.4 percent) among SZ veterans. DDx patients obtained more prescriptions than other patients over a similar period of time, and these effects were somewhat greater for BP DDx patients than for SZ DDx patients. DDx patients also showed more mental health services use and had more co‐morbidities. After controlling for these differences, DDx veterans still were dispensed more total psychotropic prescriptions, but most differences between diagnostic groups and medication class were no longer significant.

Originality/value

The paper shows that DDx veterans consume more resources in terms of both psychotropic medications and clinic visits. Further attention should be paid to the overall complexity of their clinical needs, including the increased likelihood of both licit and illicit drug‐drug interactions rather than just to their substance use.

Details

Advances in Dual Diagnosis, vol. 6 no. 1
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 6 September 2011

Kelly L. Mutch, Kimberly B. Heidal, Kevin H. Gross and Brenda Bertrand

The purpose of this research was to assess the preferred route of nutrition support (enteral versus parenteral) for treatment of severe acute pancreatitis in the acute…

Abstract

Purpose

The purpose of this research was to assess the preferred route of nutrition support (enteral versus parenteral) for treatment of severe acute pancreatitis in the acute care setting. Further, in cases when enteral nutrition is the preferred route, is nasal‐bridling a lower‐morbidity and cost‐effective method?

Design/methodology/approach

A retrospective review of pre‐existing data from an 870‐bed hospital system. Medical records were reviewed via an online database system (n=25\; patients) with severe acute pancreatitis. Length of stay and cost were analyzed.

Findings

More patients received TPN versus the nasal‐jejunal (post‐pyloric) tube feeds group. No significant relationship was found between total cost and number of co‐morbidities or between either of the two treatment groups. However, a medium to large effect size was shown which could indicate a significant relationship in a larger sample size.

Originality/value

The findings of this research add to the literature already available and will be of interest to those who specialize in this area.

Details

International Journal of Health Care Quality Assurance, vol. 24 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 April 2009

M. T. Arends, H. A. De Haan and G.I.C.M. Van ’T Hoff

Heterogenic care of addicted detainees in the various prisons in the Netherlands triggered the National Agency of Correctional Institutions of the Ministry of Justice, to…

Abstract

Heterogenic care of addicted detainees in the various prisons in the Netherlands triggered the National Agency of Correctional Institutions of the Ministry of Justice, to order the Dutch Institute for Health Care Improvement (CBO) to formulate the first national guideline titled ‘Pharmacological care for detained addicts’. This article presents the content of this guideline, which mainly focuses on opioid‐dependent addicts. In the Netherlands, approximately 50% of the detainees are problematic substance abusers, while again half of this group suffers from psychiatric co‐morbidity. In addition, somatic co‐morbidity, especially infectious diseases, is also common. Due to the moderate outcome seen with voluntary drug counselling regimes in prison, there is a policy shift to extent utilization of legally enforced approaches. Continuity of care is of great importance. In case of opioid addicts this, in general, means continuation of methadone maintenance treatment. Aftercare immediately after detention and optimalization of medical information transfer is crucial. This guideline aims to realize optimal and uniform management of addiction disorders in the Dutch prison system.

Details

International Journal of Prisoner Health, vol. 5 no. 4
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 6 July 2010

Joel French and Robert Weathersby

Only 55% of patients receive recommended care, with little difference found between care recommended for prevention, to address acute episodes, or to treat chronic…

Abstract

Only 55% of patients receive recommended care, with little difference found between care recommended for prevention, to address acute episodes, or to treat chronic conditions (McGlynn et al, 2003). The lag time between the discovery of more effective forms of medical treatment and their incorporation into routine patient care averages seventeen (17) years (IOM). Computerized provider order entry (CPOE) has been widely documented as a necessary tool to reduce preventable medication and other related errors but only 7.4% of acute care hospitals in the United States utilize CPOE with appropriate rules and evidence (HIMSS Analytics). The most fundamental building block for CPOE is the evidence based order set, but complexities associated with creating, managing and updating order sets have introduced major obstacles to CPOE implementation efforts. Chronic conditions such as heart disease, diabetes or arthritis affect more than 130 million Americans directly, and account for 7 in 10 deaths. Further, these chronic conditions consume 75% of all healthcare spending, and account for nearly two-thirds of the growth in health spending over the past 20 years -costing the U. S. economy $1 trillion annually (Almanac of Chronic Conditions, 2008 Edition). Estimates suggest the average patient upon hospitalization has 2.75 diagnoses - meaning "appropriate care" must span and synthesize multiple morbidity-specific best practices to effectively administer care to that "average" patient. The traditional approach to treating patients with evidence based protocols requires a physician to perform an ad hoc exercise of "mental merging" - reconciling duplicate candidate orders across multiple order sets to treat a patient with co-morbidities (today's norm). A more clinically effective, productive, and patient safety-centric alternative is to employ a proprietary software merging algorithm. These advanced algorithms remove duplicate orders, resolve conflicts, completes validation of the appropriate medical evidence and organizes the resulting merged order set so the physician can succinctly address the patients' often complicated treatment by focusing on the unique combination of labs, medications, etc. appropriate for the specific presenting conditions. This article describes a patent-pending propriety method of algorithmically merging multiple independent order sets for patients with co-morbid and chronic conditions into a single, maintenance free and evidence-based order set that can be immediately implemented into physician workflow to satisfy "Meaningful Use" guidelines for incremental provider reimbursement based on the American Recovery and Reinvestment Act (ARRA) legislation.

Details

International Journal of Innovation Science, vol. 2 no. 1
Type: Research Article
ISSN: 1757-2223

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Article
Publication date: 1 January 2013

Elizabeth Barkham, Santhana Gunasekaran and Caroline Lovelock

The purpose of this paper is to offer a general review of care for individuals on the autism spectrum, including Asperger's syndrome within a medium secure setting.

Abstract

Purpose

The purpose of this paper is to offer a general review of care for individuals on the autism spectrum, including Asperger's syndrome within a medium secure setting.

Design/methodology/approach

The authors undertook a review of the current literature relating to pathways to care, offending characteristics and treatment interventions. They examined the available evidence and current practice.

Findings

Available evidence suggests offending characteristics of individuals with autism are different to those of mental disorders such as schizophrenia. Limited evidence in treatment interventions and in risk management for those with autism presents a challenge to clinicians. The heterogeneity makes a strong case for an individualised case formulation approach to treatment and risk management.

Originality/value

This paper offers an overview of the current evidence base relating to the treatment of individuals with autism spectrum disorders within medium secure settings.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 4 no. 1/2
Type: Research Article
ISSN: 2050-8824

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Article
Publication date: 10 September 2018

Lisa Kawatsu, Kazuhiro Uchimura, Makoto Kobayashi and Nobukatsu Ishikawa

Although globally, prisoners are considered one of the vulnerable groups to tuberculosis (TB), little is known about the situation of TB in prison setting in Japan. The…

Abstract

Purpose

Although globally, prisoners are considered one of the vulnerable groups to tuberculosis (TB), little is known about the situation of TB in prison setting in Japan. The purpose of this paper is to examine the characteristics of TB among prisoners in Japan.

Design/methodology/approach

Records of TB patients from one medical prison were analyzed in terms of general demographic characteristics, clinical manifestations, risk factors and delay in diagnosis and in initiating treatment, and compared with data from the national TB surveillance and other published data on health of inmates, where appropriate. Continuous variables were compared using student independent samples t-test. Proportions were compared using χ2 or Fisher exact test as appropriate. Kaplan–Meier survival analysis was conducted to determine the time from entry to prison institution to diagnosis of TB.

Findings

A total of 49 patients were analyzed. The mean age was 49.5 (±14.3) and 69.4 percent were males. Being unemployed and homeless prior to incarceration, and several co-morbidities were potential risk factors for TB (p<0.01). Analysis of diagnosis and treatment delay showed that 16.1 percent of smear positive patients took more than a week to be placed on treatment after being diagnosed of TB. Approximately 50 percent of the patients were diagnosed within four months of entering the prison institution.

Practical implications

Several potential risk factors identified suggest the need to strengthen screening for specific sub-groups within the prison population, such as those with poor socio-economic status and co-morbidities, as well as to consider the possible role of systematic screening for latent TB infection.

Originality/value

This study presents some important data to help understand the profile of TB patients in prisons in Japan, as well as showing that a detailed epidemiological analysis of existing records can provide useful insight.

Details

International Journal of Prisoner Health, vol. 14 no. 3
Type: Research Article
ISSN: 1744-9200

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Book part
Publication date: 12 January 2012

Cynthia A. Plotts

Assessment and identification of children with emotional and behavioral disorders (EBD) is complex and involves multiple techniques, levels, and participants. While…

Abstract

Assessment and identification of children with emotional and behavioral disorders (EBD) is complex and involves multiple techniques, levels, and participants. While federal law sets the general parameters for identification in school settings, these criteria are vague and may lead to inconsistencies in selection and interpretation of assessment measures. Assessment practice across school settings is greatly influenced by clinical guidelines such as the DSM-IV, which more specifically defines emotional and behavioral disorders and highlights the issue of co-morbidity. Before a student is assessed for special education eligibility under the IDEIA category of emotional disturbance, screening techniques and pre-referral interventions are needed. Positive Behavioral Supports and Response to Intervention models provide empirically supported frameworks for establishing the need for formal psychological assessment. Collaboration among members of the multidisciplinary team, including parents, helps to ensure that identification and intervention efforts have ecological validity. Tests and techniques vary considerably, but developmental histories, interviews, observations across settings, and behavioral checklists and rating scales are recommended, along with cognitive and achievement testing. While problems exist in the reliability and validity of projective techniques, they continue to be used in school-based assessment for EBD. Multitrait, multisetting, and multimethod approaches are essential for culturally fair assessment and reduction of bias in identification and placement.

Details

Behavioral Disorders: Identification, Assessment, and Instruction of Students with EBD
Type: Book
ISBN: 978-1-78052-504-4

Keywords

Content available
Article
Publication date: 10 August 2012

Abstract

Details

Advances in Dual Diagnosis, vol. 5 no. 3
Type: Research Article
ISSN: 1757-0972

Abstract

Details

Advances in Dual Diagnosis, vol. 11 no. 1
Type: Research Article
ISSN: 1757-0972

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