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About 4% of all prisoners can be diagnosed with a psychotic disorder, but it is largely unknown how these prisoners function during imprisonment. The present study aimed to describe symptoms of psychotic prisoners during imprisonment and incidents caused by them as well as care provided to these prisoners. A total of 61 prisoners were observed for a maximum of 12 weeks. Results show that poverty of speech and blunted affect significantly decreased over time. The largest group of psychotic prisoners either did not suffer from positive psychotic symptoms or the encountered positive psychotic symptoms exhibited a steady or decreasing pattern during their imprisonment. Reasons for these findings still remain unclear.

The purpose of this paper is to describe experiences of caregivers in managing psychotic symptoms of persons with schizophrenia in various circumstances.

The data were obtained via a focus group and in-depth interviews among caregivers who cared for relatives with schizophrenia for more than five years. Thematic analysis was used for data analysis.

“Making it better” emerged as the main theme describing caregivers’ experiences in trying to manage psychotic symptoms. It comprises four sub-themes including cutting off the wind, protecting from harm, preventing relapses and pulling back to normality. The caregivers gradually learned and adjusted their strategies through trial and error. They tried to stop aggressive and violent behaviors soon after they had begun by giving cool water to their relatives to drink or shower, while expressing their own affect with gently talking. They also dealt with a hardship in protecting the patients, other people, their properties and their own selves from harm resulting from violent behavior. When the psychotic symptoms improved, the caregivers tried to prevent relapses by using various strategies to maintain medication adherence and by soothing their relatives’ mental state. They also tried to pull their relatives back to normal as much as they could by promoting their relatives’ memories and abilities to perform daily functions.

The findings increase knowledge in nursing regarding psychotic symptoms management. The findings can be applied to the development of a program to help caregivers to manage psychotic symptoms effectively in order to promote good clinical outcomes of patients and alleviate the caregivers’ burden.

The aim of this article is an analysis of the links between race and psychotic illness, psychiatric diagnosis and treatment, as well as psychiatric, police and prison violence against people with mental health problems. The analysis focuses on Black men who are more frequently diagnosed with schizophrenia and other psychotic disorders and who face more brutal treatment than other people with such diagnoses. We have adopted a multidisciplinary approach which draws insights from psychiatry, psychology, and sociology and challenges the biologistic interpretation of “mental illness.” We take into account the United States and Britain – two countries with large Black minorities and an established tradition of research on these groups. Among the crucial findings of this study are the facts that racial bias and stereotypes heavily influence the way Black men with a diagnosis of psychotic illness are treated by the psychiatric system, police and prison staff, and that the dominant approach to psychosis masks the connections between racism and mental health.

Historically, children with autism spectrum disorder (ASD) were sometimes diagnosed with schizophrenia or major psychosis. Although significant advancements in the process of differential diagnosis have been made since 1950s, there still exists a problematic delay in diagnosis due to overlap of symptoms. Negative symptoms of schizophrenia can mimic the social difficulties and stereotyped behaviors characteristic of ASD, whereas positive symptoms of schizophrenia can be perceived as restricted and repetitive behaviors, complicating the diagnostic process. The purpose of this paper is to present two clinical cases that highlight the complexities in differential diagnosis of early psychosis, schizophrenia and ASD.

Two females, 14 and 16 years of age, were referred to a free screening clinic in Southern California to be assessed for possible ASD. Both females were referred because of the presentation of restricted and repetitive behaviors and social communication difficulties. Both females and their families were administered a battery of measures to ascertain the youths’ cognitive functioning, adaptive living skills and severity of autism-related behaviors.

The 14-year-old presented with early-stage (prodromal or at-risk mental state) psychosis; 16-year-old met criteria for schizophrenia. Both were referred to clinics specializing in treatment for psychosis and/or schizophrenia. Neither met criteria for ASD.

More published studies are needed on the overlap of symptoms between ASD and schizophrenia to help prevent diagnostic overshadowing of autistic symptoms and promote treatment during the early stages of psychosis. This is particularly important given the strong evidence that early treatment for psychosis improves social, cognitive and functional outcomes.

Despite the prevalence of co-occurring mental health and substance use disorders, the assessment and placement processes for each often remain separate. The purpose of this paper is to describe an expanded use of the American Society of Addiction Medicine (ASAM) Criteria^TM to make placements into substance use, co-occurring, and mental health treatment.

A rationale for the development of two new domains (Domain 7, substance use and Domain 8, independent living skills) and preliminary data supporting the use of the ASAM Criteria^TM as a placement process for all types of behavioral health issues will be provided.

Dimension 3 and Domains 7 and 8 were correlated with selected clinical indices in the expected direction (Dimension 3: depression (F (4, 4650)=202.092, p<0.001), medication usage (F (4, 4,637)=174.254, p<0.001), and psychotic symptoms (F (4, 4,561)=62.954, p<0.001); Domain 7: alcohol use (F (4, 4,458)=213.786, p<0.001) and drug use (F (4, 4,471)=611.491, p<0.001); and Domain 8: functional impairment (F (4, 3,927)=815.646, p<0.001) and number of “high needs” (F (4, 3,927)=737.568, p<0.001).

The limitations of this research included a lack of inter-rater reliability data and less established intake assessments.

This single placement approach for clients seeking behavioral health services can create a more efficient, person-centered intake experience.

This paper suggests that it is possible to deploy a single assessment and placement approach for all types of behavioral health issues.

Risk assessment is a fundamental aspect of forensic practice. This paper reviews some of the logical issues inherent in the process of assessing risk. A structured generic model for conducting such assessments is outlined and explicated. This is followed by coverage of some of the major recent research findings, with a particular focus on the assessment of risk of violence towards others in forensic mental health contexts. In conclusion some of the major points for practice and future research are discussed.

Sex Offenders with a Major Mental Illness (SOMMI) are doubly stigmatized, as these individuals are members of two highly marginalized social groups (Guidry and Saleh, 2004). Within each of these groups SOMMI only represent a small minority. For professionals seeking to base their practice in empirical research this has led to a significant problem since the literature related specifically to this group is both limited and hard to locate. Additionally, intensity of psychological risk factors varies as a function of psychiatric decompensation for some SOMMI making it hard to apply certain procedures that work with ordinary sexual offenders. The purpose of this paper is to provide a review of the relevant literature and recommendations for clinical practice that are responsive to the particular challenges posed by this unusual group of sexual offenders.

The current paper provides a review of literature on risk factors for sexual recidivism and validity of current risk tools as it pertains to SOMMI. Recommendations for risk assessment with SOMMI are provided.

The static actuarial tools appear to be useful with SOMMI. However, risk assessments measuring dynamic risk factors have poorer predictive validity. Additional factors that will need to be considered involve a possible higher recidivism rate for SOMMI and a variable relationship between major mental illness and sex offending with it sometimes predisposing, sometimes exacerbating existing risk factors, and sometimes mitigating risk.

There is a paucity of research and guidance in assessment and risk management of SOMMI. The current paper is the first to thoroughly explore the efficacy of current sex offender risk assessment tools with SOMMI and provide structured guidance for making decisions about risk and risk management needs for this challenging population.

People with autism spectrum disorders (ASD) have been associated with criminal acts and affiliation with groups and organisations with violent ideology and practice. The purpose of this paper is to present patients in mental health services with both ASD and psychosis, who are affiliated with such groups.

Three vignettes are used as examples. Some of the information is combined for the three participants for presentation. They were scored for mental health symptoms and behaviour problems on admission and discharge from inpatient care.

The combination of ASD and psychosis aggravates the problems of both conditions, which may elicit a collapse of both cognitive functioning and especially impulse control, and of the ability to judge whether situations are dangerous or offensive or not.

The present paper may contribute to a better understanding of the combination of ASD, psychosis and affiliation with groups and organisations as described, especially regarding the importance of identifying psychosis.

The purpose of this paper is to increase our understanding of the role of mental disorder in sexual offending as well as identifying innovations in assessment and treatment with offenders who present with these typically complex risks and needs.

The converging literatures on “good lives” and other developments in sexual offender treatment are compared with recovery from mental disorder and what is known about the particular needs and characteristics of sexual offenders with mental illness and severe personality disorder (PD).

A key outcome of this review is that many mentally disordered sexual offenders have similar needs to those in prison and the community but there are particular challenges posed by severe PD, paraphilias and the relatively rare individuals whose offending is functionally linked to psychotic symptoms.

Practical implications include the need for case formulation of complex needs related to mental disorder using direct and indirect measures of attitudes and interests. Treatment needs to be responsive to very different personality and mental health presentations as well as problems with offending and cognitive schemas. Direct functional links between mental health symptoms such as delusions and hallucinations are very rare in practice and are usually secondary to PD and sexual offending issues. In practice, treatment promoting recovery from mental disorder is highly compatible with the “good lives” approach to sexual offender treatment. Staff development, supervision and support are particularly important for staff treating mentally disordered sexual offenders.

It is argued that mentally disordered sexual offenders are an under-researched sub-group within the wider sexual offender population. This paper brings together the relatively limited literature on treatment with examples of recent treatment innovations, multi-modal assessment approaches and reviews of research on the needs of this relatively uncommon but highly risky group.