Clozapine use in a forensic population in a New South Wales prison hospital

OBJECTIVE: To document and measure various parameters and outcomes in patients prescribed clozapine in a forensic psychiatric setting. METHOD: A retrospective file review was conducted on patients prescribed clozapine. Parameters and outcomes were recorded and compared against a group prescribed other antipsychotics, matched for sex and diagnosis. RESULTS: Patients prescribed clozapine had higher rates of substance misuse syndromes and comorbidity when compared to patients prescribed other antipsychotics. Clozapine was found to be effective in treatment of psychosis. High rates of adverse effects were noted. Discontinuation of clozapine for a variety of reasons was common. CONCLUSION: Patients identified as treatment resistant who are prescribed clozapine are often more complex in the pattern of illness and subsequent needs. Clozapine is effective in the treatment of psychosis in this forensic service. Its benefits need to be balanced against the potential for adverse effects and problems ensuring adherence. Regular, objective monitoring of clinical and adverse effects would aid patient safety, clinical decision-making and future research.     

Hepatitis B in a hospital for the mentally subnormal in South Wales

ABSTRACT. The resident population in a long-stay hospital for the mentally handicapped was surveyed in order to assess evidence for past and present infection with the Hepatitis B virus. The authors found a 0.5% prevalence of carriage of Hepatitis B^c Antigen and do not recommend mass vaccination of staff and residents in this hospital.     

Appealing a Mental Illness Verdict in New South Wales

Under current regimes in place in Australia, a mental illness verdict has significant repercussions. What may once have been considered an exemption from criminal punishment, the verdict results in a mandated mental health pathway that may involve coercive treatment, potentially onerous restrictions and monitoring requirements. In New South Wales (NSW), a mental illness verdict may be made in relation to a person who is not fit for trial. This raises the further issue of the person's ability to understand properly the implications of relying on a mental illness defence. In several instances in NSW, offenders found to be mentally ill at the time of the offence and made subject to a detention order have raised objection to the original verdict and attempted to appeal. We consider these cases and the avenues for appeal from a mental illness verdict in NSW.     

Mental disorder in the New South Wales prisoner population

OBJECTIVES: To determine the prevalence of mental illness among prisoners in New South Wales (NSW), Australia. METHOD: Mental illness was examined in two NSW prisoner populations: (i) new receptions to the correctional system; and (ii) sentenced prisoners. Reception prisoners were screened at four male centres and one female centre in NSW. The sentenced population was randomly selected from 28 correctional centres across the state. Reception prisoners were screened consecutively whenever possible while the sentenced group was randomly selected as part of the 2001 Inmate Health Survey. We adopted the same instrument, Composite International Diagnostic Interview - Auto (CIDI-A), for diagnosing mental illness as used in the Australian National Survey of Mental Health and Wellbeing. RESULTS: Overall, 43% of those screened had at least one of the following diagnoses: psychosis, anxiety disorder, or affective disorder. Reception prisoners suffered from mental illness to a greater extent than sentenced prisoners (46%vs. 38%). Women had higher levels of psychiatric morbidity than men (61%vs. 39%). Nine percent (9%) of all prisoners had experienced psychotic symptoms (due to any cause) in the prior 12 months. Twenty percent (20%) of all prisoners had suffered from at least one type of mood disorder and 36% had experienced an anxiety disorder. Posttraumatic stress disorder was the most common disorder, diagnosed in 26% of receptions and 21% of sentenced prisoners. CONCLUSIONS: These findings confirm that prisoners are a highly mentally disordered group compared with the general community. Given the high prevalence of mental illness identified by this study, it is essential that prison mental health services be adequately resourced to address the demand and, at minimum, ensure that mental health does not deteriorate during incarceration.     

Manic-depressive psychosis and season of birth.

National series of psychiatric inpatients studied in Scandinavian countries and in England and Wales have all shown that compared with live births in the general population, schizophrenic patients have a significant excess of births in the early months of the year. But there has been disagreement on whether a similar birth distribution holds for manic-depression. The present paper presents new data on the seasonal distribution of births of patients born in England and Wales between 1921 and 1955. Compared with all live births, manic-depression was associated with a significant excess of births in the first quarter, and a corresponding deficiency in the third quarter of the year. Neurotic depression showed no such association. Possible reasons for the disagreement among national findings for manic-depression include difference in the proportion of first ever admissions in the series, differences in age structure, and differences in diagnostic practice and classification. The importance of the age structure of a series is considered in relation to: a) the possible effect of age on the manifestation of a disorder associated with some seasonally related constitutional damage; b) the possibility of secular variation in the severity of a seasonally related noxious factor; and c) the effect of age incidence on distorting the expected seasonal distribution of births in any series of cases.     

Delay in treatment for psychosis

BACKGROUND: Recent evidence that treatment delay may compromise the potential for recovery from psychotic disorders has resulted in increased interest in factors that influence help seeking. In this paper, we test the hypotheses, derived from past research, that having a positive family history of a psychotic disorder in first or second degree relatives will be associated with a shorter duration of untreated psychosis (DUP), but a longer duration of untreated illness (DUI). Data were derived from 169 patients who presented for treatment to a first episode psychotic disorders program. Information was collected concerning family history, DUP, DUI and the timing of family recognition of the need for help. RESULTS: The findings failed to confirm a positive family history being associated with shorter DUP, but did support the prediction of such a history being related to longer DUI. Paradoxically, given the latter findings, families with a history of psychotic illness were more likely to recognize the need for help for the ill person prior to the onset of psychotic symptoms. The difference in DUI appears to reflect the presence of a longer period of early signs prior to the emergence of psychosis in those cases with a positive family history. CONCLUSIONS: These findings suggest the importance of examining family history as a possible confound of any relationship between DUI and long-term course of illness.     

Inadequate provision for electroconvulsive therapy in the New South Wales Mental Health Act 1983

Division 2 of Part X of the NSW Mental Health Act 1983 lays down a set of conditions which must be satisfied before electroconvulsive therapy (ECT) can be given. These provisions are too restrictive and would deny ECT to a considerable proportion of the patients who are most likely to benefit from it. For many of them it would be the only effective treatment. Principles which should govern the authorisation of ECT are proposed.     

Prevalence of chronic inflammatory demyelinating polyneuropathy in New South Wales, Australia

A prevalence study of chronic inflammatory demyelinating polyneuropathy (CIDP) was performed in New South Wales (NSW), Australia, with a prevalence day of August 6, 1996, which coincided with a national census. The population of NSW was 5,995,544, and the crude prevalence of CIDP was 1.9 per 100,000 population. It was higher in male patients than in female patients, and the age-specific prevalence reached a maximum of 6.7 per 100,000 population in the 70- to 79-year-old age group. The prevalence in the city of Newcastle, with a population of 448,663, was 2.0 per 100,000 population and is representative of the whole of NSW. The estimated crude annual incidence was 0.15 per 100,000 population. The mean age of onset was 47.6 years (median, 53.5 years), 51% of patients had a relapsing-remitting course, the mean duration on prevalence day was 7.1 years (median, 5 years), and 87% of patients were able to walk without walking aids or other assistance.     

Prevalence of psychoses on reception to male prisons in New South Wales

OBJECTIVE: To estimate the prevalence of psychotic illnesses among men received to prisons in New South Wales. The study also sought to estimate the sensitivity and specificity of the psychosis screener in the Composite International Diagnostic Interview (CIDI-Auto). METHOD: The study was part of a larger study on psychiatric disorder in men received to New South Wales prisons. Using a structured questionnaire, the CIDI-Auto (modified), which included screening questions for psychotic illness, the prisoners who gave positive responses to the screening questions for psychosis as well as any subjects considered by the experienced clinicians performing the CIDI-Auto interviews to show features of a psychotic illness, were referred to the researchers for a clinical assessment. The clinical assessment included a review of all available information. RESULTS: Of the prisoners, 5.1% were thought to have definite psychotic illness and 1.9% to have possible psychotic illness. The psychosis screener was found to be neither sensitive nor specific. CONCLUSIONS: The rate of psychotic illness among people remanded to New South Wales prisons is between 10 and 14 times the rate found in a similar study in the wider community. The poor performance of the psychosis screener suggests that screening for psychotic illness on reception to prisons should be performed by clinically trained staff.     

Health and Education Working Together: The New South Wales School-Link Initiative

New South Wales (NSW) School-Link is a landmark initiative aimed at enhancing the identification, treatment and prevention of depression and related disorders in adolescents in NSW, Australia. The initiative has been outstanding in forging collaboration between two systems, health and education. The School-Link Training Program has been an important focus, assisting in consolidating the initiative at state and local levels.     

Follow-up of community placement of the chronic mentally ill in New South Wales

A total of 208 long-stay hospital patients in New South Wales, Australia, who were discharged to supported community accommodations were studied to determine their adjustment in the community. For 172 patients, measurements were obtained of the patients' satisfaction with their accommodations, the caretakers' perceptions of the patients' impairment and management difficulty, and the restrictiveness of practices in the various accommodations. Most patients were considered to be functioning well, although 22 of the more impaired and difficult patients were rehospitalized at the time of the study. Seventy-eight percent of the patients preferred living in the community, and only 7 percent preferred a hospital. The patients benefited from the supported, subsidized, permanent housing available in the community and required low levels of mental health care.     

Indigenous Gambling Motivations, Behaviour and Consequences in Northern New South Wales, Australia

Against a background of public health, we sought to examine and explain gambling behaviours, motivations and consequences of Indigenous Australians in northern New South Wales. Adhering to national Aboriginal and ethical guidelines and using qualitative methods, 169 Indigenous Australians were interviewed individually and in small groups using semi-structured interviews. Over 100 in-depth interviews were conducted. Using thematic analysis, the results indicate a range of contrasting social and more problematic gambling behaviours, motivations and consequences. Acknowledging the cultural distinctiveness of Indigenous gambling and distinguishing between their social and more problematic gambling behaviours, motivations and consequences can assist with public health prevention, harm reduction and treatment programs for Indigenous gamblers in all parts of Australia.