Cortisol secretion and stress in maximum security hospital patients

Stress has been shown to elicit predictable stereotyped biochemical and physiological response in normal human subjects.We have recently described abnormal adrenomedullary and physiological responses to stress in approximately 25% of male admissions to a maximum security hospital, principally increased excretion of noradrenaline as opposed to the increased excretion of adrenaline seen in the remainder of the sample and control subjects faced with the same stress; together with reduced cardiovascular and electromyographic reactivity.Examination of cortisol secretion in these subjects has revealed further anomalies. While the ‘normoresponsive’ subgroup exhibit the expected rise in plasma cortisol in response to stress, no significant rise was observed in the subjects whose catecholamine responses were abnormal.     

Urinary catecholamines and test habituation in maximum security hospital patients

The effect of anticipation of a complex stress test on maximum security hospital detainees elicits atypical biochemical responses in approximately 25% of such subjects. This paper describes the effects of repeating the same test procedure on two consecutive days. Subjects whose initial reactions were normal showed a statistically significant habituation response relating to urinary adrenaline. Subjects whose initial reaction was atypical showed either an exaggerated habituation response or no habituation response relating to urinary adrenaline. The maintenance of an atypical catecholamine response on the second day of testing appeared highly correlated with violent personal crimes resulting in fatality.     

Reports of self-injury in a maximum security hospital

Previous studies have suggested that self-injury rates vary during the day. This study is an analysis of all self-injury incidents over an 18-month period on the women's wards in a maximum security hospital. Self-injury showed a marked peak late in the evening. Possible explanations are considered. Copyright © 1998 Whurr Publishers Ltd.     

Suicide in high security hospital patients

Purpose  

People with mental disorder and people who are violent are separately recognised as being at high risk of suicide. People detained in high security hospitals are recognised for their violence to others, but perhaps less so for their suicide potential. We aimed to investigate suicide rates among such patients during and after their high security hospital residency, and to establish risk factors for suicide.     

Epilepsy and violence in mentally abnormal offenders in a maximum security mental hospital

A retrospective study of the relationship between epilepsy and violence in mentally abnormal offenders is described. All patients were identified with a preadmission diagnosis of epilepsy who were in Broadmoor Hospital, a maximum security mental hospital for offenders in England, on November 17, 1992. The diagnosis of epilepsy in these patients, their violence ratings, and brain investigation findings were reviewed. Excluding those with neuroleptic-induced seizures, nonepileptic seizures, and equivocal episodic behaviours, the prevalence of epilepsy in Broadmoor Hospital was 2.7% (male) and 2% (female) in this study. This prevalence is lower than previous estimates. Patients with epilepsy were not different from patients without epilepsy in terms of their violence ratings. There was no obvious association between criminal behaviour and seizures in these patients with epilepsy, confirming previous findings. Careful assessment of offenders with a preadmission diagnosis of seizures in a maximum security hospital setting can help improve the diagnosis of epilepsy and avoid incorrect attribution of violence and offence to epilepsy.     

长期住院精神分裂症患者糖代谢异常分析

目的：调查住院慢性精神分裂症患者合并糖代谢异常情况。方法：自制一般情况调查表，回顾糖尿病病史，检测空腹血糖、餐后2h血糖、血脂，计算体重指数(BMI)。结果：305例住院男性慢性精神分裂症患者中，糖尿病25例(8．2％)，糖代谢异常者111例(36．4％)；高年龄、长病程、肥胖者，糖代谢异常发生率高；糖代谢异常组三酰甘油(TG)、BMI较高；病程、TG、肥胖是糖代谢异常发生的危险因素。结论：慢性精神分裂症患者糖代谢异常发生率高于普通人群，临床上应予以关注。     

Dissociation between amygdala and bed nucleus of the stria terminalis during threat anticipation in female post‐traumatic stress disorder patients

Feelings of uncontrollability and anxiety regarding possibly harmful events are key features of post‐traumatic stress disorder (PTSD) symptomatology. Due to a lack of studies, the neural correlates of anticipatory anxiety in PTSD are still poorly understood. During functional magnetic resonance imaging, female PTSD patients with interpersonal violence trauma and healthy controls (HC) anticipated the temporally unpredictable presentation of aversive (human scream) or neutral sounds. Based on separate analysis models, we investigated phasic and sustained brain activations. PTSD patients reported increased anxiety during anticipation of aversive versus neutral sounds. Furthermore, we found both increased initial, phasic amygdala activation and increased sustained activation of the bed nucleus of the stria terminalis (BNST) during anticipation of aversive versus neutral sounds in PTSD patients in comparison to HC. PTSD patients as compared with HC also showed increased phasic responses in mid‐cingulate cortex (MCC), posterior cingulate cortex (PCC), mid‐insula and lateral prefrontal cortex (PFC) as well as increased sustained responses in MCC, PCC, anterior insula and lateral and medial PFC. Our results demonstrate a relationship between anticipatory anxiety in PTSD patients and hyperresponsiveness of brain regions that have previously been associated with PTSD symptomatology. Additionally, the dissociation between amygdala and BNST indicates distinct temporal and functional characteristics and suggests that phasic fear and sustained anxiety responses are enhanced during unpredictable anticipation of aversive stimuli in PTSD. Hum Brain Mapp 38:2190–2205, 2017. © 2017 Wiley Periodicals, Inc.     

Sexual attitudes, experience and relationships amongst patients in a high security hospital

Background Detention in high security hospitals tends to last several years during patients' early adulthood, yet romantic partnerships and sexuality have been little studied. Aims To study such relationships among these inpatients. Method Patients were engaged in a confidential, purpose‐designed semi‐structured interview concerning their relationships and their views on those of others. Results Seven (of 10) women and 18 (of 24) men gave interviews. All but one had previously been sexually active. No previous relationship lasted into high security but half (15) reported a new relationship. Most emphasized the importance of caring in respect of sexual activity but sexual intimacy short of intercourse was reported. Most (17) could describe ‘safe sex’ practices, but few (5) had ever followed them. At least half had experienced seriously abusive sexual relationships in childhood. Conclusions Patients appeared able to talk reliably about their romantic and sexual relationships, their interest in which did not cease on incarceration. Findings suggest that it is important for staff to have accurate information on these to ensure safety and adequate support. Copyright © 2006 John Wiley & Sons, Ltd.     

Uncertainty during pain anticipation: The adaptive value of preparatory processes

Objectives: Anticipatory processes prepare the organism for upcoming experiences. The aim of this study was to investigate neural responses related to anticipation and processing of painful stimuli occurring with different levels of uncertainty. Experimental design: Twenty‐five participants (13 females) took part in an electroencephalography and functional magnetic resonance imaging (fMRI) experiment at separate times. A visual cue announced the occurrence of an electrical painful or nonpainful stimulus, delivered with certainty or uncertainty (50% chance), at some point during the following 15 s. Principal observations: During the first 2 s of the anticipation phase, a strong effect of uncertainty was reflected in a pronounced frontal stimulus‐preceding negativity (SPN) and increased fMRI activation in higher visual processing areas. In the last 2 s before stimulus delivery, we observed stimulus‐specific preparatory processes indicated by a centroparietal SPN and posterior insula activation that was most pronounced for the certain pain condition. Uncertain anticipation was associated with attentional control processes. During stimulation, the results revealed that unexpected painful stimuli produced the strongest activation in the affective pain processing network and a more pronounced offset‐P2. Conclusions: Our results reflect that during early anticipation uncertainty is strongly associated with affective mechanisms and seems to be a more salient event compared to certain anticipation. During the last 2 s before stimulation, attentional control mechanisms are initiated related to the increased salience of uncertainty. Furthermore, stimulus‐specific preparatory mechanisms during certain anticipation also shaped the response to stimulation, underlining the adaptive value of stimulus‐targeted preparatory activity which is less likely when facing an uncertain event. Hum Brain Mapp 36:744–755, 2015. © 2014 Wiley Periodicals, Inc .     

Length of stay, leave and re-offending by patients from a Queensland security patients hospital

OBJECTIVE: The release of patients from a security patients hospital has been the subject of public controversy. The present study uses empirical data to examine the length of stay, leave, and re-offending of patients from a security hospital. METHODS: Survival analysis was used to examine factors that may be predictive of length of stay and time under restriction, as well as time to first overnight leave. Data on re-offending were obtained from a variety of sources and were compared with seriousness of index offences. RESULTS: Consistent with international research, patients with more serious offences had longer hospitalisations. Patients with more serious offences were also hospitalised for longer periods before leave was granted. Compared with international studies, re-offending was in the lower range. CONCLUSIONS: Despite concerns raised in the media regarding patient 'dangerousness', time spent in hospital and the granting of leave, patients with serious offences were more likely to be hospitalised longer, which suggests decision makers do take into account public safety.