Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-31T15:13:55.126Z Has data issue: false hasContentIssue false
  • English
  • Français

Patients with personality disorder admitted to secure forensic psychiatry services

Published online by Cambridge University Press:  03 January 2018

Jeremy Coid ,
Nadji Kahtan ,
Simon Gault  and
Brian Jarman
Jeremy Coid*
Affiliation:
Academic Section of Forensic Psychiatry, St Bartholomew's and the Royal London School of Medicine and Dentistry, London
Nadji Kahtan
Affiliation:
Academic Section of Forensic Psychiatry, St Bartholomew's and the Royal London School of Medicine and Dentistry, London
Simon Gault
Affiliation:
Department of Primary Health Care and General Practice, Imperial College School of Medicine, London
Brian Jarman
Affiliation:
Department of Primary Health Care and General Practice, Imperial College School of Medicine, London
*
Professor Jeremy Coid, Forensic Psychiatry Research Unit, John Howard Centre, 2 Crozier Terrace, London E9 6AT
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Treatment of patients with personality disorder remains controversial and severe mental illness is prioritised in secure forensic psychiatry services.

Aims

To compare patients with personality disorder and mental illness according to demography, referral, criminality, previous institutionalisation and diagnostic comorbidity.

Method

A record survey of 511 patients with personality disorder and 2575 with mental illness admitted to secure forensic psychiatry services between 1 January 1988 and 31 December 1994 from half of England and Wales.

Results

Personality disorder admissions declined over time; more were female, White, younger and extensively criminal (specifically, sexual and arson offences). Personality disorder was highly comorbid; antisocial, borderline, paranoid and dependent personality disorder were most prevalent.

Conclusions

Patients with personality disorder were highly selected and previously known to psychiatric services. Referrer, diagnostic comorbidity and behavioural presentation determined their pathways into care. Future research must determine whether their continuing admission represents effective use of scarce resources and whether new services are required.

Type
Papers
Information
The British Journal of Psychiatry , Volume 175 , Issue 6 , December 1999 , pp. 528 - 536
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Declaration of interest

Funding was provided by the Department of Health.

References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Bailey, J. & MacCulloch, M. (1992) Patterns of reconviction in patients discharged directly to the community from a special hospital: implications for aftercare. Journal of Forensic Psychiatry 3, 445–461.CrossRefGoogle Scholar
Beyaert, F. (1990) Dutch forensic psychiatry and the Pieter Baan Centre, Utrecht. In Principles and Practice of Forensic Psychiatry (eds Bluglass, R. & Bowden, P.). pp. 1339–1342. Edinburgh: Churchill Livingstone.Google Scholar
Coid, J. W. (1991) Psychiatric profiles of difficult disruptive prisoners. In Special Units for Difficult Prisoners (eds Bottomley, A. K. & Hay, W.), pp. 44–71. Hull: Centre for Criminology and Criminal justice, University of Hull.Google Scholar
Coid, J. W. (1992) DSM–III diagnosis in criminal psychopaths: a way forward. Criminal Behaviour and Mental Health, 2, 78–79.CrossRefGoogle Scholar
Coid, J. W. (1993) An affective syndrome in psychopaths with borderline personality disorder? British Journal of Psychiatry, 162, 641–650.CrossRefGoogle ScholarPubMed
Coid, J. W. (1996) Psychopathology in Psychopaths: A Study of Diagnostic Comorbidity and Aetiology. MD thesis. University of London: Department of Psychiatry.Google Scholar
Coid, J. W. (1998a) Axis II disorders and motivation for serious criminal behaviour. In Psychopathology and Violent Crime, (ed. Skodol, A. E.), pp. 53–98. Washington, DC: American Psychiatric Press.Google Scholar
Coid, J. W. (1998b) The management of dangerous psychopaths in prison. In Psychopathy, Antisocial, Criminal and Violent Behavior (eds Millon, T., Simonsen, E., Birkett-Smith, M., et al), pp. 431–457. New York: Guilford Press.Google Scholar
Coid, J. W. & Cordess, C. (1992) Compulsory admission of dangerous psychopaths. British Medical Journal, 304, 1581–1582.Google Scholar
Cope, R. (1993) A survey of forensic psychiatrists' views on psychopathic disorder. Journal of forensic Psychiatry, 4, 215–235.CrossRefGoogle Scholar
Department of Health (1994a) Guidance on the Discharge of Mentally Disordered People and Their Continuing Care in the Community. HSG (94) 27/LASSL (94)5. London: Department of Health.Google Scholar
Department of Health (1994b) Introduction of Supervision Registers for Mentally III People from 1 April 1994. HSG (94)5. London: Department of Health.Google Scholar
Doian, B. & Coid, J. (1993) Psychopathic and Antisocial Personality Disorders. Treatment and Research Issues. London: Gaskell.Google Scholar
Fallon, P., Bluglass, R. & Edwards, B. (1999) Report of the Committee of Inquiry into the Personality Disorder Unit, Ashworth Special Hospital, Volume 1. CM4194–11. London: The Stationery Office.Google Scholar
Government Statistical Service (1991) Inpatients Formally Detained in Hospitals under the Mental Health Act, 1983. and Other Legislations, England 1984–1988/89. Statistical Bulletin 2(1) 91. London: Department of Health.Google Scholar
Home Office (1998) Criminal Statistics England and Wales. London: HMSO.Google Scholar
Home Office & Department of Health and Social Security (1975) Report of the Committeee on Mentally Abnormal Offenders (The Butler Report). Cmnd 6244. London: HMSO.Google Scholar
Kohut, H. (1973) Thoughts on narcissism and narcissistic rage. Psychoanlaytic Study of the Child, 27, 360–400.Google Scholar
Lyons, M. J., Tyrer, P., Gunderson, J., et al (1997) Heuristic models of comorbidity of Axis I and Axis II disorders. Journal of Personality Disorders, 11, 260–269.CrossRefGoogle ScholarPubMed
Oldham, J. M. & Skodol, A. E. (1991) Personality disorders in the public sector. Hospital and Community Psychiatry, 42, 481–487.Google ScholarPubMed
Reich, J. K. & de Giroiamo, G. (1996) Epidemiology of DSM–III personality disorders in the community and in clinical populations. In Assessment and Diagnosis of Personality Disorders. The ICD–10 International Personality Disorder Emmination (IPDE) (eds Loranger, A. W., A-Janca, & Sartorius, N.), pp. 18–42. Cambridge: Cambridge University Press.Google Scholar
Singleton, N., Meitzer, H., Gatward, R., et al (1998) Psychiatric Morbidity among Prisoners in England and Wales. London: The Stationery Office.Google Scholar
Special Hospital Services Authority (1995) Understanding the Enigma. Summary of the Anglo-Dutch Conference on Personality Disorder and Offending. London: Special Hospital Services Authority.Google Scholar
Tyrer, P., Gunderson, J., Lyons, M., et al (1997) Extents of comorbidity between mental state and personality disorders. Journal of Personality Disorders, 11, 242–259.Google Scholar
World Health Organization (1992) The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD–10). Geneva: WHO.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.