Ultra high risk of psychosis on committal to a young offender prison: an unrecognised opportunity for early intervention

BMC Psychiatry

Harry G Kennedy²  Stephen Monks¹  Luke Quirke¹  Damian Smith¹  Darran Flynn¹ 

[1] National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland;Department of Psychiatry, Trinity College, Dublin, Ireland

关键词: Substance misuse;    Psychosis;    Ultra high risk;    Young offenders;   

Others  :  1124331
DOI  :  10.1186/1471-244X-12-100

 received in 2012-01-09, accepted in 2012-07-30,  发布年份 2012

【 摘 要 】

Background

The ultra high risk state for psychosis has not been studied in young offender populations. Prison populations have higher rates of psychiatric morbidity and substance use disorders. Due to the age profile of young offenders one would expect to find a high prevalence of individuals with pre-psychotic or ultra-high risk mental states for psychosis (UHR). Accordingly young offender institutions offer an opportunity for early interventions which could result in improved long term mental health, social and legal outcomes. In the course of establishing a mental health in-reach service into Ireland’s only young offender prison, we sought to estimate unmet mental health needs.

Methods

Every third new committal to a young offenders prison was interviewed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to identify the Ultra High Risk (UHR) state and a structured interview for assessing drug and alcohol misuse according to DSM-IV-TR criteria, the Developmental Understanding of Drug Misuse and Dependence - Short Form (DUNDRUM-S).

Results

Over a twelve month period 171 young male offenders aged 16 to 20 were assessed. Of these 39 (23%, 95% confidence interval 18% to 30%) met UHR criteria. UHR states peaked at 18 years, were associated with lower SOFAS scores for social and occupational function and were also associated with multiple substance misuse. The relationship with lower SOFAS scores persisted even when co-varying for multiple substance misuse.

Conclusions

Although psychotic symptoms are common in community samples of children and adolescents, the prevalence of the UHR state in young offenders was higher than reported for community samples. The association with impaired function also suggests that this may be part of a developing disorder. Much more attention should be paid to the relationship of UHR states to substance misuse and to the health needs of young offenders.

【 授权许可】

   
2012 Flynn et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

【 参考文献 】

• [1]Teplin LA, Abram KM, McClelland GM, Dulcan MK, Mericle AA: Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry 2002, 59:1133-1143.
• [2]Fazel S, Doll H, Langstrom N: Mental disorders among adolescents in juvenile detention and correctional facilities: a systematic review and metaregression analysis of 25 surveys. J Am Acad Child Adolesc Psychiatry 2008, 47:1010-1019.
• [3]Colins O, Vermeiren R, Vreugdenhil C, van den Brink W, Doreleijers T, Broekaert E: Psychiatric disorders in detained male adolescents: a systematic literature review. Can J Psychiatry 2010, 55:255-263.
• [4]Lader D, Singleton N, Meltzer H: Psychiatric morbidity among young offenders in England and Wales. Int Rev Psychiatry 2003, 15:144-147.
• [5]The National Crime Council: Tackling The Underlying Causes of Crime: A Partnership Approach. The Stationary Office, Dublin; 2002.
• [6]Kutcher S, McDougall A: Problems with access to adolescent mental health care can lead to dealings with the criminal justice system. Paediatr Child Health 2009, 14:15-18.
• [7]Fazel S, Seewald K: Severe mental illness in 33,588 prisoners worldwide: systematic review and meta-regression analysis. Br J Psychiatry 2012, 200:364-373.
• [8]Linehan SA, Duffy DM, Wright B, Curtin K, Monks S, Kennedy HG: Psychiatric Morbidity in a Cross-Sectional Sample of Male Remanded Prisoners. Ir J Psych Med 2005, 22:128-132.
• [9]Duffy DM, Linehan SA, Kennedy HG: Psychiatric Morbidity in the Male Sentenced Irish Prisons Population. Ir J Psych Med 2006, 23:54-62.
• [10]Ginsberg Y, Lindefors N: Methylphenidate treatment of adult male prison inmates with attention-deficit hyperactivity disorder: randomised double-blind placebo-controlled trial with open-label extension. Br J Psychiatry 2012, 200:68-73.
• [11]Harris MG, Henry LP, Harrigan SM, Purcell R, Schwartz OS, Farrelly SE, et al.: The relationship between duration of untreated psychosis and outcome: an eight-year prospective study. Schizophr Res 2005, 79:85-93.
• [12]Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T: Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005, 62:975-983.
• [13]Yung AR, Phillips LJ, McGorry PD, McFarlane CA, Francey S, Harrigan S, et al.: Prediction of psychosis. A step towards indicated prevention of schizophrenia. Br J Psychiatry Suppl 1998, 172:14-20.
• [14]Yung AR, Nelson B, Stanford C, Simmons MB, Cosgrave EM, Killackey E, et al.: Validation of "prodromal" criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up. Schizophr Res 2008, 105:10-17.
• [15]Woods SW, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA, Heinssen R, et al.: Validity of the prodromal risk syndrome for first psychosis: findings from the North American Prodrome Longitudinal Study. Schizophr Bull 2009, 35:894-908.
• [16]Phillips LJ, Nelson B, Yuen HP, Francey SM, Simmons M, Stanford C, et al.: Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: study design and baseline characteristics. Aust N Z J Psychiatry 2009, 43:818-829.
• [17]Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J, et al.: Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. Br J Psychiatry 2004, 185:291-297.
• [18]Amminger GP, Schafer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, et al.: Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry 2010, 67:146-154.
• [19]Yung AR, Nelson B: Young people at ultra high risk for psychosis: a research update. Early Interv Psychiatry 2011, 5(Suppl 1):52-57.
• [20]Preti A, Cella M: Randomized-controlled trials in people at ultra high risk of psychosis: a review of treatment effectiveness. Schizophr Res 2010, 123:30-36.
• [21]Yung AR, Yuen HP, McGorry PD, Phillips LJ, Kelly D, Dell'Olio M, et al.: Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Aust N Z J Psychiatry 2005, 39:964-971.
• [22]McGorry PD, Yung AR, Phillips LJ: The "close-in" or ultra-high risk model: a safe and effective strategy for research and clinical intervention in prepsychotic mental disorder. Schizophr Bull 2003, 29(4):771-790.
• [23]Yung AR, Phillips LJ, Yuen HP, Francey SM, McFarlane CA, Hallgren M, et al.: Psychosis prediction: 12-month follow up of a high-risk ("prodromal") group. Schizophr Res 2003, 60:21-32.
• [24]Hafner H, Riecher-Rossler A, Der An HW, Maurer K, Fatkenheuer B, Loffler W: Generating and testing a causal explanation of the gender difference in age at first onset of schizophrenia. Psychol Med 1993, 23:925-940.
• [25]Jarrett M, Craig T, Parrott J, Forrester A, Winton-Brown T, Maguire H, et al.: Identifying men at ultra high risk of psychosis in a prison population. Schizophr Res 2012, 136:1-6.
• [26]Smith D, Duffy R, Flynn D, Monks S, Kennedy HG: The Dundrum-DS. Developmental Understanding of Drug Misuse and Dependence - Short Form. 2012. http://hdl.handle.net/2262/64141 webcite
• [27]Smith D, Duffy R, Flynn D, Monks S, Kennedy HG: The Dundrum-D. Developmental Understanding of Drug Misuse and Dependence - Handbook. 2012. http://hdl.handle.net/2262/64140 webcite
• [28]Goldman HH, Skodol AE, Lave TR: Revising axis V for DSM-IV: a review of measures of social functioning. Am J Psychiatry 1992, 149:1148-1156.
• [29]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Text Revision; 1994.
• [30]First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition. (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute, New York; 2002.
• [31]Curtin K, Monks S, Wright B, Duffy DM, Linehan SA, Kennedy HG: Psychiatric Morbidity in 615 Male Sentenced and Remanded Committals to Irish Prisons. Ir J Psych Med 2009, 26:169-173.
• [32]Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, et al.: Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry 2008, 65:28-37.
• [33]Ruhrmann S, Schultze-Lutter F, Klosterkotter J: Early detection and intervention in the initial prodromal phase of schizophrenia. Pharmacopsychiatry 2003, 36(Suppl 3):S162-S167.
• [34]Bryant TN: Computer software for calculating confidence intervals. In Statistics with confidence. 2nd edition. Edited by Altman DG, Machin D, Bryant T, Gardner MJ. BMJ Books, Bristol; 2000:208-213.
• [35]Duffy D, Linehan S, O'Neill H, Kennedy HG: Irish Travellers and forensic mental health. Irish Journal of Psychological Medicine 2002, 19(3):76-79.
• [36]Version IBMSPSS: [18.0.0]. IBM; 2009.
• [37]Hambrecht M, Hafner H: Substance abuse and the onset of schizophrenia. Biological Psychiatry 1996, 40:1155-1163.
• [38]Lewis G, David A, Andreasson S, Allebeck P: Schizophrenia and city life. Lancet 1992, 340:137-140.
• [39]Pedersen CB, Mortensen PB: Are the cause(s) responsible for urban-rural differences in schizophrenia risk rooted in families or in individuals? Am J Epidemiol 2006, 163:971-978.
• [40]Wright B, Duffy DM, Curtin K, Linehan SA, Monks S, Kennedy HG: Psychiatric Morbidity among Women Prisoners newly Committed and amongst Remanded and Sentenced Women in the Irish Prison System. Ir J Psych Med 2006, 23:47-53.
• [41]Kelly BD: Structural violence and schizophrenia. Soc Sci Med 2005, 61:721-730.
• [42]Fazel S, Bains P, Doll H: Substance abuse and dependence in prisoners: a systematic review. Addiction 2006, 101:181-191.
• [43]Casadio P, Fernandes C, Murray RM, Di FM: Cannabis use in young people: the risk for schizophrenia. Neurosci Biobehav Rev 2011, 35:1779-1787.
• [44]Phillips LJ, Curry C, Yung AR, Yuen HP, Adlard S, McGorry PD: Cannabis use is not associated with the development of psychosis in an 'ultra' high-risk group. Aust N Z J Psychiatry 2002, 36:800-806.
• [45]Keshavan MS, Anderson S, Pettegrew JW: Is schizophrenia due to excessive synaptic pruning in the prefrontal cortex? The Feinberg hypothesis revisited. J Psychiatr Res 1994, 28:239-265.
• [46]McGlashan TH: Schizophrenia in Translation: Is Active Psychosis Neurotoxic? Schizophr Bull 2006, 32:609-613.
• [47]Kelleher I, Keeley H, Corcoran P, Lynch F, Fitzpatrick C, Devlin N, et al.: Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies. Br J Psychiatry 2012, 201:26-32.
• [48]Yung AR, Yuen HP, Berger G, Francey S, Hung TC, Nelson B, et al.: Declining transition rate in ultra high risk (prodromal) services: dilution or reduction of risk? Schizophr Bull 2007, 33:673-681.