Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital
Abstract Background We evaluated change in response to multi-modal psychosocial ‘treatment as usual’ programs offered within a forensic hospital. Methods Sixty nine patients with a diagnosis of schizophrenia or schizoaffective disorder were followed for up to four years. Patient progress was evaluat...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12888-018-1862-0 |
| _version_ | 1819071760878796800 |
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| author | Melanie S. Richter Ken O’Reilly Danny O’Sullivan Padraic O’Flynn Aiden Corvin Gary Donohoe Ciaran Coyle Mary Davoren Caroline Higgins Orla Byrne Tina Nutley Andrea Nulty Kapil Sharma Paul O’Connell Harry G. Kennedy |
| author_facet | Melanie S. Richter Ken O’Reilly Danny O’Sullivan Padraic O’Flynn Aiden Corvin Gary Donohoe Ciaran Coyle Mary Davoren Caroline Higgins Orla Byrne Tina Nutley Andrea Nulty Kapil Sharma Paul O’Connell Harry G. Kennedy |
| author_sort | Melanie S. Richter |
| collection | DOAJ |
| description | Abstract Background We evaluated change in response to multi-modal psychosocial ‘treatment as usual’ programs offered within a forensic hospital. Methods Sixty nine patients with a diagnosis of schizophrenia or schizoaffective disorder were followed for up to four years. Patient progress was evaluated using the DUNDRUM-3, a measure of patient ability to participate and benefit from multi-modal psychosocial programs and the HCR-20 dynamic items, a measure of violence proneness. We report reliable change index (RCI) and reliable and clinically meaningful change (RMC). We assessed patients’ cognition using the MCCB, psychopathology using the PANSS. The effect of cognition and psychopathology on change in DUNDRUM-3 was examined using hierarchical multiple regression with age, gender, and baseline DUNDRUM-3 scores. Results The DUNDRUM-3 changed significantly (p < 0.004, d = 0.367, RCI 32% of 69 cases, RMC 23%) and HCR-20-C (p < 0.003, d = 0.377, RCI 10%). Both cognition and psychopathology accounted for significant variance in DUNDRUM-3 at follow up. Those hospitalized for less than five years at baseline changed more than longer stay patients. Mediation analysis demonstrated that the relationship between cognition and change in violence proneness (HCR-20-C) was both directly affected and indirectly mediated by change in DUNDRUM-3. Conclusions Change in response to multi-modal psychosocial programs (DUNDRUM-3) reduced a measure of violence proneness over four years. Forensic in-patients’ ability to benefit from psychosocial treatment appears to be a function of the outcome measure used, unit of measurement employed, degree of cognitive impairment, psychopathology, and length of stay. Lower risk of re-offending may be partially attributable to participation and engagement in psychosocial interventions. |
| first_indexed | 2024-12-21T17:26:58Z |
| format | Article |
| id | doaj.art-549fcaf745e94fdaaee0dd28135785d9 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-21T17:26:58Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
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| series | BMC Psychiatry |
| spelling | doaj.art-549fcaf745e94fdaaee0dd28135785d92022-12-21T18:56:01ZengBMCBMC Psychiatry1471-244X2018-09-0118111510.1186/s12888-018-1862-0Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospitalMelanie S. Richter0Ken O’Reilly1Danny O’Sullivan2Padraic O’Flynn3Aiden Corvin4Gary Donohoe5Ciaran Coyle6Mary Davoren7Caroline Higgins8Orla Byrne9Tina Nutley10Andrea Nulty11Kapil Sharma12Paul O’Connell13Harry G. Kennedy14National Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalDepartment of Psychiatry, Trinity CollegeDepartment of Psychology, National University of Ireland GalwayNational Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalNational Forensic Mental Health Service, Central Mental HospitalAbstract Background We evaluated change in response to multi-modal psychosocial ‘treatment as usual’ programs offered within a forensic hospital. Methods Sixty nine patients with a diagnosis of schizophrenia or schizoaffective disorder were followed for up to four years. Patient progress was evaluated using the DUNDRUM-3, a measure of patient ability to participate and benefit from multi-modal psychosocial programs and the HCR-20 dynamic items, a measure of violence proneness. We report reliable change index (RCI) and reliable and clinically meaningful change (RMC). We assessed patients’ cognition using the MCCB, psychopathology using the PANSS. The effect of cognition and psychopathology on change in DUNDRUM-3 was examined using hierarchical multiple regression with age, gender, and baseline DUNDRUM-3 scores. Results The DUNDRUM-3 changed significantly (p < 0.004, d = 0.367, RCI 32% of 69 cases, RMC 23%) and HCR-20-C (p < 0.003, d = 0.377, RCI 10%). Both cognition and psychopathology accounted for significant variance in DUNDRUM-3 at follow up. Those hospitalized for less than five years at baseline changed more than longer stay patients. Mediation analysis demonstrated that the relationship between cognition and change in violence proneness (HCR-20-C) was both directly affected and indirectly mediated by change in DUNDRUM-3. Conclusions Change in response to multi-modal psychosocial programs (DUNDRUM-3) reduced a measure of violence proneness over four years. Forensic in-patients’ ability to benefit from psychosocial treatment appears to be a function of the outcome measure used, unit of measurement employed, degree of cognitive impairment, psychopathology, and length of stay. Lower risk of re-offending may be partially attributable to participation and engagement in psychosocial interventions.http://link.springer.com/article/10.1186/s12888-018-1862-0Forensic psychiatryTreatmentCognitionViolence riskDUNDRUM toolkit |
| spellingShingle | Melanie S. Richter Ken O’Reilly Danny O’Sullivan Padraic O’Flynn Aiden Corvin Gary Donohoe Ciaran Coyle Mary Davoren Caroline Higgins Orla Byrne Tina Nutley Andrea Nulty Kapil Sharma Paul O’Connell Harry G. Kennedy Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital BMC Psychiatry Forensic psychiatry Treatment Cognition Violence risk DUNDRUM toolkit |
| title | Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital |
| title_full | Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital |
| title_fullStr | Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital |
| title_full_unstemmed | Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital |
| title_short | Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital |
| title_sort | prospective observational cohort study of treatment as usual over four years for patients with schizophrenia in a national forensic hospital |
| topic | Forensic psychiatry Treatment Cognition Violence risk DUNDRUM toolkit |
| url | http://link.springer.com/article/10.1186/s12888-018-1862-0 |
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