Littlemore Hospital

Introduction Risk assessment is integral to forensic psychiatry. Previous work has highlighted the benefits of using scalable and evidence-based actuarial risk tools developed within forensic populations, such as the online Forensic Psychiatry and Violence Oxford (FoVOx) violence risk assessment tool. We examined the feasibility of using FoVOx in a Swedish forensic cohort and tested whether adding modifiable (dynamic) factors would increase its useability to clinicians. Methods We completed FoVOx assessments on all patients discharged from forensic psychiatric hospitals in Stockholm County, Sweden, between 2012 and 2017 and investigated recidivism rates. In addition, interviews were conducted with the clinicians responsible for each patient on the perceived accuracy, usefulness, and impact of FoVOx, which was examined using thematic analysis. Results Ninety-five discharges from forensic psychiatric hospitals were followed up. The median FoVOx score was a 7% likelihood of violent reoffending in two years after discharge. Six discharged patients (6%) were confirmed as violent recidivists using official records with a similar distribution of FoVOx risk categories as the rest of the sample. FoVOx was considered accurate by clinicians in more than half of cases, who suggested that modifiable risk factors could be added to increase acceptability. All clinicians thought that FoVOx was useful, and in 20% of discharges, it would have materially altered patient care. Overall, FoVOx was thought to impact decision-making and risk management, was practical to use, and could be completed without reference to written case material. Conclusion Completing FoVOx in forensic psychiatric hospitals can complement current approaches to clinical decision-making on violence risk assessment and management.

Introduction: Over time, there have been different views regarding the verbal auditory hallucinations (VAHs) reported by borderline personality disorder (BPD) and schizophrenia patients. More recently, their similarity has been emphasized, a view that undoubtedly has significant implications in terms of differential diagnosis and management. To explore this important issue, we undertook a detailed phenomenological assessment of persistent VAH reported by BPD and schizophrenia DSM-IV participants. Methods: The Psychotic Symptoms Rating Scale (PSYRATS), the Revised Beliefs About Voices Questionnaire (BAVQ-R), the Multidimensional Scale for Hallucinations (MSH), and a detailed clinical interview were administered to 11 BPD and 10 schizophrenia DSM-IV participants. Results: The VAHs of both groups were similar regarding intensity, reported as located inside or outside the head, and frequency in which they were described as a third-person phenomenon. However, the patients’ stance towards their VAH was clearly different. Whilst BPD patients identified them in a clear way in terms of gender and age and disliked them, schizophrenia patients identified them more vaguely, reported them both as more disruptive but at the same time engaged with them more positively; schizophrenia patients also integrated their VAH more into delusions. Discussion: Whilst reporting similar intensity of their VAH, the 2 groups’ stance towards them were strikingly different in that BPD participants regarded them as identifiable and unequivocally unpleasant whilst schizophrenia participants regarded them in a rather vague and ambiguous manner. Methodologically, this preliminary study suggests that in-depth phenomenological assessment can help to elucidate the differential diagnosis of VAH in these, possibly other, clinical groups. Further research is warranted to establish whether these preliminary findings are replicated on a bigger clinical sample.

Bluebird House is the only mixed gender NHS secure forensic psychiatric hospital for adolescents in the South of England. It has admitted more than 30 female patients since the service opened in 2008. The admission criteria are that patients must be detained under the Mental Health Act and present evidence of being a risk of harm to others. This article describes the clinical characteristics of 30 consecutive female patients admitted to a highly specialised adolescent forensic inpatient service. Key results include a very high rate of incidents of risk behaviours exhibited by female patients within the unit but good clinical outcomes. The majority of patients had severe symptoms of mental disorder, especially emotional instability, self-harm behaviours and aggressive behaviours. Few had diagnoses of mental illness. Assessment findings from the Millon Adolescent Clinical Inventory and the Structured Assessment of Violence Risk are discussed, as are parallel with studies from other female secure services.

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The author describes psychotherapeutic treatment with a woman who uses severe forms of self-harm to express her hope that she can find real understanding and an environment that can respond to her. She discusses the significance of the earliest experiences of maternal care and the particular importance of the skin; she describes how traumatic breakdowns in early care are unconsciously re-created in later assaults on the body, which serve to communicate distress, anger, protest and the hope that a real attempt will be made to relate to the person who self-harms. Self-harm is viewed not as a suicidal gesture, but rather, as an attempt to preserve life, and to represent and contain unbearable states of minds. The author outlines ways in which self-harm can create a narrative and embody unbearable feelings and unspoken thoughts. It is seen as a form of self-expression and communication, both conscious and unconscious, which is not wholly destructive but has important hopeful and self-preservative aims.

Acta Neurologica ScandinavicaVolume 45, Issue 1 p. 119-123 THE COMPOSITION OF THE CEREBRO-SPINAL FLUID IN THE NEUROSYPHILITIC PSYCHOSES Kenneth Dewhurst, Kenneth Dewhurst Received August 17, 1968 from the Littlemore Hospital, Oxford, England (Kenneth Dewhurst, M.D.Search for more papers by this author Kenneth Dewhurst, Kenneth Dewhurst Received August 17, 1968 from the Littlemore Hospital, Oxford, England (Kenneth Dewhurst, M.D.Search for more papers by this author First published: March 1969 https://doi.org/10.1111/j.1600-0404.1969.tb01226.xCitations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume45, Issue1March 1969Pages 119-123 RelatedInformation

The neuromodulatory effect of manipulating monoaminergic receptor function was assessed by combining a psychological and a pharmacological activation during repeated positron emission tomographic (PET) scans. The effects of buspirone (a 5-HT1A receptor partial agonist) on changes in regional cerebral blood flow (rCBF) associated with free word recall were examined. A factorial design was used to demonstrate a significant interaction (changes in rCBF brought about by psychological activation which depend on drug administration) in the left parahippocampal region. This interaction was an attenuation of increases in local neuronal activity (rCBF) related to memory function. Buspirone-induced decreases in rCBF, independent of the memory effect, were seen in the left prefrontal and parietal cortices. We suggest that combined psychological and pharmacological activation is a way of measuring direct (main) drug effects and modulatory effects on neurotransmission associated with cognitive functions (interaction).

Aims and MethodThis study aimed to determine the proportion of patients hospitalised with mania who had capacity to consent to treatment, to determine the predictors of capacity and to explore the relationship between detained status and capacity. Fifty in-patients with mania participated in a clinical interview to assess capacity.ResultsNineteen patients (38%) had overall capacity. Capacity was predicted by higher IQ, lower severity of manic symptoms and more episodes of depression; it was not related to voluntary or detained status. The domains of capacity were not hierarchical.Clinical ImplicationsMany patients hospitalised with mania have capacity to make an informed choice regarding treatment even when compulsorily detained. Their capacity should be reviewed frequently and measures adopted to enhance capacity.

Process issues in relation to the introduction of standardised needs assessments have traditionally received little attention. Descriptive approach to the theoretical and practical aspects of the development of an assessment process using a structured instrument, the clinical version of the Salford Needs Assessment Schedule for Adolescents (SNASA). The context for this was child and adolescent mental health liaison with a social services secure unit for adolescent boys. The use of a structured process model facilitated the implementation process enormously. Positive outcomes were experienced by participating staff at different levels within agency hierarchies and by the wider professional network. Successful implementation and continuing use of structured assessments and other instruments in multi-agency settings requires attention to process issues. Such attention needs to be concerted and ongoing. Within child and adolescent mental health settings such an approach may be helpful beyond the field of secure adolescent care.