BACKGROUND: Length of stay (LoS) is a critical parameter of inpatient forensic treatment functioning. Inpatient forensic LoS in Czechia varies across hospitals with the number of patients per 100,000 inhabitants and the treatment duration. We aimed to analyse these inter-hospital differences and provide relevant sociodemographic and treatment-related data. METHODS: We collected descriptive parameters from 841 forensic inpatients from 13 hospitals in Czechia, with follow-up data collection after 6 months (N = 800). Data from eight hospitals with > 50 patients (N = 765) were entered into linear regression analyses with subsequent resampling to identify differences in LoS associated with index offence, diagnosis, and treatment type, thereby highlighting interhospital variations. RESULTS: The cohort comprised predominantly males (mean age, 41.84 years; standard deviation [SD] 3.63) with extended mental health histories; the mean main diagnosis length was 13.2 years (SD 12.18). Most inmates committed violent offences, with psychotic, substance use, or paraphilic disorders predominating. Family contact remained common despite the patients' poor socioeconomic status. The mean LoS was 1,327.58 (SD 1642.41) days. We observed significant differences in LoS among patients from the same diagnostic group. Within the whole system, patients with substance abuse disorders, psychotic disorders, and intellectual disabilities stayed for 760, 1490, and 2441 days, respectively. Violent index offences increased LoS in most hospitals, as did sexual offences, but "other" minor criminal offences (non-violent, non-sexual) were associated with increased LoS only in some hospitals. Sex offender treatment significantly affected LoS in some hospitals, while enrolment into substance use programmes shortened it. CONCLUSIONS: Our study revealed significant inter-hospital variations in LoS associated with index offences, diagnoses, or treatment programs, which could be related to previously unrecognised institutional factors. Regular evaluation of treatment outcomes and implementation of standardised guidelines across the entire system is necessary to balance these differences. The insights provided into inpatient treatment in Czechia can be used to guide policy and practice improvements, enhancing the quality of forensic psychiatric care and ensuring the rights and well-being of the patients. The study addressed the knowledge gap existing in the available literature regarding previously unrecognised factors influencing the LoS at the system "mezzo" level.
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Youth mental health is a growing concern, with reports of psychiatric diagnoses becoming increasingly prevalent. Among other factors, psychiatrization may inflate the observed prevalence by interpreting experiences previously understood as adversities inherent to human life as symptoms of psychopathology. The current study explores the pathologization of behaviors typical of adolescence by asking contemporary psychiatrists to diagnose and treat a character from a novel who is considered a prototypical teenager of the 19th century: Tom Sawyer. METHODS: A one-page vignette was distributed either in sealed envelopes or via email to 57 psychiatrists who had obtained their license for independent practice between 2021 and 2023 in the Czech Republic. In total, 47 psychiatrists took part, yielding an overall response rate of 82%. The number and frequency of diagnostic conclusions, prescribed medications, and recommended interventions are reported. RESULTS: Most respondents diagnosed the boy described in the vignette with a psychiatric disorder (94%; CI = 81-98%) and recommended an intervention within the healthcare system (89%; CI =76-96%). Two thirds (62%, CI = 46-75%) recommended pharmacotherapy: antidepressants (27%), antipsychotics (22%), stimulants (13%), and anxiolytics (2%); 68% (53-80%) recommended psychotherapy. Nonmedical interventions (e.g., counseling, social services) were recommended by 49%. CONCLUSIONS: The experiences of an adolescent boy, once interpreted as normative "adventures" in the 19th century, were recognized by newly certified psychiatrists as psychiatric disorder. These findings illustrate the extent of psychiatrization over time and suggest that expert diagnoses may substantially contribute to the overinterpretation of problems of living as psychiatric disorders.
- Publikační typ
- časopisecké články MeSH
Hrozící či již manifestní násilné jednání plynoucí z duševního onemocnění je jednou z příčin hospitalizace. Syndrom násilného jednání zahrnující psychotické, impulzivní a predační násilí vyžaduje správnou diagnostiku daného konání a specifické intervence k zabránění manifestace násilí. V současné době převažuje posouzení míry rizika násilného jednání prostým klinickým hodnocením, na druhou stranu se nabízí široká paleta diagnostických škál. Tyto nástroje ulehčují diagnostiku a zefektivňují kroky léčby násilného jednání i přístup celého ošetřovatelského týmu. Zavádění takových nástrojů dává naději na tzv. patient-tailored medicine, ve smyslu ovlivnění konkrétních symptomů, interakcí či organizace péče. Cílem našeho nesystematického přehledového článku je poskytnout základní přehled efektivních škál pro hodnocení rizika násilného jednání.
The threat or manifestation of violent behaviour as a result of mental illness is one of the reasons for hospitalisation. The syndrome of violent behaviour, including psychotic, impulsive and predatory violence, requires a correct diagnosis of the behaviour and specific interventions to prevent the manifestation of violence. At present, the assessment of the risk of violent behaviour is mainly based on a simple clinical assessment, but a number of diagnostic scales are available. These tools facilitate diagnosis and make the treatment of violent behaviour and the approach of the whole care team more effective. The introduction of such tools offers the hope of patient-tailored medicine, in the sense of influencing the specific symptoms, interactions or organisation of care. The aim of our text is to provide a nonsystematic review of effective scales for assessing the risk of violent behaviour.
BACKGROUND: Secure forensic hospital treatments are resource-intensive, aiming to rehabilitate offenders and enhance public safety. While these treatments consume significant portions of mental health budgets and show efficacy in some countries, their effectiveness in Czechia remains underexplored. Previous research has highlighted various factors influencing the likelihood of discharge from these institutions. Notably, the role of sociodemographic variables and the length of stay (LoS) in the context of forensic treatments has presented inconsistent findings across studies. METHODS: The study, part of the 'Deinstitutionalization project' in Czechia, collected data from all inpatient forensic care hospitals. A total of 793 patients (711 male, 79 female and 3 unknown) were included. Data collection spanned 6 months, with tools like HoNOS, HoNOS-Secure, MOAS, HCR-20V3 and AQoL-8D employed to assess various aspects of patient health, behaviour, risk and quality of life. RESULTS: The study revealed several determinants influencing patient discharge from forensic hospitals. Key assessment tools, such as HoNOS secure scores and the HCR-20 clinical subscale, showed that higher scores equated to lower chances of release. Furthermore, specific diagnoses like substance use disorder increased discharge odds, while a mental retardation diagnosis significantly reduced it. The type of index offense showed no influence on discharge decisions. CONCLUSION: Factors like reduced risk behaviours, absence of mental retardation diagnosis, social support and secure post-release housing plans played significant roles. The results underscored the importance of using standardized assessment tools over clinical judgement. A standout insight was the unique challenges faced by patients diagnosed with mental retardation, emphasizing a need for specialized care units or tailored programmes.
- MeSH
- deinstitucionalizace MeSH
- délka pobytu * MeSH
- dospělí MeSH
- duševní poruchy * terapie MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- propuštění pacienta * MeSH
- soudní psychiatrie MeSH
- ústavy pro duševně nemocné * MeSH
- zločinci psychologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Progress in psychiatric treatment has led to important improvements in the quality of life of patients with severe mental illness (SMI). Nevertheless, the life expectancy of patients with SMI remains two decades shorter than that of the general population, and the most prevalent cause of death is cardiovascular disease. Given that the delivery of somatic care to a population of individuals with mental illness is specific, we developed a screening and intervention programme aimed at this vulnerable population. The "SOMA" programme is a complex somatic health intervention system consisting of screening and a set of interventions. Risk screening is evaluated automatically; the interventions include dietary intervention, healthy lifestyle education (HSE), physiotherapy, kinesiotherapy, and occupational therapy (KOP). The programme was introduced into the practice of the hospital, and its outcomes were monitored with a pilot population divided into 2 subprogrammes. CV risk factor prevalence study (n= 5481) as the most common CV risk factors identified hypertension (56.6 %) and smoking (55.7 %), high-risk patients proportion was 1364 (27 %). HSE (n=40) enrolled patients improved their body weight. KOP results show that patients with schizophrenia preferred physical activity less than others; 53 % of patients have no physical activity during hospitalization, and spontaneous physical activity depends on BMI in our sample. We observed improvement in cognitive functioning, perception of physical functions, or perceived limitations was comparable to the general population. Results show the usability of the program design; initial screening with two intervention branches can increase motivation for physical activity and adoption of health-promoting behaviors and support a recovery process in SMI patients. SOMA project is unique in the Czech environment, however, larger sample with longer observation period is needed.
- MeSH
- dospělí MeSH
- duševní poruchy * terapie epidemiologie MeSH
- ergoterapie metody MeSH
- kardiovaskulární nemoci prevence a kontrola epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- plošný screening MeSH
- rizikové faktory MeSH
- schizofrenie terapie epidemiologie MeSH
- techniky fyzikální terapie MeSH
- zdravý životní styl MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Výkon ústavního ochranného léčení (OL) je vykonáván psychiatrickými nemocnicemi s regionální odpovědností. Cílem šetření / současného výzkumu je zmapovat a popsat populaci nemocných ve výkonu ochranného léčení, prezentovat data o nařízených OL, počtech nemocných v jednotlivých nemocnicích a ošetřovací době. Materiál a metoda: V rámci projektu "Deinstitucionalizace služeb pro duševně nemocné" probíhá pravidelný sběr dat, jehož součástí jsou i data nemocných s nařízeným OL. Další data byla získána z Centrální evidence statistických listů a výkaznictví (CSLAV) vedené Ministerstvem spravedlnosti ČR. Výsledky: Ke konci roku 2020 bylo za účelem výkonu OL hospitalizováno 839 pacientů, (82 žen a 757 mužů). V přepočtu na 100 000 obyvatel spádové oblasti existuje značná rozdílnost počtu nemocných, která mezi nemocnicemi kolísá v rozmezí 3-24 nemocných. Celostátní průměrná ošetřovací doba ústavních OL je 2, 6 roku, kdy mezi nemocnicemi jsou také značné rozdíly, a ošetřovací doba se pohybuje v rozmezí od několika měsíců po 6 let. Nejvyšší počet nemocných ve výkonu ústavního OL je z Karlovarského, Ústeckého a Moravskoslezského kraje. V diagnostickém složení se ukazuje nejvyšší podíl nemocných z okruhu psychotických poruch (F2) 47 %, 17 % nemocných je z okruhu F62-F69, který zahrnuje i parafilní poruchy, 16 % má diagnózu z okruhu F10-F19, tedy poruchy způsobené užíváním psychoaktivních látek. Závěr: V mezinárodním srovnání lze počet nemocných umístit do nižšího průměru evropských zemí, průměr ošetřovací doby se také jeví být v nižším průměru. Struktura a podrobnost dat z pravidelných cenzů neumožňují podrobnější popis populace z pohledu jejich rizikovosti pro společnost či spáchaného jednání.
Objective: Psychiatric hospitals with designated catchment areas are responsible for inpatient forensic treatment. We aim to present descriptive data concerning the inpatient forensic treatment population, patient numbers in hospitals, and treatment lengths. Method: As a part of the "Deinstitutionalization of Services for the Mentally Ill" project, regular data collection is performed, including collection of data on patients with a sentenced forensic treatment. Further data were obtained from the Central Register of Statistical Sheets and Reporting (CSLAV) kept by the Ministry of Justice of the Czech Republic. Results: The number of forensic patients at the end of the year 2020 was 839 (82 women and 757 men). There is a difference in patients ́ numbers in terms of 100,000 inhabitants of the catchment area, which varies between hospitals between 3 up to 24 patients. The national average treatment length of inpatient forensic treatment is 2.6 years, but there are differences between hospitals, and the treatment length varies from several months up to six years. The highest number of patients in inpatient forensic treatment is from regions: Karlovy Vary, Ústí nad Labem and Moravian-Silesian region. The diagnostic spectrum shows that the highest proportion of patients are diagnosed with psychotic disorders F2; (47%), 17% of patients are diagnosed with F62-F69 disorders, which also include paraphilic disorders, 16% have as the main diagnosis substance abuse; F10-F19. Conclusion: In an international comparison, patient numbers seem to be lower than in other European countries; the average treatment length also appears to be lower. The data structure from regular censuses has certain limitations as they do not allow a more detailed description of the population regarding risk for the society or the conduct committed.
- Klíčová slova
- ochranné léčení,
- MeSH
- délka pobytu statistika a číselné údaje MeSH
- hospitalizace statistika a číselné údaje MeSH
- lidé MeSH
- ústavní terapie * statistika a číselné údaje MeSH
- ústavy pro duševně nemocné MeSH
- vystavení násilí MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
