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      Continuity of supply of psychiatric medicines for newly received prisoners

      Author(s): , , ,
      Publication date (Electronic):
      Journal: The Psychiatrist
      Publisher: Royal College of Psychiatrists

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          Abstract

          Aims and method

          A retrospective case-note review was undertaken at five English prisons between June 2008 and March 2009 to estimate the proportion of psychiatric medicines (antidepressants, antipsychotics and hypnotics/anxiolytics) reported at prison reception that are discontinued on entry to prison.

          Results

          Of the 1006 records sampled, the review showed that 18% of prisoners had been prescribed psychiatric medication before being placed in custody. Altogether, 240 separate psychiatric medicines were recorded among prisoners at reception. Of these, 47% were not prescribed during the first week of custody. In only 11% of cases where medication was discontinued had psychiatric assessment been completed.

          Clinical implications

          Prison mental health policy states that psychiatric medication should not be withdrawn in custody without proper clinical assessment. Denial of medication in the absence of clinical assessment during early custody has the potential to create additional stress in individuals during a period of increased vulnerability and risk.

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          Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse.

          J. Moncrieff (2006)
          To examine the evidence that discontinuation of long-term antipsychotic medication, including clozapine, may provoke a psychotic episode. Databases were searched and citations scrutinised. Evidence for a rapid onset psychosis (supersensitivity psychosis) following clozapine withdrawal was found and weaker evidence that this might occur with some other antipsychotic drugs. Some cases were reported in people without a psychiatric history. It appears that the psychosis may be a feature of drug withdrawal rather than the re-emergence of an underlying illness, at least in some patients. Meta-analyses of withdrawal studies have suggested that antipsychotic discontinuation may also increase the risk of relapse over and above the risk because of the underlying disorder, but not all individual studies show this effect. Mechanisms may relate to brain adaptations to long-term drug use but data are sparse. These effects require further urgent research. Interventions to reduce morbidity after drug withdrawal need to be developed.
          Article 0 comments Cited 56 times – based on 0 reviews     Review now
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            A randomised controlled trial of methadone maintenance treatment versus wait list control in an Australian prison system.

            Wayne Hall, Stephen Dolan, Margaret Macdonald … (2003)
            The aim was to determine whether methadone maintenance treatment reduced heroin use, syringe sharing and HIV or hepatitis C incidence among prisoners. All eligible prisoners seeking drug treatment were randomised to methadone or a waitlist control group from 1997 to 1998 and followed up after 4 months. Heroin use was measured by hair analysis and self report; drugs used and injected and syringe sharing were measured by self report. Hepatitis C and HIV incidence was measured by serology. Of 593 eligible prisoners, 382 (64%) were randomised to MMT (n=191) or control (n=191). 129 treated and 124 control subjects were followed up at 5 months. Heroin use was significantly lower among treated than control subjects at follow up. Treated subjects reported lower levels of drug injection and syringe sharing at follow up. There was no difference in HIV or hepatitis C incidence. Consideration should be given to the introduction of prison methadone programs particular where community based programs exist.
            Article 0 comments Cited 33 times – based on 0 reviews     Review now
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              Suicide by prisoners

              Louis Appleby, Denise Baker, Isabelle M Hunt … (2004)
              The number of suicides in prison has increased over recent years. This is the first study to describe the clinical care of a national sample of prison suicides. To describe the clinical and social circumstances of self-inflicted deaths among prisoners. A national clinical survey based on a 2-year sample of self-inflicted deaths in prisoners. Detailed clinical and social information was collected from prison governors and prison health care staff. There were 172 self-inflicted deaths: 85 (49%; 95% CI 42–57) were of prisoners on remand; 55 (32%; 95% CI 25–39) occurred within 7 days of reception into prison. The commonest method was hanging or self-strangulation (92%; 95% CI 88–96). A total of 110 (72%; 95% CI 65–79) had a history of mental disorder. The commonest primary diagnosis was drug dependence (39, 27%; 95% CI 20–35). Eighty-nine (57%; 95% CI 49–64) had symptoms suggestive of mental disorder at reception into prison. Suicide prevention measures should be concentrated in the period immediately following reception into prison. Because hanging is the commonest method of suicide, removal of potential ligature points from cells should be a priority.
              Article 0 comments Cited 24 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: The Psychiatrist
                Abbreviated Title: Psychiatrist
                Publisher: Royal College of Psychiatrists
                ISSN (Print): 1758-3209
                ISSN (Electronic): 1758-3217
                Publication date Created: July 2011
                Publication date (Electronic): January 02 2018
                Publication date (Print): July 2011
                Volume: 35
                Issue: 7
                Pages: 244-248
                Article
                DOI: 10.1192/pb.bp.110.031757
                SO-VID: 199f34f0-cb92-4135-8bdf-75873752f89e
                Copyright © © 2011
                License:

                http://creativecommons.org/licenses/by/4.0/

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