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Articles   |    
Criminal Justice Settings as Possible Sites for Early Detection of Psychotic Disorders and Reducing Treatment Delay
Claire Ramsay Wan, M.P.H.; Beth Broussard, M.P.H.; Patrick Haggard, M.D.; Michael T. Compton, M.D., M.P.H.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300206
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Ms. Ramsay Wan and Dr. Haggard are with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Ms. Broussard and Dr. Compton are with the Department of Psychiatry, Lenox Hill Hospital, New York City. Dr. Compton is also with the Department of Psychiatry, Hofstra North Shore–LIJ School of Medicine at Hofstra University, Hempstead, New York. Send correspondence to Dr. Compton (e-mail: mcompton@nshs.edu).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Interventions to reduce the duration of untreated psychosis should target institutions and key figures that may interact with individuals who have emerging or untreated psychosis. These individuals may come into contact with criminal justice settings, such as jails and prisons. This study sought to determine the frequency of arrests and incarcerations during the duration of untreated psychosis.

Methods  Retrospective data were collected from an urban, largely African-American group of 191 patients hospitalized for first-episode psychosis.

Results  Thirty-seven percent of participants were incarcerated at some point during their duration of untreated psychosis. Patients who had been incarcerated during this period had a much longer treatment delay, more severe positive symptoms (specifically, hallucinations), and poorer premorbid academic adjustment. For this group, the mean number of incarcerations during the duration of untreated psychosis was 2.0±1.5, the median number of days detained was 30.5, and most were detained for nonviolent, often petty, crimes.

Conclusions  Interventions to identify young people with untreated psychosis in jails and prisons and to refer these individuals to appropriate psychiatric care may reach some who would otherwise experience very long delays in treatment initiation. Crisis intervention team training of police officers could serve as one of several approaches for identifying these young people and diverting them into treatment.

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Table 1Characteristics of 191 patients with first-episode psychosis
Table Footer Note

a Diagnoses were made with the Structured Clinical Interview for DSM-IV Axis I Disorders.

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Table 2History of arrest and incarceration among 191 patients with first-episode psychosis, by time period
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Table 3Associations between incarceration history and clinical and demographic characteristics among 191 patients with first-episode psychosisa
Table Footer Note

a Because the duration of untreated psychosis and duration of untreated illness variables were highly right-skewed, statistical tests were performed using a log transformation of the variable. For interpretability, medians are reported, rather than the log-transformed means.

Table Footer Note

b PANSS, Positive and Negative Syndrome Scale. Possible scores range from 7 to 49, with higher scores indicating greater severity of positive symptoms.

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c Possible scores range from 16 to 112, with higher scores indicating greater severity of general psychopathology symptoms.

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d Measured with the Birchwood Insight Scale. Possible scores range from 0 to 12, with higher scores indicating better insight.

Table Footer Note

e PAS, Premorbid Adjustment Scale. Possible scores range from 0 to 6, with higher scores indicating poorer academic functioning.

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