Pharmacotherapy for personality disorder-prescribing practice at a high secure hospital: a preliminary report.

The aim of this study was to examine the prescription of psychotropic medication for patients with a primary diagnosis of personality disorder (PD) detained at Rampton High Secure Hospital, compared with that for patients with a primary diagnosis of mental illness. The name and the dose of psychotropic medication prescribed for each patient in the sample, on 2 July 2010, were examined. Although nearly all patients with a primary diagnosis of mental illness were prescribed psychotropic medication (98%), the percentage within the Personality Disorder (73%) and the Dangerous and Severe Personality Disorder services (62%) was also high, with the most commonly prescribed drug being an antipsychotic in all groups. The dose of antipsychotic and mood-stabilizing medication was lower for patients with a primary diagnosis of PD, and clozapine was the antipsychotic of choice for a significant proportion of these patients. Medication may have a key role to play in the management of some groups of patients with PD.

Suicide in high security hospital patients.

PURPOSE: People with mental disorder and people who are violent are separately recognised as being at high risk of suicide. People detained in high security hospitals are recognised for their violence to others, but perhaps less so for their suicide potential. We aimed to investigate suicide rates among such patients during and after their high security hospital residency, and to establish risk factors for suicide. METHODS: We extracted data from the Special Hospitals' Case Register on each person resident at any time between 1 January 1972 and 31 December 2000. Suicide rates were calculated for the whole period. We compared rates to the general population using standardised mortality ratios (SMRs). We used poisson regression to estimate the effects of gender, legal category of detention, offending history and length of admission on the suicide rate. RESULTS: Of the 5,955 individuals, 218 completed suicide. The suicide rate was nearly 7 times higher among resident men (SMR 662, 95% CI 478-845) and over 40 times higher in resident women (SMR 4,012, 95% CI 2,526-5,498) than in the general population; it was 23 times higher (SMR 2,325, 95% CI 1,901-2,751) and 45 times higher (SMR 4,486, 95% CI 2,727-6,245) among post-discharge men and women, respectively. The suicide rate was significantly higher among women than men inside high security but not after discharge. CONCLUSIONS: The suicide rate among high security hospital patients was significantly higher than in the general population. Women were especially at risk while resident, whereas for men, the risk was higher after discharge.