Statistical association criteria in forensic psychiatry-a criminological evaluation of casuistry.

PURPOSE: Identification of potential shared primary psychoprophylaxis and crime prevention is measured by analyzing the rate of commitments for patients-subjects to forensic examination. MATERIAL AND METHOD: The statistic trial is a retrospective, document-based study. The statistical lot consists of 770 initial examination reports performed and completed during the whole year 2007, primarily analyzed in order to summarize the data within the National Institute of Forensic Medicine, Bucharest, Romania (INML), with one of the group variables being 'particularities of the psychiatric patient history', containing the items 'forensic onset', 'commitments within the last year prior to the examination' and 'absence of commitments within the last year prior to the examination'. The method used was the Kendall bivariate correlation. For this study, the authors separately analyze only the two items regarding commitments by other correlation alternatives and by modern, elaborate statistical analyses, i.e. recording of the standard case study variables, Kendall bivariate correlation, cross tabulation, factor analysis and hierarchical cluster analysis. RESULTS: The results are varied, from theoretically presumed clinical nosography (such as schizophrenia or manic depression), to non-presumed (conduct disorders) or unexpected behavioral acts, and therefore difficult to interpret. CONCLUSIONS: One took into consideration the features of the batch as well as the results of the previous standard correlation of the whole statistical lot. The authors emphasize the role of medical security measures that are actually applied in the therapeutic management in general and in risk and second offence management in particular, as well as the role of forensic psychiatric examinations in the detection of certain aspects related to the monitoring of mental patients.

Diabetic ketoacidosis among patients receiving clozapine: a case series and review of socio-demographic risk factors.

BACKGROUND: Diabetic ketoacidosis (DKA) has been associated with clozapine. The purpose of this study is to examine the clinical-demographic correlates of DKA among outpatients receiving clozapine. METHODS: A literature search was conducted from 1966 to present using Medline to identify 23 case reports of clozapine-associated DKA. In addition, a cohort of twenty-six patients with clozapine-associated diabetes at the University of Rochester Medical Center Department of Psychiatry were examined for histories of DKA through review of medical records. Based on a total sample of 26 case reports including three unpublished cases at University of Rochester, associations between clinical and demographic variables and DKA were examined. RESULTS: African American patients were significantly more likely than other patients to have DKA (p < 0.0001). Clozapine treatment duration was significantly shorter among patients with DKA than those without DKA (p < 0.0001), with 61.5% of patients developing DKA within three months of clozapine initiation. Also, presence of antidiabetic medications was negatively correlated with DKA (p < 0.0001). Trends were noted toward an association between low doses of clozapine (p < 0.0583) and toward a negative association between family history of diabetes (p < 0.0696). CONCLUSION: Clozapine is associated with DKA that usually presents in patients who have not previously been diagnosed with diabetes. DKA typically occurs early in the course of treatment, when clozapine treatment duration is short and doses are low.

Diabetes mellitus among outpatients receiving clozapine: prevalence and clinical-demographic correlates.

BACKGROUND: Treatment with antipsychotic drugs has been associated with increased risk for developing diabetes mellitus. Recent consensus statements suggest that clozapine may pose an especially high risk. The purpose of this study is to examine the prevalence and clinical-demographic correlates of diabetes among outpatients with DSM-IV-diagnosed schizophrenia or schizoaffective disorder receiving clozapine. METHOD: One hundred one outpatients receiving clozapine at the University of Rochester Department of Psychiatry, Rochester, N.Y., were evaluated between September 2002 and September 2003. Demographic data were collected from medical records, and body mass index (BMI) and body fat measurements were conducted. Diagnosis of diabetes was established through review of medical records and fasting blood glucose testing. Associations between clinical and demographic variables and diabetes were examined using t tests, Fisher exact tests, and logistic regression. RESULTS: Mean (SD) age of patients was 40.4 (9.5) years, and 79% were white. Mean (SD) dose and duration of clozapine treatment were 426 (164) mg/day and 5.7 (3.6) years, respectively. Point prevalence of diabetes was 25.7%. Mean (SD) BMI was 32.6 (8.0) kg/m(2), and mean (SD) body fat was 34.0% (11.0%). Logistic regression revealed significant associations between diabetes and nonwhite race/ethnicity and family history of diabetes (p = .02 and .002, respectively). No significant associations were found between diabetes prevalence and BMI or body fat. CONCLUSION: Patients receiving clozapine are at substantial risk for developing diabetes, although the level of risk relative to other antipsychotic medications has not been fully determined. Clinicians should monitor all severely mentally ill patients receiving antipsychotic drugs for diabetes, with closer monitoring of patients with established demographic risk factors.

Prevalence of diabetes mellitus among outpatients with severe mental disorders receiving atypical antipsychotic drugs.

BACKGROUND: Recent studies have suggested that patients receiving atypical antipsychotic drugs are at increased risk for developing diabetes mellitus. The purpose of this study is to examine the prevalence of diabetes in a group of adults with schizophrenia and other severe mental disorders receiving atypical antipsychotic drugs within a community mental health center setting. METHOD: A retrospective chart review was conducted on 436 outpatients receiving either atypical antipsychotic or decanoate antipsychotic drugs at a community mental health center. Diagnosis of diabetes was established through the presence of documentation in the medical record. Patients with a history of diabetes prior to age 18 years were excluded. Data were gathered from April 2001 through September 2002. RESULTS: The mean (SD) age of patients was 42.5 (10.8) years, and 57.3% were men. Patients were 61.5% white, 31.8% black, 5.3% Hispanic, and 2.3% other. Seventeen percent of patients had a positive family history of diabetes. Point prevalence of diabetes was 14.2% for the entire group. Chi-square analysis for the group revealed significant effects of age (chi(2) = 16.514, p <.001), family history of diabetes (chi(2) = 27.128, p <.001), and gender (chi(2) = 14.114, p <.001). A trend was noted toward a higher prevalence of diabetes among patients receiving atypical drugs (15.2%) compared with those receiving decanoate drugs (6.3%) (chi(2) = 2.984, p =.078). CONCLUSION: Prevalence of diabetes mellitus among outpatients with severe mental disorders receiving atypical antipsychotic drugs is substantially higher than that reported in the general population. Results of this study are limited by the retrospective methodology, which may underestimate actual prevalence by failing to detect undiagnosed cases.