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The British Journal of Psychiatry (2002) 180: 351-357
© 2002 The Royal College of Psychiatrists

Psychosis in high-security and general psychiatric services

Report from the UK700 and Special Hospitals' Treatment Resistant Schizophrenia groups

ELIZABETH WALSH, MRCPsych

MORVEN LEESE, PhD, PAMELA TAYLOR, FRCPsych and INGRID JOHNSTON, BSc

Institute of Psychiatry, London

TOM BURNS, MD

St George's Hospital Medical School, London

FRANCIS CREED, MD

School of Psychiatry and Behavioural Sciences, University of Manchester

ANNA HIGGIT, MRCPsych

St Charles' Hospital, London

ROBIN MURRAY, DSc

Institute of Psychiatry, London, UK

Correspondence: Dr Elizabeth Walsh, Section of Forensic Mental Health, Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK

Declaration of interest Funding is detailed in the Acknowledgements.

Background Serious violence is an unusual but significant correlate of psychosis, and leads to the need for specialist secure psychiatric services. Most such service users have previously used general psychiatric services.

Aims To examine diagnostic and socio-demographic differences between high-security psychiatric service users from their peers in community services.

Method Two groups of patients with psychosis were compared: a national sample of high-security hospital residents, and a sample of patients in contact with general psychiatric services.

Results Schizophrenia was the almost invariable diagnosis for all special hospital patients. White patients in the community sample were significantly more likely to have affective components to their illness compared with African—Caribbean patients; unlike those in special hospitals. There was a small excess in the proportion of African—Caribbean patients in the special hospital group, controlling for diagnosis, gender and locality. Men were overrepresented in this group.

Conclusions Among patients with psychosis, having a diagnosis of schizophrenia and being male increase the likelihood of special hospital admission. Suggestions that ethnic minority patients are much more likely to have engaged in serious violence and need high-security placement were not borne out.




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M. LEESE, G. THORNICROFT, J. SHAW, S. THOMAS, R. MOHAN, M. A. HARTY, and M. DOLAN
Ethnic differences among patients in high-security psychiatric hospitals in England
The British Journal of Psychiatry, April 1, 2006; 188(4): 380 - 385.
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