Major Mental Illness as a Risk Factor for Incarceration.

OBJECTIVE: Individuals with serious mental illness are overrepresented in correctional populations. However, little is known about the representation of persons with serious mental illness at earlier stages in the criminal justice process. This research sought to measure the prevalence of arrestees in New York State who were treated for a major mental illness in the year before their arrest and to assess whether these individuals had a disproportionate rate of incarceration. METHODS: Approximately 600,000 individuals arrested in New York State between January 1, 2010, and December 31, 2013, were matched against public mental health records to identify defendants diagnosed as having a major mental illness in the 12 months before their arrest. RESULTS: Between 4% and 6% of the arrestees were diagnosed as having a major mental illness during a mental health service visit in the 12 months prior to their arrest. A major mental illness diagnosis was associated with more than a 50% increase in the odds of a jail sentence for misdemeanor arrestees, after the analyses controlled for the other case characteristics. Conversely, it was unrelated to the likelihood of a prison sentence given a felony arrest, but it did moderate the effect of other case characteristics within the group of arrestees with felonies. CONCLUSIONS: Differential adjudication of misdemeanor arrestees with a major mental illness diagnosis appears to contribute to their overrepresentation within the jail population. The role that poverty and pretrial incarceration may play in this relationship was not explored in this research and should be the subject of future investigation.

No place like home: A case study of a patient discharged from an Intensive Care Unit for end of life care at home.

INTRODUCTION: Both in the UK and internationally, discharge from an intensive care unit to home for end of life care is a rare and challenging occurrence. These challenges include clinicians' ability to identify appropriate patients in whom it is possible to communicate with about their wishes and preferences, the critical nature of their condition and the interface between hospital and community services. METHOD: We present a case report of a patient who had been admitted to hospital with a myocardial infarction and subsequently suffered a cardiac arrest, from which he was successfully resuscitated. Subsequently, he suffered multi-organ failure, but despite treatments, the ceiling of care was reached. With a poor prognosis, medical and nursing staff engaged in advance care planning to determine his wishes and preferences at the end of life and to facilitate his discharge from the intensive care unit to his home. CONCLUSION: This case study has highlighted that through good communication amongst patients, families and professionals and collaborative working across boundaries and organisations, appropriate patients in the critical care setting can have a real choice regarding where they wish to be cared for and die at the end of their life.

Predictors of general and violent recidivism among SMI prisoners returning to communities in New York State.

Correctional and forensic mental health systems throughout the country are routinely called on to manage and provide treatment for mentally ill prison inmates. This study identifies criminal justice and mental health predictors of general re-arrest and re-arrest for violence in seriously mentally ill (SMI) persons leaving prison in New York State. Both length and diversity of criminal history predicted general re-arrest, as did substance abuse diagnoses, participation in community mental health treatment, parole supervision, and coordinated parole and mental health services. Only demographics and criminal justice measures were predictive of re-arrest for violence. The rate of re-arrest for violence in this SMI sample was lower than that of general prison release populations.

The effect of length of hospitalization on re-arrest among insanity plea acquittees.

State psychiatric hospitals are increasingly populated by forensic patients. In New York State, the growth in the forensic population is largely attributable to increased lengths of stay of patients deemed not guilty by reason of insanity (NGRI). This research was conducted to determine whether longer periods of hospitalization are associated with better outcomes in the community, as measured by re-arrest for any offense and re-arrest for violence. The sample included 386 NGRI patients released into the community in New York State. A Cox regression proportional hazards model was used to assess the unique effects of length of hospitalization on re-arrest. The results showed that the length of treatment had little effect on either measure of re-arrest. Re-arrest was largely explained by demographics and prior criminal histories.

Magnetic resonance imaging left ventricular mass reduction with fixed-dose angiotensin-converting enzyme inhibitor-based regimens in patients with high-risk hypertension.

Left ventricular hypertrophy, a major cardiovascular risk factor for morbidity and mortality, is commonly caused by arterial hypertension. The renin-angiotensin-aldosterone system may contribute to the pathogenesis of left ventricular hypertrophy. The Assessment of Lotrel in Left Ventricular Hypertrophy and Hypertension Study compared a single-pill combination of amlodipine/benazepril at doses 5.0/20.0 mg, 5.0/40.0 mg, and 10.0/40.0 mg with hydrochlorothiazide/benazepril at doses 12.5/20.0 mg, 12.5/40.0 mg, and 25.0/40.0 mg on the reduction of left ventricular mass index measured by cardiac MRI in stage 2 hypertensive patients over 52 weeks of treatment in a randomized clinical trial. A total of 125 male and female patients, > or =55 years of age, with echocardiographic left ventricular hypertrophy and high-risk hypertension defined as blood pressure > or =160/100 mm Hg or current antihypertensive treatment were enrolled. After 52 weeks of treatment, left ventricular mass index was significantly reduced from baseline with amlodipine/benazepril (mean: 10.16 g/m(2)) or hydrochlorothiazide/benazepril (mean: 6.74 g/m(2); both P<0.0001), with a mean difference between treatment groups of 3.36 g/m(2) (P=0.16). No significant treatment differences were observed in subgroups defined by age, male gender, race, diabetes status, or dose level. However, in female patients, left ventricular mass index reduction was greater with amlodipine/benazepril (P=0.02). Both treatments were well tolerated.