Service audit of a forensic rehabilitation ward.

An open forensic rehabilitation ward provides an important link bridging the gap between secure and community provisions. This paper provides an audit of such a service by examining the records of an open forensic rehabilitation ward over a five-year period from 1 June 2000 until 31 May 2005. During the audit period there were 51 admissions, involving 45 different patients, and 50 discharges. The majority of the patients came from secure unit facilities, acute psychiatric wards or home. Thirty-nine patients were discharged either into hostels (66%) or their home (12%). The majority of patients (80%) had on admission a primary diagnosis of either schizophrenia or schizoaffective disorder. Most had an extensive forensic history. The focus of their admission was to assess and treat their mental illness/disorder and offending behaviour and this was successful as the majority of patients were transferred to a community placement after a mean of 15 months. It is essential that there is a well-integrated care pathway for forensic patients, involving constructive liaison with generic services and a well-structured treatment programme which integrates the key principles of the 'recovery model' approach to care.

Harnessing clinical psychiatric data with an electronic assessment tool (OPCRIT+): the utility of symptom dimensions.

Progress in personalised psychiatry is dependent on researchers having access to systematic and accurately acquired symptom data across clinical diagnoses. We have developed a structured psychiatric assessment tool, OPCRIT+, that is being introduced into the electronic medical records system of the South London and Maudsley NHS Foundation Trust which can help to achieve this. In this report we examine the utility of the symptom data being collected with the tool. Cross-sectional mental state data from a mixed-diagnostic cohort of 876 inpatients was subjected to a principal components analysis (PCA). Six components, explaining 46% of the variance in recorded symptoms, were extracted. The components represented dimensions of mania, depression, positive symptoms, anxiety, negative symptoms and disorganization. As indicated by component scores, different clinical diagnoses demonstrated distinct symptom profiles characterized by wide-ranging levels of severity. When comparing the predictive value of symptoms against diagnosis for a variety of clinical outcome measures (e.g. 'Overactive, aggressive behaviour'), symptoms proved superior in five instances (R(2) range: 0.06-0.28) whereas diagnosis was best just once (R(2):0.25). This report demonstrates that symptom data being routinely gathered in an NHS trust, when documented on the appropriate tool, have considerable potential for onward use in a variety of clinical and research applications via representation as dimensions of psychopathology.