The experience of long-stay patients in a forensic psychiatric hospital in China: a qualitative study.

BACKGROUND: Long stay in forensic psychiatric hospitals is common in patients who are defined as "not criminally responsible on account of mental disorder". However, little is known about how these patients experience and perceive the long stay within these settings. The aim of this study is to explore the perception and needs of long-stay patients in forensic psychiatric hospitals in China. METHODS: In-depth semi-structured interviews were conducted with 21 participants who had lived in the forensic psychiatry hospital for more than 8 years. We used thematic analysis strategies to analyse the qualitative data. RESULTS: Participants' perceptions clustered seven themes: hopelessness, loneliness, worthlessness, low mood, sleep disturbances, lack of freedom, and lack of mental health intervention. CONCLUSIONS: The views and opinions expressed by long-stay patients showed that psychological distress is prevailing in forensic psychiatric hospitals. Adequate and effective care and mental health interventions are recommended to be tailored for their special needs.

Structural Deficits in the Frontotemporal Network Associated With Psychopathic Traits in Violent Offenders With Schizophrenia.

People with schizophrenia (SZ) are at increased risk of violence compared to the general population. However, the neural mechanisms of violent behavior in patients with SZ are still unclear due to the heterogeneity of the diseased population. In this study, we aimed to examine the neural correlates of violent behavior in SZ and to determine whether the structural deficits were related to psychopathic traits. A total of 113 participants, including 31 SZ patients with violent behavior (vSZ), 39 SZ patients without violent behavior (nvSZ), and 43 healthy controls (HC), completed the T1-weighted magnetic resonance imaging (MRI) scan and were analyzed using voxel-based morphometry approach. The psychopathic traits were assessed using the Psychopathy Checklist: Screening Version (PCL:SV). The results showed decreased gray matter volume (GMV) in the vSZ group in the right temporal lobe and bilateral inferior frontal gyri compared to HCs; while reduced GMV in the inferior parietal lobe, parahippocampal and orbital frontal gyri was found in the nvSZ group compared with HCs. Correlation analyses showed that psychopathic traits were negatively associated with the GMV in the right superior temporal and left fusiform gyri in the vSZ group, indicating that psychopathic traits, as reflected by the score of antisocial factor, might be related to structural deficits in the temporal lobe, which led to a propensity to violent behavior in patients with SZ. Our findings suggest that violent behavior in patients with SZ might have a personality background associated with the frontotemporal network aberrance. In future studies, we need to take a closer look at psychopathic traits for better understanding of the mechanism of interpersonal violence in patients with SZ and to explore whether the imaging findings from this study can serve as a biomarker to predict future violent behaviors and community living.

Identification of violent patients with schizophrenia using a hybrid machine learning approach at the individual level.

Despite numerous risk factors associated with violence in patients with schizophrenia, predicting and preventing violent behavior is still a challenge. At present, machine learning (ML) has become a promising strategy for guiding individualized assessment. To build an effective model to predict the risk of violence in patients with schizophrenia, we proposed a hybrid ML method to improve the prediction capability in 42 violent offenders with schizophrenia and 33 non-violent patients with schizophrenia. The results revealed that the final model, which combined multimodal data, achieved the highest prediction performance with an accuracy of 90.67%. Specifically, the model, which fused three modalities of neuroimaging data, achieved a better accuracy than other fused models. In addition, the msot discriminative neuroimaging features involved in the prefrontal-temporal cognitive circuit and striatum reward system, indicating that dysfunction in cortical-subcortical circuits might be associated with high risk of violence in patients with schizophrenia. This study provides the first evidence supporting that the combination of specific multimodal neuroimaging and clinical data in ML analysis can effectively identify violent patients with schizophrenia. Furthermore, this work is crucial for the development of neuro-prediction models that could facilitate individualized treatment and interventions for violent behaviors in patients with schizophrenia.

Self-Harm History, Anxiety-Depression, Severity of Disease, and Insight Are Significantly Associated With Suicide Risk in Forensic Psychiatric Inpatients of China.

Background: Forensic psychiatric patients have higher suicide risk than the general population. This study aimed to evaluate the extent of suicide risk and to explore the associated factors in forensic psychiatric inpatients in China. Methods: We conducted a cross-sectional study from 1st November, 2018 to 30th January, 2019 in the Forensic Psychiatric Hospital of Hunan Province, China. Patient's information on socio-demographic, clinical, and criminological characteristics was collected. The suicidality subscale of the MINI-International Neuropsychiatric Interview (M.I.N.I.), the Brief Psychiatric Rating Scale (BPRS), and the Severity of Illness of Clinical Global Impressions Scale (CGI-SI) were used to measure present suicide risks, psychiatric symptoms, and the severity of the patient's disease, respectively. Binary logistic regression models were used to examine factors associated with suicide risk. Results: Twenty-one percent (84/408) of the forensic psychiatric inpatients reported suicide risk. Logistic regression analysis suggested that self-harm history (OR:3.47, 95% confidence interval CI: 1.45-8.33), symptoms of anxiety-depression (OR:1.15, 95% CI:1.04-1.27), and more severe mental disorder (OR:1.42, 95% CI:1.08-1.87) were associated with elevated suicide risk, while insight disorder (OR:0.81, 95% CI:0.65-0.99) was related to decreasing suicide risk. Conclusion: The study supplied useful clinical information to recognize high suicide risk in forensic psychiatric inpatients and may aid the development of valuable strategies for preventing and reducing suicide events.

The Association Between Suicide Attempts, Anxiety, and Childhood Maltreatment Among Adolescents and Young Adults With First Depressive Episodes.

Objective: Adolescents and young adults are susceptible to high-risk behaviors such as self-harm and suicide. However, the impact of childhood maltreatment on suicide attempts in adolescents and young adults with first episode of depression remains unclear. This study examined the association between suicide attempts and childhood maltreatment among adolescents and young adults with first depressive episodes. Methods: A total of 181 adolescents and young adults with first depressive episodes were included. The Child Trauma Questionnaire (CTQ), Beck Anxiety Inventory (BAI), and Patient Health Questionnaire-2 (PHQ-2) were used to assess childhood maltreatment and the severity of anxiety and depressive symptoms, respectively. The suicide item in the MINI-International Neuropsychiatric Interview (M.I.N.I.) 5.0 was used to assess the suicide attempts. Logistic regression analyses were used to explore the associated factors of suicide attempts. Results: The prevalence of SA in the total sample was 31.5% (95% CI = 24.9-38.1%). Multivariate logistic regression analyses revealed that the diagnosis of bipolar disorder (OR = 2.18, 95% CI = 1.07-4.40), smoking (OR = 2.64, 95% CI = 1.10-6.37), anxiety symptoms (OR = 1.05, 95% CI = 1.02-1.08), and childhood maltreatment (OR = 1.04, 95% CI = 1.01-1.07) were potential associated factors of SA. In addition, anxiety symptoms had a mediating effect on the relationship between childhood maltreatment and SA. Conclusion: Adolescents and young adults with first depressive episodes and having experiences of childhood maltreatment are at a high risk of suicide. The severity of anxiety symptoms may mediate the relation between childhood maltreatment and suicide attempts in this group of patients.

High Psychiatric Morbidity and Comorbidity Among Female Prisoners in Hunan, China.

BACKGROUND: High prevalence of mental disorders has been found among female prisoners in Western countries, however, little is known about the epidemiology of mental disorders in such populations in China. This study aims to investigate psychiatric morbidity and comorbidity among sentenced prisoners in a female prison in China. METHODS: A cluster sample of 2,703 female adult prisoners from Hunan Provincial Female Prison were interviewed with the Mini International Neuropsychiatric Interview, a semi-structured Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) mental disorder diagnostic tool. The rates of psychotic disorders, affective disorders, anxiety disorders, and substance use disorders were reported. RESULTS: Nearly 2/3 (66.2%, N=1,790) of the sample fulfilled the criteria for at least one lifetime DSM-IV disorder 36.5% had major depression, 22.2% had post-traumatic stress disorder (PTSD), and 16.5% had drug use disorder. Drug use disorders were the major comorbid disorders. 60.8% of people with alcohol use disorder and 37.0% of those with psychotic disorders also had a drug use disorder. More than one-quarter (26.1%) of the population met criteria for a current diagnosis of any mental disorder, of which major depression was the most common (14.7%), followed by PTSD (6.4%) and psychotic disorder (1.8%). CONCLUSION: The high levels of psychiatric morbidity and comorbidity in a representative sample of female prisoners in China indicate unmet needs that require identification and therapeutic intervention in prisons.

Cu-doped zinc oxide and its polythiophene composites: preparation and antibacterial properties.

Cu-doped zinc oxide and its polythiophene nanocomposites were prepared by the Sol-Gel and in situ polymerization methods, respectively. The structures, morphologies and compositions of the samples were characterized. The antibacterial properties of the samples on three kinds of strains were determined by using powder inhibition zones, minimum inhibitory concentrations and minimal bactericidal concentrations. The study confirmed that the antibacterial activities of the composites were better than those of their each component. The antibacterial mechanisms of the samples were discussed further.

Preparation and antibacterial activities of polyaniline/Cu0.05Zn0.95O nanocomposites.

Polyaniline/Cu(0.05)Zn(0.95)O (PANI/CZO) nanocomposites were prepared by in situ inverse microemulsion method. Based on the characterization of the crystal structure, chemical composition, and morphology of the samples, it was confirmed that CZO nanoparticles were incorporated into the polyaniline matrix. Studies of the antimicrobial activities of the samples against Staphylococcus aureus, Escherichia coli and Candida albicans were carried out using powder inhibition zone, minimum inhibitory concentration and minimal bactericidal concentrations methods. The results showed clearly that, as an antibacterial agent, PANI/CZO nanocomposites exhibited excellent antibacterial activity against the growth of microorganisms. Furthermore, the antibacterial mechanism of the samples was also deduced in this paper.