National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland.
BMC Psychiatry. 2012 Aug 3;12:100. doi: 10.1186/1471-244X-12-100.
The ultra high risk state for psychosis has not been studied in young offender populations. Prison populations have higher rates of psychiatric morbidity and substance use disorders. Due to the age profile of young offenders one would expect to find a high prevalence of individuals with pre-psychotic or ultra-high risk mental states for psychosis (UHR). Accordingly young offender institutions offer an opportunity for early interventions which could result in improved long term mental health, social and legal outcomes. In the course of establishing a mental health in-reach service into Ireland's only young offender prison, we sought to estimate unmet mental health needs.
Every third new committal to a young offenders prison was interviewed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to identify the Ultra High Risk (UHR) state and a structured interview for assessing drug and alcohol misuse according to DSM-IV-TR criteria, the Developmental Understanding of Drug Misuse and Dependence - Short Form (DUNDRUM-S).
Over a twelve month period 171 young male offenders aged 16 to 20 were assessed. Of these 39 (23%, 95% confidence interval 18% to 30%) met UHR criteria. UHR states peaked at 18 years, were associated with lower SOFAS scores for social and occupational function and were also associated with multiple substance misuse. The relationship with lower SOFAS scores persisted even when co-varying for multiple substance misuse.
Although psychotic symptoms are common in community samples of children and adolescents, the prevalence of the UHR state in young offenders was higher than reported for community samples. The association with impaired function also suggests that this may be part of a developing disorder. Much more attention should be paid to the relationship of UHR states to substance misuse and to the health needs of young offenders.
精神病超高风险状态尚未在年轻罪犯人群中进行研究。监狱人群的精神发病率和物质使用障碍率较高。由于年轻罪犯的年龄特征，人们预计会发现大量处于精神病前或精神病超高风险精神状态（UHR）的个体。因此，年轻罪犯机构提供了进行早期干预的机会，这可能会导致改善长期心理健康、社会和法律结果。在为爱尔兰唯一的年轻罪犯监狱建立心理健康服务的过程中，我们试图估计未满足的心理健康需求。
每第三个新进入年轻罪犯监狱的人都使用风险精神状态综合评估（CAARMS）进行访谈，以确定超高风险（UHR）状态，并根据 DSM-IV-TR 标准使用评估药物和酒精滥用的结构化访谈，发展性药物滥用和依赖理解-短表（DUNDRUM-S）。
在 12 个月的时间里，评估了 171 名年龄在 16 至 20 岁的年轻男性罪犯。其中 39 人（23%，95%置信区间 18%至 30%）符合 UHR 标准。UHR 状态在 18 岁时达到峰值，与社会和职业功能的 SOFAS 评分较低有关，并且还与多种物质滥用有关。即使在共变多个物质滥用时，与 SOFAS 评分较低的关系仍然存在。
尽管精神病症状在儿童和青少年的社区样本中很常见，但年轻罪犯中超高风险状态的患病率高于社区样本中的报告。与功能受损的关联也表明这可能是一种正在发展的疾病的一部分。应该更加关注 UHR 状态与物质滥用的关系以及年轻罪犯的健康需求。
