Diagnostic stability in forensic psychiatric patients

Background

Forensic psychiatric patients constitute a heterogeneous patient group with a variety of complex mental disorders, often in combination with a challenging social situation. One thing they all have in common is that they, prior to being convicted to forensic psychiatric care, have undergone a large, structured psychiatric evaluation. Previous studies on general psychiatric populations have demonstrated a large variation in stability of psychiatric diagnoses over time. Yet, despite their complex mental health needs, no specific knowledge on the long-term diagnostic stability of psychiatric diagnoses in forensic psychiatric patients is available.

Purpose

This study investigates diagnostic stability of psychiatric diagnoses in forensic psychiatric patients;

1. What is the diagnostic stability of psychiatric diagnoses in a long-time follow-up of forensic psychiatric patients after forensic psychiatric investigation? 
   
   
2. Can special patterns regarding diagnostic stability/instability be discerned?
   
   
3. Are diagnostic revisions based on clinical judgements or structured clinical judgements?
   
   
4. What treatment revisions are performed following diagnostic revisions?
   
   
5. Do patients with diagnostic stability differ compared to patients with diagnostic instability in relation to the care process and outcomes (e.g., length of stay, incidents, coercive measures)?

Methods

The study is based on retrospective, naturalistic file reviews of a 11-year cohort of forensic psychiatric patients. To be included, the patients must have been cared for during at least 6 months during the time period 2005–2015 at a large, forensic psychiatric clinic. Data will be analyzed using chi2 tests, Mann-Whitney U-test, ROC and survival analysis.

Results

In total N = 253 forensic psychiatric patients have fulfilled inclusion criteria; data collection is ongoing.

Significance

The study will provide an overview of diagnostic stability in the heterogeneous and vulnerable patient group of forensic psychiatric patients. Today, the care provided is based on the patients’ clinical profile including diagnosis, why knowledge on how different mental disorders vary over time is important for providing the right care at the right time. Thus, the present study will provide opportunities to optimize the care for forensic psychiatric patients, and hopefully be one part in diminishing the suffering of individual patients and facilitate the care process and planning.

Work plan
Data collection 2016–2019, peer-review publications 2021–2022.

Principal investigator
Märta Wallinius, associate professor

Research group
Malin Hildebrand Karlén, PhD
Kristina Sygel, post doc
Eva Lindström, associate professor

Collaborators
Lund university
Centre for Ethics, Law, and Mental Health, Gothenburg university
Regional Forensic Psychiatric Clinic Växjö, Sweden

Funding
Regional Forensic Psychiatric Clinic Växjö, Sweden
The Southern Healtcare region, Sweden