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Logo of bmcpsycBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Psychiatry
 
BMC Psychiatry. 2012; 12: 100.
Published online Aug 3, 2012. doi:  10.1186/1471-244X-12-100
PMCID: PMC3481442
Ultra high risk of psychosis on committal to a young offender prison: an unrecognised opportunity for early intervention
Darran Flynn,1 Damian Smith,1 Luke Quirke,1 Stephen Monks,1 and Harry G Kennedycorresponding author1,2
1National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
2Department of Psychiatry, Trinity College, Dublin, Ireland
corresponding authorCorresponding author.
Darran Flynn: darranflynn/at/yahoo.com; Damian Smith: damiansmith81/at/hotmail.com; Luke Quirke: luke.quirke/at/hse.ie; Stephen Monks: stephen.monks1/at/hse.ie; Harry G Kennedy: kennedh/at/tcd.ie
Received January 9, 2012; Accepted July 30, 2012.
Abstract
Background
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.
Methods
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).
Results
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.
Conclusions
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.
Keywords: Young offenders, Ultra high risk, Psychosis, Substance misuse
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