Psychosis in the community and in prisons: a report from the British National Survey of psychiatric morbidity.
OBJECTIVE
Reports of increased rates of psychosis in prisons could be due to sampling and ascertainment differences. The authors compared two samples of subjects 16-64 years of age: those from the general population of residents in Great Britain and prisoners in England and Wales.


METHODS
A random sample of remanded and sentenced male and female prisoners (N=3,142) and a two-phase, cross-sectional random sample of household residents (N=10,108) were assessed with structured questionnaires and the semistructured Schedules for Clinical Assessment in Neuropsychiatry.


RESULTS
The weighted prevalence of probable functional psychosis in the past year was 4.5 per thousand (95% CI=3.1 to 5.8) in the household survey. In the prison survey, the weighted prevalence was over 10 times greater: 52 per thousand (95% CI=45 to 60). One in four prisoners with a psychotic disorder had psychotic symptoms attributed to toxic or withdrawal effects of psychoactive substances. The proportion of subjects with specific types of hallucinations or delusions did not differ between prison and household psychosis cases.


CONCLUSIONS
This large study using standardized comparisons showed that the prevalence of psychosis in prisons is substantially higher than in the community and is deserving of greater attention to treatment and prevention. Apart from a minority of prisoners with symptoms attributable to psychoactive substances, the clinical symptom profile of psychosis is the same in both settings. Longitudinal research is needed to better understand these prevalence differences.
Brugha
Traolach
T
University of Leicester, Department of Health Sciences, Brandon Mental Health Unit, Leicester General Hospital, Gwendolen Rd., Leicester LE5 4PW, UK.
Singleton
Nicola
N
Meltzer
Howard
H
Bebbington
Paul
P
Farrell
Michael
M
Jenkins
Rachel
R
Coid
Jeremy
J
Fryers
Tom
T
Melzer
David
D
Lewis
Glyn
G
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000706:statistics & numerical data*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011329:Prisoners / Q000523:psychology / Q000706:statistics & numerical data; D011330:Prisons / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology*; D011619:Psychotropic Drugs / Q000009:adverse effects; D012494:Sampling Studies; D012737:Sex Factors; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D006113:United Kingdom / Q000453:epidemiology
D011619:Psychotropic Drugs