Personality Disorder and Serious Offending

Chris Newrith MB ChB, MSc, MRCPsych, Consultant Psychiatrist in Psychotherapy, Birmingham Personality Disorder Service, Birmingham, UKClive Meux MB BS, MRCPsych, Consultant Forensic Psychiatrist, Oxford Clinic Medium Secure Unit, Littlemore, UKPamela J Taylor MB BS, MRCP, FRCPsych, FMedSci, Professor of Forensic Psychiatry, Wales College of Medicine, Cardiff, UK

• Part 1 Theoretical FrameworkDescribing personality and its abnormal deviations Presenting characteristics of PD Assessment of individuals with PD Diagnostic arguments Cost to society of untreated disorder (including cost to patient)Part 2 Origins and Grounds for Intervention and PreventionEarly intervention and prevention and the extent of failure in this groupAttachment theoryProviding stability and continuityChemically mediated impulsivity (including serotonin agonists)Other organic contributions and drug supportAttention deficit disorders and stimulantsMaladaptive learning and cognitive behavioural workPsychosis and personality disorderChronic post traumatic stress disorderDynamic approaches including the narcissism debateTheory of mindAuthority and peer groupThe therapeutic communityThe advantages of an eclectic and often multimodal approach.Part 3 The clinical settingThe advantages and disadvantages of a secure hospital setting and/or compulsory detentionWoodstock Ward: The model for one defined patient groupA service for womenA service for patients with co-morbidity for alcoholillegal drug addictionsA service for sex offendersLearning disabilityTranslation of described models to other level of securityPart 4 Separation and Facilitating DepartureConsultation, liaison and transfer to other servicesSeparation from the treatment centreLiaison and planning mattersThe law and individual rightsConfidentialityResearch toolsResearch, including long term follow-up and early clinical indicatorsAuditDeveloping for the future.