Predictors of admission to a high-security hospital of people with intellectual disability with and without schizophrenia

Admission to secure hospital facilities is a rare outcome for people with i ntellectual disability with or without concomitant psychosis. The present s tudy compares people with mild intellectual disability with and without sch izophrenia resident in the Scottish and Northern Irish State Hospital, Cars tairs, to matched mild intellectual disability controls, also with and with out schizophrenia, in the community. It is hoped that this study may identi fy socio-demographic, clinical or historical predictors which may lead to a dmission to secure hospital facilities for people with mild intellectual di sability. One hundred and eight subjects were identified from two previous studies which concerned State Hospital patients and patients with intellect ual disability with and without schizophrenia. Four experimental groups wer e derived: (1) 14 individuals with comorbid intellectual disability and sch izophrenia who had been resident in the State Hospital; (2) 34 comorbid com munity control subjects; (3) 33 individuals with intellectual disability an d no psychosis who had been resident in the State Hospital; and (4) 27 comm unity control subjects with mild intellectual disability. The four groups w ere compared on a range of socio-demographic, historical and clinical varia bles obtained from case records and subject interviews. Relative to communi ty controls, people with intellectual disability and no psychosis in the St ate Hospital are likely to be single, to have a later age of first psychiat ric hospital admission, and to have a history of previous suicide attempts. alcohol abuse or drug misuse. Subjects with comorbid intellectual disabili ty and schizophrenia in the State Hospital are more likely to be male, to h ave an early age of first psychiatric admission, and to have no family hist ory of either schizophrenia or intellectual disability. Strategies aimed at addressing suicidal behaviour, alcohol and drug misuse amongst people with intellectual disability may facilitate a reduction in the number of admiss ions to high-security hospitals in the UK. In people with comorbid intellec tual disability and schizophrenia, males with an early age of onset and no known family history are more likely to require care and treatment in a sec ure psychiatric setting. Such comorbid subjects may be suffering from a par ticular malignant form of schizophrenia, manifesting in childhood as cognit ive impairment prior to the early onset of psychosis in teenage years.