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Whiting D, Lichtenstein P, Fazel S. Violence and mental disorders: a structured review of associations by individual diagnoses, risk factors, and risk assessment. Lancet Psychiatry 2021; 8:150-161. [PMID: 33096045 DOI: 10.1016/s2215-0366(20)30262-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/08/2023]
Abstract
In this Review, we summarise evidence on the association between different mental disorders and violence, with emphasis on high quality designs and replicated findings. Relative risks are typically increased for all violent outcomes in most diagnosed psychiatric disorders compared with people without psychiatric disorders, with increased odds in the range of 2-4 after adjustment for familial and other sources of confounding. Absolute rates of violent crime over 5-10 years are typically below 5% in people with mental illness (excluding personality disorders, schizophrenia, and substance misuse), which increases to 6-10% in personality disorders and schizophrenia spectrum disorders, and to more than 10% in substance misuse. Past criminality and comorbid substance misuse are strongly predictive of future violence in many individual disorders. We reviewed national clinical practice guidelines, which vary in content and require updating to reflect the present epidemiological evidence. Standardised and clinically feasible approaches to the assessment and management of violence risk in general psychiatric settings need to be developed.
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Affiliation(s)
- Daniel Whiting
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
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Yee N, Matheson S, Korobanova D, Large M, Nielssen O, Carr V, Dean K. A meta-analysis of the relationship between psychosis and any type of criminal offending, in both men and women. Schizophr Res 2020; 220:16-24. [PMID: 32359974 DOI: 10.1016/j.schres.2020.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Psychosis is known to be associated with an increased risk of violent offending, but the risk of criminal offending of any type is not so well understood, including the nature and extent of any differences in offending risk for men and women with psychosis. METHODS A systematic search of electronic databases from 1970 to March 2020 was conducted to identify studies comparing criminal offending amongst those with psychosis to a general population sample. A meta-analysis was performed, with separate analyses undertaken for men and women. RESULTS Eight studies, with a total of 15,446 individuals with psychosis and 186,752 controls from general population sources, met our inclusion criteria. The pooled odds ratio for any type of criminal offending for men with psychosis was 2.42 (95% CI = 1.63-3.59), and for women it was 2.81 (95% CI = 2.11-3.76). Substantial between study heterogeneity was identified. CONCLUSIONS Although the pooled odds ratio for all types of offending was not as high as has been found for violence, those with psychotic illness were more than twice as likely to have had contact with the criminal justice system for any type of criminal offence, compared to the general population. Little difference in risk was seen for women compared to men with psychosis. Clinical risk assessments and the development of interventions to reduce risk of contact with the criminal justice system should consider that risk of offending for those with psychosis extends right across the spectrum of offence types.
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Affiliation(s)
- Natalia Yee
- School of Psychiatry, University of New South Wales, Australia; Justice Health and Forensic Mental Health Network, NSW, Australia
| | - Sandra Matheson
- School of Psychiatry, University of New South Wales, Australia; Neuroscience Research Australia, NSW, Australia
| | - Daria Korobanova
- School of Psychiatry, University of New South Wales, Australia; Justice Health and Forensic Mental Health Network, NSW, Australia
| | - Matthew Large
- School of Psychiatry, University of New South Wales, Australia
| | - Olav Nielssen
- Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia
| | - Vaughan Carr
- School of Psychiatry, University of New South Wales, Australia
| | - Kimberlie Dean
- School of Psychiatry, University of New South Wales, Australia; Justice Health and Forensic Mental Health Network, NSW, Australia.
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Lepresle A, Vidal C, Mairesse E, Chariot P. Unfitness for Detention Among Arrestees with Suspected Mental Disorders in Paris, France. J Forensic Sci 2016; 62:715-721. [DOI: 10.1111/1556-4029.13337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 06/25/2016] [Accepted: 08/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Aude Lepresle
- Infirmerie Psychiatrique de la Préfecture de Police; 75014 Paris France
- Department of Forensic Medicine; Hôpital Jean-Verdier (AP-HP); 93140 Bondy France
| | - Camille Vidal
- Department of Forensic Medicine; Hôpital Jean-Verdier (AP-HP); 93140 Bondy France
| | - Eric Mairesse
- Infirmerie Psychiatrique de la Préfecture de Police; 75014 Paris France
| | - Patrick Chariot
- Department of Forensic Medicine; Hôpital Jean-Verdier (AP-HP); 93140 Bondy France
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS); UMR 8156-997; UFR SMBH; Sorbonne Paris Cité; Université Paris 13; Paris France
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Dean K. Exploring heterogeneity among mentally disordered offenders--The key to targeting Interventions. Aust N Z J Psychiatry 2015; 49:1063-4. [PMID: 26133559 DOI: 10.1177/0004867415592959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kimberlie Dean
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, Australia Justice Health and Forensic Mental Health Network, Sydney, NSW, Australia
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Stevens H, Laursen TM, Mortensen PB, Agerbo E, Dean K. Post-illness-onset risk of offending across the full spectrum of psychiatric disorders. Psychol Med 2015; 45:2447-2457. [PMID: 25851504 DOI: 10.1017/s0033291715000458] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The link between psychotic disorders and violent offending is well established; knowledge about risk of post-illness-onset offending across the full spectrum of psychiatric disorders is lacking. We aimed to compare rates of any offending and violent offending committed after the onset of illness, according to diagnostic group, with population controls. METHOD A 25% random sample of the Danish population (n = 521 340) was followed from their 15th birthday until offending occurred. Mental health status was considered as a time-varying exposure in a Poisson regression model used to examine the duration from service contact to the offence. RESULTS Males with any psychiatric contact had an incidence rate ratio (IRR) of 2.91 [95% confidence interval (CI) 2.80-3.02] for any offending; 4.18 (95% CI 3.99-4.38) for violent offending. Associations were stronger for women (IRR 4.17, 95% CI 3.95-4.40 for any offending; 8.02, 95% CI 7.20-8.94 for violent offending). Risk was similar across diagnostic groups for any offending in males, while variation between diagnostic groups was seen for male violent and female offending, both any and violent. CONCLUSIONS Risk of offending, particularly violent offending, was elevated across a range of mental disorders following first contact with mental health services. The extent of variation in strength of effect across diagnoses differed by gender.
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Affiliation(s)
- H Stevens
- National Centre for Register-based Research,Aarhus University,Aarhus,Denmark
| | - T M Laursen
- National Centre for Register-based Research,Aarhus University,Aarhus,Denmark
| | - P B Mortensen
- National Centre for Register-based Research,Aarhus University,Aarhus,Denmark
| | - E Agerbo
- National Centre for Register-based Research,Aarhus University,Aarhus,Denmark
| | - K Dean
- School of Psychiatry,University of New South Wales, and Justice Health & Forensic Mental Health Network,NSW,Australia
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First-episode psychosis in the criminal justice system: identifying a critical intercept for early intervention. Harv Rev Psychiatry 2015; 23:167-75. [PMID: 25943312 DOI: 10.1097/hrp.0000000000000066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:Evaluate emerging concepts of identification, treatment and discharge planning for individuals who are experiencing a first psychotic episode while detained in the criminal justice system. ABSTRACT The United States incarcerates more people than any other nation in the world. The system of jails and prisons that holds those individuals has become the largest provider of mental health care in the country, with rates of psychotic illness many times higher than in the community. A subset of this population includes individuals experiencing their first episode of psychosis who are untreated and are new to the rules of institutional settings. Retrospective and anecdotal reports indicate that many individuals in the criminal justice system have first-episode psychosis, yet no published information is available about the actual rates. For these patients, behavior associated with psychotic symptoms may have led to their arrest, but correctional facilities are poorly equipped to identify their needs and to provide the type of comprehensive treatment needed to improve functional status, quality of life, and illness recovery. Even as first-episode programs are flourishing in community settings, we know little about how to identify, engage, possibly divert, and treat these patients in settings designed as punishment. Efforts should be made both to reduce the number of these individuals inappropriately prosecuted within the criminal justice system and to begin in-jail efforts to engage them in treatment, in anticipation of their eventual return to the community.
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Nordentoft M, Melau M, Iversen T, Petersen L, Jeppesen P, Thorup A, Bertelsen M, Hjorthøj CR, Hastrup LH, Jørgensen P. From research to practice: how OPUS treatment was accepted and implemented throughout Denmark. Early Interv Psychiatry 2015; 9:156-62. [PMID: 24304658 DOI: 10.1111/eip.12108] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 10/10/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND The early phases of psychosis have been hypothesized to constitute a critical period, a window of opportunity. At the same time, the early phases of psychosis are associated with increased risk of unwanted outcome, such as suicidal behaviour and social isolation. This was the background for the emergence of early intervention services, and in Denmark, the OPUS trial was initiated as part of that process. METHODS Modified assertive community treatment, together with family involvement and social skills training, constituted the core elements in the original programme. A total of 547 patients with first-episode psychosis were included in the trial. RESULTS To summarize briefly the results of the OPUS trial: the OPUS treatment was superior to standard treatment in reducing psychotic and negative symptoms and substance abuse, in increasing user satisfaction and adherence to treatment, and in reducing use of bed days and days in supported housing. Moreover, relatives included in the OPUS treatment were less strained and had a higher level of knowledge about schizophrenia and higher user satisfaction. DISCUSSION The OPUS treatment was implemented throughout Denmark. Training courses were developed and manuals and books were published. Regional health authorities had access to national grants for implementing early intervention services; as a result, OPUS teams were disseminated throughout the country. The content of the treatment is now further developed, and new elements are being tried out - such as individual placement and support, lifestyle changes, cognitive remediation, specialized treatment for substance abuse and different kinds of user involvement.
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Affiliation(s)
- Merete Nordentoft
- Mental Health Centre Copenhagen, Mental health Services Capital Region of Denmark, Risskov, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Risskov, Denmark
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Nordentoft M. Specialised assertive intervention in early psychosis. Lancet Psychiatry 2015; 2:2-3. [PMID: 26359592 DOI: 10.1016/s2215-0366(14)00056-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Merete Nordentoft
- University of Copenhagen, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark.
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How successful are first episode programs? A review of the evidence for specialized assertive early intervention. Curr Opin Psychiatry 2014; 27:167-72. [PMID: 24662959 DOI: 10.1097/yco.0000000000000052] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW It has been hypothesized that the first 5 years after first episode of psychosis are a critical period with opportunities for ameliorating the course of illness. On the basis of this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions. RECENT FINDINGS The evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials, such as the Lambeth Early Onset trial, the Croydon Outreach and Assertive Support Team trial and the Norwegian site of Optimal Treatment trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred to standard treatment. However, the positive effects on service use and ability to live independently seem to be durable. SUMMARY Implementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high-quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing 2 years of intervention with extended treatment periods.
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Abstract
BACKGROUND Violent behaviour can be a presenting sign of first-episode psychosis. Duration of untreated psychosis (DUP) has been a focus of attention because it is a potentially modifiable factor that may influence outcome. AIMS The aim was to review the literature addressing the following issues: prevalence of violence or aggression in the first episode of psychosis, violence or aggression during the periods before and after the initiation of treatment, the DUP and relation between DUP and the level of violence or aggression in first-episode psychosis. METHODS MEDLINE and PubMed databases were searched for articles using the combination of key words 'aggression' (limited to humans) and 'first episode' and 'psychosis'. RESULTS Available evidence suggests that the prevalence of violent behaviour in the first episode of psychosis, particularly schizophrenia, is greater than during the later stages of the illness. First-episode psychosis is associated with an increased risk of homicide. There is some limited support for an effect of DUP length on serious violence or aggression. Violent behaviour frequently develops before the onset of first episode. Substance use disorders are additional factors that elevate the risk for violence in these patients. CONCLUSIONS Earlier treatment of first episode psychosis might prevent some homicides. Personality factors and substance abuse may be more important than psychotic symptoms in the development of aggressive behaviour in patients with first-episode psychosis.
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Affiliation(s)
- K Látalová
- Psychiatric Department, Palacký University, Olomouc, Czech Republic
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Landgraf S, Blumenauer K, Osterheider M, Eisenbarth H. A clinical and demographic comparison between a forensic and a general sample of female patients with schizophrenia. Psychiatry Res 2013; 210:1176-83. [PMID: 24103910 DOI: 10.1016/j.psychres.2013.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/05/2013] [Accepted: 09/12/2013] [Indexed: 01/05/2023]
Abstract
Diagnoses of psychiatric diseases do not include criminal behavior. In schizophrenia, a non-negligible subgroup is incarcerated for capital and other crimes. Most studies that compared offender and non-offender patients with schizophrenia have only focused on male patients. With this study, we compared demographic and disease-related characteristics between 35 female incarcerated forensic patients (fSZ) and 35 female inpatients with schizophrenia (SZ). Basic clinical documentation and basic forensic clinical documentation revealed significant clinical and demographic differences between the two groups. Compared to SZ, fSZ were more severely clinically impaired, showing higher rates of comorbid alcohol and substance disorder, more suicide attempts, had more previous hospitalizations, and were younger at disease onset. Regarding demographic variables, fSZ showed a higher rate of unemployment and homelessness and had to rely more often on housing and legal guardianships compared to SZ. These results suggest that female forensic patients with schizophrenia are more severely affected by clinical and non-clinical variables requiring an adapted intervention program. These results may also indicate two developmental trajectories for criminal and non-criminal schizophrenia in females.
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Affiliation(s)
- Steffen Landgraf
- University of Regensburg, Department of Forensic Psychiatry and Psychotherapy, Universitätsstraße 84, 93053 Regensburg, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany
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Ducat L, Ogloff JRP, McEwan T. Mental illness and psychiatric treatment amongst firesetters, other offenders and the general community. Aust N Z J Psychiatry 2013; 47:945-53. [PMID: 23739314 DOI: 10.1177/0004867413492223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Firesetting is often reported to be associated with psychopathology, but frequently these conclusions are based on studies reliant on selective forensic psychiatric samples without the use of comparison groups. The aim of the study was to examine the rates of mental illness, substance use disorders, personality pathology and psychiatric service usage in a population of convicted firesetters compared with other offenders and community controls. METHOD Using a data-linkage design, the study examined the psychiatric histories and usage of public mental health services by 1328 arsonists convicted between 2000 and 2009 in Victoria, Australia. These were compared with 1328 matched community controls and 421 non-firesetting offenders. RESULTS Firesetters were significantly more likely to have been registered with psychiatric services (37%) compared with other offenders (29.3%) and community controls (8.7%). The firesetters were also more likely to have utilised a diverse range of public mental health services. Firesetters attracted psychiatric diagnoses more often than community controls and other offenders, particularly affective, substance use, and personality disorders. CONCLUSIONS This study confirms that there is a link between firesetting and psychopathology, suggesting that there is a role for the psychiatric screening of known firesetters, and a need to consider psychopathology in formulating the risk for further firesetting.
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Affiliation(s)
- Lauren Ducat
- Centre for Forensic Behavioural Science, Monash University and Victorian Institute of Forensic Mental Health (Forensicare), Clifton Hill, Australia
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