Substance use in psychiatric crisis: relationship to violence

Influence of sleep quality on aggressive behaviours: Predictive validity of the Brøset Violence Checklist-revised

INTRODUCTION

Violent behaviours in acute psychiatric settings represent a critical issue within health systems. Prompt identification of patients at risk is a priority for nurses. The Brøset Violence Checklist (BVC), created to support nursing assessment, showed good psychometric skills; a new version of the instrument (BVCrev), including sleep alterations, seems to improve the predictivity of sleep compared to the original scale but is not available in Italian.

AIMS

To evaluate the psychometric properties of the Italian version of the Brøset Violence Checklist revised (BVCita-rev).

MATERIALS AND METHODS

This was a prospective, observational study. After back-translation and content validity assessment, the BVCita and BVCita-rev were used simultaneously for risk assessment on a sample of patients admitted to the psychiatric inpatient wards of two Italian hospitals. Sensitivity, specificity, positive predictive value, negative predictive value, and ROC curve were calculated for both BVCita and BVCita-rev.

RESULTS

137 patients were enrolled, and 1117 evaluations were performed. Thirty-four subjects (24.82 %) engaged in aggressive actions during hospitalization, 24 of whom more than once. The predictivity of BVCita-rev was higher than that of BVCita (ROC = 0.9528 vs 0.8811). The S-CVI of the new version of the instrument was = 0.92.

CONCLUSIONS

Including an item addressing sleep disturbances enhances the predictive capabilities of the BVCita-rev. This modified version of the BVC proves to be an effective tool for supporting nurses in the short-term assessment of violence risk within acute psychiatric inpatient settings.

The burden of alcohol and substance use disorders in adolescents and young adults

BACKGROUND

Substance use disorders (SUDs) play a major role in global preventable disability and mortality. Even though they impact patients of all ages, adolescents and young adults (AYAs) are at increased risk of substance use at a later age. We aim to assess the burden of SUDs and alcohol-related harms in AYAs.

METHODS

This study employed the Global Burden of Disease Study 2019 data. We assessed the prevalence, incidence, years of life lost, years of living with disability, and disability-adjusted life years (DALYs) of SUDs, alcohol use disorder (AUD), and alcohol-related burden in AYAs (10-24 years).

RESULTS

Among multiple SUDs, AUD had the highest prevalence (13.31 million), followed by cannabis use disorder (10.69 million) and opioid use disorder (4.27 million). From 2010-2019, while many SUDs saw a decrease in prevalence and incidence rates, opioid use disorder experienced increases across prevalence and incidence rates. Geographically, Europe and the Americas recorded the highest SUD burden. Higher Socio-demographic Index (SDI) levels correlated with increased SUD burden. Females showed a lower burden from SUDs and related health issues compared to males. The distribution of DALYs relative to prevalence varied across different SUDs and SDIs. The largest mortality caused by alcohol use were road injuries, interpersonal violence, and self-harm.

CONCLUSION

The worldwide burden of SUDs, particularly AUD, cannabis use disorder, opioid use disorder, and alcohol-induced harms (particularly injuries) among AYAs, is significant. Addressing this issue urgently requires the implementation of effective policies targeting SUDs.

Is There a Dose-Response Relationship Between Cannabis Use and Violence? A Longitudinal Study in Individuals with Severe Mental Disorders

Introduction: Recent longitudinal studies point toward the existence of a positive relationship between cannabis use and violence in people with severe mental disorders (SMD). However, the existence of a dose-response relationship between the frequency/severity of cannabis use and violence has seldom been investigated. Therefore, this study aims to determine if such a relationship exists in a psychiatric population. Methods: To do so, a total of 98 outpatients (81 males and 17 females, all over 18 years of age) with SMD were recruited at the Institut universitaire de santé mentale de Montréal (Montréal, Canada) and included in the analyses. Clinical evaluations were conducted every 3 months for a year. Substance use, violent behaviors, and potential covariables were assessed through self-reported assessments, urinary testing, as well as clinical, criminal, and police records. Using generalized estimating equations, the association between cannabis use frequency (nonusers, occasional, regular, and frequent users) and violence was investigated, as well as the association between the severity of cannabis use and violent behaviors. Results: It was found that cannabis use frequency and severity were significant predictors of violent behaviors. After adjustment for time, age, sex, ethnicity, diagnoses, impulsivity, and use of alcohol and stimulants, odds ratios were of 1.91 (p<0.001) between each frequency profile and 1.040 (p<0.001) for each increase of one point of the severity of cannabis use score (ranging from 0 to 79). Conclusions: Despite the high attrition rate, these findings may have important implications for clinicians as cannabis use may have serious consequences in psychiatric populations. Nevertheless, the mechanisms underlying this association remain unclear.

Investigating uses of peer-operated Virtual Overdose Monitoring Services (VOMS) beyond overdose response: a qualitative study

Background: Virtual overdose monitoring services (VOMS) are novel technologies that allow remote monitoring of individuals while they use substances (especially those who use alone) electronically.Objectives: The authors explored key partner perspectives regarding services offered by VOMS beyond overdose response with the aim of understanding the breadth and perception of the services amongst those that use these services and are impacted by them.Methods: Forty-seven participants from six key partner groups [peers who had used VOMS (25%), peers who had not used VOMS (17%), family members of peers (11%), health professionals (21%), harm reduction sector employees (15%), and VOMS operators (15%)] underwent 20-to-60-minute semi-structured telephone interviews. Of peer and family groups, thirteen participants identified as female, eleven as male and one as non-binary, gender data was not recorded for other key partner groups. Interview guides were developed and interviews were conducted until saturation was reached across all participants. Themes and subthemes were identified and member checked with partner groups.Results: Participants indicated that uses of VOMS beyond overdose monitoring included: (1) providing mental health support and community referral; (2) methamphetamine agitation de-escalation; (3) advice on self-care and harm reduction; and (4) a sense of community and peer support. Respondents were divided on how VOMS might affect emergency services (5).Conclusions: VOMS are currently being used for purposes beyond drug poisoning prevention, including community methamphetamine psychosis de-escalation, mental health support, and community peer support. VOMS are capable of delivering a broad suite of harm reduction services and referring clients to recovery-oriented services.

Cannabis use among patients presenting to the emergency department for psychosis: Associations with restraint use, medication administration, psychiatric hospitalization, and repeat visits

Cannabis use is associated with increased severity of psychotic symptoms and the risk of acute agitation and aggressive behavior in inpatient (IP) and outpatient settings. Whether or not cannabis use is associated with increased acuity of psychosis-related ED presentations and risk of repeat ED visits for psychosis is unclear. In this retrospective study of 2,134 ED visits for acute psychosis, we investigated the risk of physical restraint, parenteral medication administration, psychiatric hospitalization, and recurrent ED visits. We examined ED visits between March 1, 2019 and February 28, 2021 based on urinary Tetrahydrocannabinol (THC) screen status (positive vs negative vs no screen). The risk of physical restraint, parenteral antipsychotic, and benzodiazepine administration was significantly greater in ED visits with a positive THC screen compared to those with a negative or no THC screen. We did not find an association between a positive urinary THC screen and IP hospitalization or the risk of recurrent ED presentation for psychosis within 90 days. These findings suggest that positive urinary THC may predict acute agitation or acuity of symptoms in ED settings and underscores the importance of screening for THC during ED presentations for psychosis.

Violence, neurocognitive function and clinical correlates in patients with schizophrenia

BACKGROUND

Schizophrenia patients with violent behavior are a severe public health concern, but the correlates of this violent behavior are unknown. Additionally, the relationship between neurocognitive function and violent behavior in Chinese patients with schizophrenia has not yet been investigated.

METHODS

A total of 337 schizophrenia inpatients were recruited. The Positive and Negative Syndrome Scale (PANSS) was used to assess psychopathological symptoms. Neurocognitive functioning was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).

RESULTS

The percentage of violent behavior was 10.4% in patients with schizophrenia. Patients with violent behavior had higher PANSS-positive, excited, and total subscale scores than patients who did not show violent behavior. Patients with violent behavior also had lower RBANS language, semantic fluency, and total subscale scores. Gender (OR = 0.066∼0.819, p = 0.023), illness duration (OR = 0.876∼0.971, p = 0.002), smoking (OR = 1.127∼2.950, p = 0.014), the PANSS positive subscale (OR = 1.050∼1.197, p = 0.001), and the RBANS language subscale (OR = 0.927∼0.987, p = 0.005) significantly contributed to the development of violent behavior in schizophrenia patients.

CONCLUSION

Our findings revealed that cognitive and clinical assessments should be considered in comprehensive assessments of future risks of violence in schizophrenia patients.

The Link Between Cannabis Use and Violent Behavior in the Early Phase of Psychosis: The Potential Role of Impulsivity

INTRODUCTION

Recently, the literature has shown that Cannabis Use (CU) was a risk factor for Violent Behavior (VB) in patients with psychosis, and those in the early phase of psychosis (EPP). These findings are relevant because of the high prevalence of CU in this EPP, and the potential for prevention during this phase of illness. However, there is still a lack of clear explanations, supported by empirical evidence, about what underlies the link between CU and VB against other.

METHOD

This viewpoint reviews the scientific literature on the link between CU and VB, and the involvement of impulsivity in this relationship. This last point will be addressed at clinical and neurobiological levels.

RESULTS

Recent studies confirmed that CU is particularly high in the EPP, and is a risk factor for VB in the EPP and schizophrenia. Studies have also shown that impulsivity is a risk factor for VB in psychosis, is associated with CU, and may mediate the link between CU and VB. Research suggests a neurobiological mechanism, as CU affects the structures and function of frontal areas, known to play a role in impulsive behavior.

CONCLUSION

Scientific evidence support the hypothesis of an involvement of impulsivity as a variable that could mediate the link between CU and aggression, particularly, when CU has an early onset. However, this hypothesis should be confirmed with longitudinal studies and by taking into account confounding factors. The studies highlight the relevance of early prevention in the EPP, in addition to interventions focusing on psychotic disorders.