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Vijh R, Kouyoumdjian FG, Iwajomo T, Simpson AIF, Jones R, de Oliveira C, Kurdyak P. Chronic Psychotic Disorders and Correctional Involvement: A Population-Based Matched Case-Control Study in Ontario, Canada. Can J Psychiatry 2024; 69:196-206. [PMID: 37501606 PMCID: PMC10874599 DOI: 10.1177/07067437231189468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Individuals with chronic psychotic disorders are overrepresented in correctional facilities, but little is known about factors that increase the risk of correctional involvement. The objective of this study was to compare individuals with chronic psychotic disorders who were released from correctional facilities in Ontario to individuals with chronic psychotic disorders but no correctional involvement on sociodemographic, clinical, and prior mental health-related health service utilization characteristics. METHOD All individuals with chronic psychotic disorders who were released from a provincial correctional facility in Ontario in 2010 were matched (1:2) by age and sex to Ontario residents with chronic psychotic disorders and no correctional involvement. Covariates included sociodemographic (rural residence, marginalization such as residential instability quintile, material deprivation quintile, dependency quintile, and ethnic concentration quintile) and clinical (duration of chronic psychotic disorder and comorbidities) characteristics, and mental health-related health service utilization characteristics (primary care physician, psychiatrist and emergency department visits, and hospitalizations) 1 and 3 years prior to correctional involvement. The association between correctional involvement and prior health service utilization was measured by estimating incidence rate ratios using Poisson and negative-binomial regressions. RESULTS Individuals with correctional involvement (N = 3,197) lived in neighbourhoods with higher material deprivation and residential instability, and had a shorter duration of illness, and more psychosocial comorbidities (e.g., behavioural issues and depression) than individuals without correctional involvement (N = 6,393). Adjusting for sociodemographic and clinical variables, individuals with correctional involvement had a higher rate of mental health-related primary care physician visits, emergency department visits, and hospitalizations but a lower rate of psychiatrist visits prior to correctional involvement, compared to individuals without correctional involvement. CONCLUSIONS Despite higher mental health-related comorbidities and higher rates of accessing acute mental health services among individuals with chronic psychotic disorders and correctional involvement, visits to psychiatrists prior to involvement were low.
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Affiliation(s)
- Ruchi Vijh
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Fiona G. Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- ICES, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
| | | | - Roland Jones
- Division of Forensic Psychiatry, CAMH, Toronto, Ontario, Canada
| | - Claire de Oliveira
- ICES, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Beaudoin M, Dellazizzo L, Giguère S, Guay JP, Giguère CE, Potvin S, Dumais A. Is There a Dose-Response Relationship Between Cannabis Use and Violence? A Longitudinal Study in Individuals with Severe Mental Disorders. Cannabis Cannabinoid Res 2024; 9:241-251. [PMID: 36787482 DOI: 10.1089/can.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
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.
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Affiliation(s)
- Mélissa Beaudoin
- Psychiatry and Addictology Department, Faculty of Medicine, University of Montreal, Montreal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Laura Dellazizzo
- Psychiatry and Addictology Department, Faculty of Medicine, University of Montreal, Montreal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Sabrina Giguère
- Psychiatry and Addictology Department, Faculty of Medicine, University of Montreal, Montreal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Jean-Pierre Guay
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, Canada
- Faculty of Arts and Sciences, Criminology School, University of Montreal, Montreal, Canada
- Centre International de Criminologie Comparée, Montreal, Canada
| | | | - Stéphane Potvin
- Psychiatry and Addictology Department, Faculty of Medicine, University of Montreal, Montreal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Alexandre Dumais
- Psychiatry and Addictology Department, Faculty of Medicine, University of Montreal, Montreal, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, Canada
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Escandón K. Toward non-stigmatizing media and language in mental health: Addressing the social stigma of schizophrenia. Schizophr Res 2024; 264:491-493. [PMID: 38277739 DOI: 10.1016/j.schres.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 01/28/2024]
Affiliation(s)
- Karina Escandón
- Department of Psychology and Anthropology, Universidad de Salamanca, Spain.
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Shimange ME, Shilubane HN. Perspectives of Hospitalized Mental Health Care Users Concerning the Involvement of Family Members in Their Care: A Qualitative Study. Nurs Rep 2023; 13:1684-1694. [PMID: 38133115 PMCID: PMC10871100 DOI: 10.3390/nursrep13040139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
The value of families and professionals in mental health care is well understood. Patient perspectives appear to have gotten less attention to date. This study investigated the perspectives of hospitalized mental health care users on the involvement of family members in their care using a qualitative phenomenological design. The participants with lived experience of family members being involved in their care were chosen using non-probability, purposive sampling. Individual interviews were carried out with the assistance of a voice recorder and observation notes. Because of data saturation, only fifteen people were interviewed. The interviews were transcribed verbatim and analyzed using Colaizzi's method. It started with reading and reviewing the transcript to extract key statements about the phenomenon. The meaning was then determined by carefully studying the primary significant statements and phrases. The established meanings were then organized into themes and subthemes. The three themes that emerged from the data analysis are as follows: a wide variation in patients' perspectives when family members remind them of their medicine, unpredictable visitation by family members, and a lack of support from family members. There were also the following five sub-themes: not visiting mental health care users in the hospital causes uncertainty about their future, mental health care users were concerned by fewer visits from relatives, friends were perceived as a contributory factor to no or limited visitation by family members, disappointment by a lack of financial support, and perceived lack of emotional support from family members. There is a need for family members to visit mental health care users to remove uncertainty about their future. Healthcare providers should listen to mental health care users to identify the challenges they are faced with, and hospital policies tailored to enhancing the involvement of family members should be formulated.
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Affiliation(s)
| | - Hilda N. Shilubane
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
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Li W, Tian Y, Chen C, Li H, Chen H, Liu J, Chen X, Tang H, Zhou J, Wang S, Wang X, Cai W, Zhou J. Mapping Violent Behaviors and Psychiatric Symptoms Among Male Psychiatric Inpatients from a Network Perspective. Psychiatr Q 2023; 94:705-719. [PMID: 37831344 DOI: 10.1007/s11126-023-10056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/14/2023]
Abstract
Psychiatric symptoms are common risk factors of violent behaviors among psychiatric patients. This study explored the interrelationship between violence and psychiatric symptoms in male psychiatric inpatients. This is a cross-sectional survey conducted in 2019. All patients admitted to the Male Psychiatry Unit of the Second Xiangya Hospital were consecutively recruited. The presence of five violent behaviors and eleven psychiatric symptoms were collected by reviewing medical records and were included as categorical variable in the network analyses. A total of 673 participants were included. The most central symptoms were "flight of ideas", "property-oriented violence", "emotional high", "verbal violence", "physical violence attempt", and "physical violence" in the network of psychiatric symptoms and violent behaviors. The bridge symptoms connecting violence and psychiatric symptoms were "verbal violence", "property-oriented violence", "hyperbulia", and "emotional high" according to the indices of bridge expected influence. The directed acyclic graph analysis revealed that "emotional high" and "hyperbulia" were the key psychiatric symptoms triggering violence, while "verbal violence" and "property-oriented violence" were the most upstream violent behavior. Verbal and property-oriented violence should be addressed in the risk assessment among male psychiatric inpatients. In addition, emotional high and hyperbulia are the potential treatment targets for violent behaviors.
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Affiliation(s)
- Wen Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Ministry of Justice, Academy of Forensic Science, Shanghai, 200063, China
| | - Yusheng Tian
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- Clinical Nursing Teaching and Research Section, The second Xiangya Hospital of Central South University, Changsha, China
| | - Chen Chen
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Ministry of Justice, Academy of Forensic Science, Shanghai, 200063, China
| | - Haozhe Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiali Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Xianliang Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Huajia Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiawei Zhou
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Ministry of Justice, Academy of Forensic Science, Shanghai, 200063, China
| | - Shujian Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoping Wang
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Ministry of Justice, Academy of Forensic Science, Shanghai, 200063, China
| | - Weixiong Cai
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China.
| | - Jiansong Zhou
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Ministry of Justice, Academy of Forensic Science, Shanghai, 200063, China.
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Flannery RB, Flannery GJ. Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2017-2022. Psychiatr Q 2023; 94:559-568. [PMID: 37667138 DOI: 10.1007/s11126-023-10050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
Since the 1960s, empirical research has focused on a better understanding of the characteristics of assaultive psychiatric patients. International research from 1960 to 2017 indicated that male and female patients with schizophrenia and substance use disorder presented the greatest risk for assault with nursing personnel being at higher risk. This present review of studies sought to assess the latest research findings on assaultive patients for the most recent five-year period, 2017-2022. It was hypothesized that patients with schizophrenia and substance use disorders would present the greatest assault risk for nursing personnel. The studies in this review supported this hypothesis. Assaults by patients with schizophrenia and substance abuse has been a consistent finding worldwide for 62 years of published research. Explanations for these findings, the possible role of posttraumatic stress disorder (PTSD) in assaultive patients, and an updated methodological review are presented.
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Affiliation(s)
- Raymond B Flannery
- University of Massachusetts Chan Medical School The ASAP Program, 7 Westchester Road, Newton, MA, 02458, USA.
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Weber K, Morier S, Lesaffre L, Menu C, Bertschy P, Herrmann FR, Giannakopoulos P. Court-ordered inpatient psychiatric care in Switzerland: determinants of length of stay and treatment outcome. Front Psychiatry 2023; 14:1222337. [PMID: 37854441 PMCID: PMC10579584 DOI: 10.3389/fpsyt.2023.1222337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023] Open
Abstract
IntroductionIn several European countries, offenders with decreased or abolished responsibility and high risk of recidivism due to long-lasting mental disorders are compulsory admitted for court-ordered treatments (COT) that take place in high and medium-security hospitals. As a rule, length of stay in these structures is very long implying major restrictions for the inmate and high societal cost. Despite intensive research, the predictors of length of stay and treatment outcome in long stay forensic services is still matter of debate.MethodsWe report here a detailed analysis of the demographic, psychiatric and offense predictors of length of stay and discharge locations of 204 mentally disordered offenders convicted to COT in a new medium-security forensic psychiatry clinic in Geneva, Switzerland. Kaplan-Meier survival estimates were performed to determine time to release. Length of stay was predicted by Cox regressions, and discharge locations were predicted by multinomial logistic regressions.ResultsThe typical inpatient was a 35-age single male re-offender, submitted to COT after a conviction for physical violence (78.9%) or property violation (64.2%), with drug trafficking (52.9%), in relation to psychotic (67.2%), antisocial or borderline personality disorder (35.8%) with comorbid substance use disorders (60.3%). Sex offenses were found in 24.5% of cases and were associated with Cluster B personality disorders. The median length of stay was of 2.5 years and was independent of demographic variables, severity of crime recidivism and psychiatric diagnosis. Longer COT at admission, and type of offense (in particular drug traffic and sexual violence) predicted longer stays. At discharge, 32.8% of cases were transferred to sheltered educational housing, 23.1% to open low-security wards, while 30.6% returned to regular prisons and 9.7% to their country of origin.DiscussionYounger age and conviction for property violation rather than physical violence increased the chances to be discharged to sheltered educational housing. Longer COT at admission, personality disorders, and conviction for sexual offense increased the risk to return to prison. These data suggest that sex offenses determine not only longer stays under COT but also drastically decreases the chance of freedom for inmates with Cluster B personality disorders.
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Affiliation(s)
- Kerstin Weber
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandrine Morier
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
| | - Lise Lesaffre
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Menu
- Department of Institutions and Information Technology, Republic and State of Geneva, Geneva, Switzerland
| | - Philippe Bertschy
- Department of Institutions and Information Technology, Republic and State of Geneva, Geneva, Switzerland
| | - François R. Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Barlati S, Nibbio G, Stanga V, Giovannoli G, Calzavara-Pinton I, Necchini N, Lisoni J, Deste G, Vita A. Cognitive and clinical characteristics of offenders and non-offenders diagnosed with schizophrenia spectrum disorders: results of the Recoviwel observational study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1307-1316. [PMID: 36309882 DOI: 10.1007/s00406-022-01510-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/19/2022] [Indexed: 11/26/2022]
Abstract
The association between schizophrenia spectrum disorders (SSD) and violent behavior is complex and requires further research. The cognitive correlates of violent behavior, in particular, remain to be further investigated. Aims of the present study were to comprehensively assess the cognitive and clinical profile of SSD violent offenders and evaluate individual predictors of violent behavior. Fifty inmates convicted for violent crimes in a forensic psychiatry setting and diagnosed with SSD were compared to fifty non-offender patients matched for age, gender, education, and diagnosis. Offender and non-offender participants were compared based on socio-demographic, clinical, and cognitive variables using non-parametric testing to select potential predictors of violent behavior. Multivariate logistic regressions were then performed to identify individual predictors of violent behavior. Offender participants showed more school failures, higher prevalence of substance use, higher Clinical Global Impression Severity Scale (CGI-S) and Positive and Negative Syndrome Scale Excited Component (PANSS-EC) scores, worse working memory and better attention performance, higher Historical Clinical and Risk Management scale 20 (HCR-20) and Hare Psychopathy Checklist (PCL-R) scores in all subdomains and factors. School failures, higher PANSS-EC scores, worse working memory and processing speed, better attention performance, higher scores in HCR-20 Management subscale and the PCL-R "Callous" factor emerged as predictors of violent behavior. Better attentional performance was correlated with higher PCL-R "Callous" factor scores, worse cognitive performance in several domains with higher PCL-R "Unstable" factor scores. In conclusion, the present study highlights the importance of carefully assessing SSD patients with violent behavior in all clinical, cognitive, and behavioral aspects.
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Affiliation(s)
- Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Valentina Stanga
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giulia Giovannoli
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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Bo S, Sharp C, Lind M, Simonsen S, Bateman A. Mentalizing mediates the relationship between psychopathy and premeditated criminal offending in schizophrenia: a 6-year follow-up study. Nord J Psychiatry 2023; 77:547-559. [PMID: 36897045 DOI: 10.1080/08039488.2023.2186483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Research has shown that schizophrenia augments the risk for criminal behaviour and variables both defining- and related to schizophrenia, increase criminal offending. Premeditated criminal offending is considered a severe form of criminal offending, however, very little is known about what predicts future premeditated criminal offending in schizophrenia. METHOD AND MATERIALS In this 6-year follow-up study we explored which factors underlie future premeditated criminal behaviour in a sample of patients diagnosed with schizophrenia (N = 116). We also investigated if a specific mentalizing profile underlie part of the variance of premeditated criminal offending. RESULTS Results showed that psychopathy underlie future premeditated crime in schizophrenia, and that a specific mentalizing profile, comprised of a dysfunctional emotional and intact cognitive mentalizing profile in relation to others, mediated parts of the relation between psychopathy and premeditated criminal offending. Finally, our results indicated that patients with schizophrenia with a specific mentalizing profile (see above) engaged in premeditated criminal behaviour earlier during the 6-year follow-up period compared to patients with other mentalizing profiles. CONCLUSIONS Our findings suggest that mentalization should carefully be inspected in patients with schizophrenia in relation to future premeditated offending.
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Affiliation(s)
- Sune Bo
- Department of Psychology, University of Copenhagen, DK and Department of Psychiatry, Denmark
| | - Carla Sharp
- Department of Psychology, University of Houston, USA
| | - Majse Lind
- Department of Psychology, University of Aalborg, Denmark
| | - Sebastian Simonsen
- Department of Psychology, University of Copenhagen, and Stolpegaard Psychotherapy Centre, Denmark
| | - Anthony Bateman
- Psychoanalysis Unit, University College London, United Kingdom
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10
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van Beek J, Meijers J, Scherder EJA, Harte JM. Aggressive Incidents by Incarcerated People With Psychiatric Illness and Their Relationship With Psychiatric Symptoms. J Forensic Nurs 2023; 19:E30-E38. [PMID: 37590946 DOI: 10.1097/jfn.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
AIM A prospective design was used to investigate the relationship of current psychiatric symptoms of incarcerated people with serious mental illness (SMI) and aggressive behavior on a penitentiary ward for crisis intervention. METHODS One hundred sixty detainees with SMI, detained in a high-security penitentiary psychiatric facility, were screened every 2 weeks with the Brief Psychiatric Rating Scale-Extended (BPRS-E) by trained clinicians, to ensure that the data on psychiatric symptoms were up-to-date. Aggressive behavior was registered with the Staff Observation Aggression Scale-Revised. A binary logistic regression analysis was performed to examine the relationships between factor scores of the BPRS-E and aggressive behavior. RESULTS Significant relationships between the BPRS-E factor hostility, antisocial traits, and aggressive incidents were found, but not between the positive symptoms or manic factor scores and aggressive incidents. DISCUSSION Symptoms of SMI measured with the BPRS-E did not help to explain the occurrence of aggressive behavior. This is not in line with what is commonly found. The implication is that it can be expected that this population will display aggressive behavior but that symptoms do not help in predicting when this will occur. In addition, hostility and antisocial traits were related to aggressive behavior. For this specific population, an interactional approach might be more effective in the management of aggression than treatment of symptoms of SMI.
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Affiliation(s)
| | | | - Erik J A Scherder
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam
| | - Joke M Harte
- Department of Criminal Law and Criminology, Faculty of Law, Vrije Universiteit Amsterdam
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11
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Wolf V, Mayer J, Steiner I, Franke I, Klein V, Streb J, Dudeck M. Risk factors for violence among female forensic inpatients with schizophrenia. Front Psychiatry 2023; 14:1203824. [PMID: 37457783 PMCID: PMC10347379 DOI: 10.3389/fpsyt.2023.1203824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Schizophrenia is associated with a heightened risk of violent behavior. However, conclusions on the nature of this relationship remain inconclusive. Equally, the empirical evidence on female patients with schizophrenia spectrum disorders (SSD) is strongly underrepresented. Methods For this purpose, the first aim of the present retrospective follow-up study was to determine the risk factors of violence in a sample of 99 female SSD patients discharged from forensic psychiatric treatment between 2001 and 2017, using three different measures of violence at varying time points (i.e., violent index offense, inpatient violence, and violent recidivism). Potential risk factors were retrieved from the relevant literature on SSD as well as two violence risk assessment instruments (i.e., HCR-20 V3, FAM). Further, we aimed to assess the predictive validity of the HCR-20 V3 in terms of violent recidivism and evaluate the incremental validity of the FAM as a supplementary gender-responsive assessment. Results The given results indicate strong heterogeneity between the assessed violence groups in terms of risk factors. Particularly, violence during the index offense was related to psychotic symptoms while inpatient violence was associated with affective and behavioral instability as well as violent ideation/intent, psychotic symptoms, and non-responsiveness to treatment. Lastly, violent recidivism was related to non-compliance, cognitive instability, lack of insight, childhood antisocial behavior, and poverty. Further, the application of the HCR-20 V3 resulted in moderate predictive accuracy (AUC = 0.695), while the supplementary assessment of the FAM did not add any incremental validity. Discussion This article provides important insights into the risk factors of violence among female SSD patients while highlighting the importance of differentiating between various forms of violence. Equally, it substitutes the existing evidence on violence risk assessment in female offenders with SSD.
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Affiliation(s)
- Viviane Wolf
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Clinic Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Juliane Mayer
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Ivonne Steiner
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Irina Franke
- Psychiatric Services of Grisons, Chur, Switzerland
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Guenzburg, Germany
| | - Verena Klein
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Guenzburg, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Guenzburg, Germany
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12
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Tomé-Fernández M, Berbegal-Bernabeu M, Sánchez-Sansegundo M, Zaragoza-Martí A, Rubio-Aparicio M, Portilla-Tamarit I, Rumbo-Rodríguez L, Hurtado-Sánchez JA. Neurocognitive Suicide and Homicide Markers in Patients with Schizophrenia Spectrum Disorders: A Systematic Review. Behav Sci (Basel) 2023; 13:446. [PMID: 37366698 DOI: 10.3390/bs13060446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023] Open
Abstract
Suicide and homicide are considered important problems in public health. This study aims to identify the cognitive performance of suicidal and homicidal behaviors in people with schizophrenia spectrum disorders, as well as examining whether there are shared neuropsychological mechanisms. A systematic review of the recent literature was carried out from September 2012 to June 2022 using the Medline (via PubMed), Scopus, Embase, and Cochrane databases. Among the 870 studies initially identified, 23 were finally selected (15 related to suicidal behaviors and 8 to homicidal behaviors). The results evidenced a relationship between impairment of cognitive performance and homicidal behavior; meanwhile, for suicidal behaviors, no consistent results were found. High neuropsychological performance seems to act as a protective factor against violent behavior in people with schizophrenia spectrum disorders, but not against suicidal behavior; indeed, it can even act as a risk factor for suicidal behavior. To date, there is insufficient evidence that shared neurocognitive mechanisms exist. However, processing speed and visual memory seem to be affected in the presence of both behaviors.
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Affiliation(s)
- Mario Tomé-Fernández
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - Marina Berbegal-Bernabeu
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - Miriam Sánchez-Sansegundo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - Ana Zaragoza-Martí
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - María Rubio-Aparicio
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - Irene Portilla-Tamarit
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - Lorena Rumbo-Rodríguez
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
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13
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Dan-Glauser E, Framorando D, Solida-Tozzi A, Golay P, Gholam MM, Alameda L, Conus P, Moulin V. Evolution of impulsivity levels in relation to early cannabis use in violent patients in the early phase of psychosis. Psychol Med 2023; 53:3210-3219. [PMID: 35142601 PMCID: PMC10235661 DOI: 10.1017/s0033291721005316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 09/27/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prevention of violent behaviors (VB) in the early phase of psychosis (EPP) is a real challenge. Impulsivity was shown to be strongly related to VB, and different evolutions of impulsivity were noticed along treatments. One possible variable involved in the relationship between VB and the evolution of impulsivity is cannabis use (CU). The high prevalence of CU in EPP and its relationship with VB led us to investigate: 1/the impact of CU and 2/the impact of early CU on the evolution of impulsivity levels during a 3-year program, in violent and non-violent EPP patients. METHODS 178 non-violent and 62 violent patients (VPs) were followed-up over a 3 year period. Age of onset of CU was assessed at program entry and impulsivity was assessed seven times during the program. The evolution of impulsivity level during the program, as a function of the violent and non-violent groups of patients and CU precocity were analyzed with linear mixed-effects models. RESULTS Over the treatment period, impulsivity level did not evolve as a function of the interaction between group and CU (coef. = 0.02, p = 0.425). However, when including precocity of CU, impulsivity was shown to increase significantly only in VPs who start consuming before 15 years of age (coef. = 0.06, p = 0.008). CONCLUSION The precocity of CU in VPs seems to be a key variable of the negative evolution of impulsivity during follow-up and should be closely monitored in EPP patients entering care since they have a higher risk of showing VB.
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Affiliation(s)
- Elise Dan-Glauser
- Department of psychiatry, Institute of Forensic Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Psychology, Lausanne University, Lausanne, Switzerland
| | - David Framorando
- Department of psychiatry, Institute of Forensic Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Alessandra Solida-Tozzi
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Philippe Golay
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - M. Mehdi Gholam
- Department of Psychiatry, Center for Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Instituto de Investigación Sanitaria de Sevilla, Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Sevilla, Spain
- Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Philippe Conus
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Valerie Moulin
- Department of psychiatry, Institute of Forensic Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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14
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Chowdhury A, Rao BSS, Laxmi TR. Risky Decision-taking Task: a novel paradigm to assess the risk-taking behaviour in rats predisposed to early-life stress. J Neurosci Methods 2023; 392:109864. [PMID: 37080434 DOI: 10.1016/j.jneumeth.2023.109864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
One of the characteristic features of adolescence is risk-taking behavioural traits. Uncontrolled risk-taking without proper assessment may have harmful impact on mental health later in life. Therefore, it is essential to identify it early for the preventable health problems. In the present study, we have designed a novel paradigm, viz. Risky Decision-taking Task (RDTT), to evaluate the spontaneous risk-taking behavioural repertoire in adolescent rodents. The task was designed based on both risk and cognitive factors. To validate and compare the risk-taking tendency, we have used early maternal separation and isolation (MS) stress model, as it is known to increase anxiety and curiosity-like behaviour at adolescence. We have used Sprague-Dawley rats of both sexes. Rats were exposed to MS stress for 10 days daily for six hours during stress hyporesponsive period (SHRP) from postnatal day 4 to 13. These rats were subjected to RDTT during adolescence. This task is a reward-based task where the latency to collect reward in the presence or absence of a risk factor is assessed. It consists of habituation, training to find the location of small and large rewards, reward preference for small and large reward and testing period under risky situation. Rats were trained individually to retrieve the valuation-based rewards under the risky, but innate aversive environments. The results from RDTT showed that as compared to controls, MS rats from both sexes showed reduced latency to collect large reward in the presence of a risk element and a reduced risk-index which is indicative of a higher risk-taking tendency in these rats. In addition, MS rats showed a trend towards anxiety-like behaviour as compared to controls in the Light-Dark Test. These results together show decreased risk latency for the large reward and reduced risk assessment in MS rats which is suggestive of more risk-taking tendency in these rats. Thus, we propose that RDTT paradigm can be used to evaluate the spontaneous risk-taking behavioural repertoire based on innate, spontaneous aversion and cognitive factors in rats.
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Affiliation(s)
- Abanti Chowdhury
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru - 560 029
| | - B S Shankaranarayana Rao
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru - 560 029
| | - T R Laxmi
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru - 560 029.
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15
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Fekih-Romdhane F, Maktouf H, Cheour M. Aggressive behaviour in antipsychotic-naive first-episode schizophrenia patients, their unaffected siblings and healthy controls. Early Interv Psychiatry 2023; 17:299-310. [PMID: 35712845 DOI: 10.1111/eip.13329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 04/17/2022] [Accepted: 05/29/2022] [Indexed: 12/26/2022]
Abstract
AIM While patients with schizophrenia are more likely to be victims rather than perpetrators of aggressive behaviour, prior research has shown increased rates of aggressive behaviours in these patients that appear very early in the course of illness. We aimed to assess aggression in antipsychotic-naive first-episode schizophrenia patients, their healthy siblings, and controls; and to investigate correlates of aggression in the patients group. METHODS Patients (N = 55), siblings (N = 55) and healthy controls (N = 71) were evaluated on Buss and Perry Aggression Questionnaire (AQ), Life History of Aggression (LHA), Barratt Impulsiveness Scale, and Levenson Self-Report Psychopathy Scale. Age, gender and substance use were regarded as covariates, and differences between the three groups were evaluated using analysis of covariance. Hierarchical regression was performed to determine which variables were associated with aggression level in the patients group. RESULTS The Tukey multiple comparison test showed that both patients (p < .001) and siblings (p = .023) scored higher on the LHA Aggression than controls. Siblings scored higher than controls (p = .010) for the Anger subscale of the AQ. Patients scored significantly higher than controls in the three impulsiveness dimensions; whereas siblings scored higher than controls in the motor (p = .023) and non-planning (p = .004) dimensions. Multivariate analyses showed that, after controlling for confounders, only attentional impulsiveness (β = .446, p = .0244) and psychopathy traits (β = .359, p = .010) helped predict AQ total scores among patients. CONCLUSION Aggression and some of its risk factors including impulsiveness are likely to be trait variables that might provide important vulnerability markers for people at heightened risk of developing psychosis.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, Tunisia
| | - Hela Maktouf
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, Tunisia
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, Tunisia
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16
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Hudon A, Dellazizzo L, Phraxayavong K, Potvin S, Dumais A. Association Between Cannabis and Violence in Community-Dwelling Patients With Severe Mental Disorders: A Cross-sectional Study Using Machine Learning. J Nerv Ment Dis 2023; 211:88-94. [PMID: 36716062 DOI: 10.1097/NMD.0000000000001604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The objective of this cross-sectional study was to identify cannabis-related features and other characteristics predictive of violence using a data-driven approach in patients with severe mental disorders (SMDs). A Least Absolute Shrinkage and Selection Operator regularization regression model was used on the database consisting of 97 patients with SMD who completed questionnaires measuring substance use and violence. Cannabis use, particularly related to patients' decision to consume or time spent using, was a key predictor associated with violence. Other patterns of substance use and personality traits were identified as strong predictors. Regular patterns of cannabis use and interpersonal issues related to cannabis/stimulant abuse were inversely correlated to violence. This study identified the effect of several predictors correlated to violence in patients with SMD using a regularization regression model. Findings open the door to better identify the profiles of patients that may be more susceptible to perpetrate violent behaviors.
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17
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Cheng N, Guo M, Yan F, Guo Z, Meng J, Ning K, Zhang Y, Duan Z, Han Y, Wang C. Application of machine learning in predicting aggressive behaviors from hospitalized patients with schizophrenia. Front Psychiatry 2023; 14:1016586. [PMID: 37020730 PMCID: PMC10067917 DOI: 10.3389/fpsyt.2023.1016586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/01/2023] [Indexed: 04/07/2023] Open
Abstract
Objective To establish a predictive model of aggressive behaviors from hospitalized patients with schizophrenia through applying multiple machine learning algorithms, to provide a reference for accurately predicting and preventing of the occurrence of aggressive behaviors. Methods The cluster sampling method was used to select patients with schizophrenia who were hospitalized in our hospital from July 2019 to August 2021 as the survey objects, and they were divided into an aggressive behavior group (611 cases) and a non-aggressive behavior group (1,426 cases) according to whether they experienced obvious aggressive behaviors during hospitalization. Self-administered General Condition Questionnaire, Insight and Treatment Attitude Questionnaire (ITAQ), Family APGAR (Adaptation, Partnership, Growth, Affection, Resolve) Questionnaire (APGAR), Social Support Rating Scale Questionnaire (SSRS) and Family Burden Scale of Disease Questionnaire (FBS) were used for the survey. The Multi-layer Perceptron, Lasso, Support Vector Machine and Random Forest algorithms were used to build a predictive model for the occurrence of aggressive behaviors from hospitalized patients with schizophrenia and to evaluate its predictive effect. Nomogram was used to build a clinical application tool. Results The area under the receiver operating characteristic curve (AUC) values of the Multi-Layer Perceptron, Lasso, Support Vector Machine, and Random Forest were 0.904 (95% CI: 0.877-0.926), 0.901 (95% CI: 0.874-0.923), 0.902 (95% CI: 0.876-0.924), and 0.955 (95% CI: 0.935-0.970), where the AUCs of the Random Forest and the remaining three models were statistically different (p < 0.0001), and the remaining three models were not statistically different in pair comparisons (p > 0.5). Conclusion Machine learning models can fairly predict aggressive behaviors in hospitalized patients with schizophrenia, among which Random Forest has the best predictive effect and has some value in clinical application.
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Affiliation(s)
- Nuo Cheng
- Department of Clinical Medicine, Zhengzhou University, Zhengzhou, Henan, China
| | - Meihao Guo
- Department of Infection Prevention and Control, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Fang Yan
- Department of Infection Prevention and Control, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Zhengjun Guo
- Henan Mental Disease Prevention and Control Center, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Jun Meng
- Editorial Department of Journal of Clinical Psychosomatic Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Kui Ning
- Department of Medical Administration, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Yanping Zhang
- Department of Medicine, Zhengzhou University, Zhengzhou, Henan, China
| | - Zitian Duan
- The Seventh Psychiatric Department, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Yong Han
- Henan Key Laboratory of Biological Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
- *Correspondence: Han Yong,
| | - Changhong Wang
- Department of Clinical Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
- Wang Changhong,
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18
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Sorkhou M, Johnstone S, Kivlichan AE, Castle DJ, George TP. Does cannabis use predict aggressive or violent behavior in psychiatric populations? A systematic review. Am J Drug Alcohol Abuse 2022; 48:631-643. [PMID: 36137273 DOI: 10.1080/00952990.2022.2118060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Despite an increase in information evaluating the therapeutic and adverse effects of cannabinoids, many potentially important clinical correlates, including violence or aggression, have not been adequately investigated.Objectives: In this systematic review, we examine the published evidence for the relationship between cannabis and aggression or violence in individuals with psychiatric disorders.Methods: Following PRISMA guidelines, articles in English were searched on PubMed, Google Scholar, MEDLINE, and PsycINFO from database inception to January 2022. Data for aggression and violence in people with psychiatric diagnoses were identified during the searches.Results: Of 391 papers identified within the initial search, 15 studies met inclusion criteria. Cross-sectional associations between cannabis use and aggression or violence in samples with post-traumatic stress disorder (PTSD) were found. Moreover, a longitudinal association between cannabis use and violence and aggression was observed in psychotic-spectrum disorders. However, the presence of uncontrolled confounding factors in the majority of included studies precludes any causal conclusions.Conclusion: Although cannabis use is associated with aggression or violence in individuals with PTSD or psychotic-spectrum disorders, causal conclusions cannot be drawn due to methodological limitations observed in the current literature. Well-controlled, longitudinal studies are needed to ascertain whether cannabis plays a causal role on subsequent violence or aggression in mental health disorders.
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Affiliation(s)
- Maryam Sorkhou
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada.,Institute of Medical Sciences (IMS) and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Samantha Johnstone
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada
| | | | - David J Castle
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada.,Institute of Medical Sciences (IMS) and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tony P George
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada.,Institute of Medical Sciences (IMS) and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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19
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Bell C, Tesli N, Gurholt TP, Rokicki J, Hjell G, Fischer-Vieler T, Melle I, Agartz I, Andreassen OA, Ringen PA, Rasmussen K, Dahl H, Friestad C, Haukvik UK. Psychopathy subdomains in violent offenders with and without a psychotic disorder. Nord J Psychiatry 2022; 77:393-402. [PMID: 36260740 DOI: 10.1080/08039488.2022.2128869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Violence in psychosis has been linked to antisocial behavior and psychopathy traits. Psychopathy comprises aspects of interpersonal, affective, lifestyle, and antisocial traits which may be differently involved in violent offending by persons with psychotic disorders. We explored psychopathy subdomains among violent offenders with and without a psychotic disorder. METHODS 46 males, with a history of severe violence, with (n = 26; age 35.85 ± 10.34 years) or without (n = 20; age 39.10 ± 11.63 years) a diagnosis of a psychotic disorder, were assessed with the Psychopathy Checklist-Revised (PCL-R). PCL-R was split into subdomains following the four-facet model. Group differences in total and subdomain scores were analyzed with a general linear model with covariates. RESULTS Total PCL-R scores did not differ between the groups (p = 0.61, Cohen's d = 0.17). The violent offenders without psychotic disorders had higher facet 2 scores than the patient group with psychotic disorders (p = 0.029, Cohen's d = 0.77). Facet 1, 3, or 4 scores did not differ between the groups. Controlling for age did not alter the results. CONCLUSION Patients with a psychotic disorder and a history of severe violence have lower affective psychopathy scores than violent offenders without psychotic disorders. This observation may point toward distinct underlying mechanisms for violence and may provide a target for focused treatment and prevention.
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Affiliation(s)
- Christina Bell
- Department of Psychiatry, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Natalia Tesli
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Tiril P Gurholt
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jaroslav Rokicki
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Gabriela Hjell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry, Østfold Hospital Trust, Graalum, Norway
| | - Thomas Fischer-Vieler
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Vestre Viken Hospital Trust, Division of Mental health and Addiction, Drammen Hospital, Drammen, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Petter Andreas Ringen
- Department of Psychiatry, Oslo University Hospital, Oslo, Norway.,Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kirsten Rasmussen
- St.Olavs Hospital, Centre for Research and Education in Forensic Psychiatry, Trondheim, Norway.,Department of Psychology and Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Hilde Dahl
- St.Olavs Hospital, Centre for Research and Education in Forensic Psychiatry, Trondheim, Norway.,Department of Psychology and Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Christine Friestad
- Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,University College of Norwegian Correctional Service, Oslo, Norway
| | - Unn K Haukvik
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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20
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Rosenfield PJ, Jiang D, Pauselli L. Childhood adversity and psychotic disorders: Epidemiological evidence, theoretical models and clinical considerations. Schizophr Res 2022; 247:55-66. [PMID: 34210561 DOI: 10.1016/j.schres.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/08/2023]
Abstract
While genetic factors play a critical role in the risk for schizophrenia and other psychotic disorders, increasing evidence points to the role of childhood adversity as one of several environmental factors that can significantly impact the development, manifestations and outcome of these disorders. This paper reviews the epidemiological evidence linking childhood adversity and psychotic disorders and explores various theoretical models that seek to explain the connection. We discuss neurobiological parallels between the impact of childhood trauma and psychosis on the brain and then explore the impact of childhood adversity on different domains of clinical presentation. Finally, implications for prevention and treatment are considered, both on individual and structural levels.
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Affiliation(s)
- Paul J Rosenfield
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - David Jiang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
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21
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Ben-gal Dahan A, Koren D. Basic learning functions among young adults coping with schizophrenia. International Journal of Mental Health 2022. [DOI: 10.1080/00207411.2022.2108988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
| | - Dan Koren
- Department of Psychology, University of Haifa, Haifa, Israel
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22
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Kashiwagi H, Matsumoto J, Miura K, Takeda K, Yamada Y, Fujimoto M, Yasuda Y, Yamamori H, Ikeda M, Hirabayashi N, Hashimoto R. Neurocognitive features, personality traits, and social function in patients with schizophrenia with a history of violence. J Psychiatr Res 2022; 147:50-58. [PMID: 35021134 DOI: 10.1016/j.jpsychires.2022.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
Recent literature examining associations between cognitive function, clinical features, and violence in patients with schizophrenia has been growing; however, the results are inconsistent. Reports on social function and personality are limited. These studies are yet to be reflected in risk assessment tools and management plans. The aim of this study is to provide a resource for risk assessment and intervention studies by conducting multifaceted well-established assessments in a large population. Data from 355 patients with schizophrenia (112 patients with a history of violence; 243 patients without a history of violence) and 1265 healthy subjects were extracted from a large database of individuals with mental disorders in a general psychiatric population in Japan. The associations between violence in patients with schizophrenia and intellectual function, cognitive function (memory function, executive function, attentional function, verbal learning, processing speed, social cognition), clinical variables, personality traits, social function, and quality of life (QOL) were analyzed. Compared with healthy subjects, the schizophrenia group had broadly impaired cognitive function and social cognition, and their personality traits showed similar differences as those reported previously. Patients with schizophrenia with a history of violence showed significantly more impaired visual memory function (P = 1.9 × 10-5, Cohen's d = 0.34), longer hospitalization (P = 5.9 × 10-4, Cohen's d = 0.38), more severe excited factor on Positive and Negative Syndrome Scale (P = 1.6 × 10-4, Cohen's d = 0.47), higher self-transcendence personality construct on the Temperament and Character Inventory (P = 1.8 × 10-4, Cohen's d = 0.46), and shorter total working hours per week (P = 4.8 × 10-4, Cohen's d = 0.53) than those with schizophrenia without a history of violence. New findings, including impaired visual memory, a high self-transcendence personality trait, and shorter total working hours, could be focused on in future interventional research.
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Affiliation(s)
- Hiroko Kashiwagi
- Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Koji Takeda
- Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Yuji Yamada
- Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Michiko Fujimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Medical Corporation Foster, Osaka, 531-0075, Japan
| | - Hidenaga Yamamori
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan; Japan Community Healthcare Organization Osaka Hospital, Osaka, 553-0003, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan
| | - Naotsugu Hirabayashi
- Department of Forensic Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, 187-8551, Japan.
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Long Y, Tong X, Awad M, Xi S, Yu Y. Violence, runaway, and suicide attempts among people living with schizophrenia in China: Prevalence and correlates. PeerJ 2022; 10:e13033. [PMID: 35251789 PMCID: PMC8896021 DOI: 10.7717/peerj.13033] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND People living with schizophrenia are at higher risk of disruptive behaviors, including violence, running away from home, and suicide attempts, which often co-occur and are highly correlated, yet seldom studied together. The current study investigated the frequency and correlates of disruptive behaviors among a Chinese community sample of individuals living with schizophrenia. METHODS A cross-sectional study was conducted among 400 individuals living with schizophrenia from 12 communities. Data about disruptive behaviors in the past 2 months was collected using self-designed questionnaires. Clinical characteristics including psychiatric symptoms, depression, anxiety, disability, and functioning were collected by internationally standardized assessment instruments. RESULTS About one-fifth (21%) of the subjects had experienced at least one form of disruptive behavior in the past 2 months. Violence was the most commonly reported (17.25%), which included damaging property (15%) and physical violence toward others (7.5%); followed by running away (6.5%), and suicide attempts (4%). Logistic regression analysis suggested that medication non-adherence (OR = 4.96, 95% CI [1.79-13.72]), involuntary hospital admission (OR = 5.35, 95% CI [2.06-13.87]), depression (OR = 2.34, 95% CI [1.07-5.10]), and lower social functioning (OR = 0.97, 95% CI [0.93-0.99]) were independently associated with a higher risk of disruptive behaviors. CONCLUSIONS The overlap among three forms of disruptive behaviors warrants them to be assessed and studied together in clinical, research, and policy fields. The significant association between disruptive behaviors with medication non-adherence, involuntary admission, depression, and lower social functioning indicates the need for integrated, targeted, and needs-based intervention programs to be developed for the prevention and treatment of these disruptive behaviors.
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Affiliation(s)
- Yixiang Long
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoliang Tong
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Michael Awad
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Shijun Xi
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yu Yu
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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Balcioglu YH, Kirlioglu Balcioglu SS, Oncu F, Turkcan A, Yorulmaz AC. Impulsive and aggressive traits and increased peripheral inflammatory status as psychobiological substrates of homicide behavior in schizophrenia. The European Journal of Psychiatry 2022. [DOI: 10.1016/j.ejpsy.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Huang ZH, Wang F, Chen ZL, Xiao YN, Wang QW, Wang SB, He XY, Migliorini C, Harvey C, Hou CL. Risk factors for violent behaviors in patients with schizophrenia: 2-year follow-up study in primary mental health care in China. Front Psychiatry 2022; 13:947987. [PMID: 36741582 PMCID: PMC9895824 DOI: 10.3389/fpsyt.2022.947987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The consequences and impact of violent behavior in schizophrenia are often serious, and identification of risk factors is of great importance to achieve early identification and effective management. METHODS This follow-up study sampled adult patients with schizophrenia in primary mental health care in a rural area of southern China, in which 491 participants completed a comprehensive questionnaire at baseline and the 2-year follow-up. Sociodemographic, clinical and psychological assessment data were collected from all participants. Paired sample T-Tests and the McNemar Test were performed to examine changes over the follow-up period. Generalized Estimating Equations (GEE) were used to analyze the risk factors for violent behavior. RESULTS The results showed that about two in five community-dwelling patients with schizophrenia reported violent behavior in the past year. At follow-up, participants were significantly less employed, had more times of hospitalization, more psychotropic medication, and severer depressive symptoms, but had better health-related quality of life than at baseline. Use of clozapine and better insight into medication decreased the possibility of violent behavior, while more severe positive symptoms, insomnia, as well as use of second-generation antipsychotics other than clozapine, antidepressants and mood stabilizers increased the possibility of violent behavior. CONCLUSIONS Risk evaluation, prevention and management of violence in patients with schizophrenia are demanded in primary mental health care.
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Affiliation(s)
- Zhuo-Hui Huang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Fei Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Zi-Lang Chen
- Luoding Mental Health Center, Yunfu, Guangdong, China
| | - Yao-Nan Xiao
- Luoding Mental Health Center, Yunfu, Guangdong, China
| | - Qian-Wen Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Xiao-Yan He
- Liuzhou Worker's Hospital, Liuzhou, Guangxi, China
| | - Christine Migliorini
- Psychosocial Research Center, University of Melbourne, Melbourne, VIC, Australia.,North Western Mental Health, Melbourne, VIC, Australia
| | - Carol Harvey
- Psychosocial Research Center, University of Melbourne, Melbourne, VIC, Australia.,North Western Mental Health, Melbourne, VIC, Australia
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
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Yi Y, Huang Y, Chen Q, Yang H, Li H, Feng Y, Feng S, Zhou S, Li Z, Wu F. Violence, neurocognitive function and clinical correlates in patients with schizophrenia. Front Psychiatry 2022; 13:1087372. [PMID: 36741559 PMCID: PMC9893505 DOI: 10.3389/fpsyt.2022.1087372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
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.
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Affiliation(s)
- Yun Yi
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Yuanyuan Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Chen
- Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Hanlun Yang
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hehua Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yangdong Feng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shixuan Feng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sumiao Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
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Moulin V, Framorando D, Gasser J, Dan-Glauser E. The Link Between Cannabis Use and Violent Behavior in the Early Phase of Psychosis: The Potential Role of Impulsivity. Front Psychiatry 2022; 13:746287. [PMID: 35392388 PMCID: PMC8980530 DOI: 10.3389/fpsyt.2022.746287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Valerie Moulin
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - David Framorando
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Jacques Gasser
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Elise Dan-Glauser
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
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Hindley G, Bahrami S, Steen NE, O'Connell KS, Frei O, Shadrin A, Bettella F, Rødevand L, Fan CC, Dale AM, Djurovic S, Smeland OB, Andreassen OA. Characterising the shared genetic determinants of bipolar disorder, schizophrenia and risk-taking. Transl Psychiatry 2021; 11:466. [PMID: 34497263 DOI: 10.1038/s41398-021-01576-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/19/2021] [Accepted: 08/18/2021] [Indexed: 02/08/2023] Open
Abstract
Increased risk-taking is a central component of bipolar disorder (BIP) and is implicated in schizophrenia (SCZ). Risky behaviours, including smoking and alcohol use, are overrepresented in both disorders and associated with poor health outcomes. Positive genetic correlations are reported but an improved understanding of the shared genetic architecture between risk phenotypes and psychiatric disorders may provide insights into underlying neurobiological mechanisms. We aimed to characterise the genetic overlap between risk phenotypes and SCZ, and BIP by estimating the total number of shared variants using the bivariate causal mixture model and identifying shared genomic loci using the conjunctional false discovery rate method. Summary statistics from genome wide association studies of SCZ, BIP, risk-taking and risky behaviours were acquired (n = 82,315-466,751). Genomic loci were functionally annotated using FUMA. Of 8.6-8.7 K variants predicted to influence BIP, 6.6 K and 7.4 K were predicted to influence risk-taking and risky behaviours, respectively. Similarly, of 10.2-10.3 K variants influencing SCZ, 9.6 and 8.8 K were predicted to influence risk-taking and risky behaviours, respectively. We identified 192 loci jointly associated with SCZ and risk phenotypes and 206 associated with BIP and risk phenotypes, of which 68 were common to both risk-taking and risky behaviours and 124 were novel to SCZ or BIP. Functional annotation implicated differential expression in multiple cortical and sub-cortical regions. In conclusion, we report extensive polygenic overlap between risk phenotypes and BIP and SCZ, identify specific loci contributing to this shared risk and highlight biologically plausible mechanisms that may underlie risk-taking in severe psychiatric disorders.
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Vaskinn A, Engelstad KN, Torgalsbøen AK, Rund BR. Childhood trauma, social cognition and schizophrenia: Specific association between physical neglect and cognitive theory of mind in homicide offenders. Psychiatry Res 2021; 303:114093. [PMID: 34247060 DOI: 10.1016/j.psychres.2021.114093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/19/2022]
Abstract
Schizophrenia is associated with a small, but increased risk of violent behavior, including homicide. Violent individuals with schizophrenia have elevated rates of childhood trauma and substantial social cognitive impairments. The aim of this study was to examine if childhood trauma is related to social cognition in homicide offenders with schizophrenia. We recruited 26 individuals with schizophrenia sentenced to compulsory mental care for homicide/attempted homicide and 28 non-violent schizophrenia controls. They filled out the Childhood Trauma Questionnaire (CTQ), providing scores for physical abuse, sexual abuse, emotional abuse, physical neglect and emotional neglect. Social cognition was assessed with two measures of emotion processing (Emotion in Biological Motion, Pictures of Facial Affect) and two theory of mind (ToM) tests (Hinting Task, Movie for the Assessment of Social Cognition: MASC). Spearman's rho correlation coefficients were computed, and significant results followed up with partial correlation analyses controlling for IQ. Three associations were statistically significant, all in the homicide group; between CTQ physical neglect and cognitive ToM assessed with Hinting Task and with MASC, and between CTQ emotional neglect and Hinting Task. Only the first remained significant after controlling for IQ, indicating a specific association between physical neglect and cognitive ToM in homicide offenders with schizophrenia.
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Affiliation(s)
- Anja Vaskinn
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | | | | | - Bjørn Rishovd Rund
- Research Department, Vestre Viken Hospital Trust, Drammen, Norway; Department of Psychology, University of Oslo, Oslo, Norway
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Grover S, Shouan A, Chakrabarti S, Sahoo S, Mehra A. Comparative study of effectiveness of augmentation with ECT in clozapine resistant schizophrenia (CRS) and non-clozapine resistant schizophrenia (Non-CRS). Nord J Psychiatry 2021; 75:397-405. [PMID: 33630681 DOI: 10.1080/08039488.2021.1877349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is limited evidence for different treatment strategies in patients with clozapine resistant schizophrenia (CRS). AIM To determine the effectiveness of ECT in patients with clozapine resistant schizophrenia and compare the same with a group of patients with non-clozapine resistant schizophrenia, receiving ECT. RESULTS Out of a total of 68 patients with schizophrenia, 27 (38.66%) of patients had CRS. With 6 ECTs, there was a significant reduction in PANSS positive, negative, general psychopathology, prosocial score and depression symptoms in the CRS (p < 0.001) and Non-CRS group (p < 0.001), but no statistically significant difference was seen between the 2 groups in terms of proportion of patients showing >40% response on PANSS total score. The reduction in PANSS score of >40% in CRS group was seen in 48.1% of patients in the positive symptoms subscale, in 25.9% of patients in negative symptoms subscale, in 46.7% of cases in the general psychopathology subscale, in 44.4% of the patients in Depression subscale, in 29.6% of the patients in the modified prosocialsubscaleand in 29.6% of the patients in total PANSS score. CONCLUSION ECT is an effective augmentation strategy for patients with CRS and it is as effective as when used in patients with non-CRS.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Shouan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sun L, Han X, Wang K, Xu C, Song Z, Zhang J, Cao D, Tan L, Chen F, Wu S, He L, Wan C. Candidate symptomatic markers for predicting violence in schizophrenia: A cross-sectional study of 7711 patients in a Chinese population. Asian J Psychiatr 2021; 59:102645. [PMID: 33845298 DOI: 10.1016/j.ajp.2021.102645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Violent behaviour is an alarming problem among schizophrenia patients. The effects of historical, clinical, and pathological risk factors for violence have been investigated by multiple studies, but consensus has not been achieved. As psychotic symptoms are more direct and intuitive indicators for violence, identifying robustly associated symptoms is a crucial part of the future prediction and precise management of violent patients in clinics. This study aims to identify the psychotic symptoms correlated with violence among schizophrenia patients in a Chinese population. METHODS In this cross-sectional study, the medical records of 7711 schizophrenia patients (4711 in the discovery set and 3000 in the validation set) were collected from 1998 to 2010. Their psychotic symptoms were extracted, and the patients were divided into violent and non-violent groups. Multivariate logistic analysis was applied to identify symptoms associated with violence in the discovery set. RESULTS Eight psychotic symptoms were found to be significantly correlated with violence in schizophrenia. "Destruction of property", "verbal aggression" and "insomnia" increased the risk of violence, while "flat affect", "delusion of persecution", "auditory hallucination", "vagueness of thought" and "poverty of thought" decreased the risk of violence. The regression model was evaluated by receiver operating characteristic (ROC) analysis for its discriminatory performance, achieving area under curve (AUC) values of 0.887 in the discovery sample set and 0.824 in the validation sample set. CONCLUSIONS The correlated symptoms identified by this study can serve as future candidate predictors for violence in schizophrenia, paving the way for precise management of schizophrenia patients in clinics.
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Abstract
Emotional and behavioral dysregulation are common in severe mental illnesses, including schizophrenia, bipolar disorder, and borderline personality disorder. Emotional instability and behavioral outbursts can be driven by internal processes and/or environmental triggers and interpersonal interactions. Understanding the underlying diagnosis is important in determining the best course of treatment. Disorder-specific treatments are important in addressing underlying drivers of emotional dysregulation, irritability, and aggression. Coping skills training and behavioral modification strategies have broad applicability and are useful for aggression and irritability. Treatment planning to address emotion dysregulation and aggression in severe mental illness should address psychiatric comorbidities, substance use, and medication adherence.
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Affiliation(s)
- Aditi Sharma
- Department of Psychiatry and Behavioral Sciences, University of Washington, 4800 Sand Point WAY Northeast, MS OA.5.154, Seattle, WA 98105, USA
| | - Jon McClellan
- Department of Psychiatry and Behavioral Sciences, University of Washington, 8805 Steilacoom Boulevard Southwest, Lakewood, WA 98498, USA.
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Andersson HW, Lilleeng SE, Ruud T, Ose SO. Substance use among patients in specialized mental health services in Norway: prevalence and patient characteristics based on a national census. Nord J Psychiatry 2021; 75:160-169. [PMID: 32945698 DOI: 10.1080/08039488.2020.1817553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to investigate the clinical and demographic variation in the prevalence of substance use among the general psychiatric population in Norway. METHODS A national census in psychiatric institutions and outpatient clinics was conducted. Data were returned for 2358 inpatients (response rate, 65%) and 23,167 outpatients (response rate, 60%). Substance use was measured based on substance use disorder diagnosis or reported substance use in the last 4 weeks (alcohol 2-4 days a week or more frequently/illicit drug use). Regression analyses controlling for demographic and sociodemographic characteristics were carried out. RESULTS Substance use was identified in 32.4% of inpatients and 13.9% of outpatients. The most frequently reported substances used were alcohol, sedatives and cannabis. Among inpatients, the prevalence of substance use was highest in patients with schizophrenia, personality disorders and anxiety disorders. Among outpatients, the prevalence was highest in patients with schizophrenia and other psychoses. Inpatients with anxiety disorders and outpatients with schizophrenia and other psychoses had a significantly higher risk of substance use than other patients. In both samples, the prevalence of substance use was higher among males, 24 to 29-year-olds and the most socially deprived. CONCLUSIONS This study provides further knowledge about patients at risk for co-morbid substance abuse and poor treatment outcomes. Clinicians may consider targeting patients with schizophrenia and other psychoses, young males and those who are socially deprived in efforts to prevent emerging substance abuse and improve outcomes.
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Affiliation(s)
- Helle Wessel Andersson
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Solfrid E Lilleeng
- Department of Analysis and Performance Assessment, The Norwegian Directorate of Health, Trondheim, Norway
| | - Torleif Ruud
- Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hirjak D, Meyer-Lindenberg A, Brandt GA, Dreßing H. [Differential diagnostic distinction between substance-induced and primary psychoses: : Recommendations for general psychiatric and forensic practice]. Nervenarzt 2021; 93:11-23. [PMID: 33656571 PMCID: PMC8763934 DOI: 10.1007/s00115-021-01083-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
Substanzinduzierte psychotische Störungen (SIPS) sind häufig und für ca. 25 % der ersten Einweisungen in eine psychiatrische Klinik verantwortlich. Aus klinischer Sicht ist aufgrund ähnlicher psychopathologischer Phänomene die diagnostische Unterscheidung zwischen SIPS und primären (genuinen oder kryptogenen) psychotischen Störungen oft eine Herausforderung. Dieser Umstand wird dadurch erschwert, dass SIPS im Zusammenhang mit Cannabis, Halluzinogenen und Amphetaminen ein erhebliches Risiko des Übergangs in eine primäre psychotische Störung (z. B. Schizophrenie) haben. Im ersten Abschnitt dieser Arbeit werden zunächst zwei exemplarische Fallvignetten aus der allgemeinpsychiatrischen und forensischen Praxis vorgestellt. Danach wird im Sinne einer selektiven Literaturübersicht die Relevanz der differenzialdiagnostischen Unterscheidung beider Störungsbilder aus der Sicht der allgemeinen und forensischen Psychiatrie in Bezug auf Therapie, Prognose und richterliche Entscheidung bezüglich der Unterbringung im Maßregelvollzug (§ 63 vs. § 64 StGB) beleuchtet. Der letzte Abschnitt hat das Ziel, ein strukturiertes Vorgehen zur differenzialdiagnostischen Unterscheidung zwischen SIPS und primären psychotischen Störungen zu erarbeiten. Die in dieser Arbeit dargestellten und diskutierten Konzepte und Befunde sollen klinisch tätigen Psychiatern und Psychologen die Diagnosestellung im allgemeinen und forensischen Kontext erleichtern.
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Affiliation(s)
- Dusan Hirjak
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland.
| | - Andreas Meyer-Lindenberg
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| | - Geva A Brandt
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
| | - Harald Dreßing
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, 68159, Mannheim, Deutschland
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Camus D, Dan Glauser ES, Gholamrezaee M, Gasser J, Moulin V. Factors associated with repetitive violent behavior of psychiatric inpatients. Psychiatry Res 2021; 296:113643. [PMID: 33352415 DOI: 10.1016/j.psychres.2020.113643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 12/10/2020] [Indexed: 11/27/2022]
Abstract
A small number of psychiatric inpatients displays a large proportion of Violent Behaviors (VB). These can have a major impact on both victims and patients themselves. This study explored personal, situational and institutional risk factors and their combined effects, which could lead to repetitive VB (three or more assaults). Data from 4518 patients, aged 18 to 65, admitted to an acute psychiatric care facility, were included in the analysis. VB, defined as physical aggressions against another person, were assessed by the Staff Observation Aggression Scale-Revised. 414 VB were reported during the study period, involving 199 patients. 0.75 % of all patients were repetitively violent and committed 43% of all VB. Factors that were linked to repetitive VB were living in sheltered housing before hospitalization, suffering from schizophrenia with substance abuse comorbidity, cumulating hospitalization days and some situational factors, like the fact of being in nursing offices and pharmacies. When all personal, situational and institutional factors were considered together, the combined effects of length of stay and living in sheltered housing increased the risk of repetitive VB. We have identified a small group of vulnerable patients for whom new modalities of inter-institutional networking should be developed to prevent repetitive VB.
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Affiliation(s)
- Didier Camus
- Department of Psychiatry, Site de Cery, 1008 Prilly, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Elise S Dan Glauser
- Unit for Research in legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of psychiatry, Lausanne University Hospital (CHUV), Site de Cery, Bat. Les Cèdres, 1008 Prilly, Lausanne, Switzerland
| | - Mehdi Gholamrezaee
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Site de Cery, 1008 Prilly, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Jacques Gasser
- Unit for Research in legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of psychiatry, Lausanne University Hospital (CHUV), Site de Cery, Bat. Les Cèdres, 1008 Prilly, Lausanne, Switzerland.
| | - Valerie Moulin
- Unit for Research in legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of psychiatry, Lausanne University Hospital (CHUV), Site de Cery, Bat. Les Cèdres, 1008 Prilly, Lausanne, Switzerland.
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Moreno-Calvete MC, Ballesteros-Rodriguez FJ. Non-pharmacological strategies for self-directed and interpersonal violence in people with severe mental illness: a rapid overview of systematic reviews. BMJ Open 2021; 11:e043576. [PMID: 33431494 PMCID: PMC7802727 DOI: 10.1136/bmjopen-2020-043576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Self-directed and interpersonal violence among people with severe mental illness has become a health priority. Though non-pharmacological interventions have been investigated, to our knowledge, no summary of all systematic reviews on this topic has been reported. We will conduct a rapid overview of reviews to synthesise evidence available by identifying systematic reviews on non-pharmacological interventions for self-directed or interpersonal violence in people with severe mental illness. METHODS AND ANALYSIS This is a protocol for a rapid overview of reviews. The overview will include any systematic reviews (with or without meta-analyses) of randomised controlled trials (RCTs) or cluster RCTs that examine the effect of non-pharmacological interventions on self-directed or interpersonal violence in people with severe mental illness. This protocol applies the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols, the criteria for conducting overviews of reviews in the Cochrane Handbook of Systematic Reviews of Interventions and the criteria for the Cochrane Rapid Reviews. To identify studies, a search will be performed in the following databases: PubMed, EMBASE, PsycINFO, CINAHL, LILACS, SciELO, Web of Science, Scopus, ProQuest, the Cochrane Database of Systematic Reviews through the Cochrane Library and the Epistemonikos database of systematic reviews. The searches date from inception to September 2020. The study selection process will be described using a PRISMA flow diagram, we will assess the quality of evidence in systematic reviews included and the quality of the systematic reviews themselves and the main results will be summarised in categories to provide a map of the evidence available. ETHICS AND DISSEMINATION No patients or other participants will be involved in this study. The results will be presented at mental health conferences and for publication in a peer-reviewed journal. REGISTRATION DETAILS The protocol was registered on the Open Science Framework (https://osf.io/myzd9/).
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Affiliation(s)
| | - Francisco Javier Ballesteros-Rodriguez
- Department of Neuroscience, Biocruces Bizkaia Health Research Institute, CIBER Salud Mental (CIBERSAM), University of the Basque Country UPV/EHU, Leioa, Biscay, Spain
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Caruso R, Antenora F, Riba M, Belvederi Murri M, Biancosino B, Zerbinati L, Grassi L. Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience. Curr Psychiatry Rep 2021; 23:29. [PMID: 33825996 PMCID: PMC8026454 DOI: 10.1007/s11920-021-01233-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW We summarized peer-reviewed literature on aggressive episodes perpetrated by adult patients admitted to general hospital units, especially psychiatry or emergency services. We examined the main factors associated with aggressive behaviors in the hospital setting, with a special focus on the European experience. RECENT FINDINGS A number of variables, including individual, historical, and contextual variables, are significant risk factors for aggression among hospitalized people. Drug abuse can be considered a trans-dimensional variable which deserves particular attention. Although mental health disorders represent a significant component in the risk of aggression, there are many factors including drug abuse, past history of physically aggressive behavior, childhood abuse, social and cultural patterns, relational factors, and contextual variables that can increase the risk of overt aggressive behavior in the general hospital. This review highlights the need to undertake initiatives aimed to enhance understanding, prevention, and management of violence in general hospital settings across Europe.
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Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy. .,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
| | - Fabio Antenora
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Michelle Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI USA ,University of Michigan Comprehensive Depression Center, Ann Arbor, MI USA ,Psycho-oncology Program, University of Michigan Rogel Cancer Center, Ann Arbor, MI USA ,Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester, Leicester, UK
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy ,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
| | | | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy ,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
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38
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Moreno-Calvete MC, Ruiz-Ibañez I, Uriarte-Uriarte JJ. Scoping review protocol on non-pharmacological interventions for interpersonal and self-directed violence in adults with severe mental illness. BMJ Open 2020; 10:e037006. [PMID: 32928853 PMCID: PMC7488835 DOI: 10.1136/bmjopen-2020-037006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Violence committed by people with mental illness has implications for mental health policy and clinical practice. Several strategies to reduce the risk of aggressive and violent behaviour have been proposed, and these include non-pharmacological interventions. There is, however, a need to identify which of these interventions are effective, and as a first step, we will conduct a scoping review to identify non-pharmacological interventions for self-directed or interpersonal violence in adults with severe mental illness across different conditions and settings. METHODS AND ANALYSIS This is a scoping review protocol. The review will include any randomised controlled trials (RCTs) and cluster RCTs that assess the efficacy of interventions on self-directed or interpersonal violence with no restrictions on the control treatment in people with severe mental illness in any setting. No restrictions will be applied in terms of language or date of publication. To identify studies, a search will be performed in the following databases: Embase, MEDLINE (via PubMed), PsycINFO, CINAHL, LILACS, SciELO, Cochrane Library, Web of Science, Scopus, ProQuest, Epistemonikos and databases of clinical trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement will be followed for reporting the findings, including the use of a PRISMA flow diagram. A standardised form will be used to extract data from studies. The findings will be classified using conceptual categories that will be specified in detail and a descriptive summary of the main results will be created. Moreover, it will be assessed whether the studies identified have been included in systematic reviews or meta-analyses and the results will be used to generate a conceptual map. ETHICS AND DISSEMINATION No patients or other participants will be involved in this study. We will prepare a manuscript for publication in a peer-reviewed journal and the results will be presented at mental health conferences.
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Affiliation(s)
| | - Ivan Ruiz-Ibañez
- Basque Health Service, Bizkaia Mental Health Network, Assertive Community Treatment (ACT) Team, Buenavista Health Centre, Portugalete, Biscay, Spain
| | - Jose Juan Uriarte-Uriarte
- Biocruces Bizkaia Health Research Institute, Basque Health Service, Bizkaia Mental Health Network, Bilbao, Biscay, Spain
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Abstract
BACKGROUND Although evidence from psychosis patients demonstrates the adverse effects of cannabis use (CU) at a young age and that the rate of CU is high in subgroups of young violent patients with psychotic disorders, little is known about the possible effect of the age of onset of CU on later violent behaviors (VB). So, we aimed to explore the impact of age at onset of CU on the risk of displaying VB in a cohort of early psychosis patients. METHOD Data were collected prospectively over a 36-month period in the context of an early psychosis cohort study. A total of 265 patients, aged 18-35 years, were included in the study. Logistic regression was performed to assess the link between age of onset of substance use and VB. RESULTS Among the 265 patients, 72 had displayed VB and 193 had not. While violent patients began using cannabis on average at age 15.29 (0.45), nonviolent patients had started on average at age 16.97 (0.35) (p = 0.004). Early-onset CU (up to age 15) was a risk factor for VB (odds ratio = 4.47, confidence interval [CI]: 1.13-20.06) when the model was adjusted for age group, other types of substance use, being a user or a nonuser and various violence risk factors and covariates. History of violence and early CU (until 15) were the two main risk factors for VB. CONCLUSIONS Our results suggest that early-onset CU may play a role in the emergence of VB in early psychosis.
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Affiliation(s)
- Valerie Moulin
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Department of Psychiatry, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain.,Instituto de Investigacion Sanitaria de Sevilla, IBiS, Sevilla, Spain
| | - David Framorando
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philipp-S Baumann
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mehdi Gholam
- Department of Psychiatry, Center for Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jacques Gasser
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Kim-Q Do Cuenod
- Department of Psychiatry, Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Conus
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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40
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Gulati G, Kelly BD. Domestic violence against women and the COVID-19 pandemic: What is the role of psychiatry? Int J Law Psychiatry 2020; 71:101594. [PMID: 32768101 PMCID: PMC7264022 DOI: 10.1016/j.ijlp.2020.101594] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 05/21/2023]
Abstract
A heightened risk of domestic violence has been associated with infection-reducing measures undertaken by governments during the COVID-19 pandemic. Psychiatric services can play a key role in addressing this issue by (a) addressing certain risk factors for perpetration of domestic violence through, for example, assertive identification and management of substance misuse; (b) providing support, advocacy and treatment services for victims of domestic violence; and (c) multi-agency working to strengthen medical and social responses to domestic violence. At a time like this, it is important that multi-disciplinary mental health services are strengthened, rather than depleted, in order to address the pressing issues at hand.
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Affiliation(s)
- Gautam Gulati
- School of Medicine, University of Limerick, Limerick, Ireland.
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24 D24 NR0A, Ireland
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41
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Wang QW, Hou CL, Wang SB, Huang ZH, Huang YH, Zhang JJ, Jia FJ. Frequency and correlates of violence against patients with schizophrenia living in rural China. BMC Psychiatry 2020; 20:286. [PMID: 32505208 PMCID: PMC7275550 DOI: 10.1186/s12888-020-02696-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/27/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Violence against patients with schizophrenia is very common, however it is rarely studied in China, especially in primary health care institutions of rural areas. Therefore, we investigated the frequency of violence against patients with community-living schizophrenia in rural China and examined its associated factors and impact on quality of life (QoL) and social function. METHOD A survey was conducted among 487 patients with schizophrenia living in rural communities. Data about violent victimization experiences in the past 6 months, demographic information, and clinical characteristics were collected by questionnaires. RESULTS We found that 92 (18.9%) of 487 subjects experienced at least one type of violent event in the past 6 months. Logistic regression analysis suggested that a history of conducting dangerous behaviors(OR = 1.702, P = 0.02, 95%CI: 1.05-2.73), higher Brief Psychiatric Rating Scale (anxiety domain) score (OR = 1.15, P = 0.02, 95%CI: 1.01-1.304) and lower hospitalization rates (OR = 0.89, P = 0.04, 95%CI: 0.81-0.99) were significantly associated with violent victimization in patients with schizophrenia. Analysis of covariance showed the victims of violence tended to have worse social function in patients with schizophrenia living in rural communities of China (P = 0.04). CONCLUSIONS Individuals with schizophrenia living in rural China had a high risk of being exposed to violence and violent victimization of patients with schizophrenia had adverse consequences for social function. More attention is needed for those patients experiencing violent events, because they are simultaneously possible to conduct dangerous behaviors.
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Affiliation(s)
- Qian-Wen Wang
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province China ,Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, Guangdong Province China
| | - Cai-Lan Hou
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, Guangdong Province, China.
| | - Shi-Bin Wang
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, Guangdong Province China
| | - Zhuo-Hui Huang
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, Guangdong Province China
| | - Ying-Hua Huang
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, Guangdong Province China
| | - Ji-Jie Zhang
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province China ,Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, Guangdong Province China
| | - Fu-Jun Jia
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, Guangdong Province, China.
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Bègue C, Bouthier M, Mahé V. Rôle de l’usage de substances psycho-actives dans la commission d’infractions pénales par les sujets atteints de schizophrénie. L'Évolution Psychiatrique 2020; 85:217-28. [DOI: 10.1016/j.evopsy.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nitschke J, Sünkel Z, Mokros A. [The forensic preventive outpatient clinic in Ansbach : Evaluation of the model project for treatment of psychiatric risk patients]. Nervenarzt 2020; 91:439-445. [PMID: 31278464 DOI: 10.1007/s00115-019-0752-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Patients suffering from severe mental disorders and who have an increased risk of violent behavior, tend to be insufficiently cared for until committing a violent offense leads to compulsory placement in a forensic psychiatric clinic. OBJECTIVE The concept of the preventive outpatient clinic has been recently published in this journal. The aim of the study was to evaluate whether treatment in the outpatient clinic is preventive with respect to violence and whether there is a positive therapeutic outcome. METHOD The study design was quasi-experimental and longitudinal. The control group consisted of comparable patients from an adjacent healthcare catchment area. Measurements were taken on admission (t0) and after 6 and 12 months of treatment (t1 and t2, respectively). Dynamic risk factors, i.e. subscales C and R of the history clinical risk-20 version 2 (HCR-20 V2) scale and global assessment of functioning (GAF) scale were used as indicators of treatment success, involving both clinician ratings and self-reports. Multiple imputed data for 70 subjects in the experimental group and 51 in the control group were analyzed by mixed effects models with group as a fixed effect. RESULTS The interaction effect between time and group was statistically significant for the R (risk management) subscale and the GFA values but not for the C (clinical risk) value (after Bonferroni correction), whereby controls were made for multiple testing. CONCLUSION The hypothesis with respect to the efficacy of the treatment could be maintained regarding risk markers and global assessment of functioning. With respect to clinical parameters there was a positive tendency in the expected direction. The data therefore indicate a positive effect of the preventive outpatient clinic for the patients treated.
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Affiliation(s)
- Joachim Nitschke
- Klinik für Forensische Psychiatrie, Bezirksklinikum Ansbach, Feuchtwanger Straße 38, 91522, Ansbach, Deutschland.
| | - Zara Sünkel
- Klinik für Forensische Psychiatrie, Bezirksklinikum Ansbach, Feuchtwanger Straße 38, 91522, Ansbach, Deutschland
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Thornicroft G. People with severe mental illness as the perpetrators and victims of violence: time for a new public health approach. Lancet Public Health 2020; 5:e72-e73. [PMID: 32032557 DOI: 10.1016/s2468-2667(20)30002-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
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45
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Abstract
Background: The longitudinal course of schizophrenia shows a high level of heterogeneity with testosterone as a possible factor in the variety of clinical outcomes.Aim: Evaluation of the course of schizophrenia in male patients over an eight-year period and of the possible testosterone effects on changes in clinical features.Subjects and methods: The initial study population consisted of 120 male schizophrenic patients (aged 18-40) hospitalized in the University Psychiatric Hospital Vrapce in 2009. Patients were classified into nonaggressive (control, n = 60) and aggressive (n = 60) groups. In 2017, we reassessed 85 patients (67,5%) from the initial sample. Symptoms of schizophrenia were determined using the Positive and Negative Syndrome Scale (PANSS) and compared with the total serum testosterone level taken at the inclusion in the study. The distribution of values for individual variables was determined using the Smirnov-Kolmogorov test; for all further analyses, the appropriate non-parametric test was used.Results: The control group showed a statistically significant negative correlation between testosterone and negative PANSS. The initial PANSS scores, compared to those at the follow-up, showed a statistically significant reduction in positive and general symptoms in all groups, with the greatest reduction in the control group.Conclusion: We found a reduction in positive and general symptoms of schizophrenia among all patients and no changes in negative symptoms. Inverse correlation between testosterone and negative symptoms was found only in the control group, but there was no testosterone influence on the progression of any PANSS subscales.
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Affiliation(s)
| | | | - Nikola Žaja
- University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Miroslav Herceg
- University Psychiatric Hospital Vrapče, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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46
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Fritz M, Shenar R, Cardenas-Morales L, Jäger M, Streb J, Dudeck M, Franke I. Aggressive and Disruptive Behavior Among Psychiatric Patients With Major Depressive Disorder, Schizophrenia, or Alcohol Dependency and the Effect of Depression and Self-Esteem on Aggression. Front Psychiatry 2020; 11:599828. [PMID: 33343427 PMCID: PMC7744284 DOI: 10.3389/fpsyt.2020.599828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022] Open
Abstract
Aggressive and disruptive behavior in inpatient settings poses a serious challenge for clinical staff and fellow patients. Hence, the aim of this study was to identify different aspects of aggressive and disruptive behavior in the context of an aberrant self-esteem or clinically manifested depression as potentially influencing factors. We collected self-reported data from 282 psychiatric patients [ICD-10 diagnoses for alcohol dependency, schizophrenia or major depressive disorder (MDD)] and compared it to healthy norm groups. As expected, all three patient groups scored higher in the aggression questionnaires than the norm group. Specifically, patients with MDD exhibited significantly higher externally directed aggression, reactive aggression, and irritability compared to controls. Patients with schizophrenia displayed higher irritability, while all three groups showed distinctly higher self-aggressiveness than healthy persons. We found a lower inhibition of aggression in alcohol dependent subjects compared to both the patient groups and the norm sample. Yet, the higher the self-esteem among alcohol dependent and MDD patients, the lower were their aggression scores; similarly, a lower self-esteem among patients diagnosed with schizophrenia resulted in heighten self-aggressiveness. Thus, our data suggests that therapeutic interventions for strengthening self-esteem in patients with a diagnosis of MDD, alcohol dependency or schizophrenia could reduce certain aspects of aggressive behavior. Therefore, it seems conceivable that strengthening self-esteem in psychiatric patients could contribute to the prevention of violence in clinical practice.
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Affiliation(s)
- Michael Fritz
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Riad Shenar
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | | | - Markus Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, District Hospital Kempten, Kempten, Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Irina Franke
- Department of Forensic Psychiatry, Psychiatric Services Graubuenden, Cazis, Switzerland
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de Girolamo G, Carrà G, Fangerau H, Ferrari C, Gosek P, Heitzman J, Salize H, Walker M, Wancata J, Picchioni M. European violence risk and mental disorders (EU-VIORMED): a multi-centre prospective cohort study protocol. BMC Psychiatry 2019; 19:410. [PMID: 31856767 PMCID: PMC6924026 DOI: 10.1186/s12888-019-2379-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The link between schizophrenia spectrum disorders (SSD) and violence is a core issue for most forensic psychiatric services. However, the drivers of violence in this population remain unclear, and, to date tools to predict violence risk have a range of limitations. Perhaps because of this uncertainty about the nature of violence risk, treatment programmes and care pathways for mentally disordered offenders vary substantially across the European Union, and differences in legal and policy frameworks are highly relevant. METHODS The three-year EU-VIORMED project (Grant Number PP-2-3-2016, November 2017-October 2020) involves forensic centres in Italy, Austria, Germany, Poland, and the U.K. It aims to: (a) identify and compare violence risk factors, clinical needs, and decision making capacity in violent (N = 200, "cases") and nonviolent patients with SSD (N = 200; "controls") using a case-control design; (b) test the predictive validity of the HCR-20v3, OxMIS and FoVOx among cases alone (N = 200), using a prospective cohort study; and (c) compare forensic-psychiatric care pathways across the EU, in a continent wide service mapping study. DISCUSSION Data collection started in September 2018 and continues. By September 2019, 333 participants have been enrolled (201 cases and 132 controls were recruited). Experts from 23 countries provided data for the service mapping exercise. TRIAL REGISTRATION Retrospectively registered on January 2, 2019 as researchregistry4604 January 2, 2019.
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Affiliation(s)
- Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca (I), Milan, Italy
| | - Heiner Fangerau
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Pawel Gosek
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Janusz Heitzman
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Hans Salize
- Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | | | - Johannes Wancata
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Marco Picchioni
- Consultant Forensic Psychiatrist, St Magnus Hospital, Surrey, UK
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Engelstad KN, Rund BR, Lau B, Vaskinn A, Torgalsbøen AK. Increased prevalence of psychopathy and childhood trauma in homicide offenders with schizophrenia compared to nonviolent individuals with schizophrenia. Nord J Psychiatry 2019; 73:501-508. [PMID: 31443617 DOI: 10.1080/08039488.2019.1656777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Purpose: Schizophrenia is associated with an increased homicide risk. Personality pathology, particularly antisocial personality disorder and psychopathic traits, has been associated with increased violence risk in schizophrenia. Childhood trauma, more specifically physical abuse, has been associated with violence risk in healthy populations and in individuals with mental illness. It is, however, unclear how childhood trauma relates to homicide in schizophrenia. This is, to our knowledge, the first study to concurrently examine personality pathology and childhood trauma in a group consisting solely of homicide offenders with schizophrenia (HOS). HOS is compared to nonviolent participants with the same diagnosis (non-HOS). Additionally, currently assessed demographical and clinical characteristics of a Norwegian sample of HOS are reported. Materials and methods: Two groups of participants with schizophrenia were recruited in collaboration with in and outpatient clinics across Norway, HOS (n= 26) and non-HOS (n= 28). Assessments of personality pathology and childhood trauma were conducted, and information about clinical and demographical characteristics was registered. Results: HOS participants had significantly higher psychopathy scores, and more frequently reported moderate to severe childhood physical abuse than non-HOS participants. When simultaneously added to a logistic regression model, only psychopathy uniquely contributed to explaining group membership. Conclusions: Psychopathy and physical abuse was more prevalent among HOS participants compared to non-HOS, but only psychopathy independently predicted homicidal status. These results confirm the importance of including an evaluation of psychopathic traits in violence risk assessments of individuals with schizophrenia.
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Affiliation(s)
| | - Bjørn Rishovd Rund
- Research Department, Vestre Viken Hospital Trust , Drammen , Norway.,Department of Psychology, University of Oslo , Oslo , Norway
| | - Bjørn Lau
- Department of Psychology, University of Oslo , Oslo , Norway.,Department of Research, Lovisenberg Hospital , Oslo , Norway
| | - Anja Vaskinn
- Norwegian Centre for Mental Disorders Research (NORMENT), Oslo University Hospital , Oslo , Norway.,Institute of Clinical Medicine, University of Oslo , Oslo , Norway
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49
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Abstract
Background: Understanding the etiology of violence in patients with schizophrenia is an issue of great clinical and public importance. Although personality traits are an important aspect in determining complex behaviors of schizophrenia patients, there is a lack of research on the relationship between personality traits and violence, especially homicidal behavior, in this population. Aim: We aimed to compare temperament and character dimensions between homicidal and other mostly violent forensic patients with schizophrenia, and to determine which temperament and character dimensions are associated with homicidal behavior in these patients. Methods: We recruited 71 male forensic schizophrenia patients without concomitant substance dependence and antisocial personality disorder. The patients were divided into two groups according to trial documentation as: (1) Homicide and attempted homicide group (N 30; 42%), and (2) Other offenses group (N 41; 58%). Patients were assessed by means of the Temperament and Character Inventory and the Positive and Negative Syndrome Scale. Differences between groups were tested with t-test. Results: The two groups of patients were similar in their PANSS scores, but the homicidal men were significantly more likely to show higher harm avoidance (HA) scores than the less violent comparison men (t = 2,876, df-69, p = 0.005). Conclusions: Our results indicate that forensic schizophrenic patients with higher HA scores would show a greater risk of homicidal violence. Improved understanding of personality traits associated with such behavior is needed in order to prevent homicidal behavior. Importance of these results suggests that further study is needed.
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Affiliation(s)
- Branimir Margetić
- a Department of Forensic Psychiatry, Neuropsychiatric hospital "Dr. Ivan Barbot" , Popovača , Croatia
| | - Branka Aukst Margetić
- b Department of Psychiatry, University Hospital Centre , Sestre Milosrdnice , Zagreb
| | - Dragutin Ivanec
- c Department of Psychology, Faculty of Humanities and Social Sciences , Zagreb , Croatia
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Chan B, Shehtman M. Clinical risk factors of acute severe or fatal violence among forensic mental health patients. Psychiatry Res 2019; 275:20-26. [PMID: 30878852 DOI: 10.1016/j.psychres.2019.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 02/15/2019] [Accepted: 03/04/2019] [Indexed: 01/21/2023]
Abstract
Existing violence risk assessment studies of mental health patients focus mostly on the association of historical presence of clinical risk factors and long-term violence, with little emphasis on the short-term temporal proximity between clinically relevant risk factors and the occurrence of violent behaviors. This research examined the proximal clinical risk factors (within days to a week prior) of acute severe or fatal violence among a group of forensic patients with serious mental illness (N = 287) found Not Criminally Responsible for offenses that involved violence against person(s), based on file review. Command hallucinations (OR = 2.35, 95% CI = 1.05 - 5.24), Threat/control-override symptoms (OR = 3.10, 95% CI = 1.51 - 6.35) and Capgras syndrome (OR = 3.58, 95% CI = 1.06 - 12.15) were identified as independent significant risk factors associated with acute severe or fatal violence. First degree relatives and intimate partners were significantly associated with being a victim of acute severe or fatal violence. Gender, recent alcohol use and recent drug use were not significantly associated with acute severe or fatal violence. Clinical utilities of the results and future directions for research are discussed.
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Affiliation(s)
- Billy Chan
- Forensic Brief Assessment Unit, Centre for Addiction and Mental Health, 1001 Queen Street West, Unit 1-1, Toronto, Ontario M6J 1H4, Canada.
| | - Maria Shehtman
- Forensic Brief Assessment Unit, Centre for Addiction and Mental Health, 1001 Queen Street West, Unit 1-1, Toronto, Ontario M6J 1H4, Canada
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