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Youn S, Guadagno BL, Byrne LK, Watson AE, Murrihy S, Cotton SM. Systematic Review and Meta-analysis: Rates of Violence During First-Episode Psychosis (FEP). Schizophr Bull 2024; 50:757-770. [PMID: 38412435 PMCID: PMC11283196 DOI: 10.1093/schbul/sbae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Most people with psychotic disorders will never commit an act of violence. However, the risk of violence committed by people with schizophrenia is higher than the general population. Violence risk is also known to be highest during the first episode of psychosis compared to later stages of illness. Despite this, there have been no comprehensive reviews conducted in the past 10 years examining rates of violence during FEP. We aimed to provide an updated review of the rate of violence in people with FEP. STUDY DESIGN Meta-analytical techniques were used to identify pooled proportions of violence according to severity (less serious, serious, severe) and timing of violence (before presentation, at first presentation, after presentation to services). STUDY RESULTS Twenty-two studies were included. The pooled prevalence was 13.4% (95% CI [9.0%-19.5%]) for any violence, 16.3% (95% CI [9.1%-27.4%]) for less serious violence, 9.7% (95% CI [5.4%-17.0%]) for serious violence and 2.7% for severe violence, regardless of time point. The pooled prevalence of any violence was 11.6% (95% CI [6.8%-18.9%]) before presentation, 20.8% (95% CI [9.8%-38.7%]) at first presentation and 13.3% (95% CI [7.3%-23.0%]) after presentation to services. CONCLUSION Overall, rates of violence appear to be lower in more recent years. However, due to the high between-study heterogeneity related to study design, the findings must be interpreted with consideration of sample characteristics and other contextual factors. The prevalence of violence remained high at all-time points, suggesting that more targeted, holistic, and early interventions are needed for clinical FEP groups.
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Affiliation(s)
- Sarah Youn
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Belinda L Guadagno
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Linda K Byrne
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
- Faculty of Psychology, Counselling and Psychotherapy, The Cairnmillar Institute, 391-393 Tooroonga Road, Hawthorn East, Victoria 3123, Australia
| | - Amity E Watson
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
| | - Sean Murrihy
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Melbourne, Victoria 3010, Australia
| | - Sue M Cotton
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
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Faden J, Citrome L. A systematic review of clozapine for aggression and violence in patients with schizophrenia or schizoaffective disorder. Schizophr Res 2024; 268:265-281. [PMID: 38290941 DOI: 10.1016/j.schres.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/26/2023] [Accepted: 11/19/2023] [Indexed: 02/01/2024]
Abstract
Although uncommon, the risk of aggression and violence is greater in people with schizophrenia than in the general population. Clozapine is the "gold standard" pharmacologic treatment for the management of persistent agitation and aggression in people with schizophrenia and is consistently recommended by guidelines and reviews for this purpose. Although clozapine is indicated for treatment-resistant schizophrenia based on its superior efficacy, studies have proposed that clozapine may have specific properties that ameliorate aggression and hostility that are distinct from its antipsychotic effects. A literature review was conducted on June 3, 2023, using the US National Library of Medicine's PubMed resource to identify articles focusing on clozapine for the treatment of aggression, violence, and/or hostility in patients with schizophrenia or schizoaffective disorder. The majority of evidence, including from randomized control trials, supports the utilization of clozapine as maintenance treatment for persistent aggressive behavior in patients with schizophrenia, and supports that its anti-aggressive effects may be independent from its antipsychotic properties (e.g. - treatment of hallucinations and delusions). Future randomized control studies evaluating clozapine and clozapine serum levels with aggression as the primary outcome would be of benefit.
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Affiliation(s)
- Justin Faden
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America.
| | - Leslie Citrome
- New York Medical College, Valhalla, NY, United States of America
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Hazell CM, Hasapopoulos S, McGowan J, Hamza R, Ahmed Z, Gaughan B, Malillos MH, Gill A, Nomani A, Hickson E, Koruni A, Islam F, Souray J, Raune D. The Role of Verbal Auditory Hallucinations in Influencing and Retrospectively Predicting Physical Harm Prevalence in Early Psychosis. Clin Pract Epidemiol Ment Health 2024; 20:e17450179286452. [PMID: 39130189 PMCID: PMC11311800 DOI: 10.2174/0117450179286452240520070533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 08/13/2024]
Abstract
Background Research has established a relationship between psychosis and physical harm in the early course of psychosis. However, little is known about the relationship between specific psychosis symptoms, such as hearing voices, and physical harm. Objective This study aimed to determine the prevalence and typology of physical harm related to hearing voices, as well as what aspects of the voice-hearing experience retrospectively predicted incidents of harm within an Early Intervention in Psychosis Service (EIPS). Methods We conducted a quality improvement project in a single EIPS. We reviewed case notes of patients and extracted information on the cognitive-phenomenological features of the voices patients heard, as well as any incidents of physical harm that were causally linked to these voices. Results It was found that 32.2% of EI patients had an actual incident of physical harm in their case notes that was causally linked to hearing voices. The most common type of physical harm was neglect. In terms of cognitive phenomenological binary correlations that retrospectively predicted physical harm in the case notes, patients were 20 and 7 times more likely to have harmed themselves if they heard self-harm commands (i.e., directions to harm themselves physically) and perceived the voice as omnipotent, respectively. Patients were 6 times more likely to have harmed someone else if they heard violent commands. Conclusion Verbal auditory hallucinations commonly influence physical harm in the early course of psychosis. Hearing commands and/or believing the voice to be omnipotent are strong retrospective-correlative predictors that may aid in the assessment and therapeutic intervention.
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Affiliation(s)
- Cassie M. Hazell
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, GU2 7XH, UK
| | - Sophia Hasapopoulos
- Division of Psychology and Language Sciences, University College London, London, UK
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Jennifer McGowan
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Roman Hamza
- Division of Psychology and Language Sciences, University College London, London, UK
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Zareena Ahmed
- Division of Psychology and Language Sciences, University College London, London, UK
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Ben Gaughan
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | | | - Amber Gill
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Amber Nomani
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Emily Hickson
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Anjeza Koruni
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Faaisa Islam
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Jonathan Souray
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - David Raune
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
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Whiting D, Glogowska M, Fazel S, Lennox B. Approaches and challenges to assessing risk of violence in first episode psychosis: A qualitative interview study of clinicians, patients and carers. Early Interv Psychiatry 2024. [PMID: 38356414 DOI: 10.1111/eip.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/06/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
AIM Clinical services for early psychosis seek to improve prognosis for a range of adverse outcomes. For some individuals, perpetration of violence is an important potential outcome to reduce. How these clinical services currently assess this risk however is uncertain. This study aimed to address this gap by using qualitative methods to examine in depth current approaches, attitudes and challenges to assessing violence risk in this clinical setting, from the perspectives of multidisciplinary clinicians, patients and carers. METHODS Participants were recruited from two UK Early Intervention in Psychosis services. Semi-structured individual interviews were undertaken using a topic guide. In addition, clinical vignettes were presented to clinician participants as a probe to prompt discussion. Data were analysed using thematic analysis, informed by the constant comparative method. RESULTS We conducted 30 qualitative interviews, of 18 clinicians and 12 patients and carers. Themes developed from clinician interviews included key difficulties of low confidence, limited training, accessing collateral information and variation in how risk is appraised and communicated. Potential stigma and sensitivity of the topic of violence were perceived as barriers to its discussion. Patient and carer perspectives provided insight into how to address barriers, and highlighted the importance of an open approach, including with families. CONCLUSIONS We recommend developing contextually appropriate pathways to collaboratively assess violence risk and identify modifiable needs to reduce this risk, and for practical improvements in training and information-sharing.
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Affiliation(s)
- Daniel Whiting
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Margaret Glogowska
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Webster KD, Gunter TD, Vohs JL, Breier A. Early phase psychosis and criminal conviction in United States adults. Early Interv Psychiatry 2023. [PMID: 38030574 DOI: 10.1111/eip.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/12/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
AIM Individuals experiencing early phase psychosis (EPP) are at increased risk for legal involvement. In prior studies, between 14% and 75% of individuals with EPP reported a history of criminal offending behaviour, criminal charges, or criminal convictions. To better understand the frequency of criminal conviction in a specialty treatment clinic serving EPP clients, the research team supplemented self-reported data from the clinic intake with information from publicly available databases. METHODS In this sample of 309 adults, approximately one quarter of patients (n = 76) self-reported a history of arrest, incarceration, probation, or parole within 6 months of enrolment in a treatment clinic. The research team expanded upon this and collected data from a public database of court proceedings in Indiana for all clinic participants before and after enrolment. RESULTS Thirty-nine percent (n = 122) had three or more traffic tickets or a conviction for an ordinance violation, misdemeanour, or felony in the state of Indiana as an adult. This is over two times the national average. Drug and alcohol related convictions were the most common single conviction type, and 29% (n = 89) of subjects experienced at least one incarceration. CONCLUSIONS These data highlight the need for specialty clinics to partner with professionals with expertise in the prevention and management of criminal behaviour. Future studies should examine risk factors for individuals experiencing EPP and criminal conviction.
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Affiliation(s)
- Kyle D Webster
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tracy D Gunter
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jenifer L Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alan Breier
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Mentxaka O, Recio-Barbero M, Arana-Arri E, Segarra R. Violence in first-episode psychosis: evidence from an early intervention in psychosis programme. BJPsych Open 2023; 9:e172. [PMID: 37724609 PMCID: PMC10594161 DOI: 10.1192/bjo.2023.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Psychotic disorders are frequently associated with a public perception of dangerousness and belligerence. This situation has contributed to the social stigmatisation of people with severe mental illness and the resulting discrimination that this scenario entails. Despite efforts to demystify such disorders, the association between violent behaviour and psychosis remains unclear. AIMS To explore the incidence of the main types of violent offences in a cohort of patients presenting with first-episode psychosis (FEP). METHOD Participants were recruited from the First Episode Psychosis Intervention Program (CRUPEP) cohort between 2009 and 2016. The main clinical variables were collected, including medical-forensic records of participants registered at the Basque Institute of Forensic Medicine (BIFM), to identify any violent acts in which participants were involved, either as victims or as offenders. RESULTS Overall, 79.5% (n = 182) of the participants had no record of violent crime or offence recorded in the BIFM. Annual crime rates for the 2009-2016 period show a decreasing trend in both the general population (IRR = 0.981, 95% CI 0.978-0.983, P < 0.001) and in the FEP group (IRR = 0.019, 95% CI 0.012-0.028, P < 0.001); this pattern is more pronounced in the FEP group. Victimisation accounted for the vast majority of reported incidents; nevertheless, participants who had committed violent offences were mostly involved in intrafamily violence. CONCLUSIONS Individuals with FEP were not involved in a higher number of crimes than the general population. The types of violent acts committed by people with FEP were heterogeneous, with extreme violence being particularly uncommon.
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Affiliation(s)
- Oihane Mentxaka
- Department of Psychiatry, Cruces University Hospital, Barakaldo, Spain; Early Stages of Psychosis Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; and Department of Neurosciences, University of the Basque Country UPV/EHU, Leioa, Spain
| | - María Recio-Barbero
- Early Stages of Psychosis Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; and Department of Neurosciences, University of the Basque Country UPV/EHU, Leioa, Spain
| | | | - Rafael Segarra
- Department of Psychiatry, Cruces University Hospital, Barakaldo, Spain; Early Stages of Psychosis Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; Department of Neurosciences, University of the Basque Country UPV/EHU, Leioa, Spain; and Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM, Institute of Health Carlos III, Madrid, Spain
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Gill G, Jaka S, Yadav G, Kainth T, Segal Y, Srinivas S, Shah K, Kochhar H, Gunturu S. Examining Risk Factors for Suicidality in Adolescents and Adults Experiencing Their First Episode of Psychosis. Cureus 2023; 15:e43135. [PMID: 37622053 PMCID: PMC10445773 DOI: 10.7759/cureus.43135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
This narrative review aimed to identify the risk factors associated with suicidality in adolescents and adults with first-episode psychosis. The review included studies that examined various factors such as psychiatric, familial, and social factors, as well as previous self-harm, suicidal ideation, and comorbid mental health disorders. A comprehensive literature search was conducted across three publicly available databases (Embase, American Psychological Association PsycINFO, and PubMed) using specific search terms related to first-episode psychosis, suicide, self-harm, and children/adolescents and adults. The inclusion criteria included original articles focusing on prospective and retrospective cohort trials, with substantial data on first-episode psychosis and self-harm, measuring both suicidal intent and outcome. Non-original studies, case reports, case series, non-English-language publications, and studies examining violence and self-harm related to substance-induced psychosis were excluded. After manual screening and removing duplicate articles, 13 articles met the established criteria for inclusion in this review. Included studies adhered to similar inclusion and exclusion criteria, had long-term follow-up, and assessed outcomes at least twice. The findings suggest that depressive symptoms, substance use disorders, previous self-harm or suicidal ideation, and longer duration of untreated psychosis are associated with an increased risk of suicidality. However, insights into psychosis and premorbid intellectual functioning did not show a direct association with suicidality.
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Affiliation(s)
- Gurtej Gill
- Psychiatry, BronxCare Health System, Bronx, USA
| | - Sanobar Jaka
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Garima Yadav
- Research, Basaveshwara Medical College and Hospital, Chitradurga, IND
| | - Tejasvi Kainth
- Language Access and Internal Medicine, Winnipeg Regional Health Authority, Winnipeg, CAN
| | | | - Sushma Srinivas
- Psychiatry, A.J. Institute of Medical Sciences and Research Centre, Mangalore, IND
| | - Kaushal Shah
- Psychiatry, Griffin Memorial Hospital, Norman, USA
| | - Hansini Kochhar
- Clinical and Translational Research, Larkin Community Hospital, Miami, USA
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Whiting D, Mallett S, Lennox B, Fazel S. Assessing violence risk in first-episode psychosis: external validation, updating and net benefit of a prediction tool (OxMIV). BMJ MENTAL HEALTH 2023; 26:e300634. [PMID: 37316256 PMCID: PMC10335427 DOI: 10.1136/bmjment-2022-300634] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Violence perpetration is a key outcome to prevent for an important subgroup of individuals presenting to mental health services, including early intervention in psychosis (EIP) services. Needs and risks are typically assessed without structured methods, which could facilitate consistency and accuracy. Prediction tools, such as OxMIV (Oxford Mental Illness and Violence tool), could provide a structured risk stratification approach, but require external validation in clinical settings. OBJECTIVES We aimed to validate and update OxMIV in first-episode psychosis and consider its benefit as a complement to clinical assessment. METHODS A retrospective cohort of individuals assessed in two UK EIP services was included. Electronic health records were used to extract predictors and risk judgements made by assessing clinicians. Outcome data involved police and healthcare records for violence perpetration in the 12 months post-assessment. FINDINGS Of 1145 individuals presenting to EIP services, 131 (11%) perpetrated violence during the 12 month follow-up. OxMIV showed good discrimination (area under the curve 0.75, 95% CI 0.71 to 0.80). Calibration-in-the-large was also good after updating the model constant. Using a 10% cut-off, sensitivity was 71% (95% CI 63% to 80%), specificity 66% (63% to 69%), positive predictive value 22% (19% to 24%) and negative predictive value 95% (93% to 96%). In contrast, clinical judgement sensitivity was 40% and specificity 89%. Decision curve analysis showed net benefit of OxMIV over comparison approaches. CONCLUSIONS OxMIV performed well in this real-world validation, with improved sensitivity compared with unstructured assessments. CLINICAL IMPLICATIONS Structured tools to assess violence risk, such as OxMIV, have potential in first-episode psychosis to support a stratified approach to allocating non-harmful interventions to individuals who may benefit from the largest absolute risk reduction.
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Affiliation(s)
- Daniel Whiting
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London, London, UK
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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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] [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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Yee N, Chemjong P, Korobanova D, Scade S, Large M, Nielssen O, Carr V, Dean K. The full spectrum of clinical stages of psychosis among mentally ill prisoners in New South Wales (NSW), Australia. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2022; 30:600-617. [PMID: 37744649 PMCID: PMC10512751 DOI: 10.1080/13218719.2022.2073284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Research on the association between psychosis and criminal offending has typically focused on violent offenders with chronic psychotic illness. This stages of psychosis in prison (SOPP) study used a clinical staging approach to identify adult men referred to prison mental health services who had an at-risk mental state (ARMS), first episode of psychosis (FEP) or an established psychotic illness. Of the 105 participants included, 6% were determined to have FEP, 6% met ARMS criteria and the remainder had an established psychotic illness. Compared to a prison control sample, individuals on the psychosis spectrum were found to have higher levels of social disadvantage and other co-occurring mental health and substance use problems but were not more likely to have committed a violent offence. These findings support the notion that risk of criminal justice contact and complex illness burden exist across the full spectrum of psychotic illness.
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Affiliation(s)
- Natalia Yee
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Prabin Chemjong
- Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Daria Korobanova
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Suki Scade
- Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Matthew Large
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Olav Nielssen
- Faculty of Medicine and Health Sciences, University of Macquarie, Sydney, Australia
| | - Vaughan Carr
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Justice Health and Forensic Mental Health Network, Sydney, Australia
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11
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Kaltiala R, Holttinen T, Ellonen N. Sex offending among adolescents and young men with history of psychiatric inpatient care in adolescence. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2022; 32:87-99. [PMID: 35419915 PMCID: PMC9325519 DOI: 10.1002/cbm.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Some mental disorders have been associated with increased likelihood of sexual offending in adolescents (and adults), but relevant studies tend to be of established sex offenders. AIMS To examine relationships between adolescent mental disorders and subsequent involvement in sex offending and to explore any predictive value of primary diagnoses for subsequent interpersonal offending, whether sexual or violent. METHODS We analyse national register-based longitudinal data on males in Finland admitted for their first psychiatric inpatient treatment between the ages of 13-17 in the period 1980-2010 (N = 6749). Cox regression was used for the analysis of multivariate associations. RESULTS A subsequent criminal record for sex crime in the 10-year follow up was rare among former child and adolescent psychiatric (CAP) inpatient males (1.5%). Having a subsequent criminal record for non-sex-related violent crime was more common (25%). Time to either sex crimes or non-sex-related violent crimes after a first CAP inpatient treatment was 3-4 years. Whilst the risk of committing non-sex-related violent crimes was elevated in all diagnostic groups compared to those with schizophrenia spectrum disorders, the risk of committing subsequent sex crimes was elevated only in the group with substance use, conduct or personality disorders. Among those with pre-existing criminal history of sex crime, the risk of a subsequent criminal record for sex crime after CAP treatment was increased 11-fold, but the risk for later non-sex-related violent crimes was not increased compared to the rest of the male adolescent CAP population. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE In this first longitudinal study of criminal convictions for sex offending after a period of inpatient psychiatric treatment as an adolescent such convictions were rare, but the difference in post discharge risk of further convictions for sexual offending and non-sexual violent offending raises questions about whether more attention and specific treatment for aberrant sexual behaviours is needed for male adolescents with severe mental disorders.
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Affiliation(s)
| | - Timo Holttinen
- Tampere UniversityFaculty of Medicine and Health TechnologyTampereFinland
- Department of Adolescent PsychiatryTampere University HospitalTampereFinland
| | - Noora Ellonen
- Tampere University, Faculty of Social ScienceTampereFinland
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Micciolo R, Bianconi G, Canal L, Clerici M, Ferla MT, Giugni C, Iozzino L, Sbravati G, Tura GB, Vita A, Zagarese L, de Girolamo G. Young age and the risk of violent behaviour in people with severe mental disorders: prospective, multicentre study. BJPsych Open 2021. [PMCID: PMC8693905 DOI: 10.1192/bjo.2021.1047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background During adolescence and young adulthood people appear to be more prone to violent behaviour. A greater tendency to violent behaviour appears to be associated with hyperactivity, impulsivity and low tolerance for frustration and provocation in social settings. Aims This prospective cohort study aimed to evaluate rates of violent behaviour among young people with mental disorders, compared with older age groups. Method A total of 340 individuals with severe mental disorders (125 living in residential facilities and 215 out-patients) were evaluated at baseline with the SCID-I and II, Brief Psychiatric Rating Scale, Specific Level of Functioning scale, Brown–Goodwin Lifetime History of Aggression scale, Buss–Durkee Hostility Inventory, Barratt Impulsiveness Scale and State–Trait Anger Expression Inventory-2. Aggressive behaviour was rated every 15 days with the Modified Overt Aggression Scale (MOAS). Results The sample comprised 28 individuals aged 18–29 years, 202 aged 30–49 and 110 aged 50 and over. Younger age was associated with a personality disorder diagnosis, substance use disorder, being single and employed. These results were confirmed even controlling for the gender effect. The patterns of the cumulative MOAS mean scores showed that younger (18–29 years old) individuals were significantly more aggressive than older (≥50) ones (P < 0.001). Conclusions This study highlights how young age in people with severe mental disorders is correlated with higher levels of impulsivity, anger and hostility, confirming previous analyses. Our results may assist clinicians in implementing early interventions to improve anger and impulsivity control to reduce the risk of future aggressive behaviours.
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Affiliation(s)
- Margo D M Faay
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Faay); Department of Biomedical Sciences of Cells and Systems and Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands (Sommer)
| | - Iris E Sommer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Faay); Department of Biomedical Sciences of Cells and Systems and Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands (Sommer)
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Belshaw J. Locked up or locked out: Time to reverse the social neglect of young people with forensic mental health issues. Early Interv Psychiatry 2020; 14:249-251. [PMID: 32419368 DOI: 10.1111/eip.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- James Belshaw
- Orygen and Forensicare (Victorian Institute of Forensic Mental Health, VIFMH), Parkville, Victoria, Australia
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