151
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Scocco P, Macis A, Ferrari C, Bava M, Bianconi G, Bulgari V, Candini V, Carrà G, Cavalera C, Clerici M, Conte G, Cricelli M, Teresa Ferla M, Iozzino L, Stefana A, de Girolamo G. Self-harm behaviour and externally-directed aggression In psychiatric outpatients: a multicentre, prospective study (viormed-2 study). Sci Rep 2019; 9:17857. [PMID: 31780679 PMCID: PMC6882905 DOI: 10.1038/s41598-019-53993-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/26/2019] [Indexed: 12/03/2022] Open
Abstract
The aim of the project was to investigate differences between outpatients with Severe Mental Disorders (SMDs) with and without a history of Self-Harm behaviour (SHb) and/or Violent behaviour against other people (Vb) in relation to: (a) socio-demographic and clinical characteristics, (b) violent behaviour during a 1-year FU, (c) predictors of SHb and Vb during the FU. Outpatients with SMDs, with and without a history of Vb were enrolled. They were divided in four groups: patients with lifetime Vb (V), patients with both Vb and SHb (V-SH), patients with only SHb (SH) and patients with no history of SHb and Vb (control group, CONT). The frequency and severity of SHb and Vb during the FU were assessed every two weeks by the MOAS. Overall 246 patients were enrolled. BPRS-E Depression item, the SLOF Social acceptability, the BDHI Indirect Aggression, the BIS Motor Impulsiveness and the STAXI-2 Control-Out showed significant correlations with all the four groups (p < 0.030). V and V-SH patient groups reached higher scores in all MOAS sub-scales. Age among the SH group and BPRS-E affect-anxiety subscale among the V group significantly predicted aggression against people. In people with SMDs a history of SHb or Vb is associated with different medium-term outcomes.
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Affiliation(s)
- Paolo Scocco
- Department of Mental Health, ULSS 6 Euganea, Padova, Italy
| | - Ambra Macis
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Mattia Bava
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | | | - Viola Bulgari
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Valentina Candini
- 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, Monza, Italy.,Division of Psychiatry, University College London, London, UK
| | - Cesare Cavalera
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Department of Mental Health, ASST of Monza, Monza, Italy
| | - Giovanni Conte
- Department of Mental Health, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Marta Cricelli
- Department of Mental Health, Asst-Rhodense G.Salvini of Garbagnate, Milano, Italy
| | - Maria Teresa Ferla
- Department of Mental Health, Asst-Rhodense G.Salvini of Garbagnate, Milano, Italy
| | - Laura Iozzino
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alberto Stefana
- Department of Mental Health, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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152
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Ostinelli EG, Zangani C, Solmi M. Clozapine for persistent aggressive behaviour or agitation in people with schizophrenia. Hippokratia 2019. [DOI: 10.1002/14651858.cd013493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Edoardo G Ostinelli
- Università degli Studi di Milano; Department of Health Sciences; Via Antonio di Rudinì 8 Milan Italy 20142
| | - Caroline Zangani
- Università degli Studi di Milano; Department of Health Sciences; Via Antonio di Rudinì 8 Milan Italy 20142
| | - Marco Solmi
- University of Padua; Neurosciences Department; Padova PAdova Italy 35100
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153
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Keunecke JG, Gall C, Birkholz T, Moritz A, Eiche C, Prottengeier J. Workload and influencing factors in non-emergency medical transfers: a multiple linear regression analysis of a cross-sectional questionnaire study. BMC Health Serv Res 2019; 19:812. [PMID: 31699084 PMCID: PMC6836439 DOI: 10.1186/s12913-019-4638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/14/2019] [Indexed: 11/11/2022] Open
Abstract
Background Human workload is a key factor for system performance, but data on emergency medical services (EMS) are scarce. We investigated paramedics’ workload and the influencing factors for non-emergency medical transfers. These missions make up a major part of EMS activities in Germany and are growing steadily in number. Methods Paramedics rated missions retrospectively through an online questionnaire. We used the NASA-Task Load Index (TLX) to quantify workload and asked about a variety of medical and procedural aspects for each mission. Teamwork was assessed by the Weller teamwork measurement tool (TMT). With a multiple linear regression model, we identified a set of factors leading to relevant increases or decreases in workload. Results A total of 194 non-emergency missions were analysed. Global workload was rated low (Mean = 27/100). In summary, 42.8% of missions were rated with a TLX under 20/100. TLX subscales revealed low task demands but a very positive self-perception of performance (Mean = 15/100). Teamwork gained high ratings (Mean TMT = 5.8/7), and good teamwork led to decreases in workload. Aggression events originating from patients and bystanders occurred frequently (n = 25, 12.9%) and increased workload significantly. Other factors affecting workload were the patient’s body weight and the transfer of patients with transmittable pathogens. Conclusion The workload during non-emergency medical transfers was low to very low, but performance perception was very positive, and no indicators of task underload were found. We identified several factors that led to workload increases. Future measures should attempt to better train paramedics for aggression incidents, to explore the usefulness of further technical aids in the transfer of obese patients and to reconsider standard operating procedures for missions with transmittable pathogens.
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Affiliation(s)
- Johann Georg Keunecke
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Torsten Birkholz
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Andreas Moritz
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Christian Eiche
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
| | - Johannes Prottengeier
- Faculty of Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Anaesthesiology, University Hospital Erlangen, Erlangen, Germany
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154
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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] [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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155
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Lamsma J, Cahn W, Fazel S. Cognition and violent behavior in psychotic disorders: A nationwide case-control study. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100166. [PMID: 31832346 PMCID: PMC6890945 DOI: 10.1016/j.scog.2019.100166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/20/2019] [Accepted: 09/26/2019] [Indexed: 12/02/2022]
Abstract
Background The excess risk of violence in psychotic disorders may partly be explained by impairments in executive functions (EFs) and theory of mind (ToM). However, previous studies have been limited by composite measures of EFs and small samples of inpatients. Methods Data were collected for the research project Genetic Risk and Outcome of Psychosis (GROUP). Patients with psychotic disorders (N = 891) were recruited from various care settings in the Netherlands. The following neuropsychological tests were administered (targeted cognitive function in parentheses): (i) Continuous Performance Test-HQ (inhibition); (ii) Response Shifting Task (cognitive flexibility); (iii) Wechsler Adult Intelligence Scale, Third Edition (WAIS-III) Block Design subtest (fluid intelligence); (iv) Neuropsychological Assessment Battery (NAB) Mazes Test (planning); (v) Degraded Facial Affect Recognition Task (affective ToM); and (vi) Hinting Task (cognitive ToM). Lifetime violence was ascertained from medical records and patient interviews. We used analysis of covariance to compare the mean scores of violent and nonviolent patients on each test, adjusting for age and sex. Results Violent patients performed significantly worse than nonviolent patients on the WAIS-III Block Design subtest (F [1, 847] = 5.12, p = .024), NAB Mazes Test (F [1, 499] = 5.32, p = .022) and Hinting Task (F [1, 839] = 9.38, p = .002). For the other tests, the between-group differences were nonsignificant. Violent behavior explained no more than 1% of the variance in performance on each test. Conclusion Impairments in EFs and ToM are unlikely to provide useful targets for risk assessment and interventions.
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Affiliation(s)
- Jelle Lamsma
- Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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156
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Ostinelli EG, D'Agostino A, Shokraneh F, Salanti G, Furukawa TA. Acute interventions for aggression and agitation in psychosis: study protocol for a systematic review and network meta-analysis. BMJ Open 2019; 9:e032726. [PMID: 31601607 PMCID: PMC6797276 DOI: 10.1136/bmjopen-2019-032726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Individuals with psychosis may access emergency services due to aggression and agitation. When the de-escalation technique fails to achieve tranquillisation, several pharmacological options are available. However, evidence on which intervention to prefer in terms of efficacy and tolerability to achieve resolution of the acute episode (ie, rapid tranquillisation) of aggression and agitation is currently fragmentary. METHODS AND ANALYSIS We will include all randomised controlled trials comparing drugs or drug combinations or placebo for aggression or agitation episodes in adult individuals with psychosis. We will include individuals with psychosis (eg, schizophrenia and related disorders, bipolar disorder with psychotic symptoms, psychotic depression) but not substance or medication-induced psychosis or psychosis due to another medical condition. Our primary outcomes are the change in aggression or agitation scores within few hours since the administration of the intervention (efficacy outcome) and the proportion of participants who dropped out due to adverse effects (tolerability outcome). We will retrieve relevant studies from the register of studies of the Cochrane Schizophrenia Group. Also, we will run additional searches on CENTRAL, Embase and PubMed to retrieve potentially eligible studies focusing on other psychiatric diagnoses than those in the schizophrenia spectrum. We will conduct a random-effects network meta-analysis (NMA) for primary and secondary outcomes. In case of rare events of dichotomous outcomes, a common-effect Mantel-Haenszel NMA will be used instead. We will use the surface under the cumulative ranking curve and the mean ranks to rank all available treatments. Local and global methods of evaluation of inconsistency will be employed. Quality of evidence contributing to network estimates of the main outcomes will also be assessed with Confidence in Network Meta-Analysis. ETHICS AND DISSEMINATION This study does not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019137945.
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Affiliation(s)
- Edoardo G Ostinelli
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Farhad Shokraneh
- Cochrane Schizophrenia Group, Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior and Department of Clinical Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
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157
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Postma A, Bekmann S, Havenaar JM, Braam AW. Trashing Property: Characteristics of Psychiatric Patients Who Engage in Domestic Property Damaging. Community Ment Health J 2019; 55:1194-1201. [PMID: 31183586 PMCID: PMC6744387 DOI: 10.1007/s10597-019-00429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/03/2019] [Indexed: 11/26/2022]
Abstract
This descriptive record-based study included 75 patients who had engaged in domestic property damaging (DPD) and needed assessment by an urban emergency psychiatric service team in The Netherlands. The DPD patients were compared to 1145 other patients referred because of aggression, suicidality or other reasons. DPD patients were more often diagnosed with a psychotic disorder or a manic episode, had more often a migration background, were less often diagnosed with depression, and had lower GAF scores. There were no differences with respect to personality disorders or substance use. DPD patients were two to six times more likely to be (mostly involuntarily) admitted to a psychiatric department (64%), than the other patient groups (aggression 45%, suicidality 21%, other referral reasons 37%). The findings indicate that DPD patients represent an exclusive group who possibly have more intercultural and communication disadvantages due to less cultural acceptance or lack of knowledge about mental healthcare in the Netherlands.
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Affiliation(s)
- Amber Postma
- Department of Emergency Psychiatry, Altrecht Mental Health Care, Utrecht, The Netherlands
- Altrecht research section ‘Schroeder van der Kolk’, Utrecht, The Netherlands
- Crisisdienst Utrecht, Altrecht, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands
| | - Sophie Bekmann
- Department of Psychiatry, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Johan M. Havenaar
- Department of Emergency Psychiatry, Altrecht Mental Health Care, Utrecht, The Netherlands
- Altrecht research section ‘Schroeder van der Kolk’, Utrecht, The Netherlands
| | - Arjan W. Braam
- Department of Emergency Psychiatry, Altrecht Mental Health Care, Utrecht, The Netherlands
- Altrecht research section ‘Schroeder van der Kolk’, Utrecht, The Netherlands
- Crisisdienst Utrecht, Altrecht, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands
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158
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Affiliation(s)
- Paul S Appelbaum
- The Center for Law, Ethics, and Psychiatry, Department of Psychiatry, Columbia University, New York
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159
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Buchanan A, Sint K, Swanson J, Rosenheck R. Correlates of Future Violence in People Being Treated for Schizophrenia. Am J Psychiatry 2019; 176:694-701. [PMID: 31014102 DOI: 10.1176/appi.ajp.2019.18080909] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Violent behavior is infrequent among individuals with schizophrenia but is clinically important. The purpose of this study was to provide data on the correlates of violence, which may allow better risk assessment and care. METHODS A total of 1,435 individuals with schizophrenia who participated in the National Institute of Mental Health's Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study and were followed for 18 months were examined. The dependent variables were self-reported injurious and noninjurious violence during follow-up. The independent variables, assessed at study entry, comprised participants' recent injurious and noninjurious violence, demographic and background variables, childhood risk factors, clinical condition, current circumstances, and recent contact with hospitals and prisons. Proportional hazards models of time to first injurious violence were used to generate bivariable and multivariable hazard ratios for all participants and, separately, for participants with no injurious violence at study entry. RESULTS Seventy-seven participants (5.4%) reported engaging in injurious violence during follow-up, and 119 (8.3%) reported engaging in exclusively noninjurious violence. In the multivariable analysis, baseline injurious violence (hazard ratio=4.02), recent violent victimization (hazard ratio=3.52), severity of drug use (hazard ratio=2.93), baseline noninjurious violence (hazard ratio=2.72), childhood sexual abuse (hazard ratio=1.85), and medication nonadherence (hazard ratio=1.39) were associated with future injurious violence. For participants with no history of injurious violence at study entry, baseline noninjurious violence was the strongest predictor (hazard ratio=3.02). Recent violent victimization was no longer a significant correlate. The remaining correlates and the strength of their association with future injurious violence were similar to those for all participants. CONCLUSIONS This is the first longitudinal multivariable analysis of predictors of injurious violence in a large cohort of patients with schizophrenia followed over 18 months. The results revealed simultaneous strong effects of baseline injurious violence and recent violent victimization on future injurious violent behavior. Among clinical variables, poor medication adherence, but not baseline symptoms of psychosis or depression, significantly predicted injurious violence. Treatment strategies to reduce risk should emphasize medication adherence.
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Affiliation(s)
- Alec Buchanan
- The VA New England Mental Illness, Research, Education, and Clinical Center/VA Connecticut Healthcare System, West Haven, Conn. (Buchanan, Sint, Rosenheck); the Division of Law and Psychiatry, Yale School of Medicine, New Haven, Conn. (Buchanan); the Department of Psychiatry and Behavioral Sciences and the Division of Social and Community Psychiatry, Duke University School of Medicine, Durham, N.C. (Swanson); and the Departments of Psychiatry, Epidemiology, and Public Health and the Child Study Center, Yale University School of Medicine, West Haven, Conn. (Rosenheck)
| | - Kyaw Sint
- The VA New England Mental Illness, Research, Education, and Clinical Center/VA Connecticut Healthcare System, West Haven, Conn. (Buchanan, Sint, Rosenheck); the Division of Law and Psychiatry, Yale School of Medicine, New Haven, Conn. (Buchanan); the Department of Psychiatry and Behavioral Sciences and the Division of Social and Community Psychiatry, Duke University School of Medicine, Durham, N.C. (Swanson); and the Departments of Psychiatry, Epidemiology, and Public Health and the Child Study Center, Yale University School of Medicine, West Haven, Conn. (Rosenheck)
| | - Jeffrey Swanson
- The VA New England Mental Illness, Research, Education, and Clinical Center/VA Connecticut Healthcare System, West Haven, Conn. (Buchanan, Sint, Rosenheck); the Division of Law and Psychiatry, Yale School of Medicine, New Haven, Conn. (Buchanan); the Department of Psychiatry and Behavioral Sciences and the Division of Social and Community Psychiatry, Duke University School of Medicine, Durham, N.C. (Swanson); and the Departments of Psychiatry, Epidemiology, and Public Health and the Child Study Center, Yale University School of Medicine, West Haven, Conn. (Rosenheck)
| | - Robert Rosenheck
- The VA New England Mental Illness, Research, Education, and Clinical Center/VA Connecticut Healthcare System, West Haven, Conn. (Buchanan, Sint, Rosenheck); the Division of Law and Psychiatry, Yale School of Medicine, New Haven, Conn. (Buchanan); the Department of Psychiatry and Behavioral Sciences and the Division of Social and Community Psychiatry, Duke University School of Medicine, Durham, N.C. (Swanson); and the Departments of Psychiatry, Epidemiology, and Public Health and the Child Study Center, Yale University School of Medicine, West Haven, Conn. (Rosenheck)
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160
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Schoretsanitis G, Stegmayer K, Razavi N, Federspiel A, Müller TJ, Horn H, Wiest R, Strik W, Walther S. Inferior frontal gyrus gray matter volume is associated with aggressive behavior in schizophrenia spectrum disorders. Psychiatry Res Neuroimaging 2019; 290:14-21. [PMID: 31254799 DOI: 10.1016/j.pscychresns.2019.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/19/2022]
Abstract
We aimed to assess potential gray matter (GM) alterations for aggressive patterns of behavior in a sample of in- and outpatients with schizophrenia spectrum disorders. Eighty-four patients previously participating in brain volumetric studies were included. Aggression was assessed using the Modified Overt Aggression Scales (MOAS) based upon review of clinical records of the hospital register. Multiple regression analyses for total MOAS and each MOAS subscale separately were conducted correcting for age, sex, history of addiction, chlorpromazine equivalents, illness duration, and total intracranial volume. Significant effects were reported in two cases; the total MOAS scores and MOAS verbal aggression scores were associated with GM volume in left inferior frontal gyrus. From the demographic/clinical characteristics, only the number of episodes correlated with the subscales and the total MOAS scores. Our results highlight the role of GM volume in left inferior frontal gyri in patients with history of aggression. This evidence ties in well with previous data reporting involvement of these regions in response control and semantic networks.
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Affiliation(s)
- Georgios Schoretsanitis
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland; Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA.
| | | | - Nadja Razavi
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
| | - Andrea Federspiel
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
| | - Thomas J Müller
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland; Privatklinik Meiringen, Meiringen, Switzerland
| | - Helge Horn
- Institute of Psychiatry and Psychotherapy Bern, Switzerland; University of Bern, University Hospital of Psychiatry, Bern, Switzerland
| | - Roland Wiest
- Institute of Neuroradiology, Inselspital, Bern, Switzerland
| | - Werner Strik
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
| | - Sebastian Walther
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
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161
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Keane S, Szigeti A, Fanning F, Clarke M. Are patterns of violence and aggression at presentation in patients with first-episode psychosis temporally stable? A comparison of 2 cohorts. Early Interv Psychiatry 2019; 13:888-894. [PMID: 29888439 DOI: 10.1111/eip.12694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/14/2018] [Accepted: 05/16/2018] [Indexed: 12/29/2022]
Abstract
AIM The aim of this study is to assess the prevalence and clinical correlates of aggression and violence in individuals presenting with first-episode psychosis (FEP) and to evaluate whether this prevalence has changed in recent years when compared to a similar previous study. METHODS Retrospective cross-sectional study of clinical case notes and database records using a keyword search of a sample of patients with FEP (n = 132) aged between 18 and 65 years presenting from a geographically defined catchment area to a secondary referral psychiatric service over a 4-year period (2010-2013 inclusive). Use of the Modified Overt Aggression Scale to retrospectively assess aggression and violence in the week prior to, and post, presentation with FEP. RESULTS The overall proportion of individuals found to be aggressive and violent was 36% and 29%, respectively. These rates were similar to the 1995 to 1998 cohort (ie, 33% and 29%). A higher percentage of our sample (22%) was violent in the week prior to presentation compared to the 1995 to 1998 cohort (13%). Aggression was independently associated with involuntary (odds ratio [OR] = 4.085, 95% confidence interval [CI] 1.310-12.733) and inpatient treatment status (OR = 0.109, 95% CI 0.023-0.532) in the week prior to presentation and with high activation (OR = 6.770, 95% CI 1.372-33.394) and involuntary treatment status (OR = 10.163, 95% CI 2.257-45.759) in the week following presentation. Violence was associated with involuntary (OR = 3.691, 95% CI 1.197-11.382) and inpatient status (OR = 0.096, 95% CI 0.020-0.465) in the week prior to and with high activation (OR = 29.513 95% CI 1.879-463.676) the week following presentation. CONCLUSIONS Aggression and violence rates in FEP appear relatively stable over time.
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Affiliation(s)
- Sarah Keane
- DETECT Early Intervention in Psychosis Service, Co. Dublin, Ireland
| | - Attila Szigeti
- DETECT Early Intervention in Psychosis Service, Co. Dublin, Ireland
| | - Felicity Fanning
- DETECT Early Intervention in Psychosis Service, Co. Dublin, Ireland
| | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Co. Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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162
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Grattan RE, Lara N, Botello RM, Tryon VL, Maguire AM, Carter CS, Niendam TA. A History of Trauma is Associated with Aggression, Depression, Non-Suicidal Self-Injury Behavior, and Suicide Ideation in First-Episode Psychosis. J Clin Med 2019; 8:E1082. [PMID: 31340527 PMCID: PMC6678563 DOI: 10.3390/jcm8071082] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
The association between trauma and psychosis outcomes is well-established, and yet the impact of trauma on comorbid clinical symptoms-such as aggression, non-suicidal self-injury behavior (NSSIB), suicide ideation, and suicide behavior-for those with psychosis is unclear. To effectively treat those with first-episode psychosis (FEP) and a history of trauma, we need to understand the impact of trauma on their whole presentation. FEP participants were recruited from an Early Psychosis Program (N = 187, ages 12-35, 72.2% male). Clinicians gathered history of trauma, aggression, and suicide data, and rated current symptom severity and functioning. Data was coded using clinician rated measures, self-report measures, and retrospective clinical chart review. Regression analyses examined whether trauma was associated with a history of aggression, suicidal ideation, suicide behavior, NSSIB, symptoms, and functioning. Trauma was associated with aggression, aggression severity and type of aggression (aggression towards others). Trauma was also associated with depression severity, suicide ideation, most severe suicide ideation, and NSSIB. Trauma was not associated with suicide behavior, severity of suicide behavior or psychosocial functioning. Integrating trauma treatment into FEP care could reduce rates of depression, aggression, suicide ideation, and NSSIB for those with a history of trauma. To reduce suicide attempt occurrence and improve functioning, more research is needed.
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Affiliation(s)
- Rebecca E Grattan
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Natalia Lara
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Renata M Botello
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Valerie L Tryon
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Adrienne M Maguire
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Cameron S Carter
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA
| | - Tara A Niendam
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA 95817, USA.
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de Vries B, Pijnenborg GHM, van der Stouwe ECD, Visser E, de Jong S, Bartels-Velthuis AA, Bruggeman R, Castelein S, Jörg F, Veling W, Aleman A, van Busschbach JT. "Please tell me what happened": A descriptive study on prevalence, disclosure and characteristics of victimization in people with a psychotic disorder. PLoS One 2019; 14:e0219056. [PMID: 31318903 PMCID: PMC6638995 DOI: 10.1371/journal.pone.0219056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 06/16/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Although people with a psychotic disorder are approximately four to six times more often victimized than the general population, victimization is not routinely assessed in mental healthcare. This study investigates prevalence, context and risk factors of victimization in patients with a psychotic disorder in the Northern, relatively rural region of the Netherlands. Moreover, disclosure rates and awareness of psychiatrists are examined. Method Information on personal crime (threats, assaults and sexual violence), property and other forms of crime, the context of victimization and disclosure was routinely assessed in 353 patients with a psychotic disorder who received care at a mental health facility. In addition, involved psychiatrists reported on last year’s victimization incidents in their patients. Results One third of the patients reported victimization in the previous year. More than half of the crimes were committed by someone acquainted and took place in the victim’s own home or a place familiar to the victim. Younger age, having a comorbid disorder, drug use and perpetration of a crime were all positively associated with victimization. Approximately half of the reported personal crimes were disclosed to a health care professional but only in 16% of the cases the involved psychiatrist report to know about the incident. Conclusion This study confirms that people with a history of psychosis have an increased risk of becoming the victim of a crime. Although our results suggest that in fifty percent of cases the patients did share the information with professionals, a substantial proportion of incidents appear to go still unnoticed.
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Affiliation(s)
- Bertine de Vries
- University of Groningen, Department of Clinical Psychology, Groningen, the Netherlands
- * E-mail:
| | - Gerdina H. M. Pijnenborg
- University of Groningen, Department of Clinical Psychology, Groningen, the Netherlands
- GGZ Drenthe, Department of Psychotic Disorders, Assen, the Netherlands
| | - Elisabeth C. D. van der Stouwe
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, the Netherlands
| | - Ellen Visser
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
| | - Steven de Jong
- Lentis Psychiatric Institute, Groningen, the Netherlands
| | | | - Agna A. Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
- Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
| | - Stynke Castelein
- University of Groningen, Department of Clinical Psychology, Groningen, the Netherlands
- Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Frederike Jörg
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
- GGZ Friesland Mental Health Institution, Leeuwarden, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Psychosis Department, Groningen, the Netherlands
| | - André Aleman
- University of Groningen, Department of Clinical Psychology, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, the Netherlands
| | - Jooske T. van Busschbach
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
- Windesheim University of Applied Sciences, Department of Human Movement and Education, Zwolle, the Netherlands
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164
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Moulin V, Palix J, Golay P, Dumais A, Gholamrezaee MM, Azzola A, Baumann PS, Alameda L, Conus P. Violent behaviour in early psychosis patients: Can we identify clinical risk profiles? Early Interv Psychiatry 2019; 13:517-524. [PMID: 29143486 DOI: 10.1111/eip.12512] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 01/29/2023]
Abstract
AIMS The objective of this study is to explore, within a sample of early psychosis patients (EPP), if subgroups regarding rate of violent behaviour (VB) against others can be identified on the basis of dynamic risk factors (treatment modifiable characteristics). METHODS In a sample of 265 EPP, treated at the Treatment and Early Intervention in Psychosis Program in Lausanne, we conducted a latent-class analysis on the basis of the main dynamic VB risk factors (substance use disorder [SUD], positive symptoms, insight, and impulsivity). VB were restricted to "serious violence" and were assessed through patients self-report, interview with relatives or forensic services and with a standardized instrument. RESULTS The analysis confirmed the heterogeneity of the sample regarding rate of VB. Patients could be stratified within 4 subgroups, 3 of which were at increased risk of VB. The two groups with the highest rates of VB displayed specific clinical profiles. The first one was characterized by high levels of impulsivity, hostility, positive symptoms and SUD, and the second, by low level of insight and low social functioning. These patterns suggest that significant difficulties in social interaction may contribute to the emergence of aggressive reactions against others. CONCLUSIONS Identification of EPP at increased risk of VB seems possible on the basis of dynamic risk factors. If confirmed prospectively, this could pave the way to the development of preventive strategies and specific interventions.
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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 (CHUV), Lausanne, Switzerland
| | - Julie Palix
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Golay
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alexandre Dumais
- Institut Philippe-Pinel de Montréal and Department of Psychiatry, Faculty of Medicine, University of Montréal, Quebec, Canada
| | - Mohammad Mehdi Gholamrezaee
- Centre for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Agathe Azzola
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philipp S Baumann
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Luis Alameda
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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165
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Beaudoin M, Potvin S, Dellazizzo L, Luigi M, Giguère CE, Dumais A. Trajectories of Dynamic Risk Factors as Predictors of Violence and Criminality in Patients Discharged From Mental Health Services: A Longitudinal Study Using Growth Mixture Modeling. Front Psychiatry 2019; 10:301. [PMID: 31139099 PMCID: PMC6520437 DOI: 10.3389/fpsyt.2019.00301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Individuals with severe mental illnesses are at greater risk of offenses and violence, though the relationship remains unclear due to the interplay of static and dynamic risk factors. Static factors have generally been emphasized, leaving little room for temporal changes in risk. Hence, this longitudinal study aims to identify subgroups of psychiatric populations at risk of violence and criminality by taking into account the dynamic changes of symptomatology and substance use. Method: A total of 825 patients from the MacArthur Violence Risk Assessment Study having completed five postdischarge follow-ups were analyzed. Individuals were classified into outcome trajectories (violence and criminality). Trajectories were computed for each substance (cannabis, alcohol, and cocaine, alone or combined) and for symptomatology and inputted as dynamic factors, along with other demographic and psychiatric static factors, into binary logistic regressions for predicting violence and criminality. Best predictors were then identified using backward elimination, and receiver operator characteristic (ROC) curves were calculated for both models. Results: Two trajectories were found for violence (low versus high violence). Best predictors for belonging in the high-violence group were low verbal intelligence (baseline), higher psychopathy (baseline) and anger (mean) scores, persistent cannabis use (alone), and persistent moderate affective symptoms. The model's area under the curve (AUC) was 0.773. Two trajectories were also chosen as being optimal for criminality. The final model to predict high criminality yielded an AUC of 0.788, retaining as predictors male sex, lower educational level, higher score of psychopathy (baseline), persistent polysubstance use (cannabis, cocaine, and alcohol), and persistent cannabis use (alone). Both models were moderately predictive of outcomes. Conclusion: Static factors identified as predictors are consistent with previously published literature. Concerning dynamic factors, unexpectedly, cannabis alone was an independent co-occurring variable, as well as affective symptoms, in the violence model. For criminality, our results are novel, as there are very few studies on criminal behaviors in nonforensic psychiatric populations. In conclusion, these results emphasize the need to further study the predictors of crime, separately from violence and the impact of longitudinal patterns of specific substance use and high affective symptoms.
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Affiliation(s)
- Mélissa Beaudoin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Laura Dellazizzo
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mimosa Luigi
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Charles-Edouard Giguère
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - Alexandre Dumais
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, QC, Canada
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166
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Del Pozzo J, Athineos C, Zar T, Cruz LN, King CM. Frustrative Non-reward and Lab-Based Paradigms for Advancing the Study of Aggression in Persons with Psychosis. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00173-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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167
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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: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [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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168
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Barlati S, Stefana A, Bartoli F, Bianconi G, Bulgari V, Candini V, Carrà G, Cavalera C, Clerici M, Cricelli M, Ferla MT, Ferrari C, Iozzino L, Macis A, Vita A, de Girolamo G. Violence risk and mental disorders (VIORMED-2): A prospective multicenter study in Italy. PLoS One 2019; 14:e0214924. [PMID: 30990814 PMCID: PMC6467378 DOI: 10.1371/journal.pone.0214924] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/23/2019] [Indexed: 11/19/2022] Open
Abstract
Background The management of mentally ill offenders in the community is one of the great challenges imposed on community psychiatry. Aim The aim of this study was to analyze the association between sociodemographic, clinical, and psychosocial factors and violent behavior in a sample of outpatients with severe mental disorders. Method This was a prospective cohort study with a baseline cross-sectional design used to provide a detailed analysis of patients’ profiles, followed by a longitudinal design to measure aggressive and violent behavior during a 1-year follow-up. Patients with severe mental disorders, with or without a history of violence, were enrolled in four Italian Departments of Mental Health and underwent a comprehensive multidimensional assessment. Results The sample included 247 outpatients, for a total of 126 cases and 121 controls. Compared to controls, patients with a history of violence had a greater frequency of lifetime domestic violence, a greater lifetime propensity to misuse substances, and a higher number of compulsory admissions. The forthnightly monitoring during the 1-year follow-up did show statistically significant differences in aggressive and violent behavior rates between the two groups. Verbal aggression was significantly associated with aggression against objects and physical aggression. Moreover, outpatients with an history of violence showed statistically significant higher MOAS scores compared to both residential patients with an history of violence, assessed in the first wave of this project, and all controls. Conclusions Patients with a history of violence had specific characteristics and showed a greater occurrence of additional community violence during a 1-year observation period. Our results may assist clinicians in implementing standardized methods of patient assessment and violence monitoring in outpatient mental health services and may prompt improved collaboration between different community services.
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Affiliation(s)
- Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Stefana
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | | | - Viola Bulgari
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Valentina Candini
- 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, Monza, Italy
| | - Cesare Cavalera
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
- Department of Mental Health, San Gerardo Hospital of Monza, Italy
| | - Marta Cricelli
- Department of Mental Health, ASST-Rhodense G.Salvini of Garbagnate, Milano, Italy
| | - Maria Teresa Ferla
- Department of Mental Health, ASST-Rhodense G.Salvini of Garbagnate, Milano, Italy
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Laura Iozzino
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ambra Macis
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- * E-mail:
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169
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Daneault JG, Maraj A, Lepage M, Malla A, Schmitz N, Iyer SN, Joober R, Shah JL. Medication adherence in first episode psychosis: the role of pre-onset subthreshold symptoms. Acta Psychiatr Scand 2019; 139:336-347. [PMID: 30712261 PMCID: PMC6426680 DOI: 10.1111/acps.13011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The experience of pre-onset subthreshold psychotic symptoms (STPS, signifying a clinical high-risk state) in first episode psychosis (FEP) predicts poorer outcomes during treatment, possibly through differential adherence to medication. We explored whether adherence differs between FEP patients with and without pre-onset STPS. METHODS Antipsychotic medication adherence was compared in 263 STPS+ and 158 STPS- subjects in a specialized early intervention program for FEP. Data were gathered from a larger observational study conducted between 2003 and 2016. STPS status, sociodemographic, and baseline clinical variables were tested as predictors of non-adherence using univariate and multivariate logistic regressions. Time to onset of non-adherence was analyzed using Kaplan-Meier curves. The same predictors were tested as predictors of time to onset of non-adherence using Cox regression models. RESULTS Medication non-adherence was higher in STPS+ participants (78.9% vs. 68.9%). STPS status (OR 1.709), substance use disorder (OR 1.767), and milder positive symptoms (OR 0.972) were significant baseline predictors of non-adherence. Substance use disorder (HR 1.410), milder positive symptoms (HR 0.990), and lack of contact between the clinical team and relatives (HR 1.356) were significant baseline predictors of time to non-adherence. CONCLUSION FEP patients who experience pre-onset STPS are more likely to be non-adherent to antipsychotic medication over 2 years of intervention. FEP programs should routinely evaluate pre-onset symptomatology to deliver more personalized treatments, with emphasis on engaging both patients and family members from the beginning of care.
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Affiliation(s)
- Jean-Gabriel Daneault
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Clinique J.-P. Mottard, Hôpital en santé mentale Albert-Prévost, Département de psychiatrie, Université de Montréal, Montreal, Quebec, Canada
| | - Anika Maraj
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jai L. Shah
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada,Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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170
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Prevalence and phenomenology of violent ideation and behavior among 200 young people at clinical high-risk for psychosis: an emerging model of violence and psychotic illness. Neuropsychopharmacology 2019; 44:907-914. [PMID: 30591713 PMCID: PMC6462023 DOI: 10.1038/s41386-018-0304-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/14/2018] [Accepted: 12/16/2018] [Indexed: 11/08/2022]
Abstract
In a previously reported longitudinal study of violent ideation (VI) and violent behavior (VB) among 200 youths at clinical high-risk (CHR) for psychosis, we found that VI, hitherto underinvestigated, strongly predicted transition to first-episode psychosis (FEP) and VB, in close temporal proximity. Here, we present participants' baseline characteristics, examining clinical and demographic correlates of VI and VB. These participants, aged 13-30, were examined at Columbia University Medical Center's Center of Prevention and Evaluation, using clinical interviews and the structured interview for psychosis-risk syndromes (SIPS). At the onset of our longitudinal study, we gathered demographics, signs and symptoms, and descriptions of VI and VB. One-third of participants reported VI (n = 65, 32.5%) at baseline, experienced as intrusive and ego-dystonic, and associated with higher suspiciousness and overall positive symptoms. Less than one-tenth reported VB within 6 months of baseline (n = 17, 8.5%), which was unrelated to SIPS-positive symptoms, any DSM diagnosis or other clinical characteristic. The period from conversion through post-FEP stabilization may be characterized by heightened risk of behavioral disinhibition and violence. We provide a preliminary model of how violence risk may peak at various points in the course of psychotic illness.
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171
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Dellazizzo L, Potvin S, Beaudoin M, Luigi M, Dou BY, Giguère CÉ, Dumais A. Cannabis use and violence in patients with severe mental illnesses: A meta-analytical investigation. Psychiatry Res 2019; 274:42-48. [PMID: 30780061 DOI: 10.1016/j.psychres.2019.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Laura Dellazizzo
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada; Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
| | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Mélissa Beaudoin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada; Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
| | - Mimosa Luigi
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada; Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
| | - Bo Yi Dou
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Charles-Édouard Giguère
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada; Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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172
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Steinkamp JM, Goldblatt N, Borodovsky JT, LaVertu A, Kronish IM, Marsch LA, Schuman-Olivier Z. Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review. JMIR Ment Health 2019; 6:e12493. [PMID: 30860493 PMCID: PMC6434404 DOI: 10.2196/12493] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. OBJECTIVE The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. METHODS This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. RESULTS The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. CONCLUSIONS Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
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Affiliation(s)
| | - Nathaniel Goldblatt
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States
| | | | - Amy LaVertu
- Tufts University School of Medicine, Boston, MA, United States
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York City, NY, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Zev Schuman-Olivier
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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173
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Abstract
The concept of insight is used to indicate the propensity of patients with schizophrenia and other severe mental disorders to recognize their illness and engage in treatment. Thus, insight may have notable consequences for the ill individual: Those who lack insight are at higher risk of nonadherence to treatments, negative clinical outcomes, and worse community functioning. Although insight is an intuitive concept, its essence remains difficult to capture. However, many rating scales are available to aid assessment, both for clinical and research purposes. Insight cannot be reduced to a symptom, a psychological mechanism, or a neuropsychological function. It is likely to have dynamic relationships with all these dimensions and with responses to personal events and contextual factors. In particular, social consequences of mental illness and explanatory models that are alternative to the medical model may fundamentally shape insight and treatment choice. Moreover, the cultural or individual stigmatization of mental illness may turn the acquisition of insight into a painful event and increase the risk of depression. Clinicians need to carefully evaluate and promote insight through a personalized approach to aid patient process of care and personal growth.
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Affiliation(s)
- Martino Belvederi Murri
- Psychiatric Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Ospedale Policlinico San Martino, Genoa, Italy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mario Amore
- Psychiatric Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Ospedale Policlinico San Martino, Genoa, Italy
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174
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Onwumere J, Parkyn G, Learmonth S, Kuipers E. The last taboo: The experience of violence in first-episode psychosis caregiving relationships. Psychol Psychother 2019; 92:1-19. [PMID: 29399952 DOI: 10.1111/papt.12173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 10/26/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Informal caregiving relationships play an important role in facilitating recovery outcomes in psychosis. The relationship can serve as a source of positive experiences that co-exist alongside common challenges typically associated with mental health problems. People with psychosis, when compared to the general population, are more likely to perpetrate acts of violence, a relationship that is particularly evident during the first psychosis episode. Although victims of service user violence are typically people already known to them, such as informal carers, there remains a lack of understanding about their caring experiences and needs. This study sought to address gaps in the literature by exploring the subjective accounts of informal carers supporting a relative experiencing their first episode of psychosis who has also behaved violently towards them. DESIGN A cross-sectional design was employed. METHODS Individual semi-structured interviews, which were audio recorded and later transcribed for analyses, were undertaken with a convenience sample of eight carers drawn from a specialist early psychosis service. Interview questions focused on their experiences of patient violence, the subjective impact, and coping strategies. An interpretative phenomenological approach was used to analyse the data. RESULTS Participants were mostly living with their relative with psychosis and were typically female, parents, and from a black and minority ethnic background. Data analyses identified seven key themes from participant interviews including the lack of predictability over when the violence occurred, being scared and fearful, keeping quiet about what happens at home and in the caregiving relationship, and staying safe. CONCLUSIONS Reports by informal carers about experiencing violence and victimization from their relatives with psychosis are an important issue in some caregiving relationships during the first episode. Developing a more informed understanding of the specific needs of these carers and the caregiving relationship is indicated. The implications for service providers are discussed. PRACTITIONER POINTS Carers were exposed to a broad range of patient violence, which included being kicked and having weapons used against them. The violence typically occurred within carers' homes, when no other people were around. Patient violence impacted negatively on carer emotional and physical functioning, which included leaving carers living in fear of their own safety and what might become of their relative. The results highlight the importance of routinely asking first-episode carers about their experience of patient violence. The development of interventions (e.g., identification of early triggers, de-escalation) that are able to take account of the ongoing nature and complexity of the caregiving relationship but are purposefully aimed at supporting carers to remain safe in their relationship should be explored for their impact.
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Affiliation(s)
- Juliana Onwumere
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK
| | - Grace Parkyn
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, UK
| | - Stephanie Learmonth
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Elizabeth Kuipers
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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175
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Delusion, excitement, violence, and suicide history are risk factors for aggressive behavior in general inpatients with serious mental illnesses: A multicenter study in China. Psychiatry Res 2019; 272:130-134. [PMID: 30580136 DOI: 10.1016/j.psychres.2018.12.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 01/13/2023]
Abstract
Little is known about the risk factors for aggression in general clinical settings in China. The aim of this study is to explore potential risk factors for inpatients with serious mental illness. The study was conducted from 15 March to 14 April 2013 and involved 16 general psychiatric institutions in China. A standardized data collection form was used to collect demographic and clinical characteristics data, including information on current hallucinations, delusions, depression, excitement, aboulia, apathy, and adherence to treatment. Information on lifetime history of violence and suicidality was also collected. The Modified Overt Aggression Scale (MOAS) was also administered to indicate recent (past week) aggression. A total of 511 inpatients were enrolled. On the basis of a score of five or greater on the MOAS, 245 inpatients were assigned to aggressive group and 266 were assigned to non-aggressive group. A lifetime history of violent behaviour (OR = 3.1, 95% CI = 1.95-5.11), suicide (OR = 3.0, 95% CI = 1.49-6.10), as well as current delusions (OR = 1.92, 95% CI = 1.24-2.97), and excitement (OR = 2.63, 95% CI = 1.57-4.39) were associated with aggression. The study suggested violent history, suicide history, current delusions, and excitement are the risk factors for aggression among general psychiatric inpatients with serious mental illnesses.
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176
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Engelstad KN, Rund BR, Torgalsbøen AK, Lau B, Ueland T, Vaskinn A. Large social cognitive impairments characterize homicide offenders with schizophrenia. Psychiatry Res 2019; 272:209-215. [PMID: 30590274 DOI: 10.1016/j.psychres.2018.12.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/22/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022]
Abstract
Schizophrenia is associated with an increased violence risk, particularly homicide. One possible, but scarcely explored, contributor to the increased violence risk is social cognitive impairment. Individuals with schizophrenia show impairments in social cognition that are associated with poor functional outcome. This study examined social cognition among homicide offenders with schizophrenia (HOS), applying validated measures of emotion perception and theory of mind (ToM). Two groups of individuals with schizophrenia were compared, one had committed homicide (HOS, n = 26), and the other had no violence history (non-HOS, n = 28). Healthy controls (HC, n = 71) were included as reference group for one measure. Emotion perception was indexed by the Emotion in Biological Motion (Emotion) and Pictures of Facial Affect (PFA) tests. ToM was assessed with the Hinting Task and Movie for the Assessment of Social Cognition (MASC). The results showed that HOS participants had significantly poorer performance than non-HOS in both emotion perception and ToM. For the MASC test, HOS participants showed large deficits compared to HC (-4 standard deviations). Particularly, HOS participants made a substantial number of undermentalizing errors. The results suggest that emotion perception deficits and a tendency to undermentalize may be important for understanding homicide in 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
| | - Torill Ueland
- Department of Psychology, University of Oslo, Oslo, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Anja Vaskinn
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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177
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Gadea M, Herrero N, Picó A, Espert R, Salvador A, Sanjuán J. Psychobiological response to an anger induction task in schizophrenia: The key role of anxiety. Psychiatry Res 2019; 271:541-547. [PMID: 30554100 DOI: 10.1016/j.psychres.2018.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/22/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022]
Abstract
In this study an anger induction laboratory task was applied to men with schizophrenia, and resulted in significant changes in different psychophysiological parameters that were measured in a pre-post design. We observed a significantly greater self-reported anger mood and negative affection, lower self-reported positive affection, an increase in cardiovascular reactivity (with blood pressure in deeper affection compared to controls), higher salivary testosterone levels, lower salivary cortisol levels, and an increase in right ear items reported in dichotic listening. Furthermore, clinical risk factors related to anger in our patients were analyzed by Stepwise Regression analyses. Trait anger was significantly associated with a higher level of delusional pathology and impulsivity. Regarding the resulted state of anger as an output of the induction, the most relevant finding was that anxiety consistently and significantly predicted the increasing in anger feelings, and, remarkably, it predicted also the increasing in T levels and the cardiovascular reactivity of the patients.
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Affiliation(s)
- Marien Gadea
- Departament de Psicobiologia, Facultat de Psicologia, Universitat de València, Avda. Blasco Ibañez 21, València E. 46010, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Hospital Clínico Universitario de Valencia . Instituto de Investigación Sanitaria (INCLIVA).
| | - Neus Herrero
- Departament de Psicobiologia, Facultat de Psicologia, Universitat de València, Avda. Blasco Ibañez 21, València E. 46010, Spain
| | - Alfonso Picó
- Departament de Psicobiologia, Facultat de Psicologia, Universitat de València, Avda. Blasco Ibañez 21, València E. 46010, Spain
| | - Raúl Espert
- Departament de Psicobiologia, Facultat de Psicologia, Universitat de València, Avda. Blasco Ibañez 21, València E. 46010, Spain
| | - Alicia Salvador
- Departament de Psicobiologia, Facultat de Psicologia, Universitat de València, Avda. Blasco Ibañez 21, València E. 46010, Spain
| | - Julio Sanjuán
- Unitat de Psiquiatria i Psicologia Mèdica, Facultat de Medicina, Universitat de València, Avda. Blasco Ibáñez 15, València E. 46010, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Hospital Clínico Universitario de Valencia . Instituto de Investigación Sanitaria (INCLIVA)
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178
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De Las Cuevas C, de Leon J. Development and validation of the Patient's Health Belief Questionnaire on Psychiatric Treatment. Patient Prefer Adherence 2019; 13:527-536. [PMID: 31040653 PMCID: PMC6462159 DOI: 10.2147/ppa.s201144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Our previous studies with regard to adherence to psychiatric medications measured pharmacophobia, psychological reactance, and locus of control using a 42-item questionnaire requiring ~1.5 hours for completion. This study aims to develop the Patient's Health Belief Questionnaire on Psychiatric Treatment, a 17-item inventory which requires only 15 minutes to complete. METHODS Our new questionnaire with five subscales was based on 17 items from three previously validated scales (on pharmacophobia, psychological reactance, and locus of control). In 588 consecutive Spanish psychiatric outpatients taking 1,114 psychiatric medications, we studied the responses to the questionnaire; to validate it, medication adherence was assessed by the Sidorkiewicz tool. RESULTS Validation of the construct was addressed by performing two exploratory factor analyses independent of each other (one for the eight-item section measuring the attitudes of patients toward psychotropic drugs and one for the nine-item section measuring perceived health locus of control [HLOC]), which led to five subscales that were called Positive and Negative Aspects of Medications, Doctor-HLOC, Internal-HLOC, and Psychological Reactance. The five subscales showed better internal consistency when corrected by number of items than the original 17-item scale. Logistic regression models of the continuous scores, dichotomized subscales, and Chi-squared Automatic Interaction Detector (CHAID) analysis indicated that all five subscales help in predicting adequate adherence, although the various subscales behave differently in different analyses. CONCLUSION Future studies need to verify and further extend the preliminary findings of this study that the questionnaire may have construct and predictive validity.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Canary Islands, Spain,
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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179
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Faay MDM, van Os J. Aggressive Behavior, Hostility, and Associated Care Needs in Patients With Psychotic Disorders: A 6-Year Follow-Up Study. Front Psychiatry 2019; 10:934. [PMID: 31998154 PMCID: PMC6961536 DOI: 10.3389/fpsyt.2019.00934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/25/2019] [Indexed: 01/13/2023] Open
Abstract
Background: Hostility and aggressive behavior in patients with psychotic disorders are associated with demographic and clinical risk factors, as well as with childhood adversity and neglect. Care needs are an essential concept in clinical practice; care needs in the domain of safety for others reflect the actual problem the patient has. Hostility, aggressive behavior, and associated care needs, however, are often studied in retrospect. Method: In a sample of 1,119 patients with non-affective psychotic disorders, who were interviewed three times over a period of 6 years, we calculated the incidence of hostility, self-reported maltreatment to others and care needs associated with safety for other people (safety-to-others). Regression analysis was used to analyze the association between these outcomes and risk factors. The population attributable fraction (PAF) was used to calculate the proportion of the outcome that could potentially be prevented if previous expressions of adverse behavior were eliminated. Results: The yearly incidence of hostility was 2.8%, for safety-to-others 0.8% and for maltreatment this was 1.8%. Safety-to-others was associated with previous hostility and vice versa, but, assuming causality, only 18% of the safety-to-others needs was attributable to previous hostility while 26% was attributable to impulsivity. Hostility, maltreatment and safety-to-others were all associated with number of unmet needs, suicidal ideation and male sex. Hostility and maltreatment, but not safety-to-others, were associated with childhood adversity. Neither safety-to-others, maltreatment nor hostility were associated with premorbid adjustment problems. Conclusion: The incidence of hostility, self-reported aggressive behaviors, and associated care needs is low and linked to childhood adversity. Known risk factors for prevalence also apply to incidence and for care needs associated with safety for other people. Clinical symptoms can index aggressive behaviors years later, providing clinicians with some opportunity for preventing future incidents.
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Affiliation(s)
- Margo D M Faay
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jim van Os
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, United Kingdom
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180
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Seidel P, Konrad N, Negatsch V, Dezsö D, Kogan I, Gauger U, Neumann B, Voulgaris A, Opitz-Welke A. Violent Behavior During Psychiatric Inpatient Treatment in a German Prison Hospital. Front Psychiatry 2019; 10:762. [PMID: 31736795 PMCID: PMC6836873 DOI: 10.3389/fpsyt.2019.00762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 09/23/2019] [Indexed: 12/26/2022] Open
Abstract
Violent behavior in correctional facilities is common and differs substantially in type, target, implication, and trigger. Research on frequency and characteristics of violent behavior in correctional facilities and psychiatric hospitals is limited. Results from recent research suggest that comorbidity of severe mental disorder, personality disorder, and diagnosis of substance abuse is related to a higher risk of violent behavior. In the Berlin prison hospital, a database was created to collect data from all violent incidences (n=210) between 1997 and 2006 and between 2010 and 2016. In a retrospective, case-control study, we analyzed specific socioeconomic data and psychiatric diagnosis and compared the group of prisoners with violent behavior with randomly selected prisoners of the same department without violent behavior (n = 210). Diagnosis of schizophrenia, non-German nationality, no use of an interpreter, no children, and no previous sentence remained significantly associated with the dependent variable violent behavior. There were no significant differences regarding age and legal statuses. Practical implications for clinical work are discussed.
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Affiliation(s)
- P Seidel
- Justizvollzugskrankenhaus, JVA Plötzensee, Berlin, Germany
| | - N Konrad
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - V Negatsch
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - D Dezsö
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - I Kogan
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - U Gauger
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - B Neumann
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
| | - A Voulgaris
- Institut für Sexualforschung und Forensische Psychiatrie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - A Opitz-Welke
- Institut für Forensische Psychiatrie, Charité, Berlin, Germany
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181
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Wang J, Zhang SM, Zhong SL, Mellsop G, Guo HJ, Li QG, Zhou JS, Wang XP. Gender differences among homicide offenders with schizophrenia in Hunan Province, China. Psychiatry Res 2019; 271:124-130. [PMID: 30472507 DOI: 10.1016/j.psychres.2018.11.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 11/26/2022]
Abstract
This study aimed to understand the demographic, clinical and criminological characteristics of Chinese homicide offenders with schizophrenia from a gender-based perspective. Information on all homicide offenders with schizophrenia who received forensic psychiatric assessment between 2010 and 2016 in Hunan Province, China, was systematically retrieved (n = 669). Gender differences in the above characteristics were analyzed, and independent correlates of homicide were explored. The male to female ratio of homicide offenders was about 4:1. Proportionally more males were single, unemployed and younger when committing their first crime than was apparent in females. Male perpetrators were more often influenced by delusions. Females were more likely to target their close family members. For males, living in rural areas and having a family history of mental disorder were positively associated with homicide, while having a criminal history and being unemployed were negatively associated. For females, younger age was positively, while being unmarried and unemployment were negatively associated with homicide. Our results indicate significant gender differences among Chinese homicide offenders with schizophrenia in demographic, clinical and criminological characteristics and in independent correlates of homicide. Further research in this field, especially aims at determining risk factors for crime in this population, should take the gender differences into account.
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Affiliation(s)
- Jun Wang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, 139 Middle Renmin Road, Changsha, Hunan 410011, China; Department of Psychiatry, The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, Jiangsu 214151, China
| | - Si-Mei Zhang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, 139 Middle Renmin Road, Changsha, Hunan 410011, China; Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen 518003, China
| | - Shao-Ling Zhong
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, 139 Middle Renmin Road, Changsha, Hunan 410011, China
| | - Graham Mellsop
- Waikato Clinical Campus, University of Auckland, New Zealand
| | - Hui-Juan Guo
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, 139 Middle Renmin Road, Changsha, Hunan 410011, China
| | - Qi-Guang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, 139 Middle Renmin Road, Changsha, Hunan 410011, China
| | - Jian-Song Zhou
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, 139 Middle Renmin Road, Changsha, Hunan 410011, China
| | - Xiao-Ping Wang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, 139 Middle Renmin Road, Changsha, Hunan 410011, China.
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182
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McCann TV, Savic M, Ferguson N, Cheetham A, Witt K, Emond K, Bosley E, Smith K, Roberts L, Lubman DI. Recognition of, and attitudes towards, people with depression and psychosis with/without alcohol and other drug problems: results from a national survey of Australian paramedics. BMJ Open 2018; 8:e023860. [PMID: 30514822 PMCID: PMC6286471 DOI: 10.1136/bmjopen-2018-023860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Continuing stigma towards mental health problems means that many individuals-especially men-will first present in crisis, with emergency services often the first point of call. Given this situation, the aims of this paper were to assess paramedics' ability to recognise, and their attitudes towards, males with clinically defined depression and psychosis with and without comorbid alcohol and other drug (AOD) problems. METHODS A cross-sectional national online survey of 1230 paramedics throughout Australia. The survey was based on four vignettes: depression with suicidal thoughts, depression with suicidal thoughts and comorbid alcohol problems, and psychosis with and without comorbid AOD problems. RESULTS Just under half of respondents recognised depression, but this decreased markedly to one-fifth when comorbid AOD problems were added to the vignette. In contrast, almost 90% recognised psychosis, but this decreased to just under 60% when comorbid AOD problems were added. Respondents were more likely to hold stigmatising attitudes towards people in the vignettes with depression and psychosis when comorbid AOD problems were present. Respondents endorsed questionnaire items assessing perceived social stigma more strongly than personal stigma. Desire for social distance was greater in vignettes focusing on psychosis with and without comorbid AOD problems than depression with and without comorbid AOD problems. CONCLUSIONS Paramedics need a well-crafted multicomponent response which involves cultural change within their organisations and more education to improve their recognition of, and attitudes towards, clients with mental health and AOD problems. Education should focus on the recognition and care of people with specific mental disorders rather than on mental disorders in general. It is essential that education also focuses on understanding and caring for people with AOD problems. Educational interventions should focus on aligning beliefs about public perceptions with personal beliefs about people with mental disorders and AOD problems.
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Affiliation(s)
- Terence V McCann
- Department of Nursing and Midwifery, Institute of Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Michael Savic
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Nyssa Ferguson
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Alison Cheetham
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Katrina Witt
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kate Emond
- Department of Rural Nursing and Midwifery, College of Health, Science and Engineering, La Trobe University, Bendigo, Victoria, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Victoria, Australia
| | - Karen Smith
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Louise Roberts
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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183
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Moulin V, Alameda L, Baumann PS, Gholamrezaee MM, Palix J, Gasser J, Conus P. [Three clinical risk profiles of violent behavior in a cohort of early psychosis patients]. L'ENCEPHALE 2018; 45:214-220. [PMID: 30446287 DOI: 10.1016/j.encep.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aims to determine whether it is possible to identify clinical profiles at risk of violent behaviors (VB) in the early phase of psychotic disorders, on the basis of the main dynamic psychopathological risk factors and describe characteristics of the groups with highest levels of violent behaviors. METHOD A total of 265 patients, aged 18 to 35, treated at the Treatment and early Intervention in Psychosis Program (TIPP-Lausanne), a specialized early psychosis program, were included in this study. We conducted a latent-class analysis and a discriminative analysis on the basis of the main dynamic VB risk factors: substance use disorder, impulsivity, positive symptoms, insight, aggression, hostility, anger, emotional instability and adherence to treatment. These factors were evaluated by specialized scales and on the basis of the Positive and Negative Syndrome Scale (PANSS). VB were restricted to physical aggression against people, defined as "serious violence". They were assessed on the basis of a questionnaire listing violent offenses (Swiss Criminal Code) and VB such as assault and battery, information through the forensic psychiatric services and on the basis of the Staff Observation Aggression Scale (SOAS-R scale) during inpatient treatment phase. RESULTS Four heterogeneous subgroups were identified with respect to the studied clinical characteristics, including two groups with high rates of VB. The first group, comprising 46% of patients with VB, is distinguished by the prevalence of a range of dimensions related to hostility, impulsivity and emotional instability, associated with high levels of substance abuse and positive symptoms. These clinical dimensions are very significant at the statistical level, since they explain 70% of the construction of subgroups (discriminant analysis). The second group with 37% of patients with VB, is characterized by a lack of insight, lack of adherence to treatment and substance use. These two clinical profiles could increase the impairment of cognitive, functional and relational abilities and contribute to the development of VB in this early phase of psychosis. The third subgroup, with a violent behaviors rate of 28.6%, is distinguished by its high proportion of diagnoses of substance abuse (100%) and women (54%). A last subgroup of patients, the largest quantitatively, has a low proportion of VB (15%) and the lowest levels on the studied factors, suggesting that the majority of patients with this profile commit few VB. CONCLUSION Our results show that it is possible to identify groups at risk of violent behaviors during the early phase of psychosis on the basis of clinical characteristics that may evolve and therefore be the focus of preventive care. These results highlight the need to target substance use, impulsivity and lack of insight at follow-up in order to prevent VB.
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Affiliation(s)
- V Moulin
- Unité de recherche en psychiatrie et psychologie légales, institut de psychiatrie légale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), site de Cery, bâtiment Les Cèdres, 1008 Prilly-Lausanne, Suisse.
| | - L Alameda
- Service de psychiatrie générale, centre de neuroscience psychiatrique, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - P S Baumann
- Service de psychiatrie générale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse
| | - M M Gholamrezaee
- Centre d'épidémiologie psychiatrique et psychopathologie, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse
| | - J Palix
- Unité de recherche en psychiatrie et psychologie légales, institut de psychiatrie légale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), site de Cery, bâtiment Les Cèdres, 1008 Prilly-Lausanne, Suisse
| | - J Gasser
- Institut de psychiatrie légale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse
| | - P Conus
- Service de psychiatrie générale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse
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184
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Efficacy of typical and atypical antipsychotic medication on hostility in patients with psychosis-spectrum disorders: a review and meta-analysis. Neuropsychopharmacology 2018; 43:2340-2349. [PMID: 30093698 PMCID: PMC6180076 DOI: 10.1038/s41386-018-0161-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 12/31/2022]
Abstract
As violence against self and others is an important outcome in the treatment of patients with psychosis-spectrum disorders and hostility is an important indicator for violence, we set out to evaluate the effects of different types of antipsychotic agents in reducing hostility. We performed a systematic literature search, which provided 18 suitable randomized studies comparing typical to atypical antipsychotics for at least 4 weeks in patients with psychotic disorders. Results showed a small (0.26) but significant effect for atypical as compared to typical antipsychotics, with high heterogeneity, even though the mean dose of typical antipsychotics was higher. This effect size remained similar when separately analyzing sponsored and non-sponsored studies. When differentiating between high and low-dose studies, the high-dose group showed a significant difference between typical and atypical antipsychotics whereas the low-dose group did not. An analysis comparing clozapine to typical antipsychotics showed a moderate effect size (0.415), with low heterogeneity. These results are important for clinicians to help their shared decision making with patients when choosing maintenance treatment, as next to efficacy for psychosis and tolerability, safety for the patient and their environment is an important outcome.
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185
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Abstract
BACKGROUND There is a modest but consistent association between violence and schizophrenia. The consequences of serious violence could be catastrophic for the victims, as well as the patients themselves and the community. Any knowledge that would help to prevent acts of serious violence would be of considerable value for the individual and the society. AIM To identify external and clinical risk factors for serious violence in schizophrenia, in addition to considering the strength of the association between the factors assessed and severe violence. METHODS This was accomplished by a literature survey. One-hundred and two relevant papers were identified that were published during the past 20 years. Forty-four papers were assessed for eligibility. In all, 27 studies including clinical or cognitive variables were reviewed systematically. An effect size was reported where an odds ratio (OR) could be identified or calculated from available data. Five external factors and six clinical domains were evaluated. RESULTS Substance abuse is robustly linking schizophrenia and violence. Among the clinical factors, insight, impulsivity, psychopathy, motor speed and a global measure of cognition are the factors with the strongest empirical evidence for an association with severe violence. CONCLUSION This is the first systematic review of risk factors for severe violence in schizophrenia, in which a great number of clinical and external factors have been evaluated. Most of the clinical factors have been compared on effect size. The identified factors that represent an increased risk of violence in patients with schizophrenia should be included in risk assessments.
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Affiliation(s)
- Bjørn Rishovd Rund
- a Department of Psychology , University of Oslo, Norway and Vestre Viken Hospital Trust , Oslo , Norway
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186
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Verdolini N, Pacchiarotti I, Köhler CA, Reinares M, Samalin L, Colom F, Tortorella A, Stubbs B, Carvalho AF, Vieta E, Murru A. Violent criminal behavior in the context of bipolar disorder: Systematic review and meta-analysis. J Affect Disord 2018; 239:161-170. [PMID: 30014956 DOI: 10.1016/j.jad.2018.06.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/28/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the potential importance of understanding violent criminal behavior (VCB) in individuals suffering from bipolar disorder (BD), previous findings are conflicting. The aims of the present study are to clarify the association of VCB and BD in comparison to general population and other psychiatric conditions. METHODS A systematic review of literature from January 1st, 1980 through January 16th, 2017 from 3 electronic databases (MEDLINE/PubMed, EMBASE and PsycInfo), following the PRISMA and the MOOSE statements. Original peer-reviewed studies reporting data on VCB in BD were included. A random-effects meta-analysis was performed. Potential sources of heterogeneity were examined through subgroup and meta-regression analyses. The protocol was registered in PROSPERO, CRD42017054070. RESULTS Twelve studies providing data from 58,475 BD participants. The prevalence of VCB in BD was 7.1% (95%CI = 3.0‒16.5%; k = 4). The association of BD and VCB compared to general population was not significant (OR = 2.784; 95% CI, 0.687‒11.287, P = .152). The association was significant only in cross-sectional studies, in studies in which VCB was assessed through self-reported measures, and in studies conducted in the USA. BD was more likely to be associated with VCB when BD patients were compared to controls with depressive disorders, whilst it was found to be less associated with VCB when BD was compared to psychotic disorders. LIMITATIONS 1. the methodological heterogeneity across the included studies. 2. causal inferences were precluded by the inclusion of cross-sectional studies. CONCLUSIONS These findings might provide a more balance portrait of the association between BD and VCB to clinicians, law enforcement and general public.
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Affiliation(s)
- Norma Verdolini
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Ellisse Building, 8th Floor, Sant'Andrea delle Fratte, 06132, Perugia, Italy
| | - Isabella Pacchiarotti
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
| | - Cristiano A Köhler
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Maria Reinares
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
| | - Ludovic Samalin
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Auvergne, 58, Rue Montalembert, 63000, Clermont-Ferrand, France; Fondation FondaMental, Hôpital Albert Chenevier, Pôle de Psychiatrie, 40 rue de Mesly, 94000, Créteil, France
| | - Francesc Colom
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain; Mental Health Group, IMIM Hospital del Mar, CIBERSAM, Plaza Charles Darwin, sn, 08003 Barcelona, Catalonia, Spain
| | - Alfonso Tortorella
- FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre of Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain.
| | - Andrea Murru
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain
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187
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Kristof Z, Kresznerits S, Olah M, Gyollai A, Lukacs-Miszler K, Halmai T, Fountoulakis KN, Tenyi T, Dome P, Gonda X. Mentalization and empathy as predictors of violence in schizophrenic patients: Comparison with nonviolent schizophrenic patients, violent controls and nonviolent controls. Psychiatry Res 2018; 268:198-205. [PMID: 30048885 DOI: 10.1016/j.psychres.2018.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/05/2018] [Accepted: 07/13/2018] [Indexed: 12/30/2022]
Abstract
There are conflicting results concerning risk of violence in schizophrenia. Empathy and mentalization deficits are associated both with schizophrenia and violence, however, there are only a few studies with equivocal results concerning their relationship. 88 violent and nonviolent paranoid schizophrenic and violent and nonviolent control males in psychiatric, forensic psychiatric and correctional institutions completed the Ekman 60 Faces test, Faux Pas Recognition Test, Eysenck IVE test, Interpersonal Reactivity Index, and the Spielberger Anger Expression Scale. Data were analysed with ANOVA and logistic regression models. Significant group differences with a characteristic pattern were detected in mentalization, facial affect recognition, fear and anger recognition, interpersonal distress, and frequency of direction of anger expression. Predictors of violent behaviour were different in the schizophrenic and non-schizophrenic groups. Lack of major differences in empathy and mentalization between violent and nonviolent schizophrenia patients suggests that such deficits are core features of schizophrenia but do not determine emerging violence in this illness. Our results emphasise the importance of distinguishing between violence related to core positive symptoms of schizophrenia and that emerging from independent comorbid antisocial personality traits in order to identify targets for screening, detection, prevention and management of violence risk in different subpopulations of schizophrenia patients.
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Affiliation(s)
- Zsuliet Kristof
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - Mate Olah
- University Pharmacy Department of Pharmacy Administration, Budapest, Hungary
| | - Agoston Gyollai
- Forensic Psychiatric and Mental Institution, Budapest, Hungary
| | | | | | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Tamas Tenyi
- Department of Psychiatry and Psychotherapy, University of Pécs, Medical School, Pécs, Hungary
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
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188
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Onwumere J, Zhou Z, Kuipers E. Informal Caregiving Relationships in Psychosis: Reviewing the Impact of Patient Violence on Caregivers. Front Psychol 2018; 9:1530. [PMID: 30233448 PMCID: PMC6129604 DOI: 10.3389/fpsyg.2018.01530] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/02/2018] [Indexed: 02/02/2023] Open
Abstract
A modest association can be found between people with a schizophrenia spectrum diagnosis (psychosis) and perpetrating acts of violence. When a person with psychosis does engage in violence, it is their informal carers, when compared to those from the general population, who are more likely to be the targets, and violence will often occur within the family home. Despite the importance of carer support for improving patient outcomes, our understanding of how carers are impacted by patient initiated violence in psychosis remains limited. This paper reviews literature documenting the effects of patient-initiated violence in psychosis on carer functioning. The review comprised searches of Medline, PsychInfo, Embase, and Web of Science databases and the hand searches of reference lists from relevant published papers. The review was limited to English language publications from inception to 11th September 2017, and where carer experiences following reports of violence from patients with psychosis were specifically recorded. Data from 20 papers using mixed methodologies were reviewed. Patient violence in psychosis was linked to poorer carer outcomes, including carer reports of burden, trauma, fear, and helplessness. There is, however, a significant need for further studies to systematically quantify the impact and correlates of patient initiated violence on psychosis caregivers, and improve prevention.
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Affiliation(s)
- Juliana Onwumere
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, United Kingdom
| | - Zheng Zhou
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
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189
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Rund BR. The association between schizophrenia and violence. Schizophr Res 2018; 199:39-40. [PMID: 29506766 DOI: 10.1016/j.schres.2018.02.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 02/13/2018] [Accepted: 02/25/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway and Vestre Viken Hospital Trust, 3004 Drammen, Norway.
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190
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Caregiving for Relatives with Psychiatric Disorders vs. Co-Occurring Psychiatric and Substance Use Disorders. Psychiatr Q 2018; 89:631-644. [PMID: 29417307 DOI: 10.1007/s11126-017-9557-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the high comorbidity of psychiatric and substance use disorders, extremely little research has examined the experience of caregiving for relatives with co-occurring psychiatric and substance use disorders (COD). The primary objective of the present article is to identify characteristics pertaining to care recipients, family caregivers, and the experience of providing caregiving associated with care recipients having COD vs. only having psychiatric disorders (PD). A U.S. community recruited sample of 1394 family caregivers of persons with COD or PD was employed. Chi-square and Mann-Whitney-Wilcoxon tests were conducted. Compared to caregivers of persons with only PD, caregivers of persons with COD provided slightly less caregiving but experienced significantly greater negative effects from providing care. Caregivers of persons with COD were also more likely to fear care recipients would engage in multiple problematic behaviors. Most significant differences found in providing care to recipients with COD vs. only PD persisted when examining care recipients with severe psychiatric disorders or more moderate psychiatric disorders. Additional findings and treatment implications are described.
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191
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Total and cause-specific standardized mortality ratios in patients with schizophrenia and/or substance use disorder. PLoS One 2018; 13:e0202028. [PMID: 30138449 PMCID: PMC6107156 DOI: 10.1371/journal.pone.0202028] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/26/2018] [Indexed: 11/18/2022] Open
Abstract
Individuals with schizophrenia or substance use disorder have a substantially increased mortality compared to the general population. Despite a high and probably increasing prevalence of comorbid substance use disorder in people with schizophrenia, the mortality in the comorbid group has been less studied and with contrasting results. We performed a nationwide open cohort study from 2009 to 2015, including all Norwegians aged 20-79 with schizophrenia and/or substance use disorder registered in any specialized health care setting in Norway, a total of 125,744 individuals. There were 12,318 deaths in the cohort, and total, sex-, age- and cause-specific standardized mortality ratios (SMRs) were calculated, comparing the number of deaths in patients with schizophrenia, schizophrenia only, substance use disorder only or a co-occurring diagnosis of schizophrenia and substance use disorder to the number expected if the patients had the age-, sex- and calendar-year specific death rates of the general population. The SMRs were 4.9 (95% CI 4.7-5.1) for all schizophrenia patients, 4.4 (95% CI 4.2-4.6) in patients with schizophrenia without substance use disorder, 6.6 (95% CI 6.5-6.8) in patients with substance use disorder only, and 7.4 (95% CI 7.0-8.2) in patients with both schizophrenia and substance use disorder. The SMRs were elevated in both genders, in all age groups and for all considered causes of death, and most so in the youngest. Approximately 27% of the excess mortality in all patients with schizophrenia was due to the raised mortality in the subgroup with comorbid SUD. The increased mortality in patients with schizophrenia and/or substance use disorder corresponded to more than 10,000 premature deaths, which constituted 84% of all deaths in the cohort. The persistent mortality gap highlights the importance of securing systematic screening and proper access to somatic health care, and a more effective prevention of premature death from external causes in this group.
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192
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Khalsa HMK, Baldessarini RJ, Tohen M, Salvatore P. Aggression among 216 patients with a first-psychotic episode of bipolar I disorder. Int J Bipolar Disord 2018; 6:18. [PMID: 30097737 PMCID: PMC6161985 DOI: 10.1186/s40345-018-0126-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/05/2018] [Indexed: 12/03/2022] Open
Abstract
Background Aggression by patients with bipolar I disorder (BD-I) is not uncommon. Identifying potential risk factors early in the illness-course should inform clinical management and reduce risk. Methods In a study sample of 216 initially hospitalized, first-psychotic episode subjects diagnosed with DSM-IV-TR BD-I, we identified recent (within 1 month before hospitalization) aggression by ratings on the Brief Psychiatric Rating Scale-Expanded and review of detailed clinical research records. We compared subjects with versus without aggressive behavior for associations with selected demographic and clinical factors. Results Aggression was identified in 23/216 subjects (10.6%). It was associated significantly with recent suicide attempt (OR = 4.86), alcohol abuse (OR = 3.63), learning disability (OR = 3.14), and initial manic episode (OR = 2.59), but not with age, sex, onset-type, personality disorder, time to recovery, or functional status. Conclusions Among first-major episode BD-I patients with psychotic features, recent serious aggression towards others was identified in 10.6%. The odds of aggression increased by 4.9-times in association with a recent suicide attempt, more than 3-times with alcohol-abuse or learning disability, and by 2.6-times if the episode polarity was manic. The findings encourage closer management of alcohol misuse, suicide risk, and manic symptoms, and early detection of learning problems in BD-I patients.
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Affiliation(s)
- Hari-Mandir K Khalsa
- International Consortium for Bipolar & Psychotic Disorders Research, Psychotic Disorders Division, McLean Hospital, Belmont, MA, 02478, USA. .,Division of Mental Health and Wellbeing, Warwick Medical School, Coventry, UK. .,Department of Psychiatry, Harvard Medical School, Boston, MA, 02215, USA.
| | - Ross J Baldessarini
- International Consortium for Bipolar & Psychotic Disorders Research, Psychotic Disorders Division, McLean Hospital, Belmont, MA, 02478, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02215, USA
| | - Mauricio Tohen
- International Consortium for Bipolar & Psychotic Disorders Research, Psychotic Disorders Division, McLean Hospital, Belmont, MA, 02478, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02215, USA.,Department of Psychiatry & Behavioral Sciences, University of New Mexico, Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Paola Salvatore
- International Consortium for Bipolar & Psychotic Disorders Research, Psychotic Disorders Division, McLean Hospital, Belmont, MA, 02478, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, 02215, USA.,Psychiatry Section, Department of Medicine & Surgery, University of Parma, Parma, Italy
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193
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SanSegundo MS, Ferrer-Cascales R, Bellido JH, Bravo MP, Oltra-Cucarella J, Kennedy HG. Prediction of Violence, Suicide Behaviors and Suicide Ideation in a Sample of Institutionalized Offenders With Schizophrenia and Other Psychosis. Front Psychol 2018; 9:1385. [PMID: 30131743 PMCID: PMC6091276 DOI: 10.3389/fpsyg.2018.01385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 07/17/2018] [Indexed: 11/13/2022] Open
Abstract
This study examined the predictive validity of the Spanish version of the Suicide Risk Assessment Manual (S-RAMM) and the Historical-Clinical-Risk Management-20 (HCR-20) in a sample of violent offenders with schizophrenia and other psychosis, who had committed violent crimes and had been sentenced to compulsory psychiatric treatment by the criminal justice system. Patients were prospectively monitored within the institution for 18 months. During the follow-up period, 25% of offenders were involved in any suicidal behavior including acts of self-harm, suicidal ideation and suicide attempts and 34% were physically or verbally violent. The S-RAMM and HCR-20 risk assessment tools were strongly correlated and were able to predict suicidal behavior and violence with a moderate-large effect size (AUCs = 0.81-0.85; AUCs = 0.78-0.80 respectively). Patients scoring above the mean on the S-RAMM (>20-point cut-off) had a five times increased risk of suicide related events (OR = 5.05, 95% CI = 2.6-9.7) and sevenfold risk of violence in the HCR-20 (>21-point cut-off) (OR = 7.13, 95% CI = 2.0-21.2) than those scoring below the mean. Offenders at high risk for suicide and violence had significantly more suicide attempts (p < 0.001) and more prior sentences for violent crimes (p < 0.001). These results support the use of the S-RAMM and HCR-20 for clinical practice by providing evidence of the utility of these measures for predicting risk for suicidal and violent behavior in mentally disordered offenders.
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Affiliation(s)
| | | | - Jesús H. Bellido
- Department of Psychology, Alicante Forensic Psychiatric Hospital, Alicante, Spain
| | - Mar P. Bravo
- Department of Psychiatry, Institute of Legal Medicine, Alicante, Spain
| | | | - Harry G. Kennedy
- Department of Psychiatry, Trinity College, University of Dublin, Dundrum, Ireland
- Central Mental Hospital, Dublin, Ireland
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194
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Engelstad KN, Vaskinn A, Torgalsbøen AK, Mohn C, Lau B, Rund BR. Impaired neuropsychological profile in homicide offenders with schizophrenia. Compr Psychiatry 2018; 85:55-60. [PMID: 29981505 DOI: 10.1016/j.comppsych.2018.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/16/2018] [Accepted: 06/08/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Our ability to predict and prevent homicides committed by individuals with schizophrenia is limited. Cognitive impairments are associated with poorer functional outcome in schizophrenia, possibly also homicide. The aim of the current study was to investigate global and specific cognition among homicide offenders with schizophrenia (HOS). METHODS Twenty-six HOS were compared to 28 individuals with schizophrenia and no history of violence (non-HOS), and a group of healthy controls (HC, n = 151). HOS and non-HOS participants were recruited from in- and outpatient units across Norway. An extensive neuropsychological test battery was administered. RESULTS HOS participants performed significantly weaker than HC in all cognitive domains. Further, statistically significant differences between HOS and non-HOS participants were found for IQ (d = 0.52) and verbal learning (d = 0.82), with larger impairments in the HOS compared to the non-HOS group. CONCLUSIONS Our results indicate that HOS participants show clinically significant impairments in global and specific cognition.
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Affiliation(s)
| | - Anja Vaskinn
- NORMENT K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, P. O. Box 4956, Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P. O. Box 1039, Blindern, 0315 Oslo, Norway.
| | - Anne-Kari Torgalsbøen
- Department of Psychology, Faculty of Social Sciences, University of Oslo, P. O. Box 1094, Blindern, 0317 Oslo, Norway.
| | - Christine Mohn
- Research Department, Vestre Viken Hospital Trust, P. O. Box 800, 3004 Drammen, Norway.
| | - Bjørn Lau
- Department of Psychology, Faculty of Social Sciences, University of Oslo, P. O. Box 1094, Blindern, 0317 Oslo, Norway; Lovisenberg Diaconal Hospital, P. O. Box 4970, Nydalen, 0440 Oslo, Norway.
| | - Bjørn Rishovd Rund
- Research Department, Vestre Viken Hospital Trust, P. O. Box 800, 3004 Drammen, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, P. O. Box 1094, Blindern, 0317 Oslo, Norway.
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195
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Labrum T, Solomon P. Safety Fears Held by Caregivers about Relatives with Psychiatric Disorders. HEALTH & SOCIAL WORK 2018; 43:165-174. [PMID: 29901709 DOI: 10.1093/hsw/hly013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 04/20/2018] [Indexed: 06/08/2023]
Abstract
In this period of post-deinstitutionalization, much of the care for people with severe psychiatric disorders (PD) is provided by their families. A primary stressor for caregivers is fears regarding their own safety and that of others, which has been virtually unexplored. To fill this gap, factors in three domains were assessed: (1) relatives with PD, (2) family caregivers, and (3) interactions with each other. This investigation was a secondary analysis of data obtained from a national survey of caregivers of adults with mental illness conducted by the National Alliance for Caregiving. A subsample of 1,505 was used in the present study. Fear of harm was positively associated with the following factors: relatives with PD-serious mental health problem, alcohol and substance abuse, receipt of crisis mental health treatment, history of arrest; interaction-greater difficulty getting relative to take medications as prescribed; and fear that relative would be hurt by others or die by suicide. Social workers need to be cognizant of risk of potential violence against caregivers and ensure the safety of these family members, even if they may not be their primary clients. The article includes recommendations for family inclusion in the treatment of people with PD.
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Affiliation(s)
- Travis Labrum
- Travis Labrum, PhD, LCSW, is assistant professor, Division of Social Work, University of Wyoming, 1000 E University Avenue, Laramie, WY; e-mail: . Phyllis Solomon, PhD, is professor, School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Phyllis Solomon
- Travis Labrum, PhD, LCSW, is assistant professor, Division of Social Work, University of Wyoming, 1000 E University Avenue, Laramie, WY; e-mail: . Phyllis Solomon, PhD, is professor, School of Social Policy and Practice, University of Pennsylvania, Philadelphia
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196
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Dean K, Laursen TM, Pedersen CB, Webb RT, Mortensen PB, Agerbo E. Risk of Being Subjected to Crime, Including Violent Crime, After Onset of Mental Illness: A Danish National Registry Study Using Police Data. JAMA Psychiatry 2018; 75:689-696. [PMID: 29799904 PMCID: PMC6071849 DOI: 10.1001/jamapsychiatry.2018.0534] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE People with mental illness are more likely to have contact with the criminal justice system, but research to date has focused on risk of offense perpetration, while less is known about risk of being subjected to crime and violence. OBJECTIVES To establish the incidence of being subjected to all types of criminal offenses, and by violent crimes separately, after onset of mental illness across the full diagnostic spectrum compared with those in the population without mental illness. DESIGN, SETTING, AND PARTICIPANTS This investigation was a longitudinal national cohort study using register data in Denmark. Participants were a cohort of more than 2 million persons born between 1965 and 1998 and followed up from 2001 or from their 15th birthday until December 31, 2013. Analysis was undertaken from November 2016 until February 2018. EXPOSURES Cohort members were followed up for onset of mental illness, recorded as first contact with outpatient or inpatient mental health services. Diagnoses across the full spectrum of psychiatric diagnoses were considered separately for men and women. MAIN OUTCOMES AND MEASURES Incidence rate ratios (IRRs) were estimated for first subjection to crime event (any crime and violent crime) reported to police after onset of mental illness. The IRRs were adjusted for cohort member's own criminal offending, in addition to several sociodemographic factors. RESULTS In a total cohort of 2 058 063 (48.7% male; 51.3% female), the adjusted IRRs for being subjected to crime associated with any mental disorder were 1.49 (95% CI, 1.46-1.51) for men and 1.64 (95% CI, 1.61-1.66) for women. The IRRs were higher for being subjected to violent crime at 1.76 (95% CI, 1.72-1.80) for men and 2.72 (95% CI, 2.65-2.79) for women. The strongest associations were for persons diagnosed as having substance use disorders and personality disorders, but significant risk elevations were found across almost all diagnostic groups examined. CONCLUSIONS AND RELEVANCE Onset of mental illness is associated with increased risk of exposure to crime, and violent crime in particular. Elevated risk is not confined to specific diagnostic groups. Women with mental illness are especially vulnerable to being subjected to crime. Individual's own offending accounts for some but not all of the increased vulnerability to being subjected to crime.
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Affiliation(s)
- Kimberlie Dean
- School of Psychiatry, University of New South Wales, Sidney, Australia,Justice Health and Forensic Mental Health Network, New South Wales, Matraville, Australia
| | - Thomas M. Laursen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Carsten B. Pedersen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,CIRRAU–Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Roger T. Webb
- Centre for Mental Health & Safety, Division of Psychology & Mental Health, National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
| | - Preben B. Mortensen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark,CIRRAU–Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark,CIRRAU–Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
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197
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Schoretsanitis G, Eisenhardt S, Ricklin ME, Srivastava DS, Walther S, Exadaktylos A. Psychiatric Emergencies of Asylum Seekers; Descriptive Analysis and Comparison with Immigrants of Warranted Residence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1300. [PMID: 29933607 PMCID: PMC6068840 DOI: 10.3390/ijerph15071300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/11/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022]
Abstract
Background: The aim of our study was to assess utilization patterns of psychiatric services by asylum seekers. Methods: We included 119 adults who presented themselves at the University Emergency Department between 1 March 2012 and 1 January 2017 for psychiatric consultation. Descriptive data were compared with a control group of non-Swiss individuals with warranted residence permits using Mann-Whitney-U and chi square (χ²) tests. Results: Patients were mainly single, male, residing in reception centers, and presented themselves most frequently due to suicidal ideation. Almost 60% of the patients were assigned to inpatient treatments, with 28 involuntary cases. Compared to the control group, asylum seekers were younger and more often men (p < 0.001 for both). Further, they less often had family in Switzerland (χ² = 9.91, p = 0.007). The proportion of patients coming in as walk-ins was significantly higher in the control group than in asylum seekers (χ² = 37.0, p < 0.001). Asylum seekers were more frequently referred due to suicidal ideation and aggressive behavior than participants in the control group (χ² = 80.07, p < 0.001). Diagnoses for asylum seekers infrequently included mood, as they often reported stress-related disorders (χ² = 19.6, p = 0.021) and they were infrequently released home (χ² = 9.19, p = 0.027). Conclusion: Asylum seekers more frequently demonstrated severe symptoms such as suicidal ideation and aggressive behavior and they were mainly treated as inpatients, potentially due to minimal social resources.
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Affiliation(s)
- Georgios Schoretsanitis
- University Hospital of Psychiatry, 3008 Bern, Switzerland.
- Department of Psychiatry, Psychotherapy and Psychosomatics, and JARA⁻Translational Brain Medicine, RWTH Aachen University, 52074 Aachen, Germany.
| | | | - Meret E Ricklin
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | - David S Srivastava
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | | | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
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198
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Labrum T. Characteristics associated with family money management for persons with psychiatric disorders. J Ment Health 2018; 27:504-510. [PMID: 29749757 DOI: 10.1080/09638237.2018.1466032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Persons with psychiatric disorders (PD) commonly have their money officially or unofficially managed by others, with money managers most commonly being family members. AIMS (i) Identify characteristics of persons with PD, adult family members, and interactions with each other significantly associated with family money management (FMM). (ii) Identify significant differences in aforementioned characteristics between official versus unofficial FMM. METHODS Five hundred and seventy-three adults residing in USA with an adult relative with PD completed a survey. RESULTS Among persons with PD, FMM was positively associated with lower income, diagnosis of schizophrenia/schizoaffective or bipolar disorder, psychiatric hospitalization, and arrest history. FMM was negatively associated with family members having a mental health diagnosis. FMM was positively associated with interaction characteristics of co-residence, financial assistance, caregiving, and use of limit-setting practices. Compared to official FMM, when unofficial FMM was present, persons with PD were less likely to have been psychiatrically hospitalized or to have regularly attended mental health treatment. When unofficial FMM was present, adult family members were less likely to be a parent of the person with PD. CONCLUSIONS Practitioners should assess the level of burden experienced by family money managers and assess and address with family money managers the use of limit-setting practices.
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Affiliation(s)
- Travis Labrum
- a Division of Social Work, College of Health Science , University of Wyoming , Laramie , WY , USA
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199
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Chen X, Zhang X, Wong SCP, Yang M, Kong D, Hu J. Characteristics of alleged homicide offenders with and without schizophrenia in Sichuan, China. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2018; 28:202-215. [PMID: 29052283 DOI: 10.1002/cbm.2054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 10/06/2015] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Little is known about the characteristics of people with and without schizophrenia who have been charged with homicide in China. AIMS AND RESEARCH QUESTION Our research question was what differences are there between alleged homicide offenders with and without psychosis? METHOD All archival records of alleged homicide cases referred for assessment to the West China Forensic Central Medical Service during 1998-2006 were retrieved. The centre serves a large catchment area in the mainly rural province of Sichuan. A random 20% of cases with schizophrenia and all cases without psychosis were selected for comparison. Demographic, criminological and mental health data were extracted from the records, and violence was rated by using the Violence Risk Scale (Chinese version). RESULTS The two groups differed significantly in age, education, occupation, marital status and relationships to victim. The estimated risk of reoffending was higher in the schizophrenia group than the non-psychotic group, even after controlling for demographic differences. Despite many individuals reporting long histories of mental illness, about 40% of those with schizophrenia had never had any psychiatric treatment and less than 4% were in treatment at the time of the alleged homicide. CONCLUSIONS The tendency for homicidal people with schizophrenia to be older, less educated and more socially isolated than their non-psychotic peers is similar to experience in Western countries, but the apparently higher risk scale scores of the Chinese schizophrenia group and their greater tendency to attack strangers are different. The lack of reported previous engagement with mental health services by a clearly ill and risky group of people is a likely explanation. Similar rural problems compared with better served urban areas have been reported in the Chuvash Republic. The case for better rural mental health services seems strong. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Xiacan Chen
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, China
- Key Laboratory of Evidence Science (China University of Political Science and Law), Ministry of Education, Beijing, China
| | | | - Stephen C P Wong
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Min Yang
- School of Medicine, University of Nottingham, Nottingham, UK
- School of Public Health, Sichuan University, China
| | - Di Kong
- The Fourth People's Hospital Chengdu, Sichuan, China
| | - Junmei Hu
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, China
- Key Laboratory of Evidence Science (China University of Political Science and Law), Ministry of Education, Beijing, China
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200
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Völlm BA, Clarke M, Herrando VT, Seppänen AO, Gosek P, Heitzman J, Bulten E. European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders. Eur Psychiatry 2018; 51:58-73. [PMID: 29571072 DOI: 10.1016/j.eurpsy.2017.12.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 01/15/2023] Open
Abstract
Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues.
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Affiliation(s)
- Birgit A Völlm
- Section of Forensic Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Institute of Mental Health, Triumph Road, Nottingham NG7 2TU, United Kingdom.
| | - Martin Clarke
- Nottinghamshire Healthcare NHS Foundation Trust, Institute of Mental Health, Triumph Road, Nottingham NG7 2TU, United Kingdom.
| | - Vicenç Tort Herrando
- Unitat Polivalent de Psiquaitria Quatre Camins, Penitentiary Psychiatry, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
| | - Allan O Seppänen
- Helsinki University Hospital Psychoses and Forensic Psychiatry Vanha Valtatie 198, 04500 Kellokoski, Finland & Vanha Vaasa Hospital Vierinkiventie 1, 65380 Vaasa, Finland
| | - Paweł Gosek
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02-957 Warsaw, Poland
| | - Janusz Heitzman
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02-957 Warsaw, Poland
| | - Erik Bulten
- The Pompe Foundation, Forensic Psychiatric Centre Pompestichting, Nijmegen, Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
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