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Findeis H, Strauß M, Kröber HL. The TCO concept in German forensic homicide offenders with schizophrenia spectrum disorders - new findings from a file-based, retrospective cross-sectional study. Front Psychiatry 2024; 15:1404263. [PMID: 38919633 PMCID: PMC11196989 DOI: 10.3389/fpsyt.2024.1404263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction There is evidence that there is a small group of people with schizophrenia spectrum disorders who are more likely to commit homicide than those in the general population. However, there is limited knowledge about the psychopathology that leads to homicide in this group. The aim of this study was to examine two commonly used definitions of the Threat/Control-Override (TCO) concept, which aims to identify a certain risk of serious violence in patients with schizophrenia spectrum disorders. Methods This is a sub analysis of a file-based, retrospective and exploratory cross-sectional study. All forensic homicide offenders with schizophrenia spectrum disorders who were detained at the Forensic Hospital Berlin as of 31 December 2014 were examined for the occurrence of TCO according to two commonly used definitions. Results Of a total of 419 forensic patients with schizophrenia spectrum disorders, 78 committed homicide (18.6%). The forensic homicide offenders with schizophrenia spectrum disorders were characterised by being male, unemployed, single and having committed (attempted) manslaughter. Irrespective of the definition used, the entire TCO complex was present in less than a third of the sample. In both definitions, Threat symptoms were slightly less frequent than Control-Override symptoms. While Threat symptoms occurred less frequently in Stompe et al.'s definition, Control-Override symptoms were the most common. With regard to Kröber's definition of Threat and Control-Override, the situation is exactly the opposite. Discussion Regarding the entire TCO complex, Kröber's definition seems a little more open and Stompe et al.'s more strict (38.5% vs. 35.9%). Since TCO only occurs in about one third of the subjects in both definitions, neither definition appears to be conclusive. A combination with proportions from both definitions could be a contribution to a future definition of TCO. The present study provides scarcely published primary data on psychopathology in homicide offenders with schizophrenia spectrum disorders, especially on the much discussed TCO concept in two definitions. In order to determine the most useful definition of TCO, to avoid false positives and to identify clear psychopathological risk symptoms, larger samples and comparative studies with offenders and non-offenders should be conducted in the future.
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Affiliation(s)
- Hannelore Findeis
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
- Institut für Forensische Psychiatrie, Charité Berlin, Berlin, Germany
| | - Maria Strauß
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
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Çetinay Aydın P, Yıldırım YE, Erol A, Nursal AF, Öngel Atar A, Oyacı Y, Ayar Y, Kişioğlu S, Pehlivan S. Evaluation of the association COMT Val158Met variant and childhood trauma on aggression in Turkish SCZ patients. NUCLEOSIDES, NUCLEOTIDES & NUCLEIC ACIDS 2024:1-11. [PMID: 38206874 DOI: 10.1080/15257770.2024.2302524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/29/2023] [Indexed: 01/13/2024]
Abstract
Childhood trauma is a serious form of stress that makes individuals more vulnerable to developing Schizophrenia (SCZ). Many studies have predicted the association between the catechol-O-methyltransferase (COMT) gene Val158Met variant and aggressive attack. We aimed to investigate the association the COMT variant and childhood trauma on aggression in Turkish SCZ patientsThis study included 89 patients diagnosed with SCZ. Childhood Trauma Questionnaire (CTS) and Overt Aggression Scale (OAS) were used to assess childhood trauma and aggression. COMT Val158Met variant was analyzed by PCR-RFLP method from isolated DNAs.There was no statistically significant difference in comparing the COMT genotype distribution and clinical characteristics including suicide attempts, self-destructive behavior, crime history, substance, alcohol and tobacco use. When we evaluate Spearman's rank correlation coefficients between CTQ and OAS, the correlation between the OAS and CTQ scores of the patients was statistically significant except for the sexual abuse subgroup of the CTQ. In the univariate logistic regression analysis, in which the dichotomized OAS score was accepted as the dependent variable, it was found that age, suicide attempt, substance abuse, and CTQ total score significantly predicted the higher OAS scores. In the multivariate logistic regression analysis, which included the variables that predicted OAS significantly, age, suicide attempt, and total CTQ score were determined as independent variables predicting OAS.Because of the phenotypic complexity in SCZ, it is difficult to draw strong conclusions about COMT and to highlight a definitive relationship. Larger-scale studies are needed to examine the multifactorial inheritance pattern of schizophrenia in different dimensions.
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Affiliation(s)
- Pınar Çetinay Aydın
- Department of Psychiatry, University of Health Sciences, Medicine Faculty, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurological and Neurosurgical Diseases
| | | | - Ayşe Erol
- Department of Medical Biology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Feyda Nursal
- Department of Medical Genetics, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Ayça Öngel Atar
- Department of Psychiatry, University of Health Sciences, Medicine Faculty, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurological and Neurosurgical Diseases
| | - Yasemin Oyacı
- Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
| | | | - Sati Kişioğlu
- Department of Psychiatry, University of Health Sciences, Medicine Faculty, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurological and Neurosurgical Diseases
| | - Sacide Pehlivan
- Department of Medical Biology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Fischer-Vieler T, Ringen PA, Kvig E, Bell C, Hjell G, Tesli N, Rokicki J, Melle I, Andreassen OA, Friestad C, Haukvik UK. Associations Between Clinical Insight and History of Severe Violence in Patients With Psychosis. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad011. [PMID: 39145347 PMCID: PMC11207844 DOI: 10.1093/schizbullopen/sgad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background and Hypothesis Violence is more prevalent in patients with psychotic disorders compared to the general population. Hence, adequate violence risk assessment is of high clinical importance. Impaired insight is suggested as a risk factor for violence in psychosis, but studies have yielded conflicting results. We hypothesized that impaired insight was associated with a history of severe violence in patients with psychotic disorders. Study Design Clinical insight was assessed both using the Birchwood Insight Scale (BIS) and the Positive and Negative Symptom Scale (PANSS) item G12 (lack of judgment and insight). The degree of impaired clinical insight was compared between psychosis patients with (N = 51) and without (N = 178) a history of severe violence. Multiple linear regression analyses were performed to investigate the effects of putative confounders. Study Results We found that a history of severe violence was significantly associated with lower insight in one of the three BIS components (the relabeling of symptoms) (P = .03, R2 = 0.02) and the PANSS item G12 (P = .03, R2 = 0.02) also after controlling for putative confounders. Conclusions The results suggest there is an association between impaired insight and severe violence in psychosis patients. We propose that examination of insight by validated instruments comprising different components may add useful information to clinical violence risk assessment in psychosis patients.
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Affiliation(s)
- Thomas Fischer-Vieler
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Petter Andreas Ringen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erling Kvig
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Mental Health and Addiction, Nordlandssykehuset, Bodø, Norway
| | - Christina Bell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Gabriela Hjell
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Østfold Hospital Trust, Graalum, Norway
| | - Natalia Tesli
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jaroslav Rokicki
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole Andreas Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Christine Friestad
- Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
- University College of Norwegian Correctional Service, Oslo, Norway
| | - Unn Kristin Haukvik
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Advantages of Machine Learning in Forensic Psychiatric Research—Uncovering the Complexities of Aggressive Behavior in Schizophrenia. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020819] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Linear statistical methods may not be suited to the understanding of psychiatric phenomena such as aggression due to their complexity and multifactorial origins. Here, the application of machine learning (ML) algorithms offers the possibility of analyzing a large number of influencing factors and their interactions. This study aimed to explore inpatient aggression in offender patients with schizophrenia spectrum disorders (SSDs) using a suitable ML model on a dataset of 370 patients. With a balanced accuracy of 77.6% and an AUC of 0.87, support vector machines (SVM) outperformed all the other ML algorithms. Negative behavior toward other patients, the breaking of ward rules, the PANSS score at admission as well as poor impulse control and impulsivity emerged as the most predictive variables in distinguishing aggressive from non-aggressive patients. The present study serves as an example of the practical use of ML in forensic psychiatric research regarding the complex interplay between the factors contributing to aggressive behavior in SSD. Through its application, it could be shown that mental illness and the antisocial behavior associated with it outweighed other predictors. The fact that SSD is also highly associated with antisocial behavior emphasizes the importance of early detection and sufficient treatment.
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Reinwald JR, Horten B, Dreßing H, Salize HJ. [Structural Features and Use of Coercive Measures in Forensic Psychiatry Throughout Germany]. PSYCHIATRISCHE PRAXIS 2021; 49:22-28. [PMID: 33773502 DOI: 10.1055/a-1391-0192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Nationwide assessment of structural data and the frequency of use of coercive measures in forensic psychiatric hospitals in Germany. METHODS Quantitative survey using a postal questionnaire on structural data and on the use of coercive measures in forensic psychiatric hospitals as part of the "ZIPHER" study. RESULTS About one fourth of all forensic patients are affected by coercive measures, with seclusion (21.2 %) being way more often than mechanical restraint (3.2 %). This ratio contrasts with general psychiatric hospitals, where restraints are more common than seclusions. CONCLUSION The results of the study reveal nationwide peculiarities in the use of coercive measures in forensic psychiatric hospitals. At the same time, it demonstrated the lack of general structural and process data of forensic hospitals in Germany.
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Affiliation(s)
- Jonathan Rochus Reinwald
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
| | - Barbara Horten
- Institut für Kriminologie, Ruprecht-Karls-Universität Heidelberg
| | - Harald Dreßing
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
| | - Hans-Joachim Salize
- Arbeitsgruppe Versorgungsforschung, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
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Haouchet S, Harder C, Müller S. Comparison of the Effects of a Genetic, a Mild Encephalitis, and a Psychosocial Causal Explanation of Schizophrenia on Stigmatizing Attitudes - a Pilot Study With a Quasi-Experimental Design. Front Psychiatry 2021; 12:745124. [PMID: 34616325 PMCID: PMC8489806 DOI: 10.3389/fpsyt.2021.745124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Previous research has shown that the endorsement of biogenetic causal explanations of schizophrenia is associated with stronger stigmatizing attitudes against people with schizophrenia than the endorsement of psychosocial explanations. However, little is known about whether different biogenetic causal explanation beliefs differentially affect stigmatizing attitudes. This is particularly valid for the endorsement of the mild encephalitis hypothesis of schizophrenia. Aim: To examine to what extent different causal explanations of schizophrenia influence the desire for social distance from persons with schizophrenia. Methods: A study with a prospective, quasi-experimental design was carried out with students in Germany (N = 333). A case vignette depicting a person with schizophrenia-typical symptoms was presented, and a social distance scale (SDS) was used to measure the stigmatizing attitude against the person described. Participants were randomly assigned to one of three groups receiving different causal explanations of schizophrenia (genetic, mild encephalitis hypothesis, or psychosocial) without treatment information. Results: A one-way ANOVA showed that the mean SDS was lowest in the group with the mild encephalitis hypothesis explanation, followed by the genetic explanation group, and highest in the psychosocial explanation group. However, the differences between the groups were small and not significant. A subanalysis revealed a significant interaction between gender and causal explanation. Women showed a significantly lower desire for social distance than men when receiving the mild encephalitis hypothesis. Neither the study discipline nor the number of semesters of study had significant effects on the mean SDS. The differences between the mean SDS scores for the different items were much bigger than the differences for the different causal explanations. Regardless of the causal explanation, the extent of the desired social distance depends strongly on social proximity. Conclusion: The present study fits into previous research, which has found that biogenetic beliefs were either associated with more social distance or did not yield a statistically significant association. Although we found a small gender-specific effect of the endorsement of the mild encephalitis hypothesis, we do not recommend gender-specific anti-stigmatization campaigns because they might rightly raise suspicions of dishonesty and manipulation. Rather we support recovery-oriented messages focusing on effective treatments.
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Affiliation(s)
- Sonja Haouchet
- Department of Psychiatry and Neurosciences, CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carolin Harder
- Department of Psychiatry and Neurosciences, CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sabine Müller
- Department of Psychiatry and Neurosciences, CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Wittmann L, Groen G. [A Police Perspective on the Interaction with Individuals with Mental Disorders]. PSYCHIATRISCHE PRAXIS 2020; 48:31-36. [PMID: 32659794 DOI: 10.1055/a-1190-7598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Police officers often come in contact with individuals suffering from behavior disturbances. The present study examined the subjective experience of these interactions from a police perspective to detect further needs in police trainings to make these interactions safer. METHODS N = 958 police officers filled out a questionnaire regarding their subjective experience. The questionnaire assessed the frequency of contact with individuals with behavior disturbances, specific challenges in regard to the interaction and associated subjective anxiety or stress as well as knowledge about behavior disturbances. RESULTS Police staff experience individuals suffering from behavior disturbances often as unpredictable, verbally and physically aggressive. 27.9 % report anxiety in these interactions and 76 % report a lack of specific knowledge. CONCLUSION Police training programs should focus on increasing mental health literacy, specific communication skills and anti-stigma interventions.
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Affiliation(s)
| | - Gunter Groen
- Hochschule für Angewandte Wissenschaften Hamburg
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Storvestre GB, Jensen A, Bjerke E, Tesli N, Rosaeg C, Friestad C, Andreassen OA, Melle I, Haukvik UK. Childhood Trauma in Persons With Schizophrenia and a History of Interpersonal Violence. Front Psychiatry 2020; 11:383. [PMID: 32431632 PMCID: PMC7214725 DOI: 10.3389/fpsyt.2020.00383] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Childhood trauma is a risk factor for psychosis as well for violent behavior and offending later in life. Childhood trauma comprises subdomains of abuse and neglect that may be differently related to later violence among patients with schizophrenia. The aim of this study was to map the subdomains of childhood trauma associated with violent offending in schizophrenia. METHODS Information on childhood trauma from predominantly male patients with a DSM-IV diagnosis of schizophrenia and a history of violent offending (interpersonal violence) (SCZ-V, n = 19), schizophrenia patients without a history of violence (SCZ-NV, n = 34), and healthy controls (HC, n = 66) was obtained with the Childhood Trauma Questionnaire (CTQ). Differences between groups in total maltreatment scores and the five subdomains including physical, emotional, and sexual abuse, as well as physical and emotional neglect were analyzed. RESULTS SCZ-V had the highest median CTQ scores for all sub-domains. SCZ-V reported significantly higher total CTQ scores than SCZ-NV and HC. SCZ-V had significantly higher scores than HC on all subdomains, and significantly higher than SCZ-NV on physical and emotional neglect. SCZ-NV had higher scores on all domains except sexual abuse compared to HC. CONCLUSION SCZ-V patients had higher exposure to childhood trauma than SCZ-NV, and both schizophrenia groups had higher exposure than HC. The results suggest that childhood physical and emotional neglect may be of specific importance to later violence in schizophrenia.
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Affiliation(s)
| | - Arvid Jensen
- Department of Psychiatry, Ostfold Hospital Trust, Grålum, Norway
| | - Espen Bjerke
- Department of Psychiatry, Ostfold Hospital Trust, Grålum, Norway
| | - Natalia Tesli
- NORMENT, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway
| | - Cato Rosaeg
- Department of Psychiatry, Ostfold Hospital Trust, Grålum, Norway
| | - Christine Friestad
- Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,Department of Research, University College of Norwegian Correctional Service, Lillestrøm, Norway
| | - Ole Andreas Andreassen
- NORMENT, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,NORMENT, Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,NORMENT, Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Unn Kristin Haukvik
- NORMENT, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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[Standards for treatment in forensic committment according to § 63 and § 64 of the German criminal code : Interdisciplinary task force of the DGPPN]. DER NERVENARZT 2019; 88:1-29. [PMID: 28776213 DOI: 10.1007/s00115-017-0382-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
People who have been convicted of a crime due to a severe mental disorder and continue to be dangerous as a result of this disorder may be placed in a forensic psychiatric facility for improvement and safeguarding according to § 63 and § 64 of the German Criminal Code (StGB). In Germany, approximately 9000 patients are treated in clinics for forensic psychiatry and psychotherapy on the basis of § 63 of the StGB and in withdrawal centers on the basis of § 64 StGB. The laws for treatment of patients in forensic commitment are passed by the individual States, with the result that even the basic conditions differ in the individual States. While minimum requirements have already been published for the preparation of expert opinions on liability and legal prognosis, consensus standards for the treatment in forensic psychiatry have not yet been published. Against this background, in 2014 the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) commissioned an interdisciplinary task force to develop professional standards for treatment in forensic psychiatry. Legal, ethical, structural, therapeutic and prognostic standards for forensic psychiatric treatment should be described according to the current state of science. After 3 years of work the results of the interdisciplinary working group were presented in early 2017 and approved by the board of the DGPPN. The standards for the treatment in the forensic psychiatric commitment aim to initiate a discussion in order to standardize the treatment conditions and to establish evidence-based recommendations.
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Müller JL, Saimeh N, Briken P, Eucker S, Hoffmann K, Koller M, Wolf T, Dudeck M, Hartl C, Jakovljevic AK, Klein V, Knecht G, Müller-Isberner R, Muysers J, Schiltz K, Seifert D, Simon A, Steinböck H, Stuckmann W, Weissbeck W, Wiesemann C, Zeidler R. Standards für die Behandlung im Maßregelvollzug nach §§ 63 und 64 StGB. FORENSISCHE PSYCHIATRIE, PSYCHOLOGIE, KRIMINOLOGIE 2018. [DOI: 10.1007/s11757-017-0445-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Frommberger U, Hamann K, Kammerer J, Papp L, Schwarz M, Weithmann G, Steinert T. A feasibility study on violence prevention in outpatients with schizophrenia. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 58:54-62. [PMID: 29853013 DOI: 10.1016/j.ijlp.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 08/13/2017] [Accepted: 02/14/2018] [Indexed: 06/08/2023]
Abstract
Patients with schizophrenia have an increased risk of violent behavior, and occupy a large percentage of forensic beds. Most patients in forensic psychiatry have already undergone general psychiatric therapy. This predestinates general psychiatrists to identify those patients presenting such a risk, and to try to intervene so that violence can be prevented. Feasibility study of violence prevention using cognitive-behavioral therapy interventions in male patients with schizophrenia on a general psychiatric ward. Of our patients admitted with schizophrenia, 39.1% had committed violent acts against others; the severity of the act was usually low. The percentage of non-participants was high (83.1%). Study subjects were younger, had not been ill for as long, and were less apt to drop out of the ongoing general psychiatric treatment than the non-participants. Study subjects and non-participants did not differ in the violent act's severity. Our therapy manual proved to be sensible and practical. Those of us attempting to prevent schizophrenic patients from committing violence must deal with individuals who are generally hard to reach. We succeeded in achieving a low drop-out rate after having recruited patients who had displayed a substantial propensity to violence against others.
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Affiliation(s)
| | | | | | - Ludwig Papp
- Psychiatrisches Zentrum Nordbaden, Wiesloch, Germany
| | | | - Gerd Weithmann
- Zentrum für Psychiatrie Die Weißenau, Ravensburg, Germany
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Riedmüller R, Müller S. Ethical Implications of the Mild Encephalitis Hypothesis of Schizophrenia. Front Psychiatry 2017; 8:38. [PMID: 28348532 PMCID: PMC5346578 DOI: 10.3389/fpsyt.2017.00038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/27/2017] [Indexed: 02/02/2023] Open
Abstract
Schizophrenia is a serious mental disease with a high mortality rate and severe social consequences. Due to insufficient knowledge about its etiopathogenesis, curative treatments are not available. One of the most promising new research concepts is the mild encephalitis hypothesis of schizophrenia, developed mainly by Karl Bechter and Norbert Müller. According to this hypothesis, a significant subgroup of schizophrenia patients suffer from a mild, but chronic, form of encephalitis with markedly different etiologies ranging from viral infections, traumas to autoimmune diseases. This inflammatory process is thought to occur in the beginning or during the course of the disease. In this article, we investigate the consequences of the mild encephalitis hypothesis of schizophrenia for the scientific community, and evaluate these consequences ethically. The mild encephalitis hypothesis implies that schizophrenia would no longer be considered an incurable psychiatric disorder. Instead, it would be considered a chronic, but treatable, neurological disease. This paradigm shift would doubtlessly have significant consequences: (1) major reforms would be necessary in the theoretical conceptualization of schizophrenia, which would challenge the psychiatric diagnostic systems, Diagnostic and Statistical Manual of Mental Disorders version 5 and ICD-10. (2) Psychotic patients should be treated in interdisciplinary teams, optimally in neuropsychiatric units; additionally, specialists for endocrinology, diabetology, and cardiology should be consulted for the frequently occuring somatic comorbidities. (3) Current diagnostic procedures and (4) therapies would have to be modified significantly. (5) There might be repercussions for the pharmaceutical industry as well: first, because old drugs with expired patent protection could partly replace expensive drugs and, second, because there would be a demand for the development of new anti-inflammatory drugs. (6) Legal evaluation of compulsory treatment orders might have to be reconsidered in light of causal therapies; leading to increased legal approval and reduced need for compulsory treatment orders due to better patient compliance. (7) The social inclusion of patients might improve, if treatment became more effective regarding cognitive and social functioning. (8) The stigmatization of patients and their relatives might decrease.
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Affiliation(s)
- Rita Riedmüller
- Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Müller
- Mind and Brain Research, Department of Psychiatry and Psychotherapy, CCM, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Caqueo-Urízar A, Fond G, Urzúa A, Boyer L, Williams DR. Violent behavior and aggression in schizophrenia: Prevalence and risk factors. A multicentric study from three Latin-America countries. Schizophr Res 2016; 178:23-28. [PMID: 27614568 DOI: 10.1016/j.schres.2016.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 09/02/2016] [Accepted: 09/02/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of the present study was (i) to assess the prevalence of Violent Behavior in Schizophrenia (VBS) in a sample of community-dwelling outpatients in three middle-income countries of Latin America and (ii) to determine the clinical and socio-demographical risk factors associated with VBS and aggression level. METHODS The study included 253 stabilized outpatients with schizophrenia and their principal caregivers from 3 public ambulatory psychiatric care centers in Bolivia (N=83), Chile (N=85), and Peru (N=85). VBS was defined according to the Overt Aggression Scale (OAS) score and the aggression level was measured by the aggression subscore of the Agitated Behavior Scale of Corrigan. We collected socio-demographic information and clinical data. Multiple linear and logistic regressions were performed to determine which variables were associated with VBS and aggression level. RESULTS The prevalence of VBS differed statistically between the three countries (p<0.001) with 3.5% in Chile, 14.6% in Peru and 55.4% in Bolivia. After adjustment for confounding factors, VBS was associated with a younger age, a more severe psychotic symptomatology, a lower family income and unemployment. After adjustment for confounding factors, aggression level was associated with a more severe psychotic symptomatology, a lower family income, a younger age at illness onset and higher number of hospitalizations in the last 3years. CONCLUSION These results may guide future health policies to specifically provide social support and rehabilitation care to VBS patients in middle-income countries, including psychoeducation and a more integrated work between the treating medical team and the social workers.
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Affiliation(s)
- Alejandra Caqueo-Urízar
- Universidad de Tarapacá, Avenida 18 de Septiembre 2222, Arica, Chile; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States.
| | - Guillaume Fond
- Université Paris Est-Créteil, Pôle de psychiatrie des hôpitaux universitaires H Mondor, INSERM U955, Eq Psychiatrie Translationnelle, DHU Pe-Psy, France; Fondation FondaMental Fondation de coopération scientifique en santé mentale, France.
| | - Alfonso Urzúa
- Universidad Católica del Norte, Avda. Angamos 0610, Antofagasta, Chile.
| | - Laurent Boyer
- Aix-Marseille Univ, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005 Marseille, France.
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States; Department of African and African American Studies, Harvard University, Cambridge, MA, United States.
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14
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Zwischenmenschliche Gewalt im Kontext affektiver und psychotischer Störungen. DER NERVENARZT 2015; 87:53-68. [DOI: 10.1007/s00115-015-0040-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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15
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Ghoreishi A, Kabootvand S, Zangani E, Bazargan-Hejazi S, Ahmadi A, Khazaie H. Prevalence and attributes of criminality in patients with schizophrenia. J Inj Violence Res 2014; 7:7-12. [PMID: 24879076 PMCID: PMC4288290 DOI: 10.5249/jivr.v7i1.635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/15/2014] [Indexed: 11/30/2022] Open
Abstract
Background: Existing research in law and psychiatry point to schizophrenia as a risk factor for violence and offense behaviors. The present study aims to: 1) report on the prevalence and types of offensive or criminal acts in patients with schizophrenia; 2) identify attributes of schizophrenic offenders; and 3) examine factors associated with offensive or criminal behaviors within a sample of schizophrenic offenders. Methods: This was a cross-sectional study of 358 patients with schizophrenia who were admitted to a psychiatric ward in Iran between 2004 and 2008. Study data was collected using patients’ medical, criminal records, as well as via personal interview with the family member. Study variables included criminality or offensive behavior, types of schizophrenia (paranoid vs. nonparanoid), experiencing hallucination, disease onset, and patients’ demographics. Results: Of the sample, 64.8% were male, 80.7% were 45 years old or younger, and 74.1% were either single or divorced. Slightly over 59 % were offenders with criminal status, of which, 9.8% were legal offenders and 48.6% were hidden offenders. The results of unadjusted logistic regression between these variables and criminality show, except for employment, marital status, and opium use, all other variables were statically associated with criminality. Conclusions: Methodological difficulties arising from this study, as well as, the role of mental health professionals, family, and legal system for prevention of violence in and by patients with schizophrenia are discussed.
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Affiliation(s)
| | | | | | | | | | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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