1
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Youn S, Guadagno BL, Byrne LK, Watson AE, Murrihy S, Cotton SM. Systematic Review and Meta-analysis: Rates of Violence During First-Episode Psychosis (FEP). Schizophr Bull 2024:sbae010. [PMID: 38412435 DOI: 10.1093/schbul/sbae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Most people with psychotic disorders will never commit an act of violence. However, the risk of violence committed by people with schizophrenia is higher than the general population. Violence risk is also known to be highest during the first episode of psychosis compared to later stages of illness. Despite this, there have been no comprehensive reviews conducted in the past 10 years examining rates of violence during FEP. We aimed to provide an updated review of the rate of violence in people with FEP. STUDY DESIGN Meta-analytical techniques were used to identify pooled proportions of violence according to severity (less serious, serious, severe) and timing of violence (before presentation, at first presentation, after presentation to services). STUDY RESULTS Twenty-two studies were included. The pooled prevalence was 13.4% (95% CI [9.0%-19.5%]) for any violence, 16.3% (95% CI [9.1%-27.4%]) for less serious violence, 9.7% (95% CI [5.4%-17.0%]) for serious violence and 2.7% for severe violence, regardless of time point. The pooled prevalence of any violence was 11.6% (95% CI [6.8%-18.9%]) before presentation, 20.8% (95% CI [9.8%-38.7%]) at first presentation and 13.3% (95% CI [7.3%-23.0%]) after presentation to services. CONCLUSION Overall, rates of violence appear to be lower in more recent years. However, due to the high between-study heterogeneity related to study design, the findings must be interpreted with consideration of sample characteristics and other contextual factors. The prevalence of violence remained high at all-time points, suggesting that more targeted, holistic, and early interventions are needed for clinical FEP groups.
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Affiliation(s)
- Sarah Youn
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Belinda L Guadagno
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Linda K Byrne
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
- Faculty of Psychology, Counselling and Psychotherapy, The Cairnmillar Institute, 391-393 Tooroonga Road, Hawthorn East, Victoria 3123, Australia
| | - Amity E Watson
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
| | - Sean Murrihy
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Melbourne, Victoria 3010, Australia
| | - Sue M Cotton
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
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2
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Zhang L, Qi X, Wen L, Hu X, Mao H, Pan X, Zhang X, Fang X. Identifying risk factors to predict violent behaviour in community patients with severe mental disorders: A retrospective study of 5277 patients in China. Asian J Psychiatr 2023; 83:103507. [PMID: 36796125 DOI: 10.1016/j.ajp.2023.103507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/07/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Patients with Severe Mental Disorders (SMD) have a higher risk of violent behaviour than the general population. The study aimed to investigate the predictive factors for the occurrence of violent behaviour in community SMD patients. METHODS The cases and follow-up data were collected from SMD patient Information Management system in Jiangning District, Jiangsu Province. The incidence of violent behaviours was described and analyzed. Logistic regression model was used to examine the influencing factors for violent behaviours in those patients. RESULTS Among 5277 community patients with SMD in Jiangning District, 42.4% (2236/5277) had violent behaviours. The stepwise logistic regression analysis revealed that the disease-related factors (including disease type, disease course, times of hospitalization, medication adherence, past violent behaviours), the demographic factors (age, male sex, educational level, economic and social living status), and the policy-related factors (like free treatment, annual physical check, disability certificate, family physician services, and community interviews) were significantly related to the violent behaviours in community SMD patients. After gender stratification, we found that male patients with unmarried status and with a longer course of disease were more likely to violent. However, we found that female patients with lower economic status and educational experience were more likely to violent. CONCLUSION Our results suggest that community SMD patients had a high incidence of violent behaviour. The findings may provide valuable information for policymakers and mental health professionals worldwide taking a number of measures to reduce the incidence of violence in community SMD patients and to better maintain social security.
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Affiliation(s)
- Lin Zhang
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Xin Qi
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Lu Wen
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Xiuxiu Hu
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Hongjun Mao
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Xinming Pan
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
| | - Xinyu Fang
- Department of Geriatric Psychiatry, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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3
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Incidence rate and distinctive characteristics of first episode psychosis during the COVID-19 pandemic: a multicenter observational study. Sci Rep 2022; 12:22036. [PMID: 36543820 PMCID: PMC9772195 DOI: 10.1038/s41598-022-26297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic has affected the mental health of people around the world. However, its impact on first-episode psychosis (FEP) remains unclear. The aim of this study was to determine the incidence rate (IR) and the clinical and sociodemographic characteristics of patients who developed FEP during the nine-month period following the COVID-19 outbreak in Spain and to compare these data to the corresponding period in the previous year. We included all patients (n = 220) treated for the first time during these two time periods at three FEP programs in Spain. The IR was 0.42/100,000 person-years during the pandemic vs. 0.54/100,000 in the prior year (p = 0.057). Compared to prior year, women accounted for a significantly higher proportion of FEP patients (46.3% vs. 28%; p = 0.005) during the COVID-19 period. This association was significant on the logistic regression analysis (odds ratio, female: 2.12 [confidence interval 1.17-3.82]; p = 0.014). These data reveal a non-significant trend towards a lower incidence of FEP during the pandemic period. Female sex was associated with a greater risk of developing FEP during the pandemic period, perhaps due to differences between males and females in the susceptibility and expression of psychosis. The findings of this study contribute to a better understanding of stress-related disorders.
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4
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Caruso R, Antenora F, Riba M, Belvederi Murri M, Biancosino B, Zerbinati L, Grassi L. Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience. Curr Psychiatry Rep 2021; 23:29. [PMID: 33825996 PMCID: PMC8026454 DOI: 10.1007/s11920-021-01233-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW We summarized peer-reviewed literature on aggressive episodes perpetrated by adult patients admitted to general hospital units, especially psychiatry or emergency services. We examined the main factors associated with aggressive behaviors in the hospital setting, with a special focus on the European experience. RECENT FINDINGS A number of variables, including individual, historical, and contextual variables, are significant risk factors for aggression among hospitalized people. Drug abuse can be considered a trans-dimensional variable which deserves particular attention. Although mental health disorders represent a significant component in the risk of aggression, there are many factors including drug abuse, past history of physically aggressive behavior, childhood abuse, social and cultural patterns, relational factors, and contextual variables that can increase the risk of overt aggressive behavior in the general hospital. This review highlights the need to undertake initiatives aimed to enhance understanding, prevention, and management of violence in general hospital settings across Europe.
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Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy. .,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
| | - Fabio Antenora
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Michelle Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI USA ,University of Michigan Comprehensive Depression Center, Ann Arbor, MI USA ,Psycho-oncology Program, University of Michigan Rogel Cancer Center, Ann Arbor, MI USA ,Department of Psycho-oncology, Cancer and Molecular Medicine, University of Leicester, Leicester, UK
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy ,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
| | | | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy ,University Hospital Psychiatry Unit and Consultation-Liaison Psychiatry and Program on Psycho-Oncology and Psychiatry in Palliative Care, S. Anna University Hospital and Health Trust, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
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5
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Dillinger RL, Kersun JM. Caring for caregivers: Understanding and meeting their needs in coping with first episode psychosis. Early Interv Psychiatry 2020; 14:528-534. [PMID: 31452318 DOI: 10.1111/eip.12870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 11/16/2018] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
Abstract
AIM The first episode of psychosis is a challenging time for both patients and those who care for them. Although literature on treatment is plentiful, literature on how to best support caregivers is more scarce. This review was undertaken to better understand the caregiver experience, determine which interventions most effectively alleviate their burden and examine which other factors may affect outcomes. METHODS Articles were retrieved from PubMed and OVID using the following search terms: first episode psychosis (FEP), schizophrenia, caregiver, intervention and burden in various combinations. Only peer-reviewed articles germane to FEP caregiver experience and interventions written in English were included. RESULTS Caregivers can experience grief, guilt and anxiety during this time. While concerned for their loved one, their own lives take a back seat and their mental and physical health are adversely affected. Some are better prepared to cope and are typically warm, decisive, confident and optimistic. Their families are organized and flexible. Others are less prepared and are more likely to have poor self-esteem, use avoidant coping strategies and be overly critical. Their families are controlling and have difficulty with communication and balance. These caregivers stand to benefit most from interventions. CONCLUSIONS Effective interventions incorporate psychoeducation, problem solving strategies, peer support and clinician guidance. A higher level of interaction with facilitators and peers is associated with better results. Benefits include decreases in caregiver burden, depressive and anxious symptoms and feelings of shame and isolation. Although the literature has yet to isolate the key factors of a successful intervention, this review provides practical suggestions for clinicians and further illustrates the need for more research.
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Affiliation(s)
| | - Jonathan M Kersun
- Department of Psychiatry, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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6
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Kachouchi A, Sebbani M, Akammar S, Berghalout M, Adali I, Manoudi F, Amine M, Asri F. Protéine C-réactive et agitation chez des patients atteints de schizophrénie : suivi d’une cohorte avec groupe témoin. Encephale 2020; 46:264-268. [DOI: 10.1016/j.encep.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 11/06/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
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7
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Thungana Y, Zingela Z, van Wyk S. First-episode psychosis and substance use in Nelson Mandela Bay: Findings from an acute mental health unit. S Afr J Psychiatr 2019; 25:1372. [PMID: 31745443 PMCID: PMC6851873 DOI: 10.4102/sajpsychiatry.v25i0.1372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background Use of psychoactive substances is a common finding in studies on first-episode psychosis (FEP), and this has prognostic implications. We know very little about psychoactive substance use (SU) among patients with FEP in the Eastern Cape province (EC) of South Africa (SA). Aim The study seeks to determine SU prevalence and associated features among inpatients with non-affective FEP in an acute mental health unit (MHU) in Nelson Mandela Bay, EC. Setting Researchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses, and demographics. Data were then subjected to statistical analysis. Methods Researchers conducted a retrospective clinical file review of a 12-month admission cohort of patients with FEP, without a concurrent mood episode, to the Dora Nginza Hospital MHU. Information collected included SU history, psychiatric diagnoses and demographics. Data were then subjected to statistical analysis. Results A total of 117 patients (86 [73.5%] males; 31 [26.5%] females) aged 18–60 years (mean 29 years) met the inclusion criteria. After controlling for missing information, 95 of 117 (81.2%) patients had a history of active or previous SU, 82 of 90 (91.1%) were single and 61 of 92 (66.3%) were unemployed. A significant association was found between SU and unemployment (p < 0.001), as well as male sex (p < 0.001). The most common substances used were cannabis (59.8%), followed by alcohol (57.3%) and stimulants (46.4%). Conclusion In keeping with national and international literature, the results of this study showed a high prevalence of substance use in South African patients with first-episode psychosis. The high prevalence of lifetime substance use in this cohort compared to previous studies in South Africa requires further investigation and highlights the urgent need for dual diagnosis services in the Eastern Cape province.
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Affiliation(s)
- Yanga Thungana
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa.,Acute Mental Health Care Unit, Dora Nginza Hospital, Bethelsdorp, South Africa
| | - Zukiswa Zingela
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa.,Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - Stephan van Wyk
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University, Mthatha, South Africa.,Nelson Mandela Academic Hospital, Mthatha, South Africa
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8
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Rolin SA, Marino LA, Pope LG, Compton MT, Lee RJ, Rosenfeld B, Rotter M, Nossel I, Dixon L. Recent violence and legal involvement among young adults with early psychosis enrolled in Coordinated Specialty Care. Early Interv Psychiatry 2019; 13:832-840. [PMID: 29740953 PMCID: PMC6226380 DOI: 10.1111/eip.12675] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/09/2018] [Accepted: 03/13/2018] [Indexed: 12/18/2022]
Abstract
AIM Individuals with serious mental illnesses have a small increased risk of engaging in violence or legal involvement compared to the general population. This seems to be particularly true for young adults experiencing early stages of psychosis. This study analysed the prevalence of and risk factors for reports of violence and legal involvement in a sample of young adults receiving Coordinated Specialty Care for early non-affective psychosis. METHODS A total of 373 young adults (ages 16-30) within 2 years of the onset of non-affective psychosis were enrolled in 10 Coordinated Specialty Care sites in New York State from October 2013 to August 2016. Baseline violent ideation or behaviour and legal involvement was described and predictors identified. RESULTS Approximately one-quarter of individuals had either recent violent ideation or behaviour at baseline (n = 90, 24.6%); nearly one-tenth of the sample reported recent legal involvement (n = 33, 9.0%). Individuals with violent ideation or behaviour had lower levels of education and were less likely to be working. Those with recent legal involvement were more likely to be male and more likely to have substance use (alcohol, cannabis and other drugs). CONCLUSIONS The overall rate of recent violent ideation or behaviour is similar to other studies; up to one-third of individuals experiencing a first-episode of psychosis (FEP) report violence. Recent legal involvement was strongly associated with substance use. This study presents insight into violence and legal involvement among individuals with FEP and indicates the need for further research.
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Affiliation(s)
- Stephanie A Rolin
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York.,Office of Mental Health, New York State Psychiatric Institute, New York, New York
| | - Leslie A Marino
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York.,Office of Mental Health, New York State Psychiatric Institute, New York, New York
| | - Leah G Pope
- Vera Institute of Justice, New York, New York
| | - Michael T Compton
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York.,Office of Mental Health, New York State Psychiatric Institute, New York, New York
| | - Rufina J Lee
- Silberman School of Social Work, Hunter College, City University of New York, New York, New York
| | | | | | - Ilana Nossel
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York.,Office of Mental Health, New York State Psychiatric Institute, New York, New York
| | - Lisa Dixon
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York.,Office of Mental Health, New York State Psychiatric Institute, New York, New York
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9
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Rammou A, Fisher HL, Johnson S, Major B, Rahaman N, Chamberlain-Kent N, Stone JM. Negative symptoms in first-episode psychosis: Clinical correlates and 1-year follow-up outcomes in London Early Intervention Services. Early Interv Psychiatry 2019; 13:443-452. [PMID: 29148264 DOI: 10.1111/eip.12502] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
Abstract
AIM Negative symptoms (NS) have been associated with poor outcome and remain difficult to treat in patients with psychosis. This study examined the association of NS with clinical features at first presentation to mental health services for psychosis and with outcomes at 1-year follow-up. METHODS Clinical data were utilized from five London Early Intervention Services (EIS) included in the MiData audit database. The sample comprised 484 first-episode psychosis patients with complete Positive and Negative Syndrome Scale data at baseline and 1-year follow-up. Multiple imputation (N = 50) was conducted to account for missing follow-up data. RESULTS Baseline NS were associated with male gender (B = -1.63, P < .05), younger age at onset (B = -.15, P <. 05), a higher level of impairment on the Global Assessment of Functioning (disability) Scale at baseline (B = -.19, P <. 010), an absence of reported substance misuse prior to baseline assessment (B = -3.05, P <. 001) and unemployment at baseline (B = -.93, P <. 01). At 1-year follow-up, NS at presentation were associated with worse Global Assessment of Functioning Scale for symptom (B = -.28, P < .01) and disability (B = -.27, P <. 05) and with hospital admission (OR = 1.06, P < .01). CONCLUSIONS Negative symptoms at presentation to EIS were associated with worse functioning at entry and poorer outcomes 1 year later. Future research is required to better understand the aetiology and trajectories of NS in early psychosis and propose novel targeted interventions.
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Affiliation(s)
- Aikaterini Rammou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Helen L Fisher
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Barnaby Major
- EQUIP, Hackney, East London NHS Foundation Trust, London, UK.,Herefordshire Early Intervention Service, 2gether NHS Foundation Trust, Hereford, UK
| | - Nikola Rahaman
- Kensington, Chelsea, Westminster and Brent Early Intervention Service, Central & North West London NHS Foundation Trust, London, UK
| | - Nick Chamberlain-Kent
- Wandsworth Early Intervention Service, South West London & St Georges' Mental Health NHS Trust, London, UK
| | - James M Stone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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10
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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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11
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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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12
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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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13
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Onwumere J, Sirykaite S, Schulz J, Man E, James G, Afsharzadegan R, Khan S, Harvey R, Souray J, Raune D. Understanding the experience of "burnout" in first-episode psychosis carers. Compr Psychiatry 2018; 83:19-24. [PMID: 29505884 DOI: 10.1016/j.comppsych.2018.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 01/23/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The first onset of psychosis can exert a significant negative impact on the functioning and positive wellbeing of family carers. Carer reports of "burnout" have recently been recorded in early psychosis carers, though the literature is scarce detailing our understanding of how burnout relates to the primary experience of caregiving. The current study investigated reports of burnout and its relationship with beliefs about caregiving and wellbeing in a large group of early psychosis carers who were routinely assessed within an early intervention team. METHODS AND MATERIALS Using a cross-sectional design, 169 early psychosis carers completed the Maslach Burnout Inventory alongside measures of caregiving experiences, affect and wellbeing. RESULTS The mean illness length for patients with psychosis was 18 months. Their mean age was 24.4 years and most was male (65%). The majority of carer participants were parental caregivers and living with their relative with psychosis. Across the three key burnout dimensions, 58% of the sample reported high levels of emotional exhaustion; 31% endorsed high levels of depersonalization; and 43% reported low levels personal accomplishment. The most severe level of burnout, reflecting elevated rates across all three dimensions, was observed in 16% of the sample. Carer burnout was positively associated with negative caregiving experiences (i.e. burden), poor affect, and reduced levels of positive wellbeing and perception of being in good health. CONCLUSIONS Reports by early psychosis carers of exhaustion, feeling inadequate and expressing negativity towards the relative they care for is not uncommon and are closely associated with their overall negative appraisals of caregiving. The results underscore the importance of developing targeted interventions during the early phase, which are designed to reduce the development and entrenchment of burnout responses in carers, but to also mitigate its negative sequelae.
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Affiliation(s)
- Juliana Onwumere
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | | | - Joerg Schulz
- Department of Psychology, University of Hertfordshire, UK
| | - Emma Man
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Gareth James
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Roya Afsharzadegan
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Sanna Khan
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Raythe Harvey
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Jonathan Souray
- Early Intervention in Psychosis Service, West London Mental Health NHS Trust, UK
| | - David Raune
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
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14
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Brucato G, Appelbaum PS, Lieberman JA, Wall MM, Feng T, Masucci MD, Altschuler R, Girgis RR. A Longitudinal Study of Violent Behavior in a Psychosis-Risk Cohort. Neuropsychopharmacology 2018; 43:264-271. [PMID: 28745307 PMCID: PMC5729561 DOI: 10.1038/npp.2017.151] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/12/2017] [Accepted: 07/07/2017] [Indexed: 12/23/2022]
Abstract
There is a lack of insight into the relationships between violent ideation, violent behavior, and early, particularly attenuated, psychosis. Our aims were to examine the relationships between baseline violent behavior and violent ideation and outcome violent behavior and conversion to psychosis in at-risk individuals. We longitudinally assessed 200 individuals at clinical high risk for psychosis for violent ideation and violent behavior using the Structured Interview for Psychosis-Risk Syndromes (SIPS), and rated these according to MacArthur Community Violence categories. Fifty-six individuals (28%) reported violent ideation at baseline, 12 (6%) reported violent behavior within 6 months pre-baseline, and 8 (4%) committed acts of violence during the follow-up time period. Information about violent ideation was obtained only by indirect, but not direct, inquiry about violent ideation. Both violent ideation and violent behavior at baseline significantly predicted violent behavior (RR=13.9, p=0.001; RR=8.3, p=0.003, respectively) during follow-up, as well as a diagnosis of psychosis (RR=2.3 and 2.4, respectively; both p<0.001), independent of more than 40 clinical and demographic variables. The targets of the subjects' violent ideation at baseline were completely different than their subsequent targets of violent behavior. Violent behavior occurred within 7 days (SD 35 days) of a diagnosis of syndromal psychosis. These data suggest that checking carefully for violent ideation and behavior in clinical high-risk patients is essential, as these have predictive value for conversion to psychosis and likelihood of violence in the future.
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Affiliation(s)
- Gary Brucato
- The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Paul S Appelbaum
- The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey A Lieberman
- The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Melanie M Wall
- The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Tianshu Feng
- The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Michael D Masucci
- The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Rebecca Altschuler
- The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Ragy R Girgis
- The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA,New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, Unit 31, New York, NY 10032, USA, Tel: +1 646 774 5553, Fax: +1 646 774-5237, E-mail:
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15
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Mi W, Zhang S, Liu Q, Yang F, Wang Y, Li T, Mei Q, He H, Chen Z, Su Z, Liu T, Xie S, Tan Q, Zhang J, Zhang C, Sang H, Chen W, Shi L, Li L, Shi Y, Guo L, Zhang H, Lu L. Prevalence and risk factors of agitation in newly hospitalized schizophrenia patients in China: An observational survey. Psychiatry Res 2017; 253:401-406. [PMID: 28463820 DOI: 10.1016/j.psychres.2017.02.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 02/10/2017] [Accepted: 02/23/2017] [Indexed: 02/05/2023]
Abstract
This multi-center observational study investigated the prevalence of agitation in newly hospitalized schizophrenia patients in China and its potential risk factors. It was performed in 2014 and covered 14 hospitals. Newly hospitalized patients with schizophrenia or suspected schizophrenia who met the diagnostic criteria of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, were recruited. Agitation and related risk factors were evaluated by a questionnaire designed for the survey. General demographic data, disease characteristics, scores on schizophrenia rating scales and agitation rating scales (e.g., Positive and Negative Syndrome Scale-Excited Component [PANSS-EC] and Behavioral Activity Rating Scale [BARS]) were collected. Among the 1512 patients screened in the study, 1400 (92.59%) were eligible. According to the PANSS-EC and BARS, the prevalence of agitation was 60.92% (853 of 1400) and 59.00% (826 of 1400), respectively. The overall prevalence of agitation was 47.50% (665 of 1400). The most important risk factor of agitation was being aggressive at baseline (Modified Overt Aggression Scale score ≥4, odds ratio=6.54; 95% confidence interval=4.93-8.69). Other risk factors included a history of aggressive behavior, northern region of residence, involuntary hospitalization, disease severity, low level of education, living alone, being unemployed or retired.
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Affiliation(s)
- Weifeng Mi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China
| | - Suzhen Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China
| | - Qi Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China
| | - Fude Yang
- Beijing HuiLong Guan Hospital, Huilong guan Changping District, Beijing 100096, China
| | - Yong Wang
- Shanghai Mental Health Center, 600, Wanpingnan Street, Shanghai 200030, China
| | - Tao Li
- West China Hospital of Sichuan, 37, Guoxue Street, Wuhou District, Chengdu, Sichuan 610041, China
| | - Qiyi Mei
- Suzhou Guangji Hospital, 285, Guangji Street, Gusu District, Suzhou, Jiangsu 215008, China
| | - Hongbo He
- Guangzhou Psychiatric Hospital, 36, Mingxin Street, Liwan District, Guangzhou, Guangdong 510000, China
| | - Zhiyu Chen
- The Seventh People's Hospital of Hangzhou, 305, Tianmushan Street, Xihu District, Hangzhou, Zhejiang 310013, China
| | - Zhonghua Su
- Jining Mental Hospital, 1, Jidai Street, Jining, Shandong 272000, China
| | - Tiebang Liu
- Shenzhen Kangning Hospital, 1080, Cuizhu Street, Luohu District, Shenzhen 518003, China
| | - Shiping Xie
- Nanjing Brain Hospital, 264, Guangzhou Road, Gulou District, Nanjing, Jiangsu 210029, China
| | - Qingrong Tan
- Xijing Hospital of Forth Military Medical University, 15, Changlexi Road, Xi'an, Shanxi 710032, China
| | - Jinbei Zhang
- The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong 510630, China
| | - Congpei Zhang
- Harbin First Specific Hospital, 217, Hongwei Road, Harbin, Heilongjiang 150056, China
| | - Hong Sang
- Sixth Hospital of Changchun, 4596, Beihuan Road, Changchun, Jilin 130052, China
| | - Wenhao Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China
| | - Lingzhi Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China
| | - Ying Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China
| | - Lihua Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China
| | - Hongyan Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China.
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51, Huayuan Bei Road, Beijing 100191, China.
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16
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Gleeson J, Lederman R, Herrman H, Koval P, Eleftheriadis D, Bendall S, Cotton SM, Alvarez-Jimenez M. Moderated online social therapy for carers of young people recovering from first-episode psychosis: study protocol for a randomised controlled trial. Trials 2017; 18:27. [PMID: 28095883 PMCID: PMC5240433 DOI: 10.1186/s13063-016-1775-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/29/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND First-episode psychosis most often has its onset during late adolescence. In caring for the young person, families endure high levels of stress and depression. Meanwhile, the social networks of families often erode. Our group has previously shown that family cognitive behaviour therapy (CBT) leads to significantly improved perceived stress compared with specialist first-episode treatment as usual; however, there are well-known barriers to the dissemination of effective family interventions. To address this, we have developed a novel online intervention entitled 'Altitudes' that fully integrates purpose-built online social networking, expert and peer moderation, and evidence-based psychoeducation within a single application. The primary aim of this trial is to evaluate the effectiveness of Altitudes in reducing stress in carers over a 6-month period. METHODS/DESIGN We describe here a single-blinded cluster randomised controlled trial (cRCT) with permutated blocks. The clusters comprise individual families. The two treatment conditions include Altitudes plus Specialist Treatment as Usual (STAU) and STAU alone. Altitudes involves participation in our novel online programme whereas STAU comprises specialist family work at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. We aim to recruit 160 family members of young, 15-27 year-old, patients registered for treatment for first-episode psychosis (FEP) at EPPIC. The design includes two assessment time points, namely, baseline and 6-month follow-up. The study is due for completion within 2 years including an 18-month recruitment period and a 6-month treatment phase. The primary outcome is carers' perceived stress at 6 months. Secondary outcome measures include a biomarker of stress, depressive symptoms, worry, substance use, loneliness, social support, satisfaction with life, and a range of measures that tap into coping resources. We seek to gain a dynamic picture of carer stress through our Smartphone Ecological Momentary Assessment (SEMA) tool. DISCUSSION This is the first randomised controlled trial designed to evaluate an online intervention for carers of young people recovering from FEP. It has the potential to produce evidence in support of a highly novel, accessible, and cost-effective intervention to reduce stress in carers who are providing support to young people at a critical phase in their recovery from psychosis. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry, identifier: ACTRN12616000968471 . Retrospectively registered on 22 July 2016.
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Affiliation(s)
- John Gleeson
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Australia
| | - Reeva Lederman
- The Department of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Helen Herrman
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Peter Koval
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Australia
- Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Dina Eleftheriadis
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Australia
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Sarah Bendall
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Sue M. Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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17
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San L, Marksteiner J, Zwanzger P, Figuero MA, Romero FT, Kyropoulos G, Peixoto AB, Chirita R, Boldeanu A. State of Acute Agitation at Psychiatric Emergencies in Europe: The STAGE Study. Clin Pract Epidemiol Ment Health 2016; 12:75-86. [PMID: 27857778 PMCID: PMC5084082 DOI: 10.2174/1745017901612010075] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 11/22/2022]
Abstract
Background: Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome. Objective: An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries. Method: For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered. The clinical characteristics and management of the agitation episode were also described. A descriptive analysis was performed. Results: A total of 334 agitation episodes out of 7295 psychiatric emergencies were recorded, giving a prevalence rate of 4.6% (95% CI: 4.12-5.08). Of them, 172 [9.4% (95% CI: 8.2-10.9)] were attended at the ER and 162 [2.8% (95% CI: 2.4-3.3)] at AIU. Only data from 165 episodes of agitation (those with a signed informed consent form) was registered and described in this report. The most common psychiatric conditions associated with agitation were schizophrenia, bipolar disorder and personality disorder. The management of agitation included from non-invasive to more coercive measures (mechanical, physical restraint or seclusion) that were unavoidable in more than half of the agitation episodes (59.5%). Conclusion: The results show that agitation is a common symptom in the clinical practice, both in emergency and inpatient psychiatric departments. Further studies are warranted to better recognize (using a standardized definition) and characterize agitation episodes.
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Affiliation(s)
- Luis San
- Hospital Sant Joan de Déu, Department of Child and Adolescent Psychiatry, Barcelona, Spain
| | - Josef Marksteiner
- LKH Hall, Department of Psychiatry and Psychotherapy, Milser Strasse 10-12. A-6060, Hall in Tirol, Austria
| | - Peter Zwanzger
- Kbo-Inn-Salzach Clinic for Psychiatry, Psychotherapy, Neurology and Psychosomatic Medicine, Gabersee 7, 83512, Wasserburg am Inn, Germany
| | - María Aragüés Figuero
- Hospital Universitario 12 de Octubre, Department of Psychiatry, Avda de Córdoba, s/n, 28041, Madrid, Spain
| | - Francisco Toledo Romero
- Hospital Clínico Universitario Virgen de la Arrixaca, Department of Psychiatry Acute Unit, Ctra. Madrid-Cartagena, s/n, 30120 Murcia, Spain
| | - Grigorios Kyropoulos
- General Hospital of Thessaloniki "Papanikolaou", Psychiatric Clinic Department of Psychiatry, Eksoxi - 57010, Thessaloniki, Greece
| | - Alberto Bessa Peixoto
- Hospital de Braga, Department of Psychiatry, Sete Fontes, 4710-243 São Victor, Braga, Portugal
| | - Roxana Chirita
- Psychiatric Clinical Hospital Socola, Department of Psychiatry, Șoseaua Bucium 36, 700282, Iasi, Romania
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18
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Huber CG, Hochstrasser L, Meister K, Schimmelmann BG, Lambert M. Evidence for an agitated-aggressive syndrome in early-onset psychosis correlated with antisocial personality disorder, forensic history, and substance use disorder. Schizophr Res 2016; 175:198-203. [PMID: 27117676 DOI: 10.1016/j.schres.2016.04.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Agitation, aggression, and violence are increased in psychotic disorders. Additionally, an earlier age at onset may be associated with aggressive behavior. However, the relationship of age at onset, an agitated-aggressive syndrome as measured with the Positive And Negative Syndrome Scale for Schizophrenia - Excited Component (PANSS-EC), and its potential correlates in first-episode psychosis (FEP) has not been studied. METHOD This study assessed the association between age at onset, an agitated-aggressive syndrome, and its potential correlates in a prospective sample of 52 FEP patients with early-onset and adult-onset followed up for 12months. RESULTS Twenty-six patients conformed to the criteria of early-onset psychosis. Early age at onset was associated with antisocial personality disorder (p=0.004; φc=0.39), a history of legal involvement (p=0.005; φc=0.39), and higher rates of lifetime substance use disorder (SUD; p=0.002; φc=0.42). Early-onset patients had significantly higher PANSS-EC scores over the course of observation (F(1,44.4)=5.39; p=0.025; d=0.656), but no significant group differences emerged for the remaining PANSS subscores. PANSS-EC scores were correlated positively with antisocial personality disorder and forensic history at 6weeks, 3months, 6months, and 12months, and with lifetime substance use disorder at 3months and 6months. CONCLUSIONS Patients with early onset psychosis may have increased levels of agitation/aggressiveness, and, more likely, antisocial personality disorder, forensic history, and lifetime substance use disorder. These variables were linked to suicidality, aggressiveness, and involuntary treatment.
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Affiliation(s)
- Christian G Huber
- Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, 4012 Basel, Switzerland.
| | - Lisa Hochstrasser
- Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, 4012 Basel, Switzerland
| | - Klara Meister
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie, Martinistr. 52, 20246 Hamburg, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Effingerstr. 12, 3011 Bern, Switzerland; Universitätsklinikum Hamburg-Eppendorf, Klinik für Kinder- und Jugendpsychiatrie, Martinistr. 52, 20246 Hamburg, Germany
| | - Martin Lambert
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie, Martinistr. 52, 20246 Hamburg, Germany
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19
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Coid JW, Ullrich S, Bebbington P, Fazel S, Keers R. Paranoid Ideation and Violence: Meta-analysis of Individual Subject Data of 7 Population Surveys. Schizophr Bull 2016; 42:907-15. [PMID: 26884548 PMCID: PMC4903063 DOI: 10.1093/schbul/sbw006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is controversy whether associations between psychosis and violence are due to coexisting substance misuse and factors increasing risk in nonpsychotic persons. Recent studies in clinical samples have implicated independent effects of paranoid delusions. Research findings suggest that individual psychotic-like-experiences on the psychosis continuum in the general population are associated with violence; it remains unclear whether this association is due to psychiatric comorbidity. We pooled data from 7 UK general population surveys (n = 23 444) and conducted a meta-analysis of individual subject data. Further meta-analyses were performed to identify heterogeneity. Main exposure variables: 5 psychotic-like-experiences and a categorical measure of psychosis. Comorbidity was established through standardized self-report instruments. Information was collected on violence, severity, victims. Paranoid ideation was associated with violence (AOR 2.26, 95% CI 1.75-2.91), severity and frequency, even when controlling for effects of other psychotic-like-experiences. Associations were not explained by comorbid conditions, including substance dependence. Psychotic disorder was associated with violence and injury to the perpetrator but associations were explained by paranoid ideation. Individual associations between hypomania, thought insertion, hallucinations, and violence were nonsignificant after adjustments, and significantly associated only when comorbid with antisocial personality disorder. Strange experiences were only associated with intimate partner violence. Paranoid ideation on a psychosis-continuum in the general population was associated with violence. All other associations were explained by comorbidity. Further investigation should determine whether paranoid ideation among persons in the community require preventive interventions, similar to those presenting to mental health services. Nevertheless, risks are considerably increased for psychotic-like-experiences with co-occurring antisocial personality disorder.
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Affiliation(s)
- Jeremy W Coid
- Violence Prevention Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Simone Ullrich
- Violence Prevention Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK;
| | - Paul Bebbington
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Robert Keers
- Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
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20
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González RA, Igoumenou A, Kallis C, Coid JW. Borderline personality disorder and violence in the UK population: categorical and dimensional trait assessment. BMC Psychiatry 2016; 16:180. [PMID: 27255770 PMCID: PMC4891918 DOI: 10.1186/s12888-016-0885-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 05/24/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterised by difficulties with impulse control and affective dysregulation. It is unclear whether BPD contributes to the perpetration of violence or whether this is explained by comorbidity. We explored independent associations between categorical and dimensional representations of BPD and violence in the general population, and differential associations from individual BPD criteria. METHODS We used a representative combined sample of 14,753 men and women from two British national surveys of adults (≥16 years). BPD was assessed using the Structured Clinical Interview II- Questionnaire. We measured self-reported violent behaviour in the past 5 years, including severity, victims and locations of incidents. Associations for binary, dimensional and trait-level exposures were performed using weighted logistic regression, adjusted for demography and comorbid psychopathology. RESULTS Categorical diagnosis of BPD was associated only with intimate partner violence (IPV). Associations with serious violence leading to injuries and repetitive violence were better explained by comorbid substance misuse, anxiety and antisocial personality disorder (ASPD). However, anger and impulsivity BPD items were independently associated with most violent outcomes including severity, repetition and injury; suicidal behaviours and affective instability were not associated with violence. Both trait-level and severity-dimensional analyses showed that BPD symptoms might impact males and females differently in terms of violence. CONCLUSIONS For individuals diagnosed BPD, violence is better explained by comorbidity. However, BPD individual traits show different pathways to violence at the population level. Gender differences in BPD traits and their severity indicate distinct, underlying mechanisms towards violence. BPD and traits should be evaluated in perpetrators of IPV.
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Affiliation(s)
- Rafael A González
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Puerto Rico, USA
| | - Artemis Igoumenou
- Violence Prevention Research Unit, Queen Mary University of London, London, UK.
| | - Constantinos Kallis
- Violence Prevention Research Unit, Queen Mary University of London, London, UK
| | - Jeremy W Coid
- Violence Prevention Research Unit, Queen Mary University of London, London, UK
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Childhood adversity and conduct disorder: A developmental pathway to violence in schizophrenia. Schizophr Res 2016; 172:54-9. [PMID: 26879586 DOI: 10.1016/j.schres.2016.01.047] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/14/2016] [Accepted: 01/25/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Both childhood adversity and conduct disorder are over-represented among adult patients with schizophrenia and have been proposed as significant factors that may increase the risk of violence. It is not known how childhood adversity and conduct disorder might interact to contribute towards an increased risk of violence in schizophrenia. This study aimed to explore the relationships between childhood adversity, conduct disorder and violence among men with schizophrenia. METHODS 54 male patients with schizophrenia from a range of inpatient and outpatient mental health services were assessed for exposure to a variety of childhood adversities, conduct disorder before the age of 15 and later violent behaviour in adulthood. RESULTS Exposure to domestic violence during childhood was associated with an increased propensity to violence in adulthood. Symptoms of conduct disorder were associated both with cumulative exposure to childhood adversities and with later propensity to violence. The cumulative number of childhood adversities was associated with adult propensity to violence. This association was significantly attenuated by inclusion of conduct disorder in the model. CONCLUSIONS This is the first study to demonstrate an association between childhood exposure to domestic violence and later violent behaviour in schizophrenia. Conduct disorder may mediate the association between cumulative childhood adversities and adult propensity to violence, indicating an indirect pathway. These results indicate a complex interplay between childhood adversity, conduct disorder and later violent behaviour in schizophrenia, and suggest that there may be shared aetiological risk factors on a common developmental pathway to violence.
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Alnıak İ, Erkıran M, Mutlu E. Substance use is a risk factor for violent behavior in male patients with bipolar disorder. J Affect Disord 2016; 193:89-93. [PMID: 26771949 DOI: 10.1016/j.jad.2015.12.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/24/2015] [Accepted: 12/26/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND To determine the factors involved in violent behavior in patients with bipolar disorder (BD) and to investigate the relationship between violence and substance use disorder (SUD). METHODS A sample of 100 male inpatients diagnosed with BD type I who were experiencing a current mood episode participated in the study. Violent behavior was defined as physical aggression against others. All patients were evaluated using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale-positive subscale (PANSS-p), Barratt Impulsivity Scale-11 (BIS-11), Buss-Perry Aggression Questionnaire (BPAQ) and Overt Aggression Scale (OAS). Lifetime SUD and current use of substances were evaluated. Logistic regression analysis was conducted to predict violent behavior. RESULTS Current substance use (CSU) rather than lifetime SUD was found to be related to violent behavior in patients with BD, and CSU was associated with a threefold increase in the risk of violence. The rate of lifetime SUD in our sample was 59%, and the rate of CSU was 39%. The most commonly abused substances were cannabis and alcohol, followed by synthetic cannabinoids, in both groups of patients with lifetime SUD and CSU. Individuals abusing any substance were more likely to have a criminal record and history of incarceration than other patients. One of the most significant risk factors for violence was a previous history of violent behavior. LIMITATIONS The sample was limited to male patients. Data on some participants' recent substance use from standard urine analysis was not obtained. The data on the use of synthetic cannabinoids was obtained from patients and their families owing to the lack of equipment for detecting synthetic cannabinoids using laboratory analysis. CONCLUSIONS CSU appears to be a significant predictive factor in violent behavior in male patients. Further investigation of co-occurrence of violence with CSU and improvement in treatment strategies might reduce or prevent violence in patients with BD.
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Affiliation(s)
- İzgi Alnıak
- Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Turkey.
| | - Murat Erkıran
- Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Turkey.
| | - Elif Mutlu
- İstanbul Gelişim University, Department of Psychology, Turkey.
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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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Chang WC, Chan SSI, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prevalence and risk factors for violent behavior in young people presenting with first-episode psychosis in Hong Kong: A 3-year follow-up study. Aust N Z J Psychiatry 2015; 49:914-22. [PMID: 26320236 DOI: 10.1177/0004867415603130] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the current study was to examine the rates of violence prior to and 3 years following treatment initiation, and predictors of post-treatment violence in Chinese young people presenting with first-episode psychosis (FEP). METHOD Seven hundred patients aged 15-25 years consecutively enrolled in a territory-wide early intervention program for FEP in Hong Kong from July 2001 to August 2003 were studied. Socio-demographic, pre-treatment, baseline and 3-year follow-up variables were collected via systematic medical file review. Violent behavior was defined as physical aggression towards people and was further categorized at two levels of severity. RESULTS After onset of psychosis, 6.7% (n = 47) patients exhibited violence before treatment. During 3-year treatment period, 9.4% (n = 66) committed violent behavior and 4.3% (n = 30) perpetrated serious violence. Two-fifths (40.4%) of patients who displayed pre-treatment violent behavior engaged in further act of violence after service contact. Multivariate regression analysis showed that previous violence, male gender and lower educational attainment were significantly associated with an increased risk of violence during 3-year follow-up. Comorbid substance, male gender, lower educational level and past history of violence were found to independently predict occurrence of serious violence after commencement of treatment for FEP. CONCLUSIONS In a large representative cohort of Chinese young FEP patients, the rates of violent behavior before and after treatment were relatively lower than that reported in the literature. Risk factors for violence identified by the current study were comparable to the findings of previous research conducted in western populations. Close monitoring of patients with history of violence and specific treatments targeting at minimizing substance abuse may facilitate early identification and intervention of high-risk cases to reduce violence risk in the early course of illness.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Sherina Suet In Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Silverstein SM, Del Pozzo J, Roché M, Boyle D, Miskimen T. Schizophrenia and violence: realities and recommendations. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/23744006.2015.1033154] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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First-episode psychosis in the criminal justice system: identifying a critical intercept for early intervention. Harv Rev Psychiatry 2015; 23:167-75. [PMID: 25943312 DOI: 10.1097/hrp.0000000000000066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:Evaluate emerging concepts of identification, treatment and discharge planning for individuals who are experiencing a first psychotic episode while detained in the criminal justice system. ABSTRACT The United States incarcerates more people than any other nation in the world. The system of jails and prisons that holds those individuals has become the largest provider of mental health care in the country, with rates of psychotic illness many times higher than in the community. A subset of this population includes individuals experiencing their first episode of psychosis who are untreated and are new to the rules of institutional settings. Retrospective and anecdotal reports indicate that many individuals in the criminal justice system have first-episode psychosis, yet no published information is available about the actual rates. For these patients, behavior associated with psychotic symptoms may have led to their arrest, but correctional facilities are poorly equipped to identify their needs and to provide the type of comprehensive treatment needed to improve functional status, quality of life, and illness recovery. Even as first-episode programs are flourishing in community settings, we know little about how to identify, engage, possibly divert, and treat these patients in settings designed as punishment. Efforts should be made both to reduce the number of these individuals inappropriately prosecuted within the criminal justice system and to begin in-jail efforts to engage them in treatment, in anticipation of their eventual return to the community.
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Rubio-Valera M, Luciano JV, Ortiz JM, Salvador-Carulla L, Gracia A, Serrano-Blanco A. Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence. BMC Psychiatry 2015; 15:35. [PMID: 25881240 PMCID: PMC4356166 DOI: 10.1186/s12888-015-0417-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Agitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service. METHODS Systematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014. RESULTS Ten studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005. CONCLUSIONS Agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system.
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Affiliation(s)
- Maria Rubio-Valera
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,School of Pharmacy, Universitat de Barcelona, Barcelona, Spain. .,Research & Development Unit, Parc Sanitari Sant Joan de, 22 Déu. C/ Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
| | - Juan V Luciano
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Open University of Catalonia (UOC), Barcelona, Spain.
| | | | - Luis Salvador-Carulla
- Centre for Disability Research and Policy, Faculty of Health Sciences, and Mental Health Policy Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
| | | | - Antoni Serrano-Blanco
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
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Oruch R, Elderbi MA, Khattab HA, Pryme IF, Lund A. Lithium: A review of pharmacology, clinical uses, and toxicity. Eur J Pharmacol 2014; 740:464-73. [DOI: 10.1016/j.ejphar.2014.06.042] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/20/2014] [Accepted: 06/20/2014] [Indexed: 01/10/2023]
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Faedda GL, Serra G, Marangoni C, Salvatore P, Sani G, Vázquez GH, Tondo L, Girardi P, Baldessarini RJ, Koukopoulos A. Clinical risk factors for bipolar disorders: a systematic review of prospective studies. J Affect Disord 2014; 168:314-21. [PMID: 25086290 DOI: 10.1016/j.jad.2014.07.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Early phases and suspected precursor states of bipolar disorder are not well characterized. We evaluate the prevalence, duration, clinical features and predictive value of non-affective psychopathology as clinical risk factors for bipolar disorder in prospective studies. METHODS We screened PubMed, CINAHL, PsycINFO, Embase, SCOPUS, and ISI-Web of Science databases from inception up to January 31, 2014, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and searched: bipolar disorder AND [antecedent⁎ OR predict⁎ OR prodrom⁎ OR prospect⁎ OR risk⁎] AND [diagnosis OR development]. We included only English language reports on prospective, longitudinal studies with two structured clinical assessments (intake and follow-up); no DSM intake diagnosis of bipolar-I or -II; diagnostic outcome was bipolar-I or -II. Details of study design, risk factors, and predictive value were tabulated. RESULTS We found 16 published reports meeting selection criteria, with varying study design. Despite heterogeneity in methods, findings across studies were consistent. Clinical risk factors of bipolar disorder were early-onset panic attacks and disorder, separation anxiety and generalized anxiety disorders, conduct symptoms and disorder, ADHD, impulsivity and criminal behavior. LIMITATIONS Since risk factors identified in some prospective studies are predictive of other conditions besides bipolar disorder, these preliminary findings require replication, and their sensitivity, specificity and predictive value need to be assessed. CONCLUSIONS Clinical risk factors for bipolar disorder typically arise years prior to syndromal onset, include anxiety and behavioral disorders with unclear sensitivity and specificity. Prospectively identified clinical risk factors for bipolar disorder are consistent with retrospective and family-risk studies. Combining clinical risk factors with precursors and family-risk may improve early identification and timely and appropriate treatment of bipolar disorder.
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Affiliation(s)
- Gianni L Faedda
- Lucio Bini Mood Disorders Center, New York, NY, United States; New York University Medical Center & Child Study Center, New York, NY, United States; International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States.
| | - Giulia Serra
- Centro Lucio Bini, Rome, Italy; NESMOS Department (Neuroscience, Mental Health and Sensory Organs), "La Sapienza" University School of Medicine and Psychology, and Lithium Clinic, Sant'Andrea Hospital, Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Ciro Marangoni
- Section of Neurological, Psychiatric and Psychological Sciences, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Italy
| | - Paola Salvatore
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Section of Psychiatry, Department of Neuroscience, University of Parma, Italy
| | - Gabriele Sani
- Centro Lucio Bini, Rome, Italy; NESMOS Department (Neuroscience, Mental Health and Sensory Organs), "La Sapienza" University School of Medicine and Psychology, and Lithium Clinic, Sant'Andrea Hospital, Rome, Italy; IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, "La Sapienza" University School of Medicine, Rome, Italy
| | - Gustavo H Vázquez
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Neuroscience, University of Palermo, Buenos Aires, Argentina
| | - Leonardo Tondo
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Centro Lucio Bini, Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Centro Lucio Bini, Cagliari, Italy
| | - Paolo Girardi
- Centro Lucio Bini, Rome, Italy; NESMOS Department (Neuroscience, Mental Health and Sensory Organs), "La Sapienza" University School of Medicine and Psychology, and Lithium Clinic, Sant'Andrea Hospital, Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Evidence for an agitated-aggressive syndrome predating the onset of psychosis. Schizophr Res 2014; 157:26-32. [PMID: 24996505 DOI: 10.1016/j.schres.2014.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aggression and suicidality prior to the initiation of treatment are frequent phenomena in psychosis patients. Increased scores in the Brief Psychiatric Rating Scale Excited Component (BPRS-EC) have been shown to predict involuntary treatment, aggression, and suicide in first-episode psychosis (FEP) patients. However, it is unclear if an agitated-aggressive syndrome as measured with the BPRS-EC is already present in at-risk mental state (ARMS). METHODS BPRS-EC scores from 43 ARMS patients, 50 FEP patients, and 25 healthy controls (HC) were analyzed. Multivariate analyses were performed to review if group differences were mediated by potential confounders. In addition, the association of BPRS-EC scores with clinical variables was examined. RESULTS BPRS-EC scores were significantly different across diagnostic groups (H(2)=22.1; p<.001), and post-hoc analyses showed significantly higher BPRS-EC scores for ARMS (p=.001) and for FEP patients (p<.001) compared to HC. Differences remained significant after controlling for gender, years of education, and intelligence. No significant differences emerged between ARMS and FEP patients. BPRS-EC was significantly correlated with lower intelligence (r=-.27; p=.008), reduced level of functioning (r=-.44; p<.001), and with smoking behavior (r=.22; p=.019). CONCLUSIONS ARMS and FEP patients in our sample had significantly higher BPRS-EC scores compared to HC. This may constitute a correlate of an agitated-aggressive syndrome and an increased risk for aggression and suicidality.
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Onwumere J, Grice S, Garety P, Bebbington P, Dunn G, Freeman D, Fowler D, Kuipers E. Caregiver reports of patient-initiated violence in psychosis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:376-84. [PMID: 25007421 PMCID: PMC4086313 DOI: 10.1177/070674371405900705] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/01/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Aggressive behaviour in psychosis is not uncommon. Community provision for people with psychosis has left informal caregivers to take on a greater role in their care. However, few studies have explored links between patient-initiated violence in mental health caregiving relationships and caregiver functioning. Our study investigated caregiver reports of aggressive acts committed by their relative with psychosis and their links to caregiver appraisals of the caregiving relationship and caregiver outcomes. METHOD Caregivers of patients with a recent relapse of psychosis, recruited to a psychological therapy trial, completed the audiotaped Camberwell Family Interview at baseline. This semi-structured interview includes questions on the quality of the relationship between caregiver and patient, and patient history of violence. Seventy-two transcripts of interviews were assessed for reports of patient-initiated violence. RESULTS One-half of the caregiver sample (52.9%) reported an incident of patient-initiated violence during their interview; 62.2% of these involved violence toward themselves, and 24.3% toward property. Reports of patient violence were associated with caregiver ratings of hostility expressed toward patients, lower self-esteem, and emotion-focused coping. People caring on their own were more likely to report incidents of patient violence. Younger patients, males, and inpatients were more frequently identified as having a history of this kind of violence. CONCLUSIONS Our findings suggested that caregiver reports of patient-initiated violence in psychosis are not uncommon. Mental health staff need to be aware of the risks of such violence for caregivers of people with psychosis, and consider appropriate procedures for minimizing it.
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Affiliation(s)
- Juliana Onwumere
- Lecturer in Clinical Psychology, Institute of Psychiatry, King’s College London, London, England
| | - Sarah Grice
- Clinical Psychologist, Institute of Psychiatry, King’s College London, London, England
| | - Philippa Garety
- Professor of Clinical Psychology, Institute of Psychiatry, King’s College London, London, England; Professor of Clinical Psychology, Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust, Institute of Psychiatry, King’s College London, London, England
| | - Paul Bebbington
- Emeritus Professor of Social and Community Psychiatry, Mental Health Science Unit, University College London, London, England
| | - Graham Dunn
- Professor of Biomedical Statistics, Centre for Biostatistics, University of Manchester, Manchester, England
| | - Daniel Freeman
- Professor of Clinical Psychology, Department of Psychiatry, University of Oxford, Oxford, England
| | - David Fowler
- Professor of Social Psychiatry, Department of Psychiatry, University of East Anglia, Norfolk, England
| | - Elizabeth Kuipers
- Professor of Clinical Psychology, Institute of Psychiatry, King’s College London, London, England; Professor of Clinical Psychology, Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust, Institute of Psychiatry, King’s College London, London, England
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Violence and crime among male inpatients with severe mental illness: attempting to explain ethnic differences. Soc Psychiatry Psychiatr Epidemiol 2014; 49:549-58. [PMID: 24042702 DOI: 10.1007/s00127-013-0760-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies report that in the U.K., among men with severe mental illness (SMI), those of black Caribbean ethnicity display increased risk of aggressive behaviour, criminal convictions, and schizophrenia. The study aimed to compare aggressive behaviour and criminal convictions among men with SMI of white British, black Caribbean and black African ethnicity, and to explore factors associated with differences across ethnicities. METHOD Sample 1 included 1,104 male inpatients with SMI. Sample 2 included a representative sub-sample of 165 who completed interviews, and authorized access to medical and criminal files. Ethnicity was self-ascribed. RESULTS Staff-rated violence prior to admission, self-reported aggressive behaviour, and convictions for non-violent and violent crimes differed among men with SMI of different ethnicities. Relative to men with SMI of white British ethnicity, those of black African ethnicity showed decreased risk of aggressive behaviour, and those of black Caribbean ethnicity showed elevated risk of convictions for non-violent, and marginally, for violent crimes. Relative to men with SMI of black African ethnicity, those of black Caribbean ethnicity showed elevated risk of aggressive behaviour and criminal convictions. Proportionately more of the men of both black African and black Caribbean ethnicity, than those of white British ethnicity, presented schizophrenia spectrum disorders. Multivariate analyses failed to identify factors that would explain differences in aggressive behaviour, and criminal convictions across ethnic groups. CONCLUSIONS Differences in four different measures of aggressive and antisocial behaviour among men with SMI of different ethnicities were observed but factors associated with these differences were not found.
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Abstract
BACKGROUND Violent behaviour can be a presenting sign of first-episode psychosis. Duration of untreated psychosis (DUP) has been a focus of attention because it is a potentially modifiable factor that may influence outcome. AIMS The aim was to review the literature addressing the following issues: prevalence of violence or aggression in the first episode of psychosis, violence or aggression during the periods before and after the initiation of treatment, the DUP and relation between DUP and the level of violence or aggression in first-episode psychosis. METHODS MEDLINE and PubMed databases were searched for articles using the combination of key words 'aggression' (limited to humans) and 'first episode' and 'psychosis'. RESULTS Available evidence suggests that the prevalence of violent behaviour in the first episode of psychosis, particularly schizophrenia, is greater than during the later stages of the illness. First-episode psychosis is associated with an increased risk of homicide. There is some limited support for an effect of DUP length on serious violence or aggression. Violent behaviour frequently develops before the onset of first episode. Substance use disorders are additional factors that elevate the risk for violence in these patients. CONCLUSIONS Earlier treatment of first episode psychosis might prevent some homicides. Personality factors and substance abuse may be more important than psychotic symptoms in the development of aggressive behaviour in patients with first-episode psychosis.
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Affiliation(s)
- K Látalová
- Psychiatric Department, Palacký University, Olomouc, Czech Republic
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Winsper C, Ganapathy R, Marwaha S, Large M, Birchwood M, Singh SP. A systematic review and meta-regression analysis of aggression during the first episode of psychosis. Acta Psychiatr Scand 2013; 128:413-21. [PMID: 23521361 DOI: 10.1111/acps.12113] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The First Episode of Psychosis (FEP) represents a period of heightened risk for aggression. However, it is not known whether this risk is significantly altered following contact with mental health services. METHOD Meta-analytic methods were used to estimate pooled prevalence of 'any' and 'serious' aggression during FEP, while meta-regression analyses were conducted to explore reasons for heterogeneity between studies. RESULTS Fifteen studies comprising 3, 294 FEP subjects were analysed. Pooled prevalence of 'any aggression' before service contact was 28% (95% CI: 22-34) and following contact 31% (95% CI: 20-42). Pooled prevalence of 'serious aggression' was 16% (95% CI: 11-20) before service contact and 13% (95% CI: 6-20) following contact. Four studies reporting repeated assessments within the same cohort revealed that aggression rates did not significantly differ post and pre service contact: Odds Ratios for any aggression: 1.18 (95% CI: 0.46-2.99) and serious aggression: 0.61 (95% CI: 0.31-1.21). CONCLUSION Rates of aggression are high during FEP, both before and following initial service contact, and seem not to alter following contact. This conclusion remains tentative due to considerable heterogeneity between studies and a lack of prospective cohort studies.
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Affiliation(s)
- C Winsper
- Warwick Medical School, University of Warwick, Coventry, UK
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Cutrim RJC, Forte Stuchi L, Martins Valença A. ¿Trastorno esquizotípico o esquizofrenia? Evaluación de la responsabilidad penal en un caso de parricidio. ACTA ACUST UNITED AC 2013; 42:292-4. [DOI: 10.1016/s0034-7450(13)70022-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
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Stevens H, Agerbo E, Dean K, Nordentoft M, Nielsen PR, Mortensen PB. Offending prior to first psychiatric contact: a population-based register study. Psychol Med 2012; 42:2673-2684. [PMID: 22716954 DOI: 10.1017/s0033291712000815] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is a well-established association between psychotic disorders and subsequent offending but the extent to which those who develop psychosis might have a prior history of offending is less clear. Little is known about whether the association between illness and offending exists in non-psychotic disorders. The aim of this study was to determine whether the association between mental disorder and offending is present prior to illness onset in psychotic and non-psychotic disorders. METHOD In a nested case-control study, cases (n=101,890) with a first psychiatric contact during the period 1995 to 2006 were identified and matched by age and gender to population-based controls (n=2,236,195). Exposure was defined as prior criminal and violent offending. RESULTS Males with one offence had an incidence rate ratio (IRR) of 2.32 [95% confidence interval (CI) 2.26-2.40] for psychiatric admission whereas two or more convictions yielded an IRR of 4.97 (95% CI 4.83-5.11). For violent offending the associations were stronger and IRRs of 3.97 (95% CI 3.81-4.12) and 6.18 (95% CI 5.85-6.52) were found for one and several offences respectively. Estimates for females were of a similar magnitude. The pattern was consistent across most diagnostic subgroups, although some variability in effect sizes was seen, and persisted after adjustment for substance misuse and socio-economic status (SES). CONCLUSIONS A prior history of offending is present in almost one in five patients presenting to mental health services, which makes it an important issue for clinicians to consider when assessing current and future risks and vulnerabilities.
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Affiliation(s)
- H Stevens
- National Centre for Register-Based Research, Aarhus University, Aarhus C, Denmark.
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Purcell R, Fraser R, Greenwood-Smith C, Baksheev GN, McCarthy J, Reid D, Lemphers A, Sullivan DH. Managing risks of violence in a youth mental health service: a service model description. Early Interv Psychiatry 2012; 6:469-75. [PMID: 22741948 DOI: 10.1111/j.1751-7893.2012.00372.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM There is a significant relationship between experiencing a severe mental illness, particularly psychosis, and exhibiting violent or offending behaviour. Reducing, if not preventing, the risks of violence among patients of mental health services is clinically warranted, but models to address this are limited. METHODS We provide a rationale for, and service description of, a pilot forensic satellite clinic embedded within an early intervention service for patients with emerging psychosis, mood disorder and/or personality disorders. The core elements of the programme and its implementation are described, and demographic, clinical and risk data are presented for the patients assessed during the clinic's pilot phase. RESULTS A total of 54 patients were referred, 45 of whom were subsequently assessed via primary or secondary consultation. The majority of patients were male, with psychosis (40%) or major depressive disorder (31%) as the most common diagnoses. Illicit substance use in the sample was common, as was previous aggression (81%) and prior criminal offences (51%). Most referrals related to assessing and managing violent behaviour (64%) and violent/homicidal ideation (38%). On the basis of the risk assessments, 71% of patients were rated as medium to high risk of offending. CONCLUSION Assessing and managing risks of violent offending among young patients are both clinically indicated for a proportion of patients and feasible via a forensic outreach model. Given the proliferation of early psychosis services worldwide, the issue of managing, and ideally preventing, patient risk of violence will almost certainly have wide application. However, a comprehensive evaluation of this model is required to ultimately determine the effectiveness of this approach for improving patient outcomes.
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Affiliation(s)
- Rosemary Purcell
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
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Khalid FN, Ford T, Maughan B. Aggressive behaviour and psychosis in a clinically referred child and adolescent sample. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1795-806. [PMID: 22349207 DOI: 10.1007/s00127-012-0480-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 01/25/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite evidence of an increased risk of violence among adults suffering from psychosis, very little is currently known about the relationship between early onset psychosis and aggressive behaviour. We aimed to identify and examine overlaps between aggressive behaviour and psychosis in a referred child and adolescent sample to assess whether potential risk factors and other associated features of this co-occurring pattern can be identified at a young age. METHODS Standardised item sheet data on young people referred to the Child and Adolescent Department of the Maudsley Hospital between 1973 and 2004 were used to contrast three groups: (1) aggressive-only (n = 1,346), (2) psychosis-only (n = 173), and (3) co-occurring aggression and psychosis (n = 39) on a range of comorbid symptoms and potential risk factors. RESULTS Co-occurring cases presented with elevated rates of depersonalisation/derealisation, intrusive thoughts and restlessness, and were more likely to have received past treatment compared with both psychosis-only and aggressive-only cases. Although co-occurring cases resembled the psychosis-only group in many domains, including socio-demographic background and rates of emotional symptoms, they differed from 'pure' psychosis cases in having high levels of special educational needs, irritability, non-aggressive antisocial behaviours, as well as being more likely to be from a low social class and have increased contact with police and child care authorities. CONCLUSIONS Our findings suggest that it is possible to identify early risk factors for aggression in individuals with psychosis.
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Affiliation(s)
- Farah N Khalid
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, 16 De Crespigny Park, Box Number PO46, London SE5 8AF, UK.
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Huf G, Coutinho ESF, Adams CE. Physical restraints versus seclusion room for management of people with acute aggression or agitation due to psychotic illness (TREC-SAVE): a randomized trial. Psychol Med 2012; 42:2265-2273. [PMID: 22405443 DOI: 10.1017/s0033291712000372] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND After de-escalation techniques have failed, restraints, seclusion and/or rapid tranquillization may be used for people whose aggression is due to psychosis. Most coercive acts of health care have not been evaluated in trials. METHOD People admitted to the emergency room of Instituto Philippe Pinel, Rio de Janeiro, Brazil, whose aggression/agitation was thought due to psychosis and for whom staff were unsure if best to restrict using physical restraints or a seclusion room, were randomly allocated to one or the other and followed up to 14 days. The primary outcomes were 'no need to change intervention early - within 1 h' and 'not restricted by 4 h'. RESULTS A total of 105 people were randomized. Two-thirds of the people secluded were able to be fully managed in this way. Even taking into account the move out of seclusion into restraints, this study provides evidence that embarking on the less restrictive care pathway (seclusion) does not increase overall time in restriction of some sort [not restricted by 4 h: relative risk 1.09, 95% confidence interval 0.75-1.58; mean time to release: restraints 337.6 (s.d.=298.2) min, seclusion room 316.3 (s.d.=264.5) min, p=0.48]. Participants tended to be more satisfied with their care in the seclusion group (17.0% v. 11.1%) but this did not reach conventional levels of statistical significance (p=0.42). CONCLUSIONS This study should be replicated, but suggests that opting for the least restrictive option in circumstances where there is clinical doubt does not harm or prolong coercion.
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Affiliation(s)
- G Huf
- National Institute of Quality Control in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - E S F Coutinho
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - C E Adams
- Division of Psychiatry, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Nielssen OB, Large MM, Dean K. The truth, the whole truth and nothing but the truth about early intervention. Aust N Z J Psychiatry 2012; 46:1004-5. [PMID: 23028196 DOI: 10.1177/0004867412442408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
BACKGROUND Mania has been reported to be a risk factor for aggression and violence in psychiatric hospitals, but the extent of any association between mania and severe interpersonal violence in community settings is not known. AIM To examine the association between mania and severe violence in a series of patients found not guilty by reason of mental illness (NGMI). METHODS A review of the court documents of those found NGMI of offences involving severe violence, including homicide, attempted homicide and assault causing wounding or serious injury, in New South Wales between 1992 and 2008. RESULTS Twelve of 272 people found NGMI were in a manic state when they committed a severe violence offence. Ten were diagnosed with schizo-affective disorder and two with bipolar disorder. Three patients were in the depressed phase of schizo-affective disorder and there were no patients in the depressed phase of bipolar disorder. CONCLUSION Mania, in particular the manic phase of bipolar disorder, is not strongly associated with severe violence.
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Affiliation(s)
- Olav B Nielssen
- 1Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Darlinghurst, Sydney, Australia
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Singh JP, Grann M, Lichtenstein P, Långström N, Fazel S. A novel approach to determining violence risk in schizophrenia: developing a stepped strategy in 13,806 discharged patients. PLoS One 2012; 7:e31727. [PMID: 22359622 PMCID: PMC3280996 DOI: 10.1371/journal.pone.0031727] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 01/11/2012] [Indexed: 12/22/2022] Open
Abstract
Clinical guidelines recommend that violence risk be assessed in schizophrenia. Current approaches are resource-intensive as they employ detailed clinical assessments of dangerousness for most patients. An alternative approach would be to first screen out patients at very low risk of future violence prior to more costly and time-consuming assessments. In order to implement such a stepped strategy, we developed a simple tool to screen out individuals with schizophrenia at very low risk of violent offending. We merged high quality Swedish national registers containing information on psychiatric diagnoses, socio-demographic factors, and violent crime. A cohort of 13,806 individuals with hospital discharge diagnoses of schizophrenia was identified and followed for up to 33 years for violent crime. Cox regression was used to determine risk factors for violent crime and construct the screening tool, the predictive validity of which was measured using four outcome statistics. The instrument was calibrated on 6,903 participants and cross-validated using three independent replication samples of 2,301 participants each. Regression analyses resulted in a tool composed of five items: male sex, previous criminal conviction, young age at assessment, comorbid alcohol abuse, and comorbid drug abuse. At 5 years after discharge, the instrument had a negative predictive value of 0.99 (95% CI = 0.98-0.99), meaning that very few individuals who the tool screened out (n = 2,359 out of original sample of 6,903) were subsequently convicted of a violent offence. Screening out patients who are at very low risk of violence prior to more detailed clinical assessment may assist the risk assessment process in schizophrenia.
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Affiliation(s)
- Jay P. Singh
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Martin Grann
- Centre for Violence Prevention, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Långström
- Centre for Violence Prevention, Karolinska Institutet, Stockholm, Sweden
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- * E-mail:
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Huf G, Coutinho ESF, Ferreira MAV, Ferreira S, Mello F, Adams CE. TREC-SAVE: a randomised trial comparing mechanical restraints with use of seclusion for aggressive or violent seriously mentally ill people: study protocol for a randomised controlled trial. Trials 2011; 12:180. [PMID: 21774823 PMCID: PMC3154155 DOI: 10.1186/1745-6215-12-180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 07/20/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Thousands of people whose aggression is thought due to serious mental illness are secluded or restrained every day. Without fair testing these techniques will continue to be used outside of a rigorous evidence base. With such coercive treatment this leaves all concerned vulnerable to abuse and criticism. This paper presents the protocol for a randomised trial comparing seclusion with restraints for people with serious mental illnesses. METHODS/DESIGN Setting-General psychiatric wards of a large psychiatric hospital in Rio de Janeiro, Brazil. Participants-Anyone aggressive or violent suspected or known to have serious mental illness for whom restriction is felt to be indicated by nursing and medical staff, but also for whom they are unsure whether seclusion or restraint would be indicated. Interventions-The standard care of either strong cotton banding to edge of bed with medications as indicated and close observation or the other standard care of use of a minimally furnished seclusion room but with open but barred windows onto the nursing station. Outcomes-time to restrictions lifted, early change of treatment, additional episodes, adverse effects/events, satisfaction with care during episode. Duration-2 weeks. Identifier: ISRCTN 49454276 http://www.controlled-trials.com/ISRCTN49454276.
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Affiliation(s)
- Gisele Huf
- National Institute of Quality Control in Health-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- University Hospital Clementino Fraga Filho-Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Evandro SF Coutinho
- National School of Public Health-Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | - Flavia Mello
- Psychiatric Institute Philippe Pinel, Rio de Janeiro, Brazil
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Abstract
The first episode of psychosis frequently occurs during adolescence and early adulthood, and is associated with high levels of trauma, affective disturbance and suicide. The social networks of service users often decrease significantly following the first onset, although many will remain in close contact with some family members particularly during the early phases. However, the negative impact of psychosis on families and their relationship with the identified service user are well documented. Family intervention is a recommended and evidence-based treatment in later psychosis. In this paper, we review the literature on family interventions in early psychosis in the context of new evidence for its efficacy and its routine incorporation in early intervention services for psychosis.
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Violence in first-episode psychosis: a systematic review and meta-analysis. Schizophr Res 2011; 125:209-20. [PMID: 21208783 DOI: 10.1016/j.schres.2010.11.026] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 11/14/2010] [Accepted: 11/29/2010] [Indexed: 01/13/2023]
Abstract
BACKGROUND Violence towards others is a recognised complication of first-episode psychosis. AIMS To estimate the rate of violence and the associations with violence in first-episode psychosis. METHOD A systematic review and meta-analysis of 9 studies. RESULTS Pooled estimates of the proportion of patients with first-episode psychosis committing any violence, serious violence and severe violence were 34.5%, 16.6% and 0.6%, respectively. Violence of any severity was associated with involuntary treatment (OR=3.84), a forensic history (OR=3.28), hostile affect (OR=3.52), symptoms of mania (OR=2.86), illicit substance use (OR=2.33), lower levels of education (OR=1.99), younger age (OR=1.85), male sex (OR =1.61) and the duration of untreated psychosis (OR=1.56). Serious violence was associated with a forensic history (OR=4.42), the duration of untreated psychosis (OR=2.76) and total symptom scores (OR=2.05). Violence in the period after initiation of treatment for first-episode psychosis was associated with involuntary treatment (OR=5.71). CONCLUSIONS A substantial proportion of patients in first-episode psychosis commit an act of violence before presenting for treatment, including a number who commit an act of more serious violence causing injury to another person. However, severe violence resulting in serious or permanent injury to the victim is uncommon in this population.
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Colasanti A, Paletta S, Moliterno D, Mazzocchi A, Mauri MC, Altamura AC. Symptom dimensions as predictors of clinical outcome, duration of hospitalization, and aggressive behaviours in acutely hospitalized patients with psychotic exacerbation. Clin Pract Epidemiol Ment Health 2010; 6:72-8. [PMID: 21283648 PMCID: PMC3026339 DOI: 10.2174/1745017901006010072] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 05/31/2010] [Accepted: 06/06/2010] [Indexed: 12/04/2022]
Abstract
In the present study we extract clusters of symptoms in acute hospitalized psychotic patients during a re-exacerbation phase, using factor analysis of BPRS-E. We aim to investigate the relative contribution of each symptom dimension in predicting the severity of symptoms at discharge, the length of acute hospitalization, and the occurrence of aggressive behaviours during acute hospitalization. The data are drawn from a prospective, naturalistic, observational study of 183 patients with Psychotic Disorders consecutively admitted to a psychiatric ward, during a re-exacerbation phase. General symptomatology has been measured through BPRS-E at admission and at discharge. Statistical analyses include principal component analysis and multiple linear regression. We found symptoms of acute psychosis disorder to cluster together in four distinct domains, labelled "Excitement/Activation", "Positive symptoms", and "Negative symptoms", and "Depression/Anxiety". Excitement/activation was the dimension most associated with occurrence of aggressive behaviours and severity of psychopathological symptoms at discharge. The negative symptoms dimension, also, predicted the severity of symptoms at discharge. Positive and negative symptoms dimensions were both predictors of duration of hospitalization. The depressive dimension was significantly associated only to self-aggression. These data indicate that during acute hospitalization due to re-exacerbation of psychosis each symptom dimension has a specific impact on distinct measures of outcome.
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Affiliation(s)
- Alessandro Colasanti
- Clinical Psychiatry, Clinical Neuropsychopharmacology Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F.Sforza 35, 20122 Milan, Italy
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Khodarahimi S. Psychopathic Deviate Tendency and Psychopathology Relationships in an Iranian Adolescents and Youth Sample: Gender Differences and Predictors. EUROPEAN JOURNAL OF MENTAL HEALTH 2010. [DOI: 10.1556/ejmh.5.2010.1.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
OBJECTIVE To determine if substance use (particularly cannabis) is more frequent among first episode psychosis patients and associated with a more problematic clinical presentation. METHOD All first episode psychosis (FEP) patients presenting to secondary services were recruited from London and Nottingham, over 2 years, in the Aetiology and Ethnicity of Schizophrenia and Other Psychoses study broad framework. Clinical and sociodemographic variables were assessed using a set of standardized instruments. A schedule was created to retrospectively collate substance use data from patients, relatives and clinicians. RESULTS Five hundred and eleven FEP were identified. They used three to five times more substances than general population. Substance use was associated with poorer social adjustment and a more acute mode of onset. Cannabis use did not affect social adjustment, but was associated with a more acute mode of onset. CONCLUSION Cannabis has a different impact on FEP than other substances. Large epidemiological studies are needed to disentangle cannabis effect.
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Soyka M, Zingg C. Association for methodology and documentation in psychiatry profiles predict later risk for criminal behavior and violent crimes in former inpatients with affective disorder. J Forensic Sci 2010; 55:655-9. [PMID: 20345783 DOI: 10.1111/j.1556-4029.2010.01354.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Few studies have investigated criminal and violent behavior in patients with affective disorders. We reviewed the national crime register for records of criminal offenses committed by 1561 patients with affective disorders and studied the predictive value of certain psychopathological symptoms assessed with the Association for Methodology and Documentation in Psychiatry (AMDP) system concerning future criminal behavior. Sixty-five (4.2%) patients had been convicted in the 7-12 years after discharge (307 cases). Patients with the AMDP syndrome mania had a significantly higher risk for later criminal behavior. The combination with the hostility syndrome further increased the risk. These findings are in line with previous data indicating a higher risk for later criminal behavior in patients with a manic/bipolar disorder compared to depressive disorder. As previously demonstrated in another sample of schizophrenic patients, the AMDP syndromes mania (and hostility) is associated with a higher risk of later criminal behavior.
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Affiliation(s)
- Michael Soyka
- Department of Psychiatry, Ludwig-Maximilian-University, Nussbaumstr. 7, 80336 Munich, Germany.
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Harris AWF, Large MM, Redoblado-Hodge A, Nielssen O, Anderson J, Brennan J. Clinical and cognitive associations with aggression in the first episode of psychosis. Aust N Z J Psychiatry 2010; 44:85-93. [PMID: 20073570 DOI: 10.3109/00048670903270423] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Although there may be an increased risk of aggression in first-episode psychosis, little is known about the clinical and cognitive associations of serious and less serious aggression during this phase of psychotic illness. METHODS Eighty-five patients in the first episode of psychosis under the age of 26 underwent comprehensive clinical assessment and cognitive testing. Aggression was assessed using a purpose-designed rating scale based on corroborative interviews to record 10 types of aggressive behaviour in the 3 months before presenting for treatment. RESULTS Thirty-seven of 85 patients (43.5%) exhibited physically aggressive behaviour and 23 patients (27.1%) had assaulted another person or used a weapon. Young age and elevated scores in the mania rating scale were associated with a history of any type of aggression. Serious aggression was associated with regular cannabis use and more errors of commission on a continuous performance task. CONCLUSIONS The clinical features associated with less serious aggression were different to those associated with more serious forms of aggression. Serious aggression is associated with regular cannabis use and also reduced behavioural inhibition. Awareness of substance use and neurocognitive deficits may assist in the identification of potentially violent patients.
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Affiliation(s)
- Anthony W F Harris
- Department of Psychiatry, Westmead Hospital, Westmead, NSW 2145, Australia.
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