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Chesney E, Lawn W, McGuire P. Assessing Cannabis Use in People with Psychosis. Cannabis Cannabinoid Res 2024; 9:49-58. [PMID: 37971872 PMCID: PMC10874830 DOI: 10.1089/can.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Introduction: Cannabis use is common in people with psychotic disorders and is associated with the exacerbation of symptoms, poor treatment adherence, and an increased risk of relapse. Accurate assessment of cannabis use is thus critical to the clinical management of psychosis. Discussion: Cannabis use is usually assessed with self-report questionnaires that were originally developed for healthy individuals or people with a cannabis use disorder. Compared to these groups, the pattern of cannabis use and the associated harms in patients with psychosis are quite different. Moreover, in people with psychosis, the accuracy of self-reported use may be impaired by psychotic symptoms, cognitive deficits, and a desire to conceal use when clinicians have advised against it. Although urinary screening for delta-9-tetrahydrocannabinol is sometimes used in the assessment of acute psychotic episodes, it is not used in routinely. Cannabis use could be assessed by measuring the concentration of cannabinoids in urine and blood, but this is rarely done in either clinical settings or research. Conclusion: Using quantitative biological measures could provide a more accurate guide to the effects of use on the disorder than asking patients or using questionnaires.
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Affiliation(s)
- Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Will Lawn
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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Barlati S, Nibbio G, Stanga V, Giovannoli G, Calzavara-Pinton I, Necchini N, Lisoni J, Deste G, Vita A. Cognitive and clinical characteristics of offenders and non-offenders diagnosed with schizophrenia spectrum disorders: results of the Recoviwel observational study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1307-1316. [PMID: 36309882 DOI: 10.1007/s00406-022-01510-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/19/2022] [Indexed: 11/26/2022]
Abstract
The association between schizophrenia spectrum disorders (SSD) and violent behavior is complex and requires further research. The cognitive correlates of violent behavior, in particular, remain to be further investigated. Aims of the present study were to comprehensively assess the cognitive and clinical profile of SSD violent offenders and evaluate individual predictors of violent behavior. Fifty inmates convicted for violent crimes in a forensic psychiatry setting and diagnosed with SSD were compared to fifty non-offender patients matched for age, gender, education, and diagnosis. Offender and non-offender participants were compared based on socio-demographic, clinical, and cognitive variables using non-parametric testing to select potential predictors of violent behavior. Multivariate logistic regressions were then performed to identify individual predictors of violent behavior. Offender participants showed more school failures, higher prevalence of substance use, higher Clinical Global Impression Severity Scale (CGI-S) and Positive and Negative Syndrome Scale Excited Component (PANSS-EC) scores, worse working memory and better attention performance, higher Historical Clinical and Risk Management scale 20 (HCR-20) and Hare Psychopathy Checklist (PCL-R) scores in all subdomains and factors. School failures, higher PANSS-EC scores, worse working memory and processing speed, better attention performance, higher scores in HCR-20 Management subscale and the PCL-R "Callous" factor emerged as predictors of violent behavior. Better attentional performance was correlated with higher PCL-R "Callous" factor scores, worse cognitive performance in several domains with higher PCL-R "Unstable" factor scores. In conclusion, the present study highlights the importance of carefully assessing SSD patients with violent behavior in all clinical, cognitive, and behavioral aspects.
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Affiliation(s)
- Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Valentina Stanga
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giulia Giovannoli
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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van Beek J, Meijers J, Scherder EJA, Harte JM. Aggressive Incidents by Incarcerated People With Psychiatric Illness and Their Relationship With Psychiatric Symptoms. JOURNAL OF FORENSIC NURSING 2023; 19:E30-E38. [PMID: 37590946 DOI: 10.1097/jfn.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
AIM A prospective design was used to investigate the relationship of current psychiatric symptoms of incarcerated people with serious mental illness (SMI) and aggressive behavior on a penitentiary ward for crisis intervention. METHODS One hundred sixty detainees with SMI, detained in a high-security penitentiary psychiatric facility, were screened every 2 weeks with the Brief Psychiatric Rating Scale-Extended (BPRS-E) by trained clinicians, to ensure that the data on psychiatric symptoms were up-to-date. Aggressive behavior was registered with the Staff Observation Aggression Scale-Revised. A binary logistic regression analysis was performed to examine the relationships between factor scores of the BPRS-E and aggressive behavior. RESULTS Significant relationships between the BPRS-E factor hostility, antisocial traits, and aggressive incidents were found, but not between the positive symptoms or manic factor scores and aggressive incidents. DISCUSSION Symptoms of SMI measured with the BPRS-E did not help to explain the occurrence of aggressive behavior. This is not in line with what is commonly found. The implication is that it can be expected that this population will display aggressive behavior but that symptoms do not help in predicting when this will occur. In addition, hostility and antisocial traits were related to aggressive behavior. For this specific population, an interactional approach might be more effective in the management of aggression than treatment of symptoms of SMI.
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Affiliation(s)
| | | | - Erik J A Scherder
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam
| | - Joke M Harte
- Department of Criminal Law and Criminology, Faculty of Law, Vrije Universiteit Amsterdam
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Guo W, Gu Y, Zhou J, Wang X, Sun Q. Characteristics and associated factors of violence in male patients with schizophrenia in China. Front Psychiatry 2023; 14:1106950. [PMID: 36970285 PMCID: PMC10036402 DOI: 10.3389/fpsyt.2023.1106950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectiveTo investigate the characteristics and associated factors of violence in male patients with schizophrenia in China.MethodsA total of 507 male patients with schizophrenia were recruited, including 386 non-violent and 121 violent patients. The socio-demographic information and medical history of the patients were collected. Psychopathological characteristics, personality traits psychopathology, and factors related to risk management were assessed using the Brief Psychiatric Rating Scale (BPRS), the History of Violence, Clinical, Risk Assessment Scale (HCR-20), and the Psychopathy Checklist-Revised (PCL-R), as appropriate. Differences in these factors were compared between the violent and non-violent patients, and logistic regression analysis was performed to explore the risk factors for violence in male patients with schizophrenia.ResultsThe results showed that the violent group had a lower level of education, longer duration of illness, as well as a higher rate of hospitalization, history of suicidal attempts, and history of alcohol compared with the non-violent group. The violent group scored higher in items of symptoms in BPRS, personality traits and psychopathy in PCL-R, and risk management in HCR-20. The regression analysis showed that previous suicidal behavior (OR = 2.07,95% CI [1.06-4.05], P = 0.033), antisocial tendency in PCL-R (OR = 1.21, 95% CI [1.01-1.45], P = 0.038), H2: young age at violent incident (OR = 6.39, 95% CI [4.16-9.84], P < 0.001), C4: impulsivity (OR = 1.76, 95% CI [1.20-2.59], P = 0.004), and H3: relationship instability (OR = 1.60, 95% CI [1.08-2.37], P = 0.019) in HCR-20 were risk factors of violence among male patients with schizophrenia.ConclusionThe present study found significant differences in socio-demographic information, history of treatment, and psychopathy characteristics between male patients with schizophrenia who had engaged in violent behaviors and their non-violent counterparts in China. Our findings suggested the necessity of individualized treatment for male patients with schizophrenia who had engaged in violent behaviors as well as the use of both HCR-20 and PCL-R for their assessment.
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Affiliation(s)
- Weilong Guo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Yu Gu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Jiansong Zhou
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Xiaoping Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Qiaoling Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
- *Correspondence: Qiaoling Sun,
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StepjanoviĆ D, Hall W, Leung J. Illicit drug use and violence. HANDBOOK OF CLINICAL NEUROLOGY 2023; 197:121-145. [PMID: 37633705 DOI: 10.1016/b978-0-12-821375-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
This chapter reviews evidence on the relationship between illicit drug use and violence, specifically cannabis, stimulant drugs, and opioids. It summarizes findings of systematic reviews of evidence on cannabis, stimulant drugs, and opioids. It also examines evidence from epidemiological studies of drug use among violent offenders and of violence among persons who use drugs, intervention studies, animal studies, human laboratory studies, and human neuroimaging studies. More studies have examined cannabis because of its higher prevalence of use. There is an association between cannabis use and violence, suggestive evidence of a dose-response relationship between the frequency of cannabis use and violence, and a stronger association in persons with psychoses. There is similar emerging evidence on stimulant use and violence, but evidence on opioids is very limited. There is limited and mixed evidence from intervention studies that reducing drug use reduces violence. Animal and human studies provide potential biological explanations for these associations. The association between cannabis use and violence is most consistent but limited by study heterogeneity and lack of control for potential confounders. It is unclear whether these associations are causal or reflect reverse causation or the effects of confounding.
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Affiliation(s)
- Daniel StepjanoviĆ
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD, Australia.
| | - Janni Leung
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD, Australia
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Aggression, Alexithymia and Sense of Coherence in a Sample of Schizophrenic Outpatients. Healthcare (Basel) 2022; 10:healthcare10061078. [PMID: 35742130 PMCID: PMC9223291 DOI: 10.3390/healthcare10061078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 02/07/2023] Open
Abstract
Schizophrenia elevates the risk for aggressive behavior, and there is a need to better understand the associated variables predicting aggression for treatment and prevention purposes. The aim of the present study is to determine the relationship between alexithymia, sense of coherence and aggressive behavior in a sample of schizophrenic outpatients. Using a correlational research design, standardized self-report questionnaires assessed aggression (brief aggression questionnaire—BAQ), alexithymia (Toronto Alexithymia Scale—TAS) and sense of coherence (sense of coherence questionnaire—SOC) in a sample of 100 schizophrenic outpatients in clinical remission. Participants reported high levels of aggression and alexithymia along with reduced sense of coherence. Significant negative correlations were evidenced among scores on the SOC scale (p < 0.001) with both the TAS as well as with the BAQ scales. However, a positive correlation (p < 0.001) was observed between the TAS and BAQ scales. Regression indicated that 27% of the variation in the BAQ rating was explained by the TAS, while an additional 17.8% was explained by the sense of coherence. The difficulty identifying feelings of alexithymia and the comprehensibility and manageability components of sense of coherence significantly predicted anger, hostility and physical aggression. Sense of coherence mediated the relationship between alexithymia and aggression. From the path analysis, comprehensibility emerged as the key factor counterbalancing alexithymic traits and aggressive behaviors, and manageability effectuated higher anger control. The findings hold practical implications for the treatment and rehabilitation of schizophrenic patients.
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Validation and recalibration of OxMIV in predicting violent behaviour in patients with schizophrenia spectrum disorders. Sci Rep 2022; 12:461. [PMID: 35013451 PMCID: PMC8748785 DOI: 10.1038/s41598-021-04266-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/16/2021] [Indexed: 12/23/2022] Open
Abstract
Oxford Mental Illness and Violence (OxMIV) addresses the need in mental health services for a scalable, transparent and valid tool to predict violent behaviour in patients with severe mental illness. However, external validations are lacking. Therefore, we have used a Dutch sample of general psychiatric patients with schizophrenia spectrum disorders (N = 637) to evaluate the performance of OxMIV in predicting interpersonal violence over 3 years. The predictors and outcome were measured with standardized instruments and multiple sources of information. Patients were mostly male (n = 493, 77%) and, on average, 27 (SD = 7) years old. The outcome rate was 9% (n = 59). Discrimination, as measured by the area under the curve, was moderate at 0.67 (95% confidence interval 0.61–0.73). Calibration-in-the-large was adequate, with a ratio between predicted and observed events of 1.2 and a Brier score of 0.09. At the individual level, risks were systematically underestimated in the original model, which was remedied by recalibrating the intercept and slope of the model. Probability scores generated by the recalibrated model can be used as an adjunct to clinical decision-making in Dutch mental health services.
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Yu T, Zhang X, Liu X, Xu C, Deng C. The Prediction and Influential Factors of Violence in Male Schizophrenia Patients With Machine Learning Algorithms. Front Psychiatry 2022; 13:799899. [PMID: 35360130 PMCID: PMC8962616 DOI: 10.3389/fpsyt.2022.799899] [Citation(s) in RCA: 2] [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: 10/22/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early to identify male schizophrenia patients with violence is important for the performance of targeted measures and closer monitoring, but it is difficult to use conventional risk factors. This study is aimed to employ machine learning (ML) algorithms combined with routine data to predict violent behavior among male schizophrenia patients. Moreover, the identified best model might be utilized to calculate the probability of an individual committing violence. METHOD We enrolled a total of 397 male schizophrenia patients and randomly stratified them into the training set and the testing set, in a 7:3 ratio. We used eight ML algorithms to develop the predictive models. The main variables as input features selected by the least absolute shrinkage and selection operator (LASSO) and logistic regression (LR) were integrated into prediction models for violence among male schizophrenia patients. In the training set, 10 × 10-fold cross-validation was conducted to adjust the parameters. In the testing set, we evaluated and compared the predictive performance of eight ML algorithms in terms of area under the curve (AUC) for the receiver operating characteristic curve. RESULT Our results showed the prevalence of violence among male schizophrenia patients was 36.8%. The LASSO and LR identified main risk factors for violent behavior in patients with schizophrenia integrated into the predictive models, including lower education level [0.556 (0.378-0.816)], having cigarette smoking [2.121 (1.191-3.779)], higher positive syndrome [1.016 (1.002-1.031)] and higher social disability screening schedule (SDSS) [1.081 (1.026-1.139)]. The Neural Net (nnet) with an AUC of 0.6673 (0.5599-0.7748) had better prediction ability than that of other algorithms. CONCLUSION ML algorithms are useful in early identifying male schizophrenia patients with violence and helping clinicians take preventive measures.
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Affiliation(s)
- Tao Yu
- Anhui Mental Health Center, Hefei Fourth People's Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Xulai Zhang
- Anhui Mental Health Center, Hefei Fourth People's Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Xiuyan Liu
- Anhui Mental Health Center, Hefei Fourth People's Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Chunyuan Xu
- Anhui Mental Health Center, Hefei Fourth People's Hospital, Affiliated Psychological Hospital of Anhui Medical University, Hefei, China
| | - Chenchen Deng
- Anhui Province Maternity and Child Health Hospital, Hefei, China
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Yi Y, Huang Y, Chen Q, Yang H, Li H, Feng Y, Feng S, Zhou S, Li Z, Wu F. Violence, neurocognitive function and clinical correlates in patients with schizophrenia. Front Psychiatry 2022; 13:1087372. [PMID: 36741559 PMCID: PMC9893505 DOI: 10.3389/fpsyt.2022.1087372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Schizophrenia patients with violent behavior are a severe public health concern, but the correlates of this violent behavior are unknown. Additionally, the relationship between neurocognitive function and violent behavior in Chinese patients with schizophrenia has not yet been investigated. METHODS A total of 337 schizophrenia inpatients were recruited. The Positive and Negative Syndrome Scale (PANSS) was used to assess psychopathological symptoms. Neurocognitive functioning was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RESULTS The percentage of violent behavior was 10.4% in patients with schizophrenia. Patients with violent behavior had higher PANSS-positive, excited, and total subscale scores than patients who did not show violent behavior. Patients with violent behavior also had lower RBANS language, semantic fluency, and total subscale scores. Gender (OR = 0.066∼0.819, p = 0.023), illness duration (OR = 0.876∼0.971, p = 0.002), smoking (OR = 1.127∼2.950, p = 0.014), the PANSS positive subscale (OR = 1.050∼1.197, p = 0.001), and the RBANS language subscale (OR = 0.927∼0.987, p = 0.005) significantly contributed to the development of violent behavior in schizophrenia patients. CONCLUSION Our findings revealed that cognitive and clinical assessments should be considered in comprehensive assessments of future risks of violence in schizophrenia patients.
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Affiliation(s)
- Yun Yi
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Yuanyuan Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Chen
- Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Hanlun Yang
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hehua Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yangdong Feng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shixuan Feng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sumiao Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zezhi Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
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Moulin V, Framorando D, Gasser J, Dan-Glauser E. The Link Between Cannabis Use and Violent Behavior in the Early Phase of Psychosis: The Potential Role of Impulsivity. Front Psychiatry 2022; 13:746287. [PMID: 35392388 PMCID: PMC8980530 DOI: 10.3389/fpsyt.2022.746287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Recently, the literature has shown that Cannabis Use (CU) was a risk factor for Violent Behavior (VB) in patients with psychosis, and those in the early phase of psychosis (EPP). These findings are relevant because of the high prevalence of CU in this EPP, and the potential for prevention during this phase of illness. However, there is still a lack of clear explanations, supported by empirical evidence, about what underlies the link between CU and VB against other. METHOD This viewpoint reviews the scientific literature on the link between CU and VB, and the involvement of impulsivity in this relationship. This last point will be addressed at clinical and neurobiological levels. RESULTS Recent studies confirmed that CU is particularly high in the EPP, and is a risk factor for VB in the EPP and schizophrenia. Studies have also shown that impulsivity is a risk factor for VB in psychosis, is associated with CU, and may mediate the link between CU and VB. Research suggests a neurobiological mechanism, as CU affects the structures and function of frontal areas, known to play a role in impulsive behavior. CONCLUSION Scientific evidence support the hypothesis of an involvement of impulsivity as a variable that could mediate the link between CU and aggression, particularly, when CU has an early onset. However, this hypothesis should be confirmed with longitudinal studies and by taking into account confounding factors. The studies highlight the relevance of early prevention in the EPP, in addition to interventions focusing on psychotic disorders.
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Affiliation(s)
- Valerie Moulin
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - David Framorando
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Jacques Gasser
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Elise Dan-Glauser
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
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Marquant T, Van Nuffel M, Sabbe B, Goethals K. Substance Use Disorders as a Critical Element for Decision-Making in Forensic Assertive Community Treatment: A Systematic Review. Front Psychiatry 2021; 12:777141. [PMID: 34950071 PMCID: PMC8688775 DOI: 10.3389/fpsyt.2021.777141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: The prevalence of substance use disorders in forensic populations is high. They are an important factor linked to negative outcomes in mentally ill offenders and are detrimental to forensic or non-forensic outcome measures. In contrast, substance use disorders are often underdiagnosed and undertreated, especially in forensic settings. Forensic Assertive Community Treatment is a forensic adaptation of regular assertive community treatment, combined with essential elements of forensic rehabilitation theories. Little is known however on the effectivity of forensic assertive community treatment when it comes to substance use disorders or what their exact role is on the outcome measures. In this paper, we explore how SUD is treated in Forensic assertive community treatment and how it relates to the forensic and non-forensic outcome measures. Methods: We performed a systematic review (PRISMA) of forensic Assertive community treatment teams that followed the main evidence-based principles of regular assertive community treatment and added basic elements of forensic rehabilitation. We analyzed articles the Psychinfo and Medline databases dating from 2005 to 2020. Fifteen studies fit the search criteria and were included in the analysis. The Quality of the studies was assessed using the Newcastle-Ottawa scale. Results: SUD was highly prevalent in all studies. Patients entered FACT through two pathways, either from a care continuum or directly from prison. The severity of SUD at intake emerges as a critical element when deciding which pathway to choose, as a high severity-score at the start of FACT follow-up was linked to recidivism. While differing in method all studies offered integrated SUD treatment. These included evidence-based techniques like CBT, therapeutic communities, and Substance Abuse Management Module. Though results on SUD outcomes were mixed 4 studies mentioned abstinence in 50-75%. The severity of SUD tended to increase initially and to stabilize afterwards. Conclusion: Severity of SUD at intake emerges as a decisive element in decision-making on entering FACT teams directly from prison or through a care-continuum. The ways to provide SUD treatment varied and outcomes for SUD were mixed. SUD was found to be detrimental to forensic and non-forensic outcome measures, such as recidivism or hospitalizations during FACT treatment.
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Affiliation(s)
- Thomas Marquant
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium
- Department of Forensic Psychiatry, Fivoor, Rotterdam, Netherlands
- Department of Justice, Brussels, Belgium
| | | | - Bernard Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium
- Department of Psychiatry, Antwerp University, Antwerp, Belgium
- Department of Psychiatry, Antwerp University Hospital, Antwerp, Belgium
| | - Kris Goethals
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium
- Department of Psychiatry, Antwerp University, Antwerp, Belgium
- Department of Psychiatry, Antwerp University Hospital, Antwerp, Belgium
- Department of Forensic Psychiatry, University Forensic Center, Antwerp, Belgium
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Lifetime Cannabis Use Disorder Is Not Associated With Lifetime Impulsive Behavior and Severe Violence in Patients With Schizophrenia Spectrum Disorders From a High-Security Hospital. J Clin Psychopharmacol 2021; 41:623-628. [PMID: 34735097 DOI: 10.1097/jcp.0000000000001493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND The link between substances of abuse, impulsivity, and violence in psychotic patients remains unclear. This study aims at unraveling whether cannabis use disorder is associated with violent and/or psychotic behavior in patients who are hospitalized in a high-security hospital. METHODS/PROCEDURES We conducted a cross-sectional retrospective study in 124 patients with schizophrenia spectrum disorders admitted to a high-security hospital. Lifetime violent behavior was assessed using the History of Aggressive Behavior Form-Subject of the MacArthur Violence Risk Assessment Study and impulsivity using the Psychopathy Checklist-Revised (considering items: "proneness to boredom," "lack of self-control," and "impulsive thoughtless gestures"). Substance use disorder was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Positive and Negative Syndrome Scale was also administered. FINDINGS/RESULTS Violent and nonviolent psychotic patients showed similar prevalence of cannabis use disorder. Alcohol and cocaine use disorders were more prevalent among violent psychotic patients. Cannabis use disorder was not associated with any dimension of impulsivity, whereas alcohol use disorder was positively correlated to impulsive thoughtless gestures (standardized β = 0.213, P = 0.027) and cocaine use disorder with proneness to boredom (standardized β = 0.290, P = 0.002). Finally, logistic regression analysis revealed that, unlike cannabis and cocaine use disorders, alcohol use disorder (odds ratio, 3.964; 95% confidence interval, 1.729-9.087; P = 0.001) was a factor associated with violence. IMPLICATIONS/CONCLUSIONS These findings show that cannabis and alcohol are largely abused and coabused by psychotic patients with a propsensity for violence, but only alcohol is associated with impulsive and violent behavior. Therefore, especially alcohol abuse should be seriously considered by practitioners when evaluating the dangerousness of patients with schizophrenia spectrum disorders.
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Jones RM, Manetsch M, Gerritsen C, Simpson AIF. Patterns and Predictors of Reincarceration among Prisoners with Serious Mental Illness: A Cohort Study: Modèles et prédicteurs de réincarcération chez les prisonniers souffrant de maladie mentale grave : Une étude de cohorte. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:560-568. [PMID: 33155829 PMCID: PMC8138736 DOI: 10.1177/0706743720970829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A small proportion of people who have serious mental illness and rapid and frequent incarcerations account for a disproportionate amount of overall service use and cost. It is important to describe such individuals, so that services can respond more effectively. METHODS We investigated a cohort of 4,704 incarcerated men and women who were discharged from a correctional mental health service and followed for a median of 535 days. We investigated social, clinical, demographic, and offense characteristics as predictors of return to the service using Cox survival analyses. Secondly, we characterized individuals as high-frequency service users as those who had 3 or more incarcerations during a 1-year period and investigated their characteristics. RESULTS We found that a higher rate of return to custody was associated with schizophrenia spectrum/bipolar affective disorder (BPAD), personality disorder traits, crack cocaine and methamphetamine use, and unstable housing. Charges of theft/robbery and breach of probation were also positively associated, and sex assault was negatively associated with return to custody. Within a 1-year time period, we found 7.2% of individuals were high-frequency service users, which accounted for 19.5% of all reincarcerations. CONCLUSION Identification of the characteristics of those with mental illness in custody, especially those who have high-frequency returns to custody, may provide opportunity to target resources more effectively. The primary targets of intervention would be to treat those with schizophrenia/BPAD and substance use problems, particularly those using stimulants, and addressing homelessness. This could reduce the problem of repeated criminalization of the mentally ill and reduce the overall incarceration rate.
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Affiliation(s)
- Roland M Jones
- 7978Centre for Addiction and Mental Health (CAMH), University of Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - Madleina Manetsch
- 7978Centre for Addiction and Mental Health (CAMH), University of Toronto, Ontario, Canada.,Forensic Psychiatric Clinic, Adolescent Forensic Psychiatry, University Psychiatric Clinics, Basel, Switzerland
| | - Cory Gerritsen
- 7978Centre for Addiction and Mental Health (CAMH), University of Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - Alexander I F Simpson
- 7978Centre for Addiction and Mental Health (CAMH), University of Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
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14
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Sariaslan A, Leucht S, Zetterqvist J, Lichtenstein P, Fazel S. Associations between individual antipsychotics and the risk of arrests and convictions of violent and other crime: a nationwide within-individual study of 74 925 persons. Psychol Med 2021; 52:1-9. [PMID: 33691828 PMCID: PMC9811342 DOI: 10.1017/s0033291721000556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/11/2021] [Accepted: 02/04/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Individuals diagnosed with psychiatric disorders who are prescribed antipsychotics have lower rates of violence and crime but the differential effects of specific antipsychotics are not known. We investigated associations between 10 specific antipsychotic medications and subsequent risks for a range of criminal outcomes. METHODS We identified 74 925 individuals who were ever prescribed antipsychotics between 2006 and 2013 using nationwide Swedish registries. We tested for five specific first-generation antipsychotics (levomepromazine, perphenazine, haloperidol, flupentixol, and zuclopenthixol) and five second-generation antipsychotics (clozapine, olanzapine, quetiapine, risperidone, and aripiprazole). The outcomes included violent, drug-related, and any criminal arrests and convictions. We conducted within-individual analyses using fixed-effects Poisson regression models that compared rates of outcomes between periods when each individual was either on or off medication to account for time-stable unmeasured confounders. All models were adjusted for age and concurrent mood stabilizer medications. RESULTS The relative risks of all crime outcomes were substantially reduced [range of adjusted rate ratios (aRRs): 0.50-0.67] during periods when the patients were prescribed antipsychotics v. periods when they were not. We found that clozapine (aRRs: 0.28-0.44), olanzapine (aRRs: 0.46-0.72), and risperidone (aRRs: 0.53-0.64) were associated with lower arrest and conviction risks than other antipsychotics, including quetiapine (aRRs: 0.68-0.84) and haloperidol (aRRs: 0.67-0.77). Long-acting injectables as a combined medication class were associated with lower risks of the outcomes but only risperidone was associated with lower risks of all six outcomes (aRRs: 0.33-0.69). CONCLUSIONS There is heterogeneity in the associations between specific antipsychotics and subsequent arrests and convictions for any drug-related and violent crimes.
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Affiliation(s)
- Amir Sariaslan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Social and Public Policy Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany
- Department of Psychosis Studies, Institute of Psychiatry, National Institute for Health Research, Mental Health Biomedical Research Centre, King's College London, London, UK
| | - Johan Zetterqvist
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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15
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Affiliation(s)
- Margo D M Faay
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Faay); Department of Biomedical Sciences of Cells and Systems and Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands (Sommer)
| | - Iris E Sommer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands (Faay); Department of Biomedical Sciences of Cells and Systems and Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands (Sommer)
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16
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Jeyagurunathan A, Lau JH, Abdin E, Shafie S, Chang S, Samari E, Cetty L, Wei KC, Mok YM, Tang C, Verma S, Chong SA, Subramaniam M. Aggression Amongst Outpatients With Schizophrenia and Related Psychoses in a Tertiary Mental Health Institution. Front Psychiatry 2021; 12:777388. [PMID: 35046853 PMCID: PMC8761620 DOI: 10.3389/fpsyt.2021.777388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
Aims: Aggression is defined as "any behavior intended to cause physical, emotional, or psychological harm to another." The aims of the current study were to (i) examine underlying factor structure of the Buss-Perry Aggression Questionnaire (BPAQ) and (ii) explore socio-demographic and clinical correlates (symptom severity, substance use and alcohol use) among patients with schizophrenia and related psychoses in a multi-ethnic Asian population. Methods: Data collected from 397 participants who were seeking outpatient treatment for schizophrenia and related psychoses at a tertiary psychiatric hospital were included in the analyses. BPAQ, a 29-item, four-factor instrument that measures physical aggression, verbal aggression, anger and hostility was used to assess aggression. Data on socio-demographic variables, age of onset of illness, drug use, alcohol use and symptom severity were also collected. Confirmatory factor analysis (CFA) was performed to establish the underlying factor structure of the BPAQ. Multiple regression analyses were utilized to examine socio-demographic and clinical correlates of the BPAQ factors. Results: The mean age of the participants was 36.2 years (SD = 10.9, range: 21-65). Factor structure obtained from the CFA indicated that a higher order four-factor solution had an acceptable fit to the observed data (WLSMV χ2 = 1,025.35, df = 320, RMSEA = 0.07, CFI = 0.94, TLI = 0.93, SRMR = 0.05). Females had lower physical aggression and hostility scores as compared to males. Those with lower education had higher physical aggression scores as compared to those with higher education. Participants who received a diagnosis after the age of 30 years had higher physical aggression and anger scores as compared to those who received a diagnosis at or before 20 years of age. Symptom severity was positively associated with higher BPAQ scores. Conclusion: The study findings demonstrated high internal consistency and applicable measurement factor structure of BPAQ in this study sample, making it an appropriate questionnaire for assessing aggressive behavior in this population. We also identified socio-demographic and clinical factors that were associated with aggression in patients with schizophrenia and related psychoses.
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Affiliation(s)
| | - Jue Hua Lau
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Ker-Chiah Wei
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Yee Ming Mok
- Department of Mood and Anxiety, Institute of Mental Health, Singapore, Singapore
| | - Charmaine Tang
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Swapna Verma
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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17
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Feeney W, Moorthy AS, Sisco E. Spectral trends in GC-EI-MS data obtained from the SWGDRUG mass spectral library and literature: A resource for the identification of unknown compounds. Forensic Chem 2020; 31:10.1016/j.forc.2022.100459. [PMID: 36578315 PMCID: PMC9793444 DOI: 10.1016/j.forc.2022.100459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Rapid identification of new or emerging psychoactive substances remains a critical challenge in forensic drug chemistry laboratories. Current analytical protocols are well-designed for confirmation of known substances yet struggle when new compounds are encountered. Many laboratories initially attempt to classify new compounds using gas chromatography-electron ionization-mass spectrometry (GC-EI-MS). Though there is a large body of research focused on the analysis of illicit substances with GC-EI-MS, there is little high-level discussion of mass spectral trends for different classes of drugs. This manuscript compiles literature information and performs simple exploratory analyses on evaluated GC-EI-MS data to investigate mass spectral trends for illicit substance classes. Additionally, this work offers other important aspects: brief discussions of how each class of drugs is used; illustrations of EI mass spectra with proposed structures of commonly observed ions; and summaries of mass spectral trends that can help an analyst classify new illicit compounds.
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Affiliation(s)
- William Feeney
- Corresponding author at: Surface and Trace Chemical Analysis Group, Material Measurement Laboratory, 100 Bureau Drive, Gaithersburg, MD 20899, USA. (W. Feeney)
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18
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Valença AM, de Moraes TM, Meyer LF, Petribú KCLD, Nardi AE, Mendlowicz MV. Violent behavior by involuntarily committed female offenders with mental disorders: A population-based case series. J Forensic Sci 2020; 66:656-663. [PMID: 33253419 DOI: 10.1111/1556-4029.14638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 01/05/2023]
Abstract
The goal of the current study was to investigate the socio-demographic, psychiatric, and criminological characteristics of female violent offenders with mental disorders involuntarily committed to a forensic psychiatric hospital. The present study was a population-based retrospective case series including all female offenders with mental disorders found not guilty by reason of insanity by the criminal courts in the state of Rio de Janeiro, Brazil, and involuntarily committed to a forensic psychiatric facility (n = 27). Patients were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders and the Positive and Negative Syndrome Scale. We found that most offenders were Afro-Brazilian, uneducated unmarried women. Schizophrenia with active psychotic symptoms was the most common clinical condition. Relatives were the frequent victims of aggressive behavior. Most patients had already been diagnosed with a mental disorder and placed under psychiatric treatment, but poor adherence and treatment dropout were common. Violent behavior in psychiatrically ill female patients is associated with a specific socio-demographic and clinical profile and is thus potentially amenable to prevention particularly if the mental health and social services are to provide the much-needed support for economically, socially, and psychologically vulnerable women.
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Affiliation(s)
- Alexandre M Valença
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Talvane M de Moraes
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,National Academy of Medicine, Rio de Janeiro, RJ, Brazil
| | - Leonardo F Meyer
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil
| | | | - Antonio E Nardi
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil.,National Academy of Medicine, Rio de Janeiro, RJ, Brazil
| | - Mauro V Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Moulin V, Alameda L, Framorando D, Baumann PS, Gholam M, Gasser J, Do Cuenod KQ, Conus P. Early onset of cannabis use and violent behavior in psychosis. Eur Psychiatry 2020; 63:e78. [PMID: 32669157 PMCID: PMC7503178 DOI: 10.1192/j.eurpsy.2020.71] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although evidence from psychosis patients demonstrates the adverse effects of cannabis use (CU) at a young age and that the rate of CU is high in subgroups of young violent patients with psychotic disorders, little is known about the possible effect of the age of onset of CU on later violent behaviors (VB). So, we aimed to explore the impact of age at onset of CU on the risk of displaying VB in a cohort of early psychosis patients. METHOD Data were collected prospectively over a 36-month period in the context of an early psychosis cohort study. A total of 265 patients, aged 18-35 years, were included in the study. Logistic regression was performed to assess the link between age of onset of substance use and VB. RESULTS Among the 265 patients, 72 had displayed VB and 193 had not. While violent patients began using cannabis on average at age 15.29 (0.45), nonviolent patients had started on average at age 16.97 (0.35) (p = 0.004). Early-onset CU (up to age 15) was a risk factor for VB (odds ratio = 4.47, confidence interval [CI]: 1.13-20.06) when the model was adjusted for age group, other types of substance use, being a user or a nonuser and various violence risk factors and covariates. History of violence and early CU (until 15) were the two main risk factors for VB. CONCLUSIONS Our results suggest that early-onset CU may play a role in the emergence of VB in early psychosis.
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Affiliation(s)
- Valerie Moulin
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Department of Psychiatry, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain.,Instituto de Investigacion Sanitaria de Sevilla, IBiS, Sevilla, Spain
| | - David Framorando
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philipp-S Baumann
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mehdi Gholam
- Department of Psychiatry, Center for Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jacques Gasser
- Department of Psychiatry, Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Kim-Q Do Cuenod
- Department of Psychiatry, Unit for Research in Schizophrenia, Center for Psychiatric Neuroscience, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Conus
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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20
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van Buitenen N, van den Berg CJW, Meijers J, Harte JM. The prevalence of mental disorders and patterns of comorbidity within a large sample of mentally ill prisoners: A network analysis. Eur Psychiatry 2020; 63:e63. [PMID: 32522312 PMCID: PMC7355171 DOI: 10.1192/j.eurpsy.2020.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Comorbidity has profound implications in both the clinical field and research, yet little is known about the prevalence and structure of comorbid mental disorders. This article aims not only to present data on the prevalence of mental disorders and comorbidity, but also to explore relationships between comorbid mental disorders by using a network approach. METHODS Data used in this cross-sectional study are part of a prospective cohort study within penitentiary psychiatric centers (PPCs) in the Netherlands. It includes DSM diagnoses of 5,257 unique male patients incarcerated in one of the PPC's. Prevalence rates of mental disorders and comorbidity were calculated, the network of comorbid DSM diagnoses was constructed using regression coefficients. RESULTS Schizophrenia spectrum and substance-related disorders were most prevalent within this sample (56.7 and 43.1%, respectively), and over half of all patients were diagnosed with a comorbid disorder (56.9%). Four distinctive groups of disorders emerged from the network analysis of DSM diagnoses: substance use, impulsivity, poor social skills, and disruptive behaviors. Psychotic disorders were considered as a separate group as it was unconnected to other disorders. CONCLUSIONS Comorbid mental disorders can be described, at least in part, as connected networks. Underlying attributes as well as direct influences of mental disorders on one another seem to be affecting the presence of comorbidity. Results could contribute to the understanding of a possible causal relation between psychopathology and criminal behavior and the development of treatment programs targeting groups of disorders.
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Affiliation(s)
| | - Chantal J W van den Berg
- Department of Criminal Law and Criminology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jesse Meijers
- Judicial Complex Zaanstad, Westzaan, The Netherlands
| | - Joke M Harte
- Department of Criminal Law and Criminology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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21
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Whiting D, Lennox BR, Fazel S. Violent outcomes in first-episode psychosis: A clinical cohort study. Early Interv Psychiatry 2020; 14:379-382. [PMID: 31758666 PMCID: PMC7237238 DOI: 10.1111/eip.12901] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/13/2019] [Accepted: 10/19/2019] [Indexed: 11/26/2022]
Abstract
AIM Violence risk is an important part of a comprehensive clinical assessment in first-episode psychosis. This study addresses limitations of previous violent outcome research in first-episode psychosis, which has typically investigated selected cohorts or been restricted to violence occurring prior to service contact, with limited use of police data. METHODS For individuals consecutively assessed by Early Intervention in Psychosis (EIP) services in two UK regions (n = 177), violent outcomes in the subsequent 12-months were collected using electronic patient records, supplemented by police data. RESULTS Of individuals accepted by EIP services (n = 109), electronic medical records indicated around 1 in 4 (n = 28, 25.7%) perpetrated any physical violence, and 1 in 10 (n = 10, 9.2%) were arrested or charged for violent offences in the 12-months after first contact. Police data on all individuals assessed (n = 177) reported 1 in 7 (n = 26, 14.7%) were arrested or charged for violent offences in the 12-months after first contact. CONCLUSIONS EIP services should consider integrating multi-agency sources of data to evaluate violent outcomes. The potential role of violence risk management should be further examined.
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Affiliation(s)
- Daniel Whiting
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, England
| | - Belinda R Lennox
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, England
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, England
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22
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Smith WR, Sisti D. Ethics and ego dissolution: the case of psilocybin. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106070. [PMID: 32461241 PMCID: PMC9202314 DOI: 10.1136/medethics-2020-106070] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/12/2020] [Accepted: 04/06/2020] [Indexed: 05/20/2023]
Abstract
Despite the fact that psychedelics were proscribed from medical research half a century ago, recent, early-phase trials on psychedelics have suggested that they bring novel benefits to patients in the treatment of several mental and substance use disorders. When beneficial, the psychedelic experience is characterized by features unlike those of other psychiatric and medical treatments. These include senses of losing self-importance, ineffable knowledge, feelings of unity and connection with others and encountering 'deep' reality or God. In addition to symptom relief, psychedelic experiences often lead to significant changes in a patient's personality and worldview. Focusing on the case of psilocybin, we argue that the peculiar features of psychedelics pose certain novel risks, which warrant an enhanced informed consent process-one that is more comprehensive than what may be typical for other psychiatric medications. We highlight key issues that should be focused on during the consent process and suggest discussion prompts for enhanced consent in psychedelic psychiatry. Finally, we respond to potential objections before concluding with a discussion of ethical considerations that will arise as psychedelics proceed from highly controlled research environments into mainstream clinical psychiatry.
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Affiliation(s)
- William R Smith
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dominic Sisti
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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23
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Zhong S, Yu R, Fazel S. Drug Use Disorders and Violence: Associations With Individual Drug Categories. Epidemiol Rev 2020; 42:103-116. [PMID: 33005950 PMCID: PMC7879597 DOI: 10.1093/epirev/mxaa006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 01/19/2023] Open
Abstract
We conducted a systematic review that examined the link between individual drug categories and violent outcomes. We searched for primary case-control and cohort investigations that reported risk of violence against others among individuals diagnosed with drug use disorders using validated clinical criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We identified 18 studies published during 1990–2019, reporting data from 591,411 individuals with drug use disorders. We reported odds ratios of the violence risk in different categories of drug use disorders compared with those without. We found odds ratios ranging from 0.8 to 25.0 for most individual drug categories, with generally higher odds ratios among individuals with polydrug use disorders. In addition, we explored sources of between-study heterogeneity by subgroup and meta-regression analyses. Cohort investigations reported a lower risk of violence than case-control reports (odds ratio = 2.7 (95% confidence interval (CI): 2.1, 3.5) vs. 6.6 (95% CI: 5.1, 8.6)), and associations were stronger when the outcome was any violence rather than intimate partner violence (odds ratio = 5.7 (95% CI: 3.8, 8.6) vs. 1.7 (95% CI: 1.4, 2.1)), which was consistent with results from the meta-regression. Overall, these findings highlight the potential impact of preventing and treating drug use disorders on reducing violence risk and associated morbidities.
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Affiliation(s)
| | | | - Seena Fazel
- Correspondence to Dr. Seena Fazel, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, Oxford, United Kingdom (e-mail: )
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