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Tesli N, Jaholkowski P, Haukvik UK, Jangmo A, Haram M, Rokicki J, Friestad C, Tielbeek JJ, Næss Ø, Skardhamar T, Gustavson K, Ask H, Fazel S, Tesli M, Andreassen OA. Conduct disorder - a comprehensive exploration of comorbidity patterns, genetic and environmental risk factors. Psychiatry Res 2024; 331:115628. [PMID: 38029627 DOI: 10.1016/j.psychres.2023.115628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
Conduct disorder (CD), a common mental disorder in children and adolescents, is characterized by antisocial behavior. Despite similarities with antisocial personality disorder (ASPD) and possible diagnostic continuity, CD has been shown to precede a range of adult-onset mental disorders. Additionally, little is known about the putative shared genetic liability between CD and adult-onset mental disorders and the underlying gene-environment interplay. Here, we interrogated comorbidity between CD and other mental disorders from the Norwegian Mother, Father and Child Cohort Study (n = 114 500) and investigated how polygenic risk scores (PRS) for mental health traits were associated with CD/CD traits in childhood and adolescence. Gene-environment interplay patterns for CD was explored with data on bullying and parental education. We found CD to be comorbid with several child and adult-onset mental disorders. This phenotypic overlap corresponded with associations between PRS for mental disorders and CD. Additionally, our findings support an additive gene-environment model. Previously conceptualized as a precursor of ASPD, we found that CD was associated with polygenic risk for several child- and adult-onset mental disorders. High comorbidity of CD with other psychiatric disorders reflected on the genetic level should inform research studies, diagnostic assessments and clinical follow-up of this heterogenous group.
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Affiliation(s)
- Natalia Tesli
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo & Oslo University Hospital, Oslo, Norway; Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.
| | - Piotr Jaholkowski
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo & Oslo University Hospital, Oslo, Norway
| | - Unn K Haukvik
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo & Oslo University Hospital, Oslo, Norway; Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Andreas Jangmo
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Marit Haram
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jaroslav Rokicki
- Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Christine Friestad
- Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway; University College of Norwegian Correctional Service, Oslo, Norway
| | - Jorim J Tielbeek
- Center for Neurogenomics and Cognitive Research, Department of Complex Trait Genetics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Øyvind Næss
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Skardhamar
- Department of Sociology and Human Geography, University of Oslo, Oslo, Norway
| | - Kristin Gustavson
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Helga Ask
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Martin Tesli
- Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo & Oslo University Hospital, Oslo, Norway
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Penney SR, Lam AA, Kolla N, Martin K, Belfry K, Simpson AIF. Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence. BJPsych Open 2023; 9:e171. [PMID: 37724335 PMCID: PMC10594185 DOI: 10.1192/bjo.2023.567] [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: 04/18/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Public stigma and fear are heightened in cases of extreme violence perpetrated by persons with serious mental illness (SMI). Prevention efforts require understanding of illness patterns and treatment needs prior to these events unfolding. AIMS To examine mental health service utilisation by persons who committed homicide and entered into forensic care, to investigate the adequacy of mental healthcare preceding these offences. METHOD Forensic patients across two mental health hospitals in Ontario with an admitting offence of homicide between 2011 and 2021 were identified (n = 112). Sociodemographic, clinical and offence-related variables were coded from the health record and reports prepared for the forensic tribunal. RESULTS Most patients (75.7%) had mental health contacts preceding the homicide, with 28.4% having a psychiatric in-patient admission in the year prior. For those with service contacts in the year preceding, 50.9% had had only sporadic contact and 70.7% were non-adherent with prescribed medications. Victims were commonly known to the individual (35.7%) and were often family members in care-providing roles (55.4%). Examination of age at onset of illness and offending patterns suggested that most persons admitted to forensic care for homicide act in the context of illness and exhibit a low frequency of pre-homicide offending. CONCLUSIONS Many individuals admitted to forensic care for homicide have had inadequate mental healthcare leading up to this point. Effective responses to reduce and manage risk should encompass services that proactively address illness-related (e.g. earlier access and better maintenance in care) and criminogenic (e.g. substance use treatment, employment and psychosocial supports) domains.
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Affiliation(s)
- Stephanie R. Penney
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Austin A. Lam
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Kolla
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Krystle Martin
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Kimberly Belfry
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Alexander I. F. Simpson
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Paulino A, Kuja-Halkola R, Fazel S, Sariaslan A, Rietz ED, Lichtenstein P, Brikell I. Post-traumatic stress disorder and the risk of violent crime conviction in Sweden: a nationwide, register-based cohort study. Lancet Public Health 2023; 8:e432-e441. [PMID: 37244673 DOI: 10.1016/s2468-2667(23)00075-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) has been linked to violent crime in veteran populations. However, whether there is a link between PTSD and violent crime in the general population is not known. This study aimed to investigate the hypothesised association between PTSD and violent crime in the Swedish general population and to investigate the extent to which familial factors might explain this association using unaffected sibling control individuals. METHODS This nationwide, register-based cohort study assessed individuals born in Sweden in 1958-93 for eligibility for inclusion. Individuals who died or emigrated before their 15th birthday, were adopted, were twins, or whose biological parents could not be identified were excluded. Participants were identified and included from the National Patient Register (1973-2013), the Multi-Generation Register (1932-2013), the Total Population Register (1947-2013), and the National Crime Register (1973-2013). Participants with PTSD were matched (1:10) with randomly selected control individuals from the population without PTSD by birth year, sex, and county of residence in the year of PTSD diagnosis for the matched individual. Each participant was followed up from the date of matching (ie, the index person's first PTSD diagnosis) until violent crime conviction or until being censored at emigration, death, or Dec 31, 2013, whichever occurred first. Stratified Cox regressions were used to estimate the hazard ratio of time to violent crime conviction ascertained from national registers in individuals with PTSD compared with control individuals. To account for familial confounding, sibling analyses were conducted, comparing the risk of violent crime in a subsample of individuals with PTSD with their unaffected full biological siblings. FINDINGS Of 3 890 765 eligible individuals, 13 119 had a PTSD diagnosis (9856 [75·1%] of whom were female and 3263 [24·9%] of whom were male), were matched with 131 190 individuals who did not, and were included in the matched cohort. 9114 individuals with PTSD and 14 613 full biological siblings without PTSD were also included in the sibling cohort. In the sibling cohort, 6956 (76·3%) of 9114 participants were female and 2158 (23·7%) were male. Cumulative incidence of violent crime convictions after 5 years was 5·0% (95% CI 4·6-5·5) in individuals diagnosed with PTSD versus 0·7% (0·6-0·7) in individuals without PTSD. At the end of follow-up (median follow-up time 4·2 years, IQR 2·0-7·6), cumulative incidence was 13·5% (11·3-16·6) versus 2·3% (1·9-2·6). Individuals with PTSD had a significantly higher risk of violent crime than the matched control population in the fully-adjusted model (hazard ratio [HR] 6·4, 95% CI 5·7-7·2). In the sibling cohort, the risk of violent crime was also significantly higher in the siblings with PTSD (3·2, 2·6-4·0). INTERPRETATION PTSD was associated with increased risk of violent crime conviction, even after controlling for familial effects shared by siblings and in the absence of SUD or a history of violent crime. Although our results might not be generalisable to less severe or undetected PTSD, our study could inform interventions that aim to reduce violent crime in this vulnerable population. FUNDING None.
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Affiliation(s)
- Anabelle Paulino
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amir Sariaslan
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Li S, Lu C, Kang L, Li Q, Chen H, Zhang H, Tang Z, Lin Y, Bai M, Xiong P. Study on correlations of BDNF, PI3K, AKT and CREB levels with depressive emotion and impulsive behaviors in drug-naïve patients with first-episode schizophrenia. BMC Psychiatry 2023; 23:225. [PMID: 37013544 PMCID: PMC10071748 DOI: 10.1186/s12888-023-04718-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The pathogenesis of schizophrenia is still unknown. Nearly a half of schizophrenic patients have depressive symptoms and even some impulsive behaviors. The definite diagnosis of schizophrenia is an immense challenge. Molecular biology plays an essential role in the research on the pathogenesis of schizophrenia. OBJECTIVE This study aims to analyze the correlations of serum protein factor levels with depressive emotion and impulsive behaviors in drug-naïve patients with first-episode schizophrenia. METHODS Seventy drug-naïve patients with first-episode schizophrenia and sixty-nine healthy volunteers from the health check center in the same period participated in this study. In both the patient group and control group, brain-derived neurotrophic factor (BDNF), phosphatidylin-ositol-3-kinase (PI3K), protein kinase B (AKT), and cAMP-response element binding protein (CREB) levels in the peripheral blood were tested by enzyme-linked immunosorbent assay (ELISA). The depressive emotion and impulsive behaviors were evaluated with Chinese versions of the Calgary Depression Scale for Schizophrenia (CDSS) and Short UPPS-P Impulsive Behavior Scale (S-UPPS-P), respectively. RESULTS The serum levels of BDNF, PI3K, and CREB in the patient group were lower than those in the control group, while AKT level, total CDSS score and total S-UPPS-P score were all higher. In the patient group, total CDSS score, and total S-UPPS-P score were both correlated negatively with BDNF, PI3K, and CREB levels but positively with AKT level, and the lack-of-premeditation (PR) sub-scale score was not significantly correlated with BDNF, PI3K, AKT, and CREB levels. CONCLUSION Our study results showed that the peripheral blood levels of BDNF, PI3K, AKT, and CREB in drug-naïve patients with first-episode schizophrenia were significantly different from those in the control group. The levels of these serum protein factors are promising biomarkers to predict schizophrenic depression and impulsive behaviors.
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Affiliation(s)
- Shan Li
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Cailian Lu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lin Kang
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qianqian Li
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongxu Chen
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Han Zhang
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ziling Tang
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanwen Lin
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Meiyan Bai
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Peng Xiong
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China.
- Yunnan Clinical Research Center for Mental Disorders, First Affiliated Hospital of Kunming Medical University, Kunming, China.
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Watts D, Mamak M, Moulden H, Upfold C, de Azevedo Cardoso T, Kapczinski F, Chaimowitz G. The HARM models: Predicting longitudinal physical aggression in patients with schizophrenia at an individual level. J Psychiatr Res 2023; 161:91-98. [PMID: 36917868 DOI: 10.1016/j.jpsychires.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
The prediction and prevention of aggression in individuals with schizophrenia remains a top priority within forensic psychiatric settings. While risk assessment methods are well rooted in forensic psychiatry, there are no available tools to predict longitudinal physical aggression in patients with schizophrenia within forensic settings at an individual level. In the present study, we used evidence-based risk and protective factors, as well as variables related to course of treatment assessed at baseline, to predict prospective incidents of physical aggression (4-month, 12-month, and 18-month follow-up) among 151 patients with schizophrenia within the forensic mental healthcare system. Across our HARM models, the balanced accuracy (sensitivity + specificity/2) of predicting physical aggressive incidents in patients with schizophrenia ranged from 59.73 to 87.33% at 4-month follow-up, 68.31-80.10% at 12-month follow-up, and 46.22-81.63% at 18-month follow-up, respectively. Additionally, we developed separate models, using clinician rated clinical judgement of short term and immediate violent risk, as a measure of comparison. Several modifiable evidence-based predictors of prospective physical aggression in schizophrenia were identified, including impulse control, substance abuse, impulsivity, treatment non-adherence, mood and psychotic symptoms, substance abuse, and poor family support. To the best of our knowledge, our HARM models are the first to predict longitudinal physical aggression at an individual level in patients with schizophrenia in forensic settings. However, it is important to caution that since these machine learning models were developed in the context of forensic settings, they may not be generalisable to individuals with schizophrenia more broadly. Moreover, a low base rate of physical aggression was observed in the testing set (6.0-11.6% across timepoints). As such, larger cohorts will be required to determine the replicability of these findings.
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Affiliation(s)
- Devon Watts
- Neuroscience Graduate Program, McMaster University, Hamilton, Canada.
| | - Mini Mamak
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Heather Moulden
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Casey Upfold
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | | | - Flavio Kapczinski
- Neuroscience Graduate Program, McMaster University, Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil.
| | - Gary Chaimowitz
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
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Chang PY, Chen JH, Cheng HW, Wang YC. Effects of Psychiatric Disease Severity and Clinical Characteristics on Duration of High Violence Risk: A Perspective on Violence Prevention in the Psychiatric Ward. Neuropsychiatr Dis Treat 2023; 19:663-671. [PMID: 37007613 PMCID: PMC10065427 DOI: 10.2147/ndt.s403388] [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: 01/02/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
Objective Prevention, de-escalation, and management of violence in the acute psychiatric ward is essential. Few studies have focused on differences in the duration of high-violence risk between different profiles of high-violence risk. This study aimed to analyze the data of high-violence patients and duration of high-violence risk to provide a new perspective on violence prevention, de-escalation and management. Methods This retrospective observational cohort study included 171 patients who were treated in the acute psychiatric ward of Keelung Chang Gung Memorial Hospital between January 2016 and June 2020, and who were assessed daily as having high violence risk. All patient data were collected from electronic hospital records (eg, age, gender, diagnosis, violence history, self-harm history, and admission condition (involuntary admission, discharged against medical advice). Between-group differences in disease severity, use of antipsychotics and benzodiazepine, and duration of high violence risk were analyzed using regression analysis. Results Only patients' age was significantly associated with duration of high-violence risk (P = 0.028), making it predictive of longer duration of high-violence risk. In patients with schizophrenia spectrum disorder or bipolar disorder, higher severity was significantly associated with longer duration of high-violence risk (P = 0.007, P = 0.001, respectively). Conclusion Only age is a predictor of longer duration of violence risk in psychiatric patients, although higher severity is associated with higher violence risk. Study results may help management and healthcare staff better understand how quickly or slowly violence risk will decrease and may improve efficient use of healthcare resources and individualized patient-centered care.
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Affiliation(s)
- Ping-Ying Chang
- Department of Psychiatry, Chang-Gung Medical Foundation Keelung Chang-Gung Memorial Hospital, Keelung, Taiwan, Republic of China
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Jian-Hong Chen
- Department of Psychiatry, Chang-Gung Medical Foundation Keelung Chang-Gung Memorial Hospital, Keelung, Taiwan, Republic of China
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Doctoral Program for Transnational Sport Management and Innovation, National Taiwan Sport University, Taoyuan, Taiwan, Republic of China
- Correspondence: Jian-Hong Chen, Email
| | - Hui-Wen Cheng
- Department of Psychiatry, Chang-Gung Medical Foundation Keelung Chang-Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Yen-Chin Wang
- Department of Psychiatry, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China
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The Lancet Psychiatry Commission on intimate partner violence and mental health: advancing mental health services, research, and policy. Lancet Psychiatry 2022; 9:487-524. [PMID: 35569504 DOI: 10.1016/s2215-0366(22)00008-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 01/26/2023]
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Whiting D, Gulati G, Geddes JR, Fazel S. Association of Schizophrenia Spectrum Disorders and Violence Perpetration in Adults and Adolescents From 15 Countries: A Systematic Review and Meta-analysis. JAMA Psychiatry 2022; 79:120-132. [PMID: 34935869 PMCID: PMC8696689 DOI: 10.1001/jamapsychiatry.2021.3721] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Violence perpetration outcomes in individuals with schizophrenia spectrum disorders contribute to morbidity and mortality at a population level, disrupt care, and lead to stigma. OBJECTIVE To conduct a systematic review and meta-analysis of the risk of perpetrating interpersonal violence in individuals with schizophrenia spectrum disorders compared with general population control individuals. DATA SOURCES Multiple databases were searched for studies in any language from January 1970 to March 2021 using the terms violen* or homicid* and psychosis or psychoses or psychotic or schizophren* or schizoaffective or delusional and terms for mental disorders. Bibliographies of included articles were hand searched. STUDY SELECTION The study included case-control and cohort studies that allowed risks of interpersonal violence perpetration and/or violent criminality in individuals with schizophrenia spectrum disorders to be compared with a general population group without these disorders. DATA EXTRACTION AND SYNTHESIS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and the Meta-analyses of Observational Studies in Epidemiology (MOOSE) proposal. Two reviewers extracted data. Quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES The main outcome was violence to others obtained either through official records, self-report and/or collateral-report, or medical file review and included any physical assault, robbery, sexual offenses, illegal threats or intimidation, and arson. RESULTS The meta-analysis included 24 studies of violence perpetration outcomes in 15 countries over 4 decades (N = 51 309 individuals with schizophrenia spectrum disorders; reported mean age of 21 to 54 years at follow-up; of those studies that reported outcomes separately by sex, there were 19 976 male individuals and 14 275 female individuals). There was an increase in risk of violence perpetration in men with schizophrenia and other psychoses (pooled odds ratio [OR], 4.5; 95% CI, 3.6-5.6) with substantial heterogeneity (I2 = 85%; 95% CI, 77-91). The risk was also elevated in women (pooled OR, 10.2; 95% CI, 7.1-14.6), with substantial heterogeneity (I2 = 66%; 95% CI, 31-83). Odds of perpetrating sexual offenses (OR, 5.1; 95% CI, 3.8-6.8) and homicide (OR, 17.7; 95% CI, 13.9-22.6) were also investigated. Three studies found increased relative risks of arson but data were not pooled for this analysis owing to heterogeneity of outcomes. Absolute risks of violence perpetration in register-based studies were less than 1 in 20 in women with schizophrenia spectrum disorders and less than 1 in 4 in men over a 35-year period. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found that the risk of perpetrating violent outcomes was increased in individuals with schizophrenia spectrum disorders compared with community control individuals, which has been confirmed in new population-based longitudinal studies and sibling comparison designs.
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Affiliation(s)
- Daniel Whiting
- Department of Psychiatry, University of Oxford, Oxford, England
| | - Gautam Gulati
- University of Limerick School of Medicine and Health Service Executive, Limerick, Ireland
| | - John R. Geddes
- Department of Psychiatry, University of Oxford, Oxford, England,Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, England
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, England,Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, England
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Sariaslan A, Kääriälä A, Pitkänen J, Remes H, Aaltonen M, Hiilamo H, Martikainen P, Fazel S. Long-term Health and Social Outcomes in Children and Adolescents Placed in Out-of-Home Care. JAMA Pediatr 2022; 176:e214324. [PMID: 34694331 PMCID: PMC8546624 DOI: 10.1001/jamapediatrics.2021.4324] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Children who are placed in out-of-home care may have poorer outcomes in adulthood, on average, compared with their peers, but the direction and magnitude of these associations need clarification. OBJECTIVE To estimate associations between being placed in out-of-home care in childhood and adolescence and subsequent risks of experiencing a wide range of social and health outcomes in adulthood following comprehensive adjustments for preplacement factors. DESIGN, SETTING, AND PARTICIPANTS This cohort and cosibling study of all children born in Finland between 1986 and 2000 (N = 855 622) monitored each person from their 15th birthday either until the end of the study period (December 2018) or until they migrated, died, or experienced the outcome of interest. Cox and Poisson regression models were used to estimate associations with adjustment for measured confounders (from linked population registers) and unmeasured familial confounders (using sibling comparisons). Data were analyzed from October 2020 to August 2021. EXPOSURES Placement in out-of-home care up to age 15 years. MAIN OUTCOMES AND MEASURES Through national population, patient, prescription drug, cause of death, and crime registers, 16 specific outcomes were identified across the following categories: psychiatric disorders; low socioeconomic status; injuries and experiencing violence; and antisocial behaviors, suicidality, and premature mortality. RESULTS A total of 30 127 individuals (3.4%) were identified who had been placed in out-of-home care for a median (interquartile range) period of 1.3 (0.2-5.1) years and 2 (1-3) placement episodes before age 15 years. Compared with their siblings, individuals who had been placed in out-of-home care were 1.4 to 5 times more likely to experience adverse outcomes in adulthood (adjusted hazard ratio [aHR] for those with a fall-related injury, 1.40; 95% CI, 1.25-1.57 and aHR for those with an unintentional poisoning injury, 4.79; 95% CI, 3.56-6.43, respectively). The highest relative risks were observed for those with violent crime arrests (aHR, 4.16; 95% CI, 3.74-4.62; cumulative incidence, 24.6% in individuals who had been placed in out-of-home care vs 5.1% in those who had not), substance misuse (aHR, 4.75; 95% CI, 4.25-5.30; cumulative incidence, 23.2% vs 4.6%), and unintentional poisoning injury (aHR 4.79; 95% CI, 3.56-6.43; cumulative incidence, 3.1% vs 0.6%). Additional adjustments for perinatal factors, childhood behavioral problems, and traumatic injuries, including experiencing violence, did not materially change the findings. CONCLUSIONS AND RELEVANCE Out-of-home care placement was associated with a wide range of adverse outcomes in adulthood, which persisted following adjustments for measured preplacement factors and unmeasured familial factors.
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Affiliation(s)
- Amir Sariaslan
- Social and Public Policy Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland,Department of Child Psychiatry, University of Turku, Turku, Finland,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Antti Kääriälä
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland,International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Mikko Aaltonen
- University of Eastern Finland Law School, University of Eastern Finland, Joensuu, Finland,Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Heikki Hiilamo
- Social and Public Policy Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland,Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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Sariaslan A, Mikkonen J, Aaltonen M, Hiilamo H, Martikainen P, Fazel S. No causal associations between childhood family income and subsequent psychiatric disorders, substance misuse and violent crime arrests: a nationwide Finnish study of >650 000 individuals and their siblings. Int J Epidemiol 2021; 50:1628-1638. [PMID: 34050646 PMCID: PMC8580272 DOI: 10.1093/ije/dyab099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/16/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Childhood family income has been shown to be associated with later psychiatric disorders, substance misuse and violent crime, but the consistency, strength and causal nature of these associations remain unclear. METHODS We conducted a nationwide cohort and co-sibling study of 650 680 individuals (426 886 siblings) born in Finland between 1986 and 1996 to re-examine these associations by accounting for unmeasured confounders shared between siblings. The participants were followed up from their 15th birthday until they either migrated, died, met criteria for the outcome of interest or reached the end of the study period (31 December 2017 or 31 December 2018 for substance misuse). The associations were adjusted for sex, birth year and birth order, and expressed as adjusted hazard ratios (aHRs). The outcomes included a diagnosis of a severe mental illness (schizophrenia-spectrum disorders or bipolar disorder), depression and anxiety. Substance misuse (e.g. medication prescription, hospitalization or death due to a substance use disorder or arrest for drug-related crime) and violent crime arrests were also examined. Stratified Cox regression models accounted for unmeasured confounders shared between differentially exposed siblings. RESULTS For each $15 000 increase in family income at age 15 years, the risks of the outcomes were reduced by between 9% in severe mental illness (aHR = 0.91; 95% confidence interval: 0.90-0.92) and 23% in violent crime arrests (aHR = 0.77; 0.76-0.78). These associations were fully attenuated in the sibling-comparison models (aHR range: 0.99-1.00). Sensitivity analyses confirmed the latter findings. CONCLUSIONS Associations between childhood family income and subsequent risks for psychiatric disorders, substance misuse and violent crime arrest were not consistent with a causal interpretation.
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Affiliation(s)
- Amir Sariaslan
- Social and Public Policy Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Janne Mikkonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Mikko Aaltonen
- UEF Law School, University of Eastern Finland, Joensuu, Finland
| | - Heikki Hiilamo
- Social and Public Policy Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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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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Zhong S, Yu R, Robert C, Wang X, Fazel S. Assessment of violence risk in 440 psychiatric patients in China: examining the feasibility and acceptability of a novel and scalable approach (FoVOx). BMC Psychiatry 2021; 21:120. [PMID: 33653305 PMCID: PMC7923307 DOI: 10.1186/s12888-021-03115-3] [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: 11/19/2020] [Accepted: 02/04/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Violence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals. The use of prediction models and risk tools can assist clinical decision-making on risk management, including decisions about further assessments, referral, hospitalization and treatment. In recent years, scalable evidence-based tools, such as Forensic Psychiatry and Violent Oxford (FoVOx), have been developed and validated for patients with mental illness. However, their acceptability and utility in clinical settings is not known. Therefore, we conducted a clinical impact study in multiple institutions that provided specialist mental health service. METHODS We followed a two-step mixed-methods design. In phase one, we examined baseline risk factors on 330 psychiatric patients from seven forensic psychiatric institutes in China. In phase two, we conducted semi-structured interviews with 11 clinicians regarding violence risk assessment from ten mental health centres. We compared the FoVOx score on each admission (n = 110) to unstructured clinical risk assessment and used a thematic analysis to assess clinician views on the accuracy and utility of this tool. RESULTS The median estimated probability of violent reoffending (FoVOx score) within 1 year was 7% (range 1-40%). There was fair agreement (72/99, 73% agreement) on the risk categories between FoVOx and clinicians' assessment on risk categories, and moderate agreement (10/12, 83% agreement) when examining low and high risk categories. In a majority of cases (56/101, 55%), clinicians thought the FoVOx score was an accurate representation of the violent risk of an individual patient. Clinicians suggested some additional clinical, social and criminal risk factors should be considered during any comprehensive assessment. In addition, FoVOx was considered to be helpful in assisting clinical decision-making and individual risk assessment. Ten out of 11 clinicians reported that FoVOx was easy to use, eight out of 11 was practical, and all clinicians would consider using it in the future. CONCLUSIONS Clinicians found that violence risk assessment could be improved by using a simple, scalable tool, and that FoVOx was feasible and practical to use.
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Affiliation(s)
- Shaoling Zhong
- grid.216417.70000 0001 0379 7164Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Rongqin Yu
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Cornish Robert
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Xiaoping Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
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Whiting D, Lichtenstein P, Fazel S. Violence and mental disorders: a structured review of associations by individual diagnoses, risk factors, and risk assessment. Lancet Psychiatry 2021; 8:150-161. [PMID: 33096045 DOI: 10.1016/s2215-0366(20)30262-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/08/2023]
Abstract
In this Review, we summarise evidence on the association between different mental disorders and violence, with emphasis on high quality designs and replicated findings. Relative risks are typically increased for all violent outcomes in most diagnosed psychiatric disorders compared with people without psychiatric disorders, with increased odds in the range of 2-4 after adjustment for familial and other sources of confounding. Absolute rates of violent crime over 5-10 years are typically below 5% in people with mental illness (excluding personality disorders, schizophrenia, and substance misuse), which increases to 6-10% in personality disorders and schizophrenia spectrum disorders, and to more than 10% in substance misuse. Past criminality and comorbid substance misuse are strongly predictive of future violence in many individual disorders. We reviewed national clinical practice guidelines, which vary in content and require updating to reflect the present epidemiological evidence. Standardised and clinically feasible approaches to the assessment and management of violence risk in general psychiatric settings need to be developed.
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Affiliation(s)
- Daniel Whiting
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
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Krona H, Anckarsäter H, Nilsson T, Hofvander B. Patterns of Lifetime Criminality in Mentally Disordered Offenders - Findings From a Nationally Representative Cohort. Front Psychiatry 2021; 12:564171. [PMID: 34393835 PMCID: PMC8357977 DOI: 10.3389/fpsyt.2021.564171] [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: 05/20/2020] [Accepted: 07/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Treatment of mentally disordered offenders (MDOs) is challenging as their behavior and clinical conditions can be traced to a complex constellation of major mental disorders, substance use and antisocial lifestyle. Finding subgroups of these offenders, which could guide treatment and risk assessment, is desirable. There are few long-term, prospective studies of risk factors for persistent criminal behavior among MDOs. Aims: The aims are (1) to provide a map of lifetime criminality in MDOs, (2) to identify subgroups of offenders, and (3), if such clusters exist, to test whether they differ in lifetime criminality and patterns of negative events during in-patient treatment. Methods: Background data on all offenders from the Malmö University Hospital catchment area sentenced to forensic psychiatric in-patient treatment 1999-2005 (n = 125) was collected. Data on negative events during treatment (violence, threats, absconding and substance use) from date of admittance until discharge or until June 30, 2008 was gathered. Court decisions for 118 of the cohort-individuals were collected from the 1st of January 1973 until December 31, 2013. We used hierarchical cluster analysis to identify subgroups and MANOVA-analysis to examine differences between these clusters on lifetime criminality variables and negative events. A MANCOVA was used to control for time in treatment. Results: The cohort was sentenced to a total of 3,380 crimes (944 violent) during the study period. Median age at first crime was 20 years (range 15-72), and at first violent crime 27 years (range 15-72). A subgroup (n = 26) was characterized by childhood adversities, neurodevelopmental disorders and later substance use disorders and was more often associated with substance-related crimes, financial crimes and lower age at first crime. During treatment, this cluster showed higher rates of substance use and threats. When controlling for treatment time, no differences in negative events were found. Conclusions: This study replicated findings from prison populations of the existence of a more criminally persistent phenotype characterized by early-onset neurodevelopmental and behavior disorders, childhood adversities and later substance use disorders. We did not find this cluster of variables to be related to negative events during inpatient treatment when controlling for length of stay.
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Affiliation(s)
- Hedvig Krona
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Henrik Anckarsäter
- Department of Forensic Psychiatry and Center of Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, University of Gothenburg, Lund, Sweden
| | - Thomas Nilsson
- Department of Forensic Psychiatry and Center of Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, University of Gothenburg, Lund, Sweden
| | - Björn Hofvander
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Non-psychopathology Related Outcomes Among Siblings of Individuals with Mental Illness: A Systematic Review. Clin Child Fam Psychol Rev 2020; 24:38-64. [PMID: 33052503 DOI: 10.1007/s10567-020-00331-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
The current study consists of a systematic review of the quantitative literature on siblings of individuals with mental illness (MI). Despite the prevalence of mental illness, little is known about how siblings are specifically affected in areas of psychosocial, emotional, and behavioral outcomes. The review yielded 56 studies that examined outcomes such as behavior problems, the sibling relationship, caregiving experiences, and knowledge of mental illness among siblings. The majority of studies from the initial search were focused on siblings-as-comparison group, examining siblings for risk factors for developing mental illness. In total, the study samples covered a sibling age range of 6-81 and a patient age range of 4-84. About half (k = 27) of the included studies had samples primarily composed of siblings of individuals with schizophrenia, leaving other MI diagnoses such as depression, anxiety, and mood disorders underrepresented. However, results from comparison studies were mixed-half found that the MI-Sibs had fewer negative outcomes than the comparison group, and half found that MI-Sibs had more negative outcomes. Multiple factors, including female sibling gender, greater severity of MI symptoms, and belief in the patient's ability to control their own behavior, were all related to more negative outcomes for MI-Sibs. Future work will focus on expanding the representativeness of MI-Sibs samples and analyzing experiences of both the sibling and the individual with MI.
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16
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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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Rôle de l’usage de substances psycho-actives dans la commission d’infractions pénales par les sujets atteints de schizophrénie. EVOLUTION PSYCHIATRIQUE 2020. [DOI: 10.1016/j.evopsy.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sariaslan A, Arseneault L, Larsson H, Lichtenstein P, Fazel S. Risk of Subjection to Violence and Perpetration of Violence in Persons With Psychiatric Disorders in Sweden. JAMA Psychiatry 2020; 77:359-367. [PMID: 31940015 PMCID: PMC6990843 DOI: 10.1001/jamapsychiatry.2019.4275] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Key outcomes for persons with psychiatric disorders include subjection to violence and perpetration of violence. The occurrence of these outcomes and their associations with psychiatric disorders need to be clarified. OBJECTIVE To estimate the associations of a wide range of psychiatric disorders with the risks of subjection to violence and perpetration of violence. DESIGN, SETTING, AND PARTICIPANTS A total of 250 419 individuals born between January 1, 1973, and December 31, 1993, were identified to have psychiatric disorders using Swedish nationwide registers. Premorbid subjection to violence was measured since birth. The patients were matched by age and sex to individuals in the general population (n = 2 504 190) and to their full biological siblings without psychiatric disorders (n = 194 788). The start date for the patients and control groups was defined as the discharge date of the first psychiatric episode. The participants were censored either when they migrated, died, experienced the outcome of interest, or reached the end of the study period on December 31, 2013. Data were analyzed from January 15 to September 14, 2019. EXPOSURES Patients with common psychiatric disorders (eg, schizophrenia, bipolar disorder, depression, and anxiety) were differentiated using a hierarchical approach. Patients with personality disorders and substance use disorders were also included. MAIN OUTCOMES AND MEASURES Subjection to violence was defined as an outpatient visit (excluding a primary care visit), inpatient episode, or death associated with any diagnosis of an injury that was purposefully inflicted by other persons. Perpetration of violence was defined as a violent crime conviction. Stratified Cox regression models were fitted to account for the time at risk, a range of sociodemographic factors, a history of violence, and unmeasured familial confounders (via sibling comparisons). RESULTS Among 250 419 patients (55.4% women), the median (interquartile range) age at first diagnosis ranged from 20.0 (17.4-24.0) years for alcohol use disorder to 23.7 (19.9-28.8) years for anxiety disorder. Compared with 2 504 190 matched individuals without psychiatric disorders from the general population, patients with psychiatric disorders were more likely to be subjected to violence (7.1 [95% CI, 6.9-7.2] vs 1.0 [95% CI, 0.9-1.0] per 1000 person-years) and to perpetrate violence (7.5 [95% CI, 7.4-7.6] vs 0.7 [95% CI, 0.7-0.7] per 1000 person-years). In the fully adjusted models, patients with psychiatric disorders were 3 to 4 times more likely than their siblings without psychiatric disorders to be either subjected to violence (adjusted hazard ratio [aHR], 3.4 [95% CI, 3.2-3.6]) or to perpetrate violence (aHR, 4.2 [95% CI, 3.9-4.4]). Diagnosis with any of the specific disorders was associated with higher rates of violent outcomes, with the sole exception of schizophrenia, which was not associated with the risk of subjection to violence. CONCLUSIONS AND RELEVANCE In this study, persons with psychiatric disorders were 3 to 4 times more likely than their siblings without psychiatric disorders to have been subjected to violence or to have perpetrated violence after the onset of their conditions. The risks of both outcomes varied by specific psychiatric diagnosis, history of violence, and familial risks. Clinical interventions may benefit from targeted approaches for the assessment and management of risk of violence in people with psychiatric disorders.
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Affiliation(s)
- Amir Sariaslan
- Warneford Hospital, Department of Psychiatry, University of Oxford, Oxford, United Kingdom,Social and Public Policy Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Louise Arseneault
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Orebro University School of Medical Sciences, Orebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Seena Fazel
- Warneford Hospital, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Lamsma J, Cahn W, Fazel S. Cognition and violent behavior in psychotic disorders: A nationwide case-control study. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100166. [PMID: 31832346 PMCID: PMC6890945 DOI: 10.1016/j.scog.2019.100166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/20/2019] [Accepted: 09/26/2019] [Indexed: 12/02/2022]
Abstract
Background The excess risk of violence in psychotic disorders may partly be explained by impairments in executive functions (EFs) and theory of mind (ToM). However, previous studies have been limited by composite measures of EFs and small samples of inpatients. Methods Data were collected for the research project Genetic Risk and Outcome of Psychosis (GROUP). Patients with psychotic disorders (N = 891) were recruited from various care settings in the Netherlands. The following neuropsychological tests were administered (targeted cognitive function in parentheses): (i) Continuous Performance Test-HQ (inhibition); (ii) Response Shifting Task (cognitive flexibility); (iii) Wechsler Adult Intelligence Scale, Third Edition (WAIS-III) Block Design subtest (fluid intelligence); (iv) Neuropsychological Assessment Battery (NAB) Mazes Test (planning); (v) Degraded Facial Affect Recognition Task (affective ToM); and (vi) Hinting Task (cognitive ToM). Lifetime violence was ascertained from medical records and patient interviews. We used analysis of covariance to compare the mean scores of violent and nonviolent patients on each test, adjusting for age and sex. Results Violent patients performed significantly worse than nonviolent patients on the WAIS-III Block Design subtest (F [1, 847] = 5.12, p = .024), NAB Mazes Test (F [1, 499] = 5.32, p = .022) and Hinting Task (F [1, 839] = 9.38, p = .002). For the other tests, the between-group differences were nonsignificant. Violent behavior explained no more than 1% of the variance in performance on each test. Conclusion Impairments in EFs and ToM are unlikely to provide useful targets for risk assessment and interventions.
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Affiliation(s)
- Jelle Lamsma
- Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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20
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Fazel S, Smith EN, Chang Z, Geddes JR. Risk factors for interpersonal violence: an umbrella review of meta-analyses. Br J Psychiatry 2018; 213:609-614. [PMID: 30058516 PMCID: PMC6157722 DOI: 10.1192/bjp.2018.145] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/10/2018] [Accepted: 06/12/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Interpersonal violence is a leading cause of morbidity and mortality. The strength and population effect of modifiable risk factors for interpersonal violence, and the quality of the research evidence is not known.AimsWe aimed to examine the strength and population effect of modifiable risk factors for interpersonal violence, and the quality and reproducibility of the research evidence. METHOD We conducted an umbrella review of systematic reviews and meta-analyses of risk factors for interpersonal violence. A systematic search was conducted to identify systematic reviews and meta-analyses in general population samples. Effect sizes were extracted, converted into odds ratios and synthesised, and population attributable risk fractions (PAF) were calculated. Quality analyses were performed, including of small study effects, adjustment for confounders and heterogeneity. Secondary analyses for aggression, intimate partner violence and homicide were conducted, and systematic reviews (without meta-analyses) were summarised. RESULTS We identified 22 meta-analyses reporting on risk factors for interpersonal violence. Neuropsychiatric disorders were among the strongest in relative and absolute terms. The neuropsychiatric risk factor that had the largest effect at a population level were substance use disorders, with a PAF of 14.8% (95% CI 9.0-21.6%), and the most important historical factor was witnessing or being a victim of violence in childhood (PAF = 12.2%, 95% CI 6.5-17.4%). There was evidence of small study effects and large heterogeneity. CONCLUSIONS National strategies for the prevention of interpersonal violence may need to review policies concerning the identification and treatment of modifiable risk factors.Declarations of interestJ.R.G. is an NIHR Senior Investigator. The views expressed within this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
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Affiliation(s)
- Seena Fazel
- Professor of Forensic Psychiatry, Department of Psychiatry, University of Oxford, UK
| | - E. Naomi Smith
- Registrar in General and Older Adult Psychiatry, Department of Psychiatry, University of Oxford, UK
| | - Zheng Chang
- Assistant Professor, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - John Richard Geddes
- Professor of Epidemiological Psychiatry, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, UK
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Li Q, Zhou J, Cao X, Liu Q, Li Q, Li W, Wang X. Clonal Characteristics of T-Cell Receptor Repertoires in Violent and Non-violent Patients With Schizophrenia. Front Psychiatry 2018; 9:403. [PMID: 30233426 PMCID: PMC6127418 DOI: 10.3389/fpsyt.2018.00403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/09/2018] [Indexed: 01/28/2023] Open
Abstract
Background: Activated or impaired T-cell function in inflammatory and degenerative process can contribute to the risk and progression of schizophrenia. This study used immune repertoire sequencing to investigate the T-cell receptor beta variable chain (TRBV) presence in blood mononuclear cells in the violent or non-violent schizophrenic patients. Methods: Ten violent and 10 non-violent schizophrenic patients and 8 matched healthy controls were enrolled. The Brief Psychiatric Rating Scale (BPRS) was used to evaluate patients' psychiatric symptoms. The level of aggression was assessed using the Modified Overt Aggression Scale (MOAS). The complementarity-determining region 3 (CDR3) of TRBV was detected using multiplex-PCR and high-throughput sequencing. Results: The TCR repertoire diversity were no significant differences in the Shannon-Wiener or inverse Simpson diversity index between three groups. Principal component analysis (PCA) of TRBV composition and abundance showed that principal component 1 and principal component 2 can explain 28.88 and 13.24% of total variation, respectively. Schizophrenic patients (violent and non-violent) had significantly different V gene distribution compared to healthy controls. In particular, TRBV2 occurred at a significantly higher frequency in the violent schizophrenia group than in the non-violent schizophrenia and healthy control groups, and TRBV7-2 occurred at a significantly higher frequency in the non-violent schizophrenia group than in the violent schizophrenia and healthy control groups. Conclusions: The results suggest that violent and non-violent schizophrenic patients carry abnormal T-cell receptor repertoires, and these data provide a useful clue to explore the etiology of violent behavior in schizophrenia.
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Affiliation(s)
- Qiguang Li
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders and National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Jiansong Zhou
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders and National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xia Cao
- Department of Health Management Center, Third Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Liu
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Qi Li
- Department of Psychiatry, State Key Laboratory for Cognitive and Brain Sciences, HKU-SIRI, University of Hong Kong, Hong Kong, China
| | - Wen Li
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders and National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xiaoping Wang
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders and National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
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22
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Hodgins S. Aggressive Behavior Among Persons With Schizophrenia and Those Who Are Developing Schizophrenia: Attempting to Understand the Limited Evidence on Causality. Schizophr Bull 2017; 43:1021-1026. [PMID: 28605537 PMCID: PMC5581895 DOI: 10.1093/schbul/sbx079] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
People with, and those who are developing, schizophrenia are at increased risk to engage in aggressive behavior (AGB). Some incidents lead to criminal prosecution. Most people with schizophrenia who commit crimes engage in delinquency and/or AGB prior to first episode. A large proportion of these individuals have a history of childhood conduct disorder (CD) and brain abnormalities suggestive of abnormal neural development distinctive from that of others with schizophrenia. Factors contributing to schizophrenia that is preceded by CD include failing to learn not-to-behave aggressively in early childhood, impairments in understanding emotions in the faces of others, maltreatment, and subsequent re-victimization. Others with no history of antisocial behavior begin engaging in AGB as positive symptoms increase and illness onsets. They too are at elevated risk to be victimized. Specific genetic variants linked to stress regulation in combination with adversity have been associated both with AGB and psychotic symptoms. Effectively treating conduct problems and preventing victimization would reduce AGB by persons with schizophrenia.
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Affiliation(s)
- Sheilagh Hodgins
- Département de Psychiatrie, Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montréal, Canada;,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,To whom correspondence should be addressed; Département de Psychiatrie, Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Centre de Recherché, 7331 Hochelaga, Montreal, Quebec H1N3V2, Canada; tel: +1-514-251-4000, fax: +1-514-251-4105, e-mail:
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23
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Sariaslan A, Larsson H, Lichtenstein P, Fazel S. Neighborhood Influences on Violent Reoffending Risk in Released Prisoners Diagnosed With Psychotic Disorders. Schizophr Bull 2017; 43:1011-1020. [PMID: 28575527 PMCID: PMC5581887 DOI: 10.1093/schbul/sbx071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Released prisoners diagnosed with psychotic disorders have elevated rates of violent reoffending risk and their exposure to adverse neighborhood environments may contribute to this risk. We identified all released sentenced prisoners in Sweden between 2003 and 2013 (n = 47226) and followed them up for a median period of 4.4 years. We identified prisoners who had ever been diagnosed with a psychotic disorder (n = 3782) or prescribed antipsychotics (n = 7366). We examined 3 neighborhood characteristics: income, proportion of welfare recipients, and crime rate. By fitting generalized mixed-effects and negative binomial regression models and adopting within-individual designs that controlled for all time-invariant unmeasured confounders within each individual, we estimated neighborhood intraclass correlations (ICCs) and associations between specific neighborhood characteristics and violent reoffending. Neighborhood factors explained 13.5% (95% CI: 10.9%; 16.6%) of the violent reoffending risk among released prisoners diagnosed with psychotic disorders. This contrasted with 4.3% (95% CI: 3.7%; 4.9%) in all released prisoners. However, after controlling for unmeasured confounding, these estimates were not statistically significant (ICCpsychotic disorders = 0.9%; 95% CI: -0.8%; 2.3%; ICCall prisoners = 0.3%; 95% CI: -0.02%; 0.6%). Similarly, none of the within-individual correlations between the specific neighborhood factors and violent reoffending were significantly different from zero. We found consistent results when we investigated prisoners with other psychiatric and substance use disorders. These findings suggest that placing released prisoners with psychotic disorders in less deprived neighborhoods might not reduce their violent reoffending risk, which may also apply to other psychiatric disorders. The assessment, treatment, and community linkage of high-risk prisoners as a strategy to reduce reoffending needs further research.
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Affiliation(s)
- Amir Sariaslan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, 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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24
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Jackson DB, Vaughn MG. Parental History of Disruptive Life Events and Household Food Insecurity. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:554-560.e1. [PMID: 28689609 DOI: 10.1016/j.jneb.2017.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate whether a history of disruptive life events (ie, school suspension or expulsion, job termination, hospitalization for mental health, and/or criminal justice involvement) among parents is positively associated with household food insecurity. DESIGN Structured interviews and self-report surveys. SETTING Households across all 50 states in the US. PARTICIPANTS Subsample of 6,270 households that participated in the Early Childhood Longitudinal Study-Birth Cohort with valid maternal and paternal data. MAIN OUTCOME MEASURES Food insecurity was measured when children were aged 9 months (wave 1), 2 years (wave 2), and 4 years (wave 3). Parental history of disruptive life events was measured at wave 1. ANALYSIS Logistic regression was used to carry out the analyses. RESULTS Each examined disruptive life event was associated with a significant increase in the odds of persistent household food insecurity (P < .05). The probability of persistent household food insecurity was >6 times as large in households with 1 or both parents reporting the occurrence of each of the disruptive life events, relative to households with none of these parental risk factors. CONCLUSIONS AND IMPLICATIONS Practitioners may want to consider parental history of various disruptive life events in their assessment of familial risk of household food insecurity. Future policy efforts might include a cost-benefit estimate analysis of intervening earlier in the food insecurity-disruptive life events nexus to advocate for savings to the taxpayer for prevention services. Moreover, future research could evaluate these practice and policy-driven efforts using quasi-experimental designs.
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Affiliation(s)
- Dylan B Jackson
- Department of Criminal Justice, University of Texas at San Antonio, San Antonio, TX.
| | - Michael G Vaughn
- College for Public Health and Social Justice, Saint Louis University, St Louis, MO
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25
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Quinn PD, Rickert ME, Weibull CE, Johansson ALV, Lichtenstein P, Almqvist C, Larsson H, Iliadou AN, D’Onofrio BM. Association Between Maternal Smoking During Pregnancy and Severe Mental Illness in Offspring. JAMA Psychiatry 2017; 74:589-596. [PMID: 28467540 PMCID: PMC5539841 DOI: 10.1001/jamapsychiatry.2017.0456] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Several recent population-based studies have linked exposure to maternal smoking during pregnancy to increased risk of severe mental illness in offspring (eg, bipolar disorder, schizophrenia). It is not yet clear, however, whether this association results from causal teratogenic effects or from confounding influences shared by smoking and severe mental illness. OBJECTIVE To examine the association between smoking during pregnancy and severe mental illness in offspring, adjusting for measured covariates and unmeasured confounding using family-based designs. DESIGN, SETTING, AND PARTICIPANTS This study analyzed population register data through December 31, 2013, for a cohort of 1 680 219 individuals born in Sweden from January 1, 1983, to December 31, 2001. Associations between smoking during pregnancy and severe mental illness in offspring were estimated with adjustment for measured covariates. Cousins and siblings who were discordant on smoking during pregnancy and severe mental illness were then compared, which helped to account for unmeasured genetic and environmental confounding by design. EXPOSURES Maternal self-reported smoking during pregnancy, obtained from antenatal visits. MAIN OUTCOMES AND MEASURES Severe mental illness, with clinical diagnosis obtained from inpatient and outpatient visits and defined using International Classification of Diseases codes for bipolar disorder and schizophrenia spectrum disorders. RESULTS Of the 1 680 219 offspring included in the analysis, 816 775 (48.61%) were female. At the population level, offspring exposed to moderate and high levels of smoking during pregnancy had greater severe mental illness rates than did unexposed offspring (moderate smoking during pregnancy: hazard ratio [HR], 1.25; 95% CI, 1.19-1.30; high smoking during pregnancy: HR, 1.51; 95% CI, 1.44-1.59). These associations decreased in strength with increasing statistical and methodologic controls for familial confounding. In sibling comparisons with within-family covariates, associations were substantially weaker and nonsignificant (moderate smoking during pregnancy: HR, 1.09; 95% CI, 0.94-1.26; high smoking during pregnancy: HR, 1.14; 95% CI, 0.96-1.35). The pattern of associations was consistent across subsets of severe mental illness disorders and was supported by further sensitivity analyses. CONCLUSIONS AND RELEVANCE This population- and family-based study failed to find support for a causal effect of smoking during pregnancy on risk of severe mental illness in offspring. Rather, these results suggest that much of the observed population-level association can be explained by measured and unmeasured factors shared by siblings.
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Affiliation(s)
- Patrick D. Quinn
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Martin E. Rickert
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Caroline E. Weibull
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna L. V. Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Anastasia N. Iliadou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M. D’Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
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26
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Manchia M, Carpiniello B, Valtorta F, Comai S. Serotonin Dysfunction, Aggressive Behavior, and Mental Illness: Exploring the Link Using a Dimensional Approach. ACS Chem Neurosci 2017; 8:961-972. [PMID: 28378993 DOI: 10.1021/acschemneuro.6b00427] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aggressive individuals have higher rates of mental illness compared to non-aggressive individuals. Multiple factors, including psychosocial, genetic, and neurobiological determinants modulate the liability to both aggressive behavior and mental illness. Concerning the latter factors, multiple lines of evidence have shown a dysfunction in the serotonin (5-HT) system occurring in aggressive and in mentally ill individuals. In particular, reduced 5-HT activity has been associated with depression as well as with aggressive behavior, especially with impulsive aggression. Consistently, psychopharmacological interventions aimed at boosting the 5-HT system (e.g., with selective serotonin reuptake inhibitors) have demonstrated therapeutic efficacy in a high percentage of patients with either or both pathological conditions. Current knowledge does not yet allow to clearly disentangle whether 5-HT dysfunction, most often a 5-HT deficiency, is the cause or the consequence of the aggressive/violent behavior, of the underlying mental disease/s, or the expression of the comorbidity. Future studies are thus needed to clarify the association between changes in 5-HT levels, altered activity of 5-HT receptors and their intracellular signaling cascades, and modifications of 5-HT genes, and in particular the neurobiological link between the altered 5-HT machinery and aggressive behavior in the context or in the absence of mental illness. In this Review, we employ a dimensional approach to discuss the trivariate relationship among the 5-HT system, aggressive behavior, and mental illness, focusing our attention on 5-HT levels, 5-HT receptors, metabolic enzymes, and their genes. Emphasis is given to controversial findings, still unanswered questions, and future perspectives.
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Affiliation(s)
- Mirko Manchia
- Section of Psychiatry,
Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Bernardo Carpiniello
- Section of Psychiatry,
Department of Medical Sciences and Public Health, University of Cagliari, 09121 Cagliari, Italy
| | - Flavia Valtorta
- San Raffaele Scientific Institute and Vita Salute University, Via Olgettina 58, 20132 Milano, Italy
| | - Stefano Comai
- San Raffaele Scientific Institute and Vita Salute University, Via Olgettina 58, 20132 Milano, Italy
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27
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Darmedru C, Demily C, Franck N. Cognitive remediation and social cognitive training for violence in schizophrenia: a systematic review. Psychiatry Res 2017; 251:266-274. [PMID: 28219026 DOI: 10.1016/j.psychres.2016.12.062] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/03/2016] [Accepted: 12/31/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED A significant correlation exists between violence and schizophrenia (SCZ). Recent studies matched some cognitive deficits like strong risk factors for violence with interesting applications in terms of treatment. Our objective was to conduct a systematic review of the effectiveness of cognitive remediation (CR) and social cognitive training (SCT) in the management of violent and aggressive behaviors in SCZ. METHODS The electronic databases Pubmed, Web of Science, Cochrane Library and ScienceDirect were searched in, using combinations of terms relating to SCZ, CR and violence. Studies were selected and data were extracted using a PRISMA statement. Inclusion criteria were adults with SCZ and a documented collection of disruptive and violent behaviors, for whom researchers had used a CR or SCT program. RESULTS Eleven studies were identified, two related to non-specific CR intervention and nine to codified CR or SCT programs. Results showed that these programs had a positive impact on the control and reduction of global aggressive attitudes and physical assaults. Therapeutic targets were social cognition and executive functions through the improvement of interpersonal relationships and impulsivity feature respectively. Effectiveness was proved at various stages of the illness, in different types of patients and units, with effects persisting for up to 12 months after interruption of CR. Conclusions are limited by some methodological restrictions. CONCLUSION Although current evidences need to be completed with further randomized studies, CR and SCT appear to be promising approaches in the management of violence in SCZ.
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Affiliation(s)
- C Darmedru
- Rehabilitation Department (CRR & CL3R), Le Vinatier Hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - C Demily
- GénoPsy, Center for the Diagnosis and Management of Genetic Psychiatric Disorders, CH Le Vinatier, Bron, France; EDR-Psy, UMR 5229, Center for Cognitive Neuroscience, CNRS & Université Claude Bernard, Université de Lyon, Lyon, France
| | - N Franck
- Rehabilitation Department (CRR & CL3R), Le Vinatier Hospital, 4 rue Jean Sarrazin, 69008 Lyon, France; EDR-Psy, UMR 5229, Center for Cognitive Neuroscience, CNRS & Université Claude Bernard, Université de Lyon, Lyon, France.
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28
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Kuroki N, Kashiwagi H, Ota M, Ishikawa M, Kunugi H, Sato N, Hirabayashi N, Ota T. Brain structure differences among male schizophrenic patients with history of serious violent acts: an MRI voxel-based morphometric study. BMC Psychiatry 2017; 17:105. [PMID: 28327107 PMCID: PMC5361832 DOI: 10.1186/s12888-017-1263-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/09/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The biological underpinnings of serious violent behaviors in patients with schizophrenia remain unclear. The aim of this study was to identify the characteristics of brain morphometry in patients with schizophrenia and a history of serious violent acts, who were being treated under relatively new legislation for offenders with mental illness in Japan where their relevant action should be strongly associated with their mental illness. We also investigated whether morphometric changes would depend on types of serious violent actions or not. METHODS Thirty-four male patients with schizophrenia who were hospitalized after committing serious violent acts were compared with 23 male outpatients or inpatients with schizophrenia and no history of violent acts. T1-weighted magnetic resonance imaging (MRI) with voxel-based morphometry was used to assess gray matter volume. Additionally, patients with violent acts were divided based on whether their relevant actions were premeditated or not. The regional volumes of these two groups were compared to those of the control patient group. RESULTS Patients with schizophrenia and a history of serious violent acts showed significantly smaller regional volumes of the right inferior temporal area expanded to the middle temporal gyrus and the temporal pole, and the right insular area compared to patients without a history of violence. Patients with premeditated violent acts showed significantly smaller regional volumes of the right inferior temporal area, the right insular area, the left planum polare area including the insula, and the bilateral precuneus area including the posterior cingulate gyrus than those without a history of violence, whereas patients with impulsive violent acts showed significantly smaller volumes of only the right inferior temporal area compared to those without a history of violence. CONCLUSIONS Patients with schizophrenia and a history of serious violent acts showed structural differences in some brain regions compared to those with schizophrenia and no history of violence. Abnormalities in the right inferior temporal area were relatively common but did not depend on whether the violent actions were premeditated or not, and abnormalities in a wider range may be attributed to not only planning the violent action against others but also to maintaining that plan. TRIAL REGISTRATION UMIN.ac.jp UMIN000008065 . Registered 2012/05/31.
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Affiliation(s)
- Noriomi Kuroki
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan. .,Department of Psychiatry, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan. .,Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, 2-1-1 Kamikitazawa, Setagaya-ku, Tokyo, 156-0057, Japan.
| | - Hiroko Kashiwagi
- 0000 0004 1763 8916grid.419280.6Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551 Japan
| | - Miho Ota
- 0000 0004 1763 8916grid.419280.6Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502 Japan
| | - Masanori Ishikawa
- grid.444801.dDepartment of Social Welfare Services, Faculty of Human Science, Mejiro University, 4-31-1 Nakaochiai, Shinjuku-ku, Tokyo, 161-8539 Japan
| | - Hiroshi Kunugi
- 0000 0004 1763 8916grid.419280.6Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8502 Japan
| | - Noriko Sato
- 0000 0004 1763 8916grid.419280.6Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551 Japan
| | - Naotsugu Hirabayashi
- 0000 0004 1763 8916grid.419280.6Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551 Japan
| | - Toshio Ota
- 0000 0001 2216 2631grid.410802.fDepartment of Psychiatry, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495 Japan
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Wolf A, Whiting D, Fazel S. Violence prevention in psychiatry: an umbrella review of interventions in general and forensic psychiatry. THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 2017; 28:659-673. [PMID: 30828267 PMCID: PMC6396870 DOI: 10.1080/14789949.2017.1284886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Relative risks of violence in psychiatric patients are high compared to the general population and existing evidence in non-psychiatric populations may not translate to reductions in violence in psychiatric populations. We searched 10 databases including Medline, EMBASE, CINAHL and Scopus, from inception until August 2015 for systematic reviews and meta-analyses of violence prevention interventions in psychiatry. Reviews were included if they used a hard outcome measure (i.e. police or hospital recorded violence, or reincarceration) and contained randomized or non-randomized controlled studies. Five reviews met our inclusion criteria (n = 8876 patients in total), of which four received a GRADE rating of 'low' or 'very low'. Three randomized studies (n = 636) reported that therapeutic community interventions may reduce reincarceration in drug-using offenders with co-occurring mental illness ('moderate' GRADE rating). The lack of intervention research in violence prevention in general and forensic psychiatry suggests that interventions from non-psychiatric populations may need to be relied upon.
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Affiliation(s)
- Achim Wolf
- Department of Psychiatry, University of Oxford, UK
| | | | - Seena Fazel
- Department of Psychiatry, University of Oxford, UK
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30
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Sariaslan A, Lichtenstein P, Larsson H, Fazel S. Triggers for Violent Criminality in Patients With Psychotic Disorders. JAMA Psychiatry 2016; 73:796-803. [PMID: 27410165 PMCID: PMC5047356 DOI: 10.1001/jamapsychiatry.2016.1349] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Absolute and relative risks of violence are increased in patients with psychotic disorders, but the contribution of triggers for violent acts to these risks is uncertain. OBJECTIVE To examine whether a range of triggers for violent acts are associated with risks of violence in patients diagnosed with psychotic disorders and in individuals without a psychiatric diagnosis. DESIGN, SETTING, AND PARTICIPANTS Using a sample of all individuals born in Sweden between 1958 and 1988 (N = 3 123 724), we identified patients in the National Patient Register who were diagnosed with schizophrenia spectrum disorders (n = 34 903) and bipolar disorder (n = 29 692), as well as unaffected controls (n = 2 763 012). We then identified, within each subsample, persons who had experienced any of the following triggers for violent acts between January 1, 2001, and December 15, 2013: exposure to violence, parental bereavement, self-harm, traumatic brain injury, unintentional injuries, and substance intoxication. By using within-individual models, we conducted conditional logistic regression to compare the risk of the individual engaging in violent acts in the week following the exposure to a trigger with the risk during earlier periods of equivalent length. All time-invariant confounders (eg, genetic and early environmental influences) were controlled for by this research design and we further adjusted for time-varying sociodemographic factors. MAIN OUTCOMES AND MEASURES Adjusted odds ratios (aORs) of violent crime occurring in the week following the exposure to a trigger event compared with earlier periods. RESULTS Among the sample of 2 827 607 individuals (1 492 186 male and 1 335 421 female), all of the examined trigger events were associated with increased risk of violent crime in the week following exposure. The largest 1-week absolute risk of violent crime was observed following exposure to violence (70-177 violent crimes per 10 000 persons). For most triggers, the relative risks did not vary significantly by diagnosis, including unintentional injuries (aOR range, 3.5-4.8), self-harm (aOR range, 3.9-4.2), and substance intoxication (aOR range, 3.0-4.0). Differences by diagnosis included parental bereavement, which was significantly higher in patients with schizophrenia spectrum disorders (aOR, 5.0; 95% CI, 3.0-8.1) compared with controls (aOR, 1.7; 95% CI, 1.3-2.2). CONCLUSIONS AND RELEVANCE In addition to identifying risk factors for violence, clarifying the timing of the triggers may provide opportunities to improve risk assessment and management in individuals with psychotic disorders.
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Affiliation(s)
- Amir Sariaslan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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