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Youn S, Guadagno BL, Byrne LK, Watson AE, Murrihy S, Cotton SM. Systematic Review and Meta-analysis: Rates of Violence During First-Episode Psychosis (FEP). Schizophr Bull 2024; 50:757-770. [PMID: 38412435 PMCID: PMC11283196 DOI: 10.1093/schbul/sbae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Most people with psychotic disorders will never commit an act of violence. However, the risk of violence committed by people with schizophrenia is higher than the general population. Violence risk is also known to be highest during the first episode of psychosis compared to later stages of illness. Despite this, there have been no comprehensive reviews conducted in the past 10 years examining rates of violence during FEP. We aimed to provide an updated review of the rate of violence in people with FEP. STUDY DESIGN Meta-analytical techniques were used to identify pooled proportions of violence according to severity (less serious, serious, severe) and timing of violence (before presentation, at first presentation, after presentation to services). STUDY RESULTS Twenty-two studies were included. The pooled prevalence was 13.4% (95% CI [9.0%-19.5%]) for any violence, 16.3% (95% CI [9.1%-27.4%]) for less serious violence, 9.7% (95% CI [5.4%-17.0%]) for serious violence and 2.7% for severe violence, regardless of time point. The pooled prevalence of any violence was 11.6% (95% CI [6.8%-18.9%]) before presentation, 20.8% (95% CI [9.8%-38.7%]) at first presentation and 13.3% (95% CI [7.3%-23.0%]) after presentation to services. CONCLUSION Overall, rates of violence appear to be lower in more recent years. However, due to the high between-study heterogeneity related to study design, the findings must be interpreted with consideration of sample characteristics and other contextual factors. The prevalence of violence remained high at all-time points, suggesting that more targeted, holistic, and early interventions are needed for clinical FEP groups.
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Affiliation(s)
- Sarah Youn
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Belinda L Guadagno
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Linda K Byrne
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia
- Faculty of Psychology, Counselling and Psychotherapy, The Cairnmillar Institute, 391-393 Tooroonga Road, Hawthorn East, Victoria 3123, Australia
| | - Amity E Watson
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
| | - Sean Murrihy
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Melbourne, Victoria 3010, Australia
| | - Sue M Cotton
- Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia
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Citrome L, Álvarez-Barón E, Gabarda-Inat I, Thangavelu K, Tocco M. The specific anti-hostility effect of lurasidone in patients with an acute exacerbation of schizophrenia: results of pooled post hoc analyses in adolescents and adults. Int Clin Psychopharmacol 2024:00004850-990000000-00146. [PMID: 39052354 DOI: 10.1097/yic.0000000000000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Symptoms of hostility in patients during acute exacerbations of schizophrenia have been associated with aggressive behavior. Data suggest that some second-generation antipsychotics have specific anti-hostility effects, independent of sedation and positive symptom improvement. Two post hoc analyses were performed to examine the efficacy of lurasidone for reducing hostility in patients with schizophrenia. One analysis pooled adults (N = 1168) from 5 placebo-controlled, 6-week trials of lurasidone (40-160 mg). Another analysis pooled younger patients (up to age 25 years, N = 427) from the adult studies and a similarly designed trial of lurasidone (40 or 80 mg) in adolescent patients (13-17 years old). The outcome measure was mean change in the hostility item (P7) of the Positive and Negative Syndrome Scale (PANSS). To address pseudospecificity, results were adjusted for positive symptom change and sedation. In adults with a baseline PANSS hostility score ≥2, significant improvement in hostility was observed for all doses with a dose-related increase in effect size (Cohen's d): lurasidone 40 mg = 0.18, 80 mg = 0.24, 120 mg = 0.36, and 160 mg = 0.53. The same dose-response pattern was observed for the more severe hostility subgroups (P7: ≥3, ≥4), and in the early-onset population. Results suggest that lurasidone has specific, dose-related anti-hostility effects.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | | | | | | | - Michael Tocco
- Medical Department, Sumitomo Pharma America, Inc., Marlborough, Massachusetts, USA
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Findeis H, Strauß M, Kröber HL. The TCO concept in German forensic homicide offenders with schizophrenia spectrum disorders - new findings from a file-based, retrospective cross-sectional study. Front Psychiatry 2024; 15:1404263. [PMID: 38919633 PMCID: PMC11196989 DOI: 10.3389/fpsyt.2024.1404263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction There is evidence that there is a small group of people with schizophrenia spectrum disorders who are more likely to commit homicide than those in the general population. However, there is limited knowledge about the psychopathology that leads to homicide in this group. The aim of this study was to examine two commonly used definitions of the Threat/Control-Override (TCO) concept, which aims to identify a certain risk of serious violence in patients with schizophrenia spectrum disorders. Methods This is a sub analysis of a file-based, retrospective and exploratory cross-sectional study. All forensic homicide offenders with schizophrenia spectrum disorders who were detained at the Forensic Hospital Berlin as of 31 December 2014 were examined for the occurrence of TCO according to two commonly used definitions. Results Of a total of 419 forensic patients with schizophrenia spectrum disorders, 78 committed homicide (18.6%). The forensic homicide offenders with schizophrenia spectrum disorders were characterised by being male, unemployed, single and having committed (attempted) manslaughter. Irrespective of the definition used, the entire TCO complex was present in less than a third of the sample. In both definitions, Threat symptoms were slightly less frequent than Control-Override symptoms. While Threat symptoms occurred less frequently in Stompe et al.'s definition, Control-Override symptoms were the most common. With regard to Kröber's definition of Threat and Control-Override, the situation is exactly the opposite. Discussion Regarding the entire TCO complex, Kröber's definition seems a little more open and Stompe et al.'s more strict (38.5% vs. 35.9%). Since TCO only occurs in about one third of the subjects in both definitions, neither definition appears to be conclusive. A combination with proportions from both definitions could be a contribution to a future definition of TCO. The present study provides scarcely published primary data on psychopathology in homicide offenders with schizophrenia spectrum disorders, especially on the much discussed TCO concept in two definitions. In order to determine the most useful definition of TCO, to avoid false positives and to identify clear psychopathological risk symptoms, larger samples and comparative studies with offenders and non-offenders should be conducted in the future.
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Affiliation(s)
- Hannelore Findeis
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
- Institut für Forensische Psychiatrie, Charité Berlin, Berlin, Germany
| | - Maria Strauß
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
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Hegde PR, Gowda GS, Vajawat B, Subramaniyan SS, Basavaraju V, Manjunatha N, Naveen Kumar C, Math SB. Proxy consultations for severe mental illnesses: An exploratory cross-sectional study from a tertiary care hospital. Int J Soc Psychiatry 2024:207640241255591. [PMID: 38849990 DOI: 10.1177/00207640241255591] [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] [Indexed: 06/09/2024]
Abstract
BACKGROUND Non-adherence to medication leading to a break in continuity of care poses significant challenges in severe mental illness (SMI), leading to poor outcomes. In India, proxy consultation, wherein caregivers consult on behalf of patients, is a commonly adopted but insufficiently researched area to address these challenges. AIMS To explore the extent of proxy consultation in outpatient care of persons with SMI and investigate its sociodemographic and clinical correlates. METHODOLOGY In a tertiary care psychiatry outpatient setting, we conducted a cross-sectional study involving 374 caregivers of persons with SMI (Schizophrenia, Bipolar and related disorders). Descriptive statistics and univariate logistic regression were performed to examine correlates' relationships with proxy consultation. RESULTS Proxy consultation prevalence was 43% in the past 1 year. Compared with 18 to 30 years, middle-aged patients aged 31 to 40, 41 to 50 and 51 to 60 years had twofold, threefold and sixfold increased chances of proxy consultation, respectively. Being illiterate had six times higher odds than graduates, three times and two times if they studied till primary and secondary education. Early age of onset was associated with three times higher chances of proxy consultation compared to the onset of illness in adulthood. On the contrary, male gender and upper and middle socioeconomic status decreased the chances of proxy consultation by 40%. Financial difficulties (n = 72, 45%) and patients' unwillingness to visit outpatients (n = 44, 27.5%) were the most commonly cited reasons for proxy consultation. CONCLUSION Proxy consultations are relatively common, driven by many social, economic, patient-related, pragmatic and practical factors. In formulating community care policies for persons with SMI, the primary imperative should be to conduct additional research, deepening our understanding of proxy consultations. Additionally, it is essential to be mindful of the diverse issues associated with proxy consultations during the formulation process.
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Affiliation(s)
- Prakyath Ravindranath Hegde
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Bhavika Vajawat
- General Adult Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sivakami Sundari Subramaniyan
- TeleMANAS (National Tele Mental Health Programme of India), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | | | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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Källman MV, Hedlund-Lindberg M, Kristiansson M, Johansson AGM. A comparison of patient ratings and staff ratings of disability using the World Health Organisation Disability Assessment Schedule in individuals with psychotic spectrum disorders who are forensic psychiatric inpatients. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024. [PMID: 38824652 DOI: 10.1002/cbm.2344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 05/19/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Psychosocial rehabilitation in forensic psychiatric services requires sound measurement of patient and staff perceptions of psychosocial function. The recommended World Health Organisation Disability Assessment Schedule 2.0 (WHODAS), designed for this, has not been examined with offender patients. AIMS To examine patient and staff WHODAS ratings of secure hospital inpatients with psychosis, any differences between them and explore associations with other clinical factors. METHODS Seventy-three patients self-rated on the WHODAS after 3 months as inpatients. An occupational therapist interviewed the patient's primary nurse and care team at about the same time (staff ratings). Scores were calculated according to the WHODAS manual. WHODAS scores and interview-rated symptom severity, cognitive measures, daily antipsychotic dose and duration of care were compared. RESULTS Patient ratings indicated less disability than staff ratings for total score and for the domains of understanding and communicating, getting along and life activities. Self-care and participation ratings were similar. Patients were more likely to rate themselves as disabled in getting around (mobility). Only one-fifth of patient- and staff- ratings (16, 22%) were similar, while for nearly a third of the patients (23, 32%) self-ratings were higher than staff ratings. More severe positive symptoms were associated with higher self-rated WHODAS disability after accounting for treatment duration, negative symptoms, cognitive score and antipsychotic dose. No variable accounted for the staff/patient differences in ratings. CONCLUSION Our mean WHODAS score findings echoed those in other patient samples-of patient underestimation of disability, linked to severity of symptoms. In this study using the WHODAS for the first time in a forensic mental health secure inpatient service, however, we found that, by comparing individuals, half of the patients reported equivalent or greater disability than did staff. Future research should focus on elucidating from patients what contributes to their self-ratings. Understanding their thought processes in rating may enhance rehabilitation planning.
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Affiliation(s)
- Malin V Källman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatric Research, Region Stockholm, Stockholm, Sweden
| | - Mathilde Hedlund-Lindberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University, University Hospital, Uppsala, Sweden
| | - Marianne Kristiansson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatric Research, Region Stockholm, Stockholm, Sweden
| | - Anette G M Johansson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatric Research, Region Stockholm, Stockholm, Sweden
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Prince JD. Substance Use Disorder and Violence Among People with Severe Mental Illness in the United States. Psychiatr Q 2024; 95:287-298. [PMID: 38880830 DOI: 10.1007/s11126-024-10077-8] [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] [Accepted: 06/02/2024] [Indexed: 06/18/2024]
Abstract
In studying substance use disorder (SUD) and violence in severe mental illness (SMI), researchers account for presence of SUD or addictions to specific substances. However these studies fail to comprehensively capture solitary drug use versus specific combinations in a single exhaustive variable with more nuance (e.g., opioids only, alcohol only, both alcohol and opioids only, and so on). Using logistic regression to predict past-year violence, this study compared conventional SUD measurement (Model I: presence versus absence of SUD or specific SUDS) to a newer and more holistic approach (Model II: a single exhaustive variable with both solitary addictions [e.g., opioids only] and specific combinations of addictions [e.g., both opioids and alcohol only]) among 10,551 people with SMI in the National Survey of Drug Use and Health (20,015 - 2019). After adjusting for a wide variety of factors in Model II, people with (1) alcohol use disorders only were 2.24 times more likely to be violent (CI = 1.46-3.45, p <.001); (2) opioid use disorders only were 3.45 times more likely (CI-1.48-8.05, p,>01); (3) both alcohol and cocaine use disorders or cocaine only were 5.85 times more likely (CI = 2.63-13.05, p <.001); and (4) both alcohol and opioid use disorders only were 4.28 times more likely (CI = 1.34-13.71, p <.05). These more nuanced findings in Model II differed substantially from those using conventional SUD assessment in Model I, and the newer and more holistic approach can better reflect the complexity of addiction in relation to violence in SMI. Therefore studies, practices, and policies that address SUD and violence in SMI could be beneficially revisited with this greater comprehensiveness and detail.
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Affiliation(s)
- Jonathan D Prince
- Silberman School of Social Work at Hunter College, City University of New York, New York, NY, USA.
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Jacobshagen L, Machetanz L, Kirchebner J. Differences between criminal offender versus non-offender female patients with schizophrenia spectrum disorder: a retrospective cohort study. Arch Womens Ment Health 2024:10.1007/s00737-024-01477-7. [PMID: 38809321 DOI: 10.1007/s00737-024-01477-7] [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: 10/04/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024]
Abstract
The purpose of this study was to investigate the difference between offender female patients (OFS) and non-offender female patients (NOFS) with schizophrenia spectrum disorder (SSD).The patients in this study were admitted to the university psychiatry in Zurich Switzerland between 1982 and 2016. Demography, psychopathology, comorbidity, and treatment differences were analyzed using binary statistics to compare 31 OFS and 29 matching NOFS with SSD. The Fisher's exact test was used for categorical data variables in small size samples and the Mann-Whitney-U-Test for nonparametric test variables, adjusted with the Benjamini and Hochberg method.The results indicate that the NOFS were cognitively more impaired, they were more likely to have had antipsychotic drugs prescribed (NOFS; 100%, OFS: 71%, OR 1.41, 95% CI 1.13-1.77, p=0.022) and their medication compliance was higher (NOFS: 84.6%, OFS: 4.5%, OR 0.09, 95% CI 0.00-0.08, p=0.000). In contrast, the OFS had completed compulsory school less often and the were observed to be more often homeless and socially isolated (OFS: 72.4%, NOFS: 34.6%, OR 4.96, 95% CI 1.58-15.6, p=0.026), self-disorders (OFS: 51.6%, NOFS: 11.1%, OR 8.53, 95% CI 2.12-34.32, p=0.011), delusions (OFS: 96.8%, NOFS: 63%, OR 17.65, 95% CI 2.08-149.99, p=0.014) and substance use disorder (51.6%, OR 0.27, 95% CI 0.09-0.85, p=0.039). Clinicians treating female offender patients with SSD should focus more on the treatment for substance use disorder, medication and early recognition of the illness for preventative purposes.
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Affiliation(s)
| | - Lena Machetanz
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Sonnweber M, Lau S, Kirchebner J. Exploring Characteristics of Homicide Offenders With Schizophrenia Spectrum Disorders Via Machine Learning. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024; 68:713-732. [PMID: 35730542 DOI: 10.1177/0306624x221102799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The link between schizophrenia and homicide has long been the subject of research with significant impact on mental health policy, clinical practice, and public perception of people with psychiatric disorders. The present study investigates factors contributing to completed homicides committed by offenders diagnosed with schizophrenia referred to a Swiss forensic institution, using machine learning algorithms. Data were collected from 370 inpatients at the Centre for Inpatient Forensic Therapy at the Zurich University Hospital of Psychiatry. A total of 519 variables were explored to differentiate homicidal and other (violent and non-violent) offenders. The dataset was split employing variable filtering, model building, and selection embedded in a nested resampling approach. Ten factors regarding criminal and psychiatric history and clinical factors were identified to be influential in differentiating between homicidal and other offenders. Findings expand the research on influential factors for completed homicide in patients with schizophrenia. Limitations, clinical relevance, and future directions are discussed.
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Lu J, Gou N, Sun Q, Huang Y, Guo H, Han D, Zhou J, Wang X. Brain structural alterations associated with impulsiveness in male violent patients with schizophrenia. BMC Psychiatry 2024; 24:281. [PMID: 38622613 PMCID: PMC11017613 DOI: 10.1186/s12888-024-05721-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Violence in schizophrenia (SCZ) is a phenomenon associated with neurobiological factors. However, the neural mechanisms of violence in patients with SCZ are not yet sufficiently understood. Thus, this study aimed to explore the structural changes associated with the high risk of violence and its association with impulsiveness in patients with SCZ to reveal the possible neurobiological basis. METHOD The voxel-based morphometry approach and whole-brain analyses were used to measure the alteration of gray matter volume (GMV) for 45 schizophrenia patients with violence (VSC), 45 schizophrenia patients without violence (NSC), and 53 healthy controls (HC). Correlation analyses were used to examine the association of impulsiveness and brain regions associated with violence. RESULTS The results demonstrated reduced GMV in the right insula within the VSC group compared with the NSC group, and decreased GMV in the right temporal pole and left orbital part of superior frontal gyrus only in the VSC group compared to the HC group. Spearman correlation analyses further revealed a positive correlation between impulsiveness and GMV of the left superior temporal gyrus, bilateral insula and left medial orbital part of the superior frontal gyrus in the VSC group. CONCLUSION Our findings have provided further evidence for structural alterations in patients with SCZ who had engaged in severe violence, as well as the relationship between the specific brain alterations and impulsiveness. This work provides neural biomarkers and improves our insight into the neural underpinnings of violence in patients with SCZ.
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Affiliation(s)
- Juntao Lu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Ningzhi Gou
- Department of Psychiatry, the First Affiliated Hospital, Medical College of Xi 'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Qiaoling Sun
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Ying Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Huijuan Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Dian Han
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jiansong Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
| | - Xiaoping Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
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Parsaei M, Arvin A, Taebi M, Seyedmirzaei H, Cattarinussi G, Sambataro F, Pigoni A, Brambilla P, Delvecchio G. Machine Learning for prediction of violent behaviors in schizophrenia spectrum disorders: a systematic review. Front Psychiatry 2024; 15:1384828. [PMID: 38577400 PMCID: PMC10991827 DOI: 10.3389/fpsyt.2024.1384828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
Background Schizophrenia spectrum disorders (SSD) can be associated with an increased risk of violent behavior (VB), which can harm patients, others, and properties. Prediction of VB could help reduce the SSD burden on patients and healthcare systems. Some recent studies have used machine learning (ML) algorithms to identify SSD patients at risk of VB. In this article, we aimed to review studies that used ML to predict VB in SSD patients and discuss the most successful ML methods and predictors of VB. Methods We performed a systematic search in PubMed, Web of Sciences, Embase, and PsycINFO on September 30, 2023, to identify studies on the application of ML in predicting VB in SSD patients. Results We included 18 studies with data from 11,733 patients diagnosed with SSD. Different ML models demonstrated mixed performance with an area under the receiver operating characteristic curve of 0.56-0.95 and an accuracy of 50.27-90.67% in predicting violence among SSD patients. Our comparative analysis demonstrated a superior performance for the gradient boosting model, compared to other ML models in predicting VB among SSD patients. Various sociodemographic, clinical, metabolic, and neuroimaging features were associated with VB, with age and olanzapine equivalent dose at the time of discharge being the most frequently identified factors. Conclusion ML models demonstrated varied VB prediction performance in SSD patients, with gradient boosting outperforming. Further research is warranted for clinical applications of ML methods in this field.
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Affiliation(s)
- Mohammadamin Parsaei
- Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Arvin
- Center for Orthopedic Trans-disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran
| | - Morvarid Taebi
- Center for Orthopedic Trans-disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Seyedmirzaei
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy
- Padua Neuroscience Center, University of Padova, Padua, Italy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy
- Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Alessandro Pigoni
- Social and Affective Neuroscience Group, MoMiLab, Institutions, Markets, Technologies (IMT) School for Advanced Studies Lucca, Lucca, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Brambilla
- Social and Affective Neuroscience Group, MoMiLab, Institutions, Markets, Technologies (IMT) School for Advanced Studies Lucca, Lucca, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Bender EM, Machetanz L, von Känel R, Euler S, Kirchebner J, Günther MP. When do drugs trigger criminal behavior? a machine learning analysis of offenders and non-offenders with schizophrenia and comorbid substance use disorder. Front Psychiatry 2024; 15:1356843. [PMID: 38516261 PMCID: PMC10954830 DOI: 10.3389/fpsyt.2024.1356843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Comorbid substance use disorder (SUD) is linked to a higher risk of violence in patients with schizophrenia spectrum disorder (SSD). The objective of this study is to explore the most distinguishing factors between offending and non-offending patients diagnosed with SSD and comorbid SUD using supervised machine learning. Methods A total of 269 offender patients and 184 non-offender patients, all diagnosed with SSD and SUD, were assessed using supervised machine learning algorithms. Results Failures during opening, referring to rule violations during a permitted temporary leave from an inpatient ward or during the opening of an otherwise closed ward, was found to be the most influential distinguishing factor, closely followed by non-compliance with medication (in the psychiatric history). Following in succession were social isolation in the past, no antipsychotics prescribed (in the psychiatric history), and no outpatient psychiatric treatments before the current hospitalization. Discussion This research identifies critical factors distinguishing offending patients from non-offending patients with SSD and SUD. Among various risk factors considered in prior research, this study emphasizes treatment-related differences between the groups, indicating the potential for improvement regarding access and maintenance of treatment in this particular population. Further research is warranted to explore the relationship between social isolation and delinquency in this patient population.
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Affiliation(s)
- Ewa-Maria Bender
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zürich, Zurich, Switzerland
| | - Lena Machetanz
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zürich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zürich, Zurich, Switzerland
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Moritz Philipp Günther
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zürich, Zurich, Switzerland
- Privatklinik Meiringen, Willigen, Meiringen, Switzerland
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12
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Balcioglu YH, Golenkov AV, Yildiz A, Uzlar RD, Oncu F. Homicide perpetrators with psychotic illness found not criminally responsible in Turkiye and Russia: An international comparison. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 93:101962. [PMID: 38330511 DOI: 10.1016/j.ijlp.2024.101962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The primary objective was to conduct a comparative analysis of homicide cases and their perpetrators with psychotic illnesses in samples from Turkiye and Russia to elucidate contextual similarities and differences, and providing novel perspectives to enhance international research in this field. METHOD This cross-national retrospective study, conducted at forensic psychiatric centers in Istanbul, Turkiye, and Chuvashia, Russia, involved individuals with psychotic illnesses (ICD-10 F20-F29) who were deemed criminally non-responsible for index homicide offenses between December 2012 and December 2022. The sample included 92 Turkish patients and 29 Russian patients who were compared for background, clinical characteristics, and each homicidal act. RESULTS Binary analyses revealed that Russian subjects were more educated, had more lifetime suicide attempts, longer illness duration, had acquaintances as victims more frequently, higher rates of blunt traumatic homicides, higher rates of intoxication with alcohol or substances, and lower rates of experiencing delusions at the time of the index homicide compared to their Turkish counterparts. Multivariate analyses indicated that more years of education, a greater frequency of lifetime suicide attempts, higher prevalence of intoxication and a lower rate of delusions at the time of the homicide were associated with belonging to the Russian group. CONCLUSION Despite several similarities, the remarkable differences between the two samples underscore the importance of international research in enhancing our understanding of mental health, homicidal offense and offender characteristics in the sociocultural context.
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Affiliation(s)
- Yasin Hasan Balcioglu
- Forensic Psychiatry Unit, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkiye.
| | - Andrei Vasilyevich Golenkov
- Department of Psychiatry and Medical Psychology, Chuvash State University, Cheboksary, Republic of Chuvashia, Russian Federation
| | - Alperen Yildiz
- Forensic Psychiatry Unit, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkiye
| | - Rustem Dogan Uzlar
- Forensic Psychiatry Unit, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkiye
| | - Fatih Oncu
- Forensic Psychiatry Unit, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkiye
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13
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Tomlin J, Meise E, Wegner J, Völlm B. Mandatory substance use treatment for justice-involved persons in Germany: a systematic review of reoffending, treatment and the recurrence of substance use outcomes. Front Psychiatry 2024; 14:1217561. [PMID: 38375516 PMCID: PMC10876065 DOI: 10.3389/fpsyt.2023.1217561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/21/2023] [Indexed: 02/21/2024] Open
Abstract
Many jurisdictions implement mandatory substance use treatment for justice-involved persons. Germany is one such country; however, debates about the appropriateness and effectiveness of this disposal abound. Very little attention has been paid in the international literature to patients receiving mandatory treatment in Germany. This systematic review synthesises research on patients receiving substance use treatment in forensic hospitals under §64 of the German Penal Code with regard to three primary outcomes: treatment completion, reoffending, and the recurrence of substance use. Forty-five publications reporting on 36 studies were reviewed; publication dates ranged from 1988 to 2023. On average, 47% of patients did not successfully complete treatment, compared to 45% who did. Average follow-up reconviction rates were higher than in mentally ill and general offender populations as reported elsewhere. Approximately half of all patients reused substances during treatment. Suggestions for future research, including a focus on strength- and recovery-based indicators, and harmonising routine outcomes measurements, are given.
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Affiliation(s)
- Jack Tomlin
- School of Law and Criminology, University of Greenwich, London, United Kingdom
| | - Esther Meise
- Department of Forensic Psychiatry, University Medicine, Rostock, Germany
| | - Juliane Wegner
- Institut für Medienforschung, University of Rostock, Rostock, Germany
| | - Birgit Völlm
- Department of Forensic Psychiatry, University Medicine, Rostock, Germany
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14
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Lamsma J, Raine A, Kia SM, Cahn W, Arold D, Banaj N, Barone A, Brosch K, Brouwer R, Brunetti A, Calhoun VD, Chew QH, Choi S, Chung YC, Ciccarelli M, Cobia D, Cocozza S, Dannlowski U, Dazzan P, de Bartolomeis A, Di Forti M, Dumais A, Edmond JT, Ehrlich S, Evermann U, Flinkenflügel K, Georgiadis F, Glahn DC, Goltermann J, Green MJ, Grotegerd D, Guerrero-Pedraza A, Ha M, Hong EL, Hulshoff Pol H, Iasevoli F, Kaiser S, Kaleda V, Karuk A, Kim M, Kircher T, Kirschner M, Kochunov P, Kwon JS, Lebedeva I, Lencer R, Marques TR, Meinert S, Murray R, Nenadić I, Nguyen D, Pearlson G, Piras F, Pomarol-Clotet E, Pontillo G, Potvin S, Preda A, Quidé Y, Rodrigue A, Rootes-Murdy K, Salvador R, Skoch A, Sim K, Spalletta G, Spaniel F, Stein F, Thomas-Odenthal F, Tikàsz A, Tomecek D, Tomyshev A, Tranfa M, Tsogt U, Turner JA, van Erp TGM, van Haren NEM, van Os J, Vecchio D, Wang L, Wroblewski A, Nickl-Jockschat T. Structural brain abnormalities and aggressive behaviour in schizophrenia: Mega-analysis of data from 2095 patients and 2861 healthy controls via the ENIGMA consortium. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.04.24302268. [PMID: 38370846 PMCID: PMC10871467 DOI: 10.1101/2024.02.04.24302268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Schizophrenia is associated with an increased risk of aggressive behaviour, which may partly be explained by illness-related changes in brain structure. However, previous studies have been limited by group-level analyses, small and selective samples of inpatients and long time lags between exposure and outcome. Methods This cross-sectional study pooled data from 20 sites participating in the international ENIGMA-Schizophrenia Working Group. Sites acquired T1-weighted and diffusion-weighted magnetic resonance imaging scans in a total of 2095 patients with schizophrenia and 2861 healthy controls. Measures of grey matter volume and white matter microstructural integrity were extracted from the scans using harmonised protocols. For each measure, normative modelling was used to calculate how much patients deviated (in z-scores) from healthy controls at the individual level. Ordinal regression models were used to estimate the associations of these deviations with concurrent aggressive behaviour (as odds ratios [ORs] with 99% confidence intervals [CIs]). Mediation analyses were performed for positive symptoms (i.e., delusions, hallucinations and disorganised thinking), impulse control and illness insight. Aggression and potential mediators were assessed with the Positive and Negative Syndrome Scale, Scale for the Assessment of Positive Symptoms or Brief Psychiatric Rating Scale. Results Aggressive behaviour was significantly associated with reductions in total cortical volume (OR [99% CI] = 0.88 [0.78, 0.98], p = .003) and global white matter integrity (OR [99% CI] = 0.72 [0.59, 0.88], p = 3.50 × 10-5) and additional reductions in dorsolateral prefrontal cortex volume (OR [99% CI] = 0.85 [0.74, 0.97], p =.002), inferior parietal lobule volume (OR [99% CI] = 0.76 [0.66, 0.87], p = 2.20 × 10-7) and internal capsule integrity (OR [99% CI] = 0.76 [0.63, 0.92], p = 2.90 × 10-4). Except for inferior parietal lobule volume, these associations were largely mediated by increased severity of positive symptoms and reduced impulse control. Conclusions This study provides evidence that the co-occurrence of positive symptoms, poor impulse control and aggressive behaviour in schizophrenia has a neurobiological basis, which may inform the development of therapeutic interventions.
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Affiliation(s)
- Jelle Lamsma
- Department of Criminology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adrian Raine
- Department of Criminology, University of Pennsylvania, Philadelphia, USA
- Department of Psychology, University of Pennsylvania, Philadelphia, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Seyed M. Kia
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dominic Arold
- Division of Psychological and Social Medicine and Developmental Neurosciences, TU Dresden, Germany
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Annarita Barone
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, USA
| | - Rachel Brouwer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Complex Trait Genetics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Vince D. Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology and Emory University, Atlanta, USA
| | - Qian H. Chew
- Department of Research, Institute of Mental Health, Singapore
| | - Sunah Choi
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Young-Chul Chung
- Department of Psychiatry, Jeonbuk National University, Jeonju, South Korea
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Mariateresa Ciccarelli
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Derin Cobia
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, USA
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Paola Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Andrea de Bartolomeis
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Marta Di Forti
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Alexandre Dumais
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada
- Institut Philippe-Pinel, Montreal, Canada
| | - Jesse T. Edmond
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology and Emory University, Atlanta, USA
- Department of Psychology, Georgia State University, Atlanta, USA
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, TU Dresden, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, TU Dresden, Germany
| | - Ulrika Evermann
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Kira Flinkenflügel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Foivos Georgiadis
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Switzerland
| | - David C. Glahn
- Department of Psychiatry, Harvard Medical School, Harvard, USA
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, USA
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Melissa J. Green
- Neuroscience Research Australia, Randwick, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | | | - Minji Ha
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Elliot L. Hong
- Department of Psychiatry and Behavioral Science, UTHealth Houston, Houston, USA
| | - Hilleke Hulshoff Pol
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
| | - Felice Iasevoli
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Stefan Kaiser
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Vasily Kaleda
- Department of Youth Psychiatry, Mental Health Research Center, Moscow, Russia
| | - Andriana Karuk
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Switzerland
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
| | - Peter Kochunov
- Department of Psychiatry and Behavioral Science, UTHealth Houston, Houston, USA
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, South Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Irina Lebedeva
- Laboratory of Neuroimaging and Multimodal Analysis, Mental Health Research Center, Moscow, Russia
| | - Rebekka Lencer
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Tiago R. Marques
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Institute of Clinical Sciences, Imperial College London, London, UK
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Robin Murray
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Dana Nguyen
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, USA
| | - Godfrey Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, USA
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Barcelona, Spain
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Stéphane Potvin
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, USA
| | - Yann Quidé
- Neuroscience Research Australia, Randwick, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Amanda Rodrigue
- Department of Psychiatry, Harvard Medical School, Harvard, USA
| | - Kelly Rootes-Murdy
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Institute of Technology and Emory University, Atlanta, USA
- Department of Psychology, Georgia State University, Atlanta, USA
| | - Raymond Salvador
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Barcelona, Spain
| | - Antonin Skoch
- National Institute of Mental Health, Klecany, Czech Republic
| | - Kang Sim
- Department of Research, Institute of Mental Health, Singapore
| | | | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | | | - Andràs Tikàsz
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - David Tomecek
- National Institute of Mental Health, Klecany, Czech Republic
- Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Alexander Tomyshev
- Laboratory of Neuroimaging and Multimodal Analysis, Mental Health Research Center, Moscow, Russia
| | - Mario Tranfa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Uyanga Tsogt
- Department of Psychiatry, Jeonbuk National University, Jeonju, South Korea
| | - Jessica A. Turner
- Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, USA
| | - Theo G. M. van Erp
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, USA
| | - Neeltje E. M. van Haren
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC Sophia, Rotterdam, the Netherlands
| | - Jim van Os
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Lei Wang
- Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, USA
| | - Adrian Wroblewski
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, University of Iowa, Iowa City, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, USA
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Lambe S, Cooper K, Fazel S, Freeman D. Psychological framework to understand interpersonal violence by forensic patients with psychosis. Br J Psychiatry 2024; 224:47-54. [PMID: 37861077 PMCID: PMC10807973 DOI: 10.1192/bjp.2023.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Forensic patients with psychosis often engage in violent behaviour. There has been significant progress in understanding risk factors for violence, but identification of causal mechanisms of violence is limited. AIMS To develop a testable psychological framework explaining violence in psychosis - grounded in patient experience - to guide targeted treatment development. METHOD We conducted in-depth interviews with 20 patients with psychosis using forensic psychiatric services across three regions in England. Interviews were analysed using reflexive thematic analysis. People with lived experience contributed to the analysis. RESULTS Analysis of interviews identified several psychological processes involved in the occurrence of violence. Violence was the dominant response mode to difficulties that was both habitual and underpinned by rules that engaged and justified an attack. Violence was triggered by a trio of sensitivities to other people: sensitivity to physical threat, from which violence protected; sensitivity to social disrespect, by which violence increased status; and sensitivity to unfairness, by which violence delivered revenge. Violence was an attempt to regulate difficult internal states: intense emotions were released through aggression and violence was an attempt to escape being overwhelmed by voices, visions or paranoia. There were different patterns of emphasis across these processes when explaining an individual participant's offending behaviour. CONCLUSIONS The seven-factor model of violence derived from our analysis of patient accounts highlights multiple modifiable psychological processes that can plausibly lead to violence. The model can guide the research and development of targeted treatments to reduce violence by individuals with psychosis.
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Affiliation(s)
- Sinéad Lambe
- Department of Experimental Psychology, University of Oxford, Oxford, UK; and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Kate Cooper
- Department of Psychology, University of Bath, Bath, UK
| | - Seena Fazel
- Oxford Health NHS Foundation Trust, Oxford, UK; and Department of Psychiatry, University of Oxford, Oxford, UK
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford, Oxford, UK; and Oxford Health NHS Foundation Trust, Oxford, UK
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16
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Chen LC, Tan WY, Xi JY, Xie XH, Lin HC, Wang SB, Wu GH, Liu Y, Gu J, Jia FJ, Du ZC, Hao YT. Violent behavior and the network properties of psychopathological symptoms and real-life functioning in patients with schizophrenia. Front Psychiatry 2024; 14:1324911. [PMID: 38274426 PMCID: PMC10808501 DOI: 10.3389/fpsyt.2023.1324911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
Objective To assess the interplay among psychopathological symptoms and real-life functioning, and to further detect their influence with violent behavior in patient with schizophrenia. Methods A sample of 1,664 patients with post-violence assessments and their propensity score-matched controls without violence from a disease registration report system of community mental health service in Guangdong, China, were studied by network analysis. Ising-Model was used to estimate networks of psychopathological symptoms and real-life functioning. Then, we tested whether network properties indicated the patterns of interaction were different between cases and controls, and calculated centrality indices of each node to identify the central nodes. Sensitivity analysis was conducted to examine the difference of interaction patterns between pre-violence and post-violence assessments in violence cases. Results Some nodes in the same domain were highly positive interrelations, while psychopathological symptoms were negatively related to real-life functioning in all networks. Many symptom-symptom connections and symptom-functioning connections were disconnected after the violence. The network density decreased from 23.53% to 12.42% without statistical significance (p = 0.338). The network structure, the global network strength, and the global clustering coefficient decreased significantly after the violence (p < 0.001, p = 0.019, and p = 0.045, respectively). Real-life functioning had a higher node strength. The strength of sleeping, lack of spontaneity and flow of conversation, and preoccupation were decreased in post-violence network of patients. Conclusion The decreasing connectivity may indicate an increased risk of violence and early warning for detecting violence. Interventions and improving health state based on nodes with high strength might prevent violence in schizophrenia patients.
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Affiliation(s)
- Li-Chang Chen
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen-Yan Tan
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Jun-Yan Xi
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xin-Hui Xie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hai-Cheng Lin
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Gong-Hua Wu
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yu Liu
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Zhi-Cheng Du
- Department of Medical Statistics, School of Public Health & Center for Health Information Research & Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuan-Tao Hao
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, China
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Dean K, Laursen TM, Marr C, Pedersen CB, Webb RT, Agerbo E. Absolute and relative risk of violent victimisation and perpetration following onset of mental illness: a Danish register-based study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 36:100781. [PMID: 38188271 PMCID: PMC10769888 DOI: 10.1016/j.lanepe.2023.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/27/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024]
Abstract
Background Previous research has suggested that people with severe mental illness are at elevated risk of both violence perpetration and violent victimisation, with risk of the latter being perhaps greater than the former. However, few studies have examined risk across both outcomes. Methods Using a total population approach, the absolute and relative risks of victimisation and perpetration were estimated for young men and women across the full psychiatric diagnostic spectrum. Information on mental disorder status was extracted from national registers and information on violent victimisation and perpetration outcomes from police records. The follow-up was from age 15 to a maximum of 31 years, with most of the person-time at risk pertaining to cohort members aged in their early twenties. Both absolute risk (at 1 and 5 years from onset of illness) and relative risk were estimated. Findings Both types of violent outcome occurred more frequently amongst those with mental illness than the general population. However, whether risk of one was greater than the other depended on a range of factors, including sex and diagnosis. Men with a mental disorder had higher absolute risks of both outcomes than women [victimisation: Cin (5 year) = 7.15 (6.88-7.42) versus Cin (5 year) = 4.79 (4.61-4.99); perpetration: Cin (5 year) = 8.17 (7.90-8.46) versus Cin (5 year) = 1.86 (1.75-1.98)], as was the case with persons in the general population without a recorded mental illness diagnosis. Women with mental illness had higher absolute risk of victimisation than perpetration, which was also true for men and women without mental illness. However, the opposite was true for men with mental illness. Men and women with diagnoses of personality disorders, substance use disorders, and schizophrenia-spectrum disorders were at highest risk of victimisation and perpetration. Interpretation Strategies developed to prevent violent victimisation and violence perpetration may need to be tailored for young adults with mental disorders. There may also be a benefit in taking a sex-specific approach to prevention in this group. Funding This study was supported by an Australian National Health and Medical Research Council Investigator Grant awarded to the first author.
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Affiliation(s)
- Kimberlie Dean
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Australia
- Justice Health and Forensic Mental Health Network, NSW, Australia
| | - Thomas Munk Laursen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - Carey Marr
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Australia
| | - Carsten B. Pedersen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- CIRRAU – Centre for Integrated Register-based Research at Aarhus University, Denmark
| | - Roger T. Webb
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, The University of Manchester and Manchester Academic Health Science Centre (MAHSC), Manchester, United Kingdom
| | - Esben Agerbo
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- CIRRAU – Centre for Integrated Register-based Research at Aarhus University, Denmark
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18
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Graham M, Morgan A, Paton E, Ross A. Examining the quality of news media reporting of complex mental illness in relation to violent crime in Australia. Int J Soc Psychiatry 2023; 69:2110-2120. [PMID: 37644701 PMCID: PMC10685681 DOI: 10.1177/00207640231194481] [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] [Indexed: 08/31/2023]
Abstract
PURPOSE News reporting on mental illness can perpetuate stigma. An understanding of the current picture of such reporting is important to identify areas for improvement. This study investigated the quality of Australian news media coverage of complex mental illness in the context of crime and violence over a 2-year period, prior to the release of new media guidelines. METHODS This research utilised a systematic search of Australian news articles that were published between July 2018 and July 2020 and reported on mental illness in relation to violent crime. Researchers developed a Mental Illness and Crime Reporting Quality Framework to determine quality scores for news articles according to 11 relevant factors in media guidelines. An additional 11 characteristics of articles were extracted for further descriptive analysis. RESULTS One-hundred and twenty-eight Australian news articles met inclusion criteria. The average quality score was 50 (SD = 13.91) out of a possible maximum score of 100 (range 11-78). Strengths and weaknesses were identified as some criteria were consistently met, and other criteria were met rarely or not at all. There were emerging trends between quality scores and article characteristics, including publication source, though these analyses were not statistically significant. CONCLUSION The findings indicate that Australian news coverage of complex mental illness and violent crime met half of the criteria of reporting guidelines that minimises risk of perpetuating or reinforcing stigma. This demonstrates significant opportunity to improve the overall quality of media reporting on crime and mental illness. Future research should evaluate the impact of the guidelines on the quality of news reporting after their implementation by utilising a similar methodology, using these findings as a baseline measure.
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Affiliation(s)
- Madeline Graham
- Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia
| | - Amy Morgan
- Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia
| | - Elizabeth Paton
- Everymind, Newcastle, NSW, Australia
- School of Humanities, Creative Industries and Social Sciences, University of Newcastle, NSW, Australia
| | - Anna Ross
- Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia
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Ranu J, Kalebic N, Melendez-Torres GJ, Taylor PJ. Association Between Adverse Childhood Experiences and a Combination of Psychosis and Violence Among Adults: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:2997-3013. [PMID: 36117458 DOI: 10.1177/15248380221122818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Relationships have been well established between adverse childhood experiences (ACEs) and later psychosis (29 systematic reviews) or violence (4 systematic reviews). To date, just one review has explored childhood maltreatment, specifically, and violence risk with psychosis. We conducted a systematic review and meta-analyses of a wider range of ACEs and later psychosis with actual violence compared with psychosis alone, violence alone or neither, completing searches in January 2021. In all, 15 studies met inclusion criteria, but only six included all four groups of interest. Two substantial studies recorded ACEs from sources independent of those affected and probably before emergent psychosis or violence; others relied on retrospective recall. Meta-analyses were possible only for within-psychosis-group comparisons; histories of physical abuse, sexual abuse, and having a criminal/violent parent or living with family alcohol/drug use were each associated with around twice the odds of psychosis with violence as psychosis alone. Although ACE measures in the four-way comparisons were too divergent for firm conclusions, abuse histories, and parental criminality emerged as likely antecedents, one study evidencing psychosis as mediating between ACEs and violence. Without longitudinal prospective study, pathways between ACEs and later problems remain unclear. Our findings add weight to the case for exploring ACEs in addition to abuse as possible indicators of later violence among people with psychosis and for trauma-informed interventions, which is important because some people are reluctant to disclose abuse histories.
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20
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Saunders KRK, Landau S, Howard LM, Fisher HL, Arseneault L, McLeod GFH, Oram S. Past-year intimate partner violence perpetration among people with and without depression: an individual participant data (IPD) meta-mediation analysis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1735-1747. [PMID: 34842963 PMCID: PMC10627935 DOI: 10.1007/s00127-021-02183-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate whether (1) depression is associated with increased risk of past-year intimate partner violence (IPV) perpetration, disaggregated by sex, after controlling for potential confounders; (2) observed associations are mediated by alcohol misuse or past-year IPV victimisation. METHODS Systematic review and individual participant data (IPD) meta-mediation analysis of general population surveys of participants aged 16 years or older, that were conducted in a high-income country setting, and measured mental disorder and IPV perpetration in the last 12 months. RESULTS Four datasets contributed to meta-mediation analyses, with a combined sample of 12,679 participants. Depression was associated with a 7.4% and 4.8% proportion increase of past-year physical IPV perpetration among women and men, respectively. We found no evidence of mediation by alcohol misuse. Among women, past-year IPV victimisation mediated 45% of the total effect of depression on past-year IPV perpetration. Past-year severe IPV victimisation mediated 60% of the total effect of depression on past-year severe IPV perpetration. We could not investigate IPV victimisation as a mediator among men due to perfect prediction. CONCLUSIONS Mental health services, criminal justice services, and domestic violence perpetrator programmes should be aware that depression is associated with increased risk of IPV perpetration. Interventions to reduce IPV victimisation might help prevent IPV perpetration by women. Data collection on mental disorder and IPV perpetration should be strengthened in future population-based surveys, with greater consistency of data collection across surveys, as only four studies were able to contribute to the meta-mediation analysis.
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Affiliation(s)
- Katherine R K Saunders
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Sabine Landau
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Louise M Howard
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen L Fisher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Louise Arseneault
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Geraldine F H McLeod
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Sian Oram
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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21
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魏 泸, 杨 先, 范 箬, 王 丹, 刘 军, 何 昌, 李 杨, 左 传, 周 涵, 刘 祥, 刘 元. [Association Between Medication Compliance and Various Risky Behaviors in Patients With Schizophrenia]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1201-1207. [PMID: 38162067 PMCID: PMC10752770 DOI: 10.12182/20231360303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Indexed: 01/03/2024]
Abstract
Objective To investigate the status of medication adherence and various types of risky behaviors of schizophrenia patients in a certain area of western China and to explore accordingly the correlation between the two. Methods A total of 292 667 patients with schizophrenia were enrolled in a follow-up survey between 2006 and 2018. In addition, based on the outcome-wide analysis strategy, a multivariate Cox proportional risk regression model was used to estimate and compare the impact of medication adherence on different types of risky behaviors in schizophrenia patients. Results In this 13-year prospective cohort, 65 175 patients (31.4%) showed good medication adherence, while 142 394 patients (68.6%) showed poor medication adherence. The incidence rates of various risky behaviors during the follow-up period were as follows, minor nuisances, 12.25%, violation of the Law of the People's Republic of China on Penalties for Administration of Public Security (APS law), 3.82%, violation of criminal law, 0.94%, suicide completed, 0.28%, self-harm, 1.42%, and attempted suicide, 0.82%. Schizophrenia patients who had poor medication adherence had higher risks of committing violence against others and self-inflicted injury compared to patients with good medication adherence did, with the associated effects being minor nuisances (hazard ratio [HR]=1.31, 95% confidence interval [CI]: 1.27-1.35), violation of APS law (HR=1.47, 95% CI: 1.38-1.56), violation of criminal law (HR=1.17, 95% CI: 1.05-1.31), and self-harm (HR=1.43, 95% CI: 1.32-1.56), respectively, while the risk of suicide completed is lower in schizophrenia patients with poor medication adherence than that in patients with good medication adherence (HR=0.56, 95% CI: 0.47-0.66). There was no statistically significant association between attempted suicide and medication adherence. Conclusion There are variations in the direction and strength of the association between medication adherence and different types of risky behaviors and further research is needed to elucidate the mechanisms of the association.
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Affiliation(s)
- 泸懿 魏
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 先梅 杨
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 箬馨 范
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 丹 王
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 军 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 昌九 何
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 杨 李
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 传隆 左
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 涵闻 周
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 祥 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 元元 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 流行病与卫生统计学系 (成都 610041)Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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22
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Tao Z. 106 Cases of homicide poisoning in China-A retrospective study. Leg Med (Tokyo) 2023; 65:102317. [PMID: 37651821 DOI: 10.1016/j.legalmed.2023.102317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/14/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
Homicidal poisoning has received limited scholarly attention, despite having recently increased in frequency in China, especially in rural areas, where it causes numerous deaths and disabilities. In this study, the author collected data on 106 cases of homicidal poisoning from 1995 to 2000. Of these cases 105 were found through website established by the Supreme Court of China, and one case was as an exception identified from the internet. There were 46 male perpetrators and 59 female perpetrators. The most common reason male perpetrators poisoned someone was conflict among neighbours (include residents in the same village) (ten cases), and the most common reason female perpetrators did so was an affair (13 cases). Compared with the perpetrators of general homicide, those who poisoned people included a high proportion of female, elderly, and well-educated individuals. This is related to the nonviolent nature of the poisoning, which requires no physical strength. Residents living in rural and urban areas chose poisoning based on convenience. People living in rural areas used pesticides most often, and people in urban areas have greater access to drugs or medications obtained at work or online. In this study, a total of 9.4% of the perpetrators were diagnosed with psychiatric disorders or psychosis. In all, the 106 cases resulted in 58 human deaths. Tetramine and paraquat caused many of the deaths, and this suggests a need for the government to manage and monitor these highly toxic pesticides. These cases are representative of issues in contemporary Chinese society, for example, population mobility, fierce competition.
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Affiliation(s)
- Zhuoli Tao
- The Psychology Research Center, Department of Medical Humanities, the School of Humanities, National Southeast University China.
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23
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Arpalahti A, Haapanen A, Auro K, Abio A, Snäll J. Psychiatric disorders and interventions in patients sustaining facial fractures from interpersonal violence. Head Face Med 2023; 19:45. [PMID: 37872614 PMCID: PMC10591386 DOI: 10.1186/s13005-023-00393-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This retrospective study clarified patients´ psychiatric morbidity in IPV-related facial fractures; in particular, their additional psychiatric care. We hypothesized that patients in need of additional support can be identified, allowing overall care processes to be improved. METHODS Patients' age, sex, anamnestic psychiatric disorders, history of substance abuse, and psychiatric interventions were recorded, as well as the perpetrator, location, time of day, assault mechanism, fracture type, treatment, and associated injuries. RESULTS In all, 807 adult patients were included in the study. Of these, 205 patients (25.4%) had anamnestic psychiatric disorders that were associated independently with female sex (OR 1.95, 95% CI 1.12, 3.41; p = 0.019) or history of substance abuse (OR 5.82, 95% CI 4.01, 8.46; p < 0.001). Patients with anamnestic psychiatric disorder were more likely to be subjected to severe violence, with an increased risk for combination fractures (OR 2.51, 95% CI 1.30, 4.83; p = 0.006). Of all patients, 61 (7.6%) received a psychiatric intervention within the first 12 months. The most common reasons for intervention were anxiety/fear and psychotic symptoms, surfacing within one month in 57% of patients. Anamnestic psychiatric disorders (OR 2.00, 95% CI 1.04, 3.82; p = 0.036), severe mental illnesses (OR 2.45, 95% CI 1.04, 5.77; p = 0.040), and use of an offensive weapon (OR 2.11, 95% CI 1.11, 4.02; p = 0.023) were the strongest independent predictors of psychiatric intervention. CONCLUSIONS Our results emphasize the need for more structured treatment protocols for patients sustaining IPV injury. Special attention is recommended for patients with anamnestic psychiatric disorders, severe mental illnesses, and those assaulted with an offensive weapon.
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Affiliation(s)
- Annamari Arpalahti
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, 00029, HUS, Finland.
| | - Aleksi Haapanen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, 00029, HUS, Finland
| | - Kirsi Auro
- Department of Psychiatry and Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Population Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Anne Abio
- Injury Epidemiology and Prevention Research Group, Division of Clinical Neurosciences, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, 00029, HUS, Finland
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Schmidt C, Anna Seeger N, Brackmann N, Guldimann A, Habermeyer E. [Forensic-Psychiatric Consultations in General Psychiatry]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023. [PMID: 37871616 DOI: 10.1055/a-2182-6606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
A subgroup of psychiatric patients are at increased risk of committing interpersonal violence, which may lead to placements in forensic-psychiatric institutions. The majority of patients treated in forensic hospitals have had contact with the general psychiatric care system years before being forensically committed due to an offence. Nevertheless, attempts to establish models related to violence prevention in general psychiatry have remained sparse. In the Canton of Zurich, the forensic psychiatric consultation liaison service provides the general psychiatric clinics with access to forensic psychiatric expertise. In this paper, we describe the consultation service's diagnostic and advisory offers and aim to characterize the patient population seen by the service. We compared the three most common diagnostic groups (schizophrenic, affective and personality disorders) regarding reason for consultation, history of violence and substance abuse. In addition, we analyzed content and kind of the recommendations made. From 2013 to 2021, 188 patients in general psychiatric clinics in Zurich have been examined after informed consent. Most patients had a positive history of violence (72.7%) and substance use (66.1%). Almost half of the patients (48.4%) had been diagnosed with schizophrenia or a related disorder.
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Affiliation(s)
- Catharina Schmidt
- Klinik für Forensische Psychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
| | - Natalia Anna Seeger
- Klinik für Forensische Psychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
| | - Nathalie Brackmann
- Klinik für Forensische Psychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
| | - Angela Guldimann
- Klinik für Forensische Psychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
| | - Elmar Habermeyer
- Klinik für Forensische Psychiatrie, Psychiatrische Universitätsklinik Zürich, Zürich, Switzerland
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25
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Sagayadevan V, Satghare P, Jeyagurunathan A, Koh YS, Shafie S, Chang S, Samari E, Subramaniam M. Mediating effect of symptom severity on the relationship between aggression, impulsivity and quality of life outcomes among patients with schizophrenia and related psychoses. Front Psychiatry 2023; 14:1154083. [PMID: 37810606 PMCID: PMC10556254 DOI: 10.3389/fpsyt.2023.1154083] [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: 01/30/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Aims Aggression and impulsivity among individuals with schizophrenia have been associated with poor clinical outcomes including worsening of symptoms and substance abuse which have been linked to a lower quality of life (QoL). The current study aimed to look at the mediating effect of symptom severity on the relationship between aggression, impulsivity and QoL among outpatients with schizophrenia and related psychoses in a multi-ethnic Asian population. Methods Data (n = 397) were collected from outpatients seeking treatment at the Institute of Mental Health. The World Health Organization quality of life-BREF (WHOQOL-BREF) scale, the symptoms checklist-90 revised (SCL-90-R), Buss Perry aggression questionnaire (BPAQ), and the Barratt impulsiveness scales (BIS) were used to assess subjective well-being, symptom severity, aggression, and impulsivity, respectively. Mediation analysis was performed using the PROCESS macro to understand the mediating effect of symptom severity. Results Motor impulsivity (MI) was indirectly associated with both the physical and psychological health domains of QoL while self-control was indirectly associated with the physical, psychological, and environmental health QoL domains through increased symptom severity. Conclusion The significant indirect effect of symptom severity in our study highlights one potential pathway through which impulsivity impacts the QoL of individuals with schizophrenia and related psychoses. Elucidating other factors besides symptom severity that have an indirect effect on the QoL of individuals provides alternative approaches for treatment through which better clinical outcomes can be achieved.
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Barlati S, Nibbio G, Stanga V, Giovannoli G, Calzavara-Pinton I, Necchini N, Lisoni J, Deste G, Vita A. Cognitive and clinical characteristics of offenders and non-offenders diagnosed with schizophrenia spectrum disorders: results of the Recoviwel observational study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1307-1316. [PMID: 36309882 DOI: 10.1007/s00406-022-01510-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/19/2022] [Indexed: 11/26/2022]
Abstract
The association between schizophrenia spectrum disorders (SSD) and violent behavior is complex and requires further research. The cognitive correlates of violent behavior, in particular, remain to be further investigated. Aims of the present study were to comprehensively assess the cognitive and clinical profile of SSD violent offenders and evaluate individual predictors of violent behavior. Fifty inmates convicted for violent crimes in a forensic psychiatry setting and diagnosed with SSD were compared to fifty non-offender patients matched for age, gender, education, and diagnosis. Offender and non-offender participants were compared based on socio-demographic, clinical, and cognitive variables using non-parametric testing to select potential predictors of violent behavior. Multivariate logistic regressions were then performed to identify individual predictors of violent behavior. Offender participants showed more school failures, higher prevalence of substance use, higher Clinical Global Impression Severity Scale (CGI-S) and Positive and Negative Syndrome Scale Excited Component (PANSS-EC) scores, worse working memory and better attention performance, higher Historical Clinical and Risk Management scale 20 (HCR-20) and Hare Psychopathy Checklist (PCL-R) scores in all subdomains and factors. School failures, higher PANSS-EC scores, worse working memory and processing speed, better attention performance, higher scores in HCR-20 Management subscale and the PCL-R "Callous" factor emerged as predictors of violent behavior. Better attentional performance was correlated with higher PCL-R "Callous" factor scores, worse cognitive performance in several domains with higher PCL-R "Unstable" factor scores. In conclusion, the present study highlights the importance of carefully assessing SSD patients with violent behavior in all clinical, cognitive, and behavioral aspects.
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Affiliation(s)
- Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Valentina Stanga
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giulia Giovannoli
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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Penney SR, Faziluddin S, Simpson AIF, Socha P, Wilkie T. Risk, resilience, and recovery in forensic mental health: An integrated conceptual model. BEHAVIORAL SCIENCES & THE LAW 2023; 41:280-291. [PMID: 36898979 DOI: 10.1002/bsl.2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
In this paper we describe a novel, integrated conceptual model that brings together core elements across structured tools assessing risk for future violence, protective factors, and progress in treatment and recovery in forensic mental health settings. We argue that the value of such a model lies in its ability to improve clinical efficiencies and streamline assessment protocols, facilitate meaningful participation of patients in assessment and treatment planning activities and increase the accessibility of clinical assessments to principal users of this information. The four domains appearing in the model (treatment engagement, stability of illness and behavior, insight, and professional and personal support) are described, and common clinical manifestations of each domain within a forensic context are illustrated. We conclude with a discussion of the types of research that would be needed to validate a concept model such as the one presented here as well as implications for clinical practice and implementation.
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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
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Suraya Faziluddin
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Alexander I F Simpson
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patti Socha
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Treena Wilkie
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Machetanz L, Hofmann AB, Möhrke J, Kirchebner J. Offenders and non-offenders with schizophrenia spectrum disorders: the crime-preventive potential of sufficient embedment in the mental healthcare and support system. Front Psychiatry 2023; 14:1231851. [PMID: 37711423 PMCID: PMC10498463 DOI: 10.3389/fpsyt.2023.1231851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/04/2023] [Indexed: 09/16/2023] Open
Abstract
Background Suffering from schizophrenia spectrum disorder (SSD) has been well-established as a risk factor for offending. However, the majority of patients with an SSD do not show aggressive or criminal behavior. Yet, there is little research on clinical key features distinguishing offender from non-offender patients. Previous results point to poorer impulse control, higher levels of excitement, tension, and hostility, and worse overall cognitive functioning in offender populations. This study aimed to detect the most indicative distinguishing clinical features between forensic and general psychiatric patients with SSD based on the course of illness and the referenced hospitalization in order to facilitate a better understanding of the relationship between violent and non-violent offenses and SSD. Methods Our study population consisted of forensic psychiatric patients (FPPs) with a diagnosis of F2x (ICD-10) or 295.x (ICD-9) and a control group of general psychiatric patients (GPPs) with the same diagnosis, totaling 740 patients. Patients were evaluated regarding their medical (and, if applicable, criminal) history and the referenced psychiatric hospitalization. Supervised machine learning (ML) was used to exploratively evaluate predictor variables and their interplay and rank them in accordance with their discriminative power. Results Out of 194 possible predictor variables, the following 6 turned out to have the highest influence on the model: olanzapine equivalent at discharge from the referenced hospitalization, a history of antipsychotic prescription, a history of antidepressant, benzodiazepine or mood stabilizer prescription, medication compliance, outpatient treatment(s) in the past, and the necessity of compulsory measures. Out of the seven algorithms applied, gradient boosting emerged as the most suitable, with an AUC of 0.86 and a balanced accuracy of 77.5%. Discussion Our study aimed to identify the most influential illness-related predictors, distinguishing between FPP and GPP with SSD, thus shedding light on key differences between the two groups. To our knowledge, this is the first study to compare a homogenous sample of FPP and GPP with SSD regarding their symptom severity and course of illness using highly sophisticated statistical approaches with the possibility of evaluating the interplay of all factors at play.
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Affiliation(s)
- Lena Machetanz
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Andreas B. Hofmann
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Jan Möhrke
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Bo S, Sharp C, Lind M, Simonsen S, Bateman A. Mentalizing mediates the relationship between psychopathy and premeditated criminal offending in schizophrenia: a 6-year follow-up study. Nord J Psychiatry 2023; 77:547-559. [PMID: 36897045 DOI: 10.1080/08039488.2023.2186483] [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: 11/11/2022] [Revised: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Research has shown that schizophrenia augments the risk for criminal behaviour and variables both defining- and related to schizophrenia, increase criminal offending. Premeditated criminal offending is considered a severe form of criminal offending, however, very little is known about what predicts future premeditated criminal offending in schizophrenia. METHOD AND MATERIALS In this 6-year follow-up study we explored which factors underlie future premeditated criminal behaviour in a sample of patients diagnosed with schizophrenia (N = 116). We also investigated if a specific mentalizing profile underlie part of the variance of premeditated criminal offending. RESULTS Results showed that psychopathy underlie future premeditated crime in schizophrenia, and that a specific mentalizing profile, comprised of a dysfunctional emotional and intact cognitive mentalizing profile in relation to others, mediated parts of the relation between psychopathy and premeditated criminal offending. Finally, our results indicated that patients with schizophrenia with a specific mentalizing profile (see above) engaged in premeditated criminal behaviour earlier during the 6-year follow-up period compared to patients with other mentalizing profiles. CONCLUSIONS Our findings suggest that mentalization should carefully be inspected in patients with schizophrenia in relation to future premeditated offending.
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Affiliation(s)
- Sune Bo
- Department of Psychology, University of Copenhagen, DK and Department of Psychiatry, Denmark
| | - Carla Sharp
- Department of Psychology, University of Houston, USA
| | - Majse Lind
- Department of Psychology, University of Aalborg, Denmark
| | - Sebastian Simonsen
- Department of Psychology, University of Copenhagen, and Stolpegaard Psychotherapy Centre, Denmark
| | - Anthony Bateman
- Psychoanalysis Unit, University College London, United Kingdom
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30
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van Beek J, Meijers J, Scherder EJA, Harte JM. Aggressive Incidents by Incarcerated People With Psychiatric Illness and Their Relationship With Psychiatric Symptoms. JOURNAL OF FORENSIC NURSING 2023; 19:E30-E38. [PMID: 37590946 DOI: 10.1097/jfn.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
AIM A prospective design was used to investigate the relationship of current psychiatric symptoms of incarcerated people with serious mental illness (SMI) and aggressive behavior on a penitentiary ward for crisis intervention. METHODS One hundred sixty detainees with SMI, detained in a high-security penitentiary psychiatric facility, were screened every 2 weeks with the Brief Psychiatric Rating Scale-Extended (BPRS-E) by trained clinicians, to ensure that the data on psychiatric symptoms were up-to-date. Aggressive behavior was registered with the Staff Observation Aggression Scale-Revised. A binary logistic regression analysis was performed to examine the relationships between factor scores of the BPRS-E and aggressive behavior. RESULTS Significant relationships between the BPRS-E factor hostility, antisocial traits, and aggressive incidents were found, but not between the positive symptoms or manic factor scores and aggressive incidents. DISCUSSION Symptoms of SMI measured with the BPRS-E did not help to explain the occurrence of aggressive behavior. This is not in line with what is commonly found. The implication is that it can be expected that this population will display aggressive behavior but that symptoms do not help in predicting when this will occur. In addition, hostility and antisocial traits were related to aggressive behavior. For this specific population, an interactional approach might be more effective in the management of aggression than treatment of symptoms of SMI.
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Affiliation(s)
| | | | - Erik J A Scherder
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam
| | - Joke M Harte
- Department of Criminal Law and Criminology, Faculty of Law, Vrije Universiteit Amsterdam
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Wolf V, Mayer J, Steiner I, Franke I, Klein V, Streb J, Dudeck M. Risk factors for violence among female forensic inpatients with schizophrenia. Front Psychiatry 2023; 14:1203824. [PMID: 37457783 PMCID: PMC10347379 DOI: 10.3389/fpsyt.2023.1203824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Schizophrenia is associated with a heightened risk of violent behavior. However, conclusions on the nature of this relationship remain inconclusive. Equally, the empirical evidence on female patients with schizophrenia spectrum disorders (SSD) is strongly underrepresented. Methods For this purpose, the first aim of the present retrospective follow-up study was to determine the risk factors of violence in a sample of 99 female SSD patients discharged from forensic psychiatric treatment between 2001 and 2017, using three different measures of violence at varying time points (i.e., violent index offense, inpatient violence, and violent recidivism). Potential risk factors were retrieved from the relevant literature on SSD as well as two violence risk assessment instruments (i.e., HCR-20 V3, FAM). Further, we aimed to assess the predictive validity of the HCR-20 V3 in terms of violent recidivism and evaluate the incremental validity of the FAM as a supplementary gender-responsive assessment. Results The given results indicate strong heterogeneity between the assessed violence groups in terms of risk factors. Particularly, violence during the index offense was related to psychotic symptoms while inpatient violence was associated with affective and behavioral instability as well as violent ideation/intent, psychotic symptoms, and non-responsiveness to treatment. Lastly, violent recidivism was related to non-compliance, cognitive instability, lack of insight, childhood antisocial behavior, and poverty. Further, the application of the HCR-20 V3 resulted in moderate predictive accuracy (AUC = 0.695), while the supplementary assessment of the FAM did not add any incremental validity. Discussion This article provides important insights into the risk factors of violence among female SSD patients while highlighting the importance of differentiating between various forms of violence. Equally, it substitutes the existing evidence on violence risk assessment in female offenders with SSD.
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Affiliation(s)
- Viviane Wolf
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Clinic Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Juliane Mayer
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Ivonne Steiner
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Irina Franke
- Psychiatric Services of Grisons, Chur, Switzerland
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Guenzburg, Germany
| | - Verena Klein
- Department of Forensic Psychiatry and Psychotherapy, kbo-Isar-Amper-Clinic Taufkirchen (Vils), Taufkirchen (Vils), Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Guenzburg, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Guenzburg, Germany
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Dan-Glauser E, Framorando D, Solida-Tozzi A, Golay P, Gholam MM, Alameda L, Conus P, Moulin V. Evolution of impulsivity levels in relation to early cannabis use in violent patients in the early phase of psychosis. Psychol Med 2023; 53:3210-3219. [PMID: 35142601 PMCID: PMC10235661 DOI: 10.1017/s0033291721005316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 09/27/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prevention of violent behaviors (VB) in the early phase of psychosis (EPP) is a real challenge. Impulsivity was shown to be strongly related to VB, and different evolutions of impulsivity were noticed along treatments. One possible variable involved in the relationship between VB and the evolution of impulsivity is cannabis use (CU). The high prevalence of CU in EPP and its relationship with VB led us to investigate: 1/the impact of CU and 2/the impact of early CU on the evolution of impulsivity levels during a 3-year program, in violent and non-violent EPP patients. METHODS 178 non-violent and 62 violent patients (VPs) were followed-up over a 3 year period. Age of onset of CU was assessed at program entry and impulsivity was assessed seven times during the program. The evolution of impulsivity level during the program, as a function of the violent and non-violent groups of patients and CU precocity were analyzed with linear mixed-effects models. RESULTS Over the treatment period, impulsivity level did not evolve as a function of the interaction between group and CU (coef. = 0.02, p = 0.425). However, when including precocity of CU, impulsivity was shown to increase significantly only in VPs who start consuming before 15 years of age (coef. = 0.06, p = 0.008). CONCLUSION The precocity of CU in VPs seems to be a key variable of the negative evolution of impulsivity during follow-up and should be closely monitored in EPP patients entering care since they have a higher risk of showing VB.
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Affiliation(s)
- Elise Dan-Glauser
- Department of psychiatry, Institute of Forensic Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Psychology, Lausanne University, Lausanne, Switzerland
| | - David Framorando
- Department of psychiatry, Institute of Forensic Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Alessandra Solida-Tozzi
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Philippe Golay
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - M. Mehdi Gholam
- Department of Psychiatry, Center for Psychiatric Epidemiology and Psychopathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Instituto de Investigación Sanitaria de Sevilla, Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Sevilla, Spain
- Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Philippe Conus
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Valerie Moulin
- Department of psychiatry, Institute of Forensic Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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de Girolamo G, Iozzino L, Ferrari C, Gosek P, Heitzman J, Salize HJ, Wancata J, Picchioni M, Macis A. A multinational case-control study comparing forensic and non-forensic patients with schizophrenia spectrum disorders: the EU-VIORMED project. Psychol Med 2023; 53:1814-1824. [PMID: 34511148 PMCID: PMC10106295 DOI: 10.1017/s0033291721003433] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The relationship between schizophrenia and violence is complex. The aim of this multicentre case-control study was to examine and compare the characteristics of a group of forensic psychiatric patients with a schizophrenia spectrum disorders and a history of significant interpersonal violence to a group of patients with the same diagnosis but no lifetime history of interpersonal violence. METHOD Overall, 398 patients (221 forensic and 177 non-forensic patients) were recruited across five European Countries (Italy, Germany, Poland, Austria and the United Kingdom) and assessed using a multidimensional standardised process. RESULTS The most common primary diagnosis in both groups was schizophrenia (76.4%), but forensic patients more often met criteria for a comorbid personality disorder, almost always antisocial personality disorder (49.1 v. 0%). The forensic patients reported lower levels of disability and better social functioning. Forensic patients were more likely to have been exposed to severe violence in childhood. Education was a protective factor against future violence as well as higher levels of disability, lower social functioning and poorer performances in cognitive processing speed tasks, perhaps as proxy markers of the negative syndrome of schizophrenia. Forensic patients were typically already known to services and in treatment at the time of their index offence, but often poorly compliant. CONCLUSIONS This study highlights the need for general services to stratify patients under their care for established violence risk factors, to monitor patients for poor compliance and to intervene promptly in order to prevent severe violent incidents in the most clinically vulnerable.
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Affiliation(s)
- Giovanni de Girolamo
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Laura Iozzino
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Pawel Gosek
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Janusz Heitzman
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Hans Joachim Salize
- Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Johannes Wancata
- Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Marco Picchioni
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- St Magnus Hospital, Haslemere, Surrey, UK
| | - Ambra Macis
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Tseligkaridou G, Egger ST, Spiller TR, Schneller L, Frauenfelder F, Vetter S, Seifritz E, Burrer A. Relationship between antipsychotic medication and aggressive events in patients with a psychotic disorder hospitalized for treatment. BMC Psychiatry 2023; 23:205. [PMID: 36978013 PMCID: PMC10052831 DOI: 10.1186/s12888-023-04692-1] [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: 01/29/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Disruptive and aggressive behavior is frequent in patients with a psychotic disorder; furthermore, it is a recurrent reason for compulsory admission. Even during treatment, many patients continue to show aggressive behavior. Antipsychotic medication is posed to have anti-aggressive properties; its prescription is a common strategy for the treatment (and prevention) of violent behavior. The present study aims to investigate the relation between the antipsychotic class, according to the dopamine D2-Receptor binding affinity (i.e., "loose" - "tight binding"), and aggressive events perpetrated by hospitalized patients with a psychotic disorder. METHODS We conducted a four-year retrospective analysis of legally liable aggressive incidents perpetrated by patients during hospitalization. We extracted patients' basic demographic and clinical data from electronic health records. We used the Staff Observation Aggression Scale (SOAS-R) to grade the severity of an event. Differences between patients with a "loose" or "tight-binding" antipsychotic were analyzed. RESULTS In the observation period, there were 17,901 direct admissions; and 61 severe aggressive events (an incidence of 0.85 for every 1,000 admissions year). Patients with a psychotic disorder perpetrated 51 events (incidence of 2.90 for every 1,000 admission year), with an OR of 15.85 (CI: 8.04-31.25) compared to non-psychotic patients. We could identify 46 events conducted by patients with a psychotic disorder under medication. The mean SOAS-R total score was 17.02 (2.74). The majority of victims in the "loose-binding" group were staff members (73.1%, n = 19), while the majority of victims in the "tight-binding" group were fellow patients (65.0%, n = 13); (X2(3,46) = 19.687; p < 0.001). There were no demographic or clinical differences between the groups and no differences regarding dose equivalents or other prescribed medication. CONCLUSIONS In aggressive behaviors conducted by patients with a psychotic disorder under antipsychotic medication, the dopamine D2-Receptor affinity seems to have a high impact on the target of aggression. However, more studies are needed to investigate the anti-aggressive effects of individual antipsychotic agents.
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Affiliation(s)
- Georgia Tseligkaridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Lena Schneller
- Legal and Compliance, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Fritz Frauenfelder
- Department of Nursing, Therapies and Social Work, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Achim Burrer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
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Rau T, Mayer S, Heimgartner A, Allroggen M. [Experiences of dangerous situations in psychiatry and psychotherapy involving patients with extremist attitudes]. DER NERVENARZT 2023; 94:408-416. [PMID: 36947217 PMCID: PMC10031705 DOI: 10.1007/s00115-023-01469-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Dangerous situations in connection with the treatment of persons with suspected extremist attitudes have become increasingly relevant. A survey of physicians and psychotherapists is intended to provide information about concrete dangerous situations among these patients. MATERIALS AND METHODS By means of an anonymous online survey, which comprised 16 main questions and up to 95 additional questions, a total of 364 health professionals were asked about the general situation and about patients, as well as relatives with suspected extremist attitudes. RESULTS In all, 17.5% of the participants were physicians, 72.1% psychotherapists. 47.7% work exclusively in a hospital, 34.2% in a private practice. A total of 57.7% of the participants have already treated patients with suspected extremist attitudes (46.7% treated relatives); 27.6% were confronted with situations of self-endangerment (30.1% in the case of relatives), 49.5% with situations of danger to others (18.3% in the case of relatives), in which they often did not feel safe. Altogether, 20.3% of the professionals informed security authorities, and not quite half found this contact to be comparatively unhelpful/not at all helpful (45.5% among relatives). The majority of the participants had no contact to other agencies, such as specialized counselling centres for deradicalization. Physicians experienced the situations of endangerment more often than non-medical psychotherapists. A comparison between professionals from hospitals and private practices shows no significant differences. DISCUSSION The study was able to show that extremism and the associated dangerous situations are an important topic in the treatment of patients and that physicians and non-medical psychotherapists should be well prepared. Networking with extremism prevention agencies and good cooperation with security authorities would be important and desirable for the future.
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Affiliation(s)
- Thea Rau
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland.
| | - Sophia Mayer
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland
| | - Anna Heimgartner
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland
| | - Marc Allroggen
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland
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Guo W, Gu Y, Zhou J, Wang X, Sun Q. Characteristics and associated factors of violence in male patients with schizophrenia in China. Front Psychiatry 2023; 14:1106950. [PMID: 36970285 PMCID: PMC10036402 DOI: 10.3389/fpsyt.2023.1106950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectiveTo investigate the characteristics and associated factors of violence in male patients with schizophrenia in China.MethodsA total of 507 male patients with schizophrenia were recruited, including 386 non-violent and 121 violent patients. The socio-demographic information and medical history of the patients were collected. Psychopathological characteristics, personality traits psychopathology, and factors related to risk management were assessed using the Brief Psychiatric Rating Scale (BPRS), the History of Violence, Clinical, Risk Assessment Scale (HCR-20), and the Psychopathy Checklist-Revised (PCL-R), as appropriate. Differences in these factors were compared between the violent and non-violent patients, and logistic regression analysis was performed to explore the risk factors for violence in male patients with schizophrenia.ResultsThe results showed that the violent group had a lower level of education, longer duration of illness, as well as a higher rate of hospitalization, history of suicidal attempts, and history of alcohol compared with the non-violent group. The violent group scored higher in items of symptoms in BPRS, personality traits and psychopathy in PCL-R, and risk management in HCR-20. The regression analysis showed that previous suicidal behavior (OR = 2.07,95% CI [1.06-4.05], P = 0.033), antisocial tendency in PCL-R (OR = 1.21, 95% CI [1.01-1.45], P = 0.038), H2: young age at violent incident (OR = 6.39, 95% CI [4.16-9.84], P < 0.001), C4: impulsivity (OR = 1.76, 95% CI [1.20-2.59], P = 0.004), and H3: relationship instability (OR = 1.60, 95% CI [1.08-2.37], P = 0.019) in HCR-20 were risk factors of violence among male patients with schizophrenia.ConclusionThe present study found significant differences in socio-demographic information, history of treatment, and psychopathy characteristics between male patients with schizophrenia who had engaged in violent behaviors and their non-violent counterparts in China. Our findings suggested the necessity of individualized treatment for male patients with schizophrenia who had engaged in violent behaviors as well as the use of both HCR-20 and PCL-R for their assessment.
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Affiliation(s)
- Weilong Guo
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Yu Gu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Jiansong Zhou
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Xiaoping Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
| | - Qiaoling Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, Hunan, China
- *Correspondence: Qiaoling Sun,
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Fekih-Romdhane F, Maktouf H, Cheour M. Aggressive behaviour in antipsychotic-naive first-episode schizophrenia patients, their unaffected siblings and healthy controls. Early Interv Psychiatry 2023; 17:299-310. [PMID: 35712845 DOI: 10.1111/eip.13329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 04/17/2022] [Accepted: 05/29/2022] [Indexed: 12/26/2022]
Abstract
AIM While patients with schizophrenia are more likely to be victims rather than perpetrators of aggressive behaviour, prior research has shown increased rates of aggressive behaviours in these patients that appear very early in the course of illness. We aimed to assess aggression in antipsychotic-naive first-episode schizophrenia patients, their healthy siblings, and controls; and to investigate correlates of aggression in the patients group. METHODS Patients (N = 55), siblings (N = 55) and healthy controls (N = 71) were evaluated on Buss and Perry Aggression Questionnaire (AQ), Life History of Aggression (LHA), Barratt Impulsiveness Scale, and Levenson Self-Report Psychopathy Scale. Age, gender and substance use were regarded as covariates, and differences between the three groups were evaluated using analysis of covariance. Hierarchical regression was performed to determine which variables were associated with aggression level in the patients group. RESULTS The Tukey multiple comparison test showed that both patients (p < .001) and siblings (p = .023) scored higher on the LHA Aggression than controls. Siblings scored higher than controls (p = .010) for the Anger subscale of the AQ. Patients scored significantly higher than controls in the three impulsiveness dimensions; whereas siblings scored higher than controls in the motor (p = .023) and non-planning (p = .004) dimensions. Multivariate analyses showed that, after controlling for confounders, only attentional impulsiveness (β = .446, p = .0244) and psychopathy traits (β = .359, p = .010) helped predict AQ total scores among patients. CONCLUSION Aggression and some of its risk factors including impulsiveness are likely to be trait variables that might provide important vulnerability markers for people at heightened risk of developing psychosis.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, Tunisia
| | - Hela Maktouf
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, Tunisia
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, Tunisia
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Zhang L, Qi X, Wen L, Hu X, Mao H, Pan X, Zhang X, Fang X. Identifying risk factors to predict violent behaviour in community patients with severe mental disorders: A retrospective study of 5277 patients in China. Asian J Psychiatr 2023; 83:103507. [PMID: 36796125 DOI: 10.1016/j.ajp.2023.103507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/07/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Patients with Severe Mental Disorders (SMD) have a higher risk of violent behaviour than the general population. The study aimed to investigate the predictive factors for the occurrence of violent behaviour in community SMD patients. METHODS The cases and follow-up data were collected from SMD patient Information Management system in Jiangning District, Jiangsu Province. The incidence of violent behaviours was described and analyzed. Logistic regression model was used to examine the influencing factors for violent behaviours in those patients. RESULTS Among 5277 community patients with SMD in Jiangning District, 42.4% (2236/5277) had violent behaviours. The stepwise logistic regression analysis revealed that the disease-related factors (including disease type, disease course, times of hospitalization, medication adherence, past violent behaviours), the demographic factors (age, male sex, educational level, economic and social living status), and the policy-related factors (like free treatment, annual physical check, disability certificate, family physician services, and community interviews) were significantly related to the violent behaviours in community SMD patients. After gender stratification, we found that male patients with unmarried status and with a longer course of disease were more likely to violent. However, we found that female patients with lower economic status and educational experience were more likely to violent. CONCLUSION Our results suggest that community SMD patients had a high incidence of violent behaviour. The findings may provide valuable information for policymakers and mental health professionals worldwide taking a number of measures to reduce the incidence of violence in community SMD patients and to better maintain social security.
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Affiliation(s)
- Lin Zhang
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Xin Qi
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Lu Wen
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Xiuxiu Hu
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Hongjun Mao
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Xinming Pan
- Department of Psychiatry, the Second People's Hospital of Jiangning District, Nanjing, Jiangsu, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Psychiatry, The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
| | - Xinyu Fang
- Department of Geriatric Psychiatry, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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[Cannabis use and impulsivity in violent behaviour]. L'ENCEPHALE 2023; 49:97-99. [PMID: 35738924 DOI: 10.1016/j.encep.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/18/2022] [Indexed: 01/21/2023]
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Müller M, Brackmann N, Jäger M, Theodoridou A, Vetter S, Seifritz E, Hotzy F. Predicting coercion during the course of psychiatric hospitalizations. Eur Psychiatry 2023; 66:e22. [PMID: 36700423 PMCID: PMC9981454 DOI: 10.1192/j.eurpsy.2023.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Coercive measures (such as seclusion, mechanical restraint, and forced medication) during psychiatric inpatient treatment should be avoided whenever possible. Different interventions were already developed to reduce coercion, but for their effective application, it is crucial to know the risk factors of individuals and clinical situations that might be associated with coercion. Since the results of previous studies differ considerably the current study aims to fill this gap by evaluating the course of the exertion of coercion in detail. METHODS In this study, we analyzed clinical, procedural, and sociodemographic data from patients (n = 16,607 cases) who were treated as inpatients in Switzerland's largest psychiatric institution with 320 beds during the years 2017 to 2020. We used regression models to identify predictors for the exertion of coercion, the number of coercive measures during a treatment episode and time until exertion of the first and last coercive measure. RESULTS Coercive measures are mostly used during the first days of treatment. We identified clinical parameters such as manic or psychotic episodes to be the most relevant predictors for the exertion of coercion. Cases with those disorders also received coercion more often and earlier in their treatment course than other diagnostic groups. Other promoting factors for frequency and early application of coercion were involuntary admission and factors of chronicity and clinical severity. CONCLUSIONS Knowing the risk factors may help to target preventive strategies for those at highest risk. In particular, interventions should focus on the critical timeframe at the beginning of treatment.
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Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Nathalie Brackmann
- Department of Forensic Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Florian Hotzy
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zürich, Switzerland
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李 硕, 杨 先, 王 丹, 范 箬, 田 绍, 王 荣, 向 虎, 张 强, 刘 元, 刘 祥. [Factors Influencing Suicide Deaths in Patients With Schizophrenia Based on Cohort Data: An Empirical Study of a Sample of 170006 Patients in Sichuan Province]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:142-147. [PMID: 36647657 PMCID: PMC10409051 DOI: 10.12182/20230160302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 01/18/2023]
Abstract
Objective To prospectively explore the risk factors of suicide in patients with schizophrenia. Methods Data on schizophrenia patients in Sichuan Province between 2006 and 2018 were obtained from the National Severe Mental Disorders Information System, and the Cox proportional hazards regression model was used to explore for risk factors for suicide in schizophrenia patients. Result A total of 170006 patients with schizophrenia were included in the study. At the end of the follow-up period, 160570 patients were alive and 9436 died from various causes, 929 of which being suicide deaths, resulting in a suicide rate of 223.61/100, 000 person-years. The Cox proportional hazards regression model suggested that risk factors for suicide in patients with schizophrenia included poverty ( HR=1.20, 95% CI: 1.02-1.41), higher education level (primary school [ HR=1.32, 95% CI: 1.09-1.60], middle school [ HR=1.40, 95% CI: 1.14-1.73], high school and above [ HR=1.93, 95% CI: 1.49-2.52]) in comparison with illiteracy and semi-literacy, suicide attempts ( HR=2.70, 95% CI: 1.70-4.29), strict medication compliance ( HR=1.91, 95% CI: 1.66-2.20), history of antipsychotic drug therapy ( HR=1.42, 95% CI: 1.06-1.90), younger age group of patients of 46-60 ( HR=1.95, 95% CI: 1.60-2.39), 31-45 ( HR=3.61, 95% CI: 2.92-4.47), and 15-30 ( HR=12.37, 95% CI: 9.69-15.78) compared with the 61-90 age group, and doing agriculture jobs ( HR=1.36, 95% CI: 1.13-1.65). Conclusion Young and middle-aged schizophrenia patients with higher education levels, especially those with a history of suicide attempts, are at high risk for suicide. Focused interventions should be directed at high-risk groups to reduce suicide deaths in patients with schizophrenia.
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Affiliation(s)
- 硕 李
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 先梅 杨
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 丹 王
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 箬馨 范
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 绍丽 田
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 荣科 王
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 虎 向
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 强 张
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 元元 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 祥 刘
- 四川大学华西公共卫生学院/四川大学华西第四医院 (成都 610041)West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Cheng N, Guo M, Yan F, Guo Z, Meng J, Ning K, Zhang Y, Duan Z, Han Y, Wang C. Application of machine learning in predicting aggressive behaviors from hospitalized patients with schizophrenia. Front Psychiatry 2023; 14:1016586. [PMID: 37020730 PMCID: PMC10067917 DOI: 10.3389/fpsyt.2023.1016586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/01/2023] [Indexed: 04/07/2023] Open
Abstract
Objective To establish a predictive model of aggressive behaviors from hospitalized patients with schizophrenia through applying multiple machine learning algorithms, to provide a reference for accurately predicting and preventing of the occurrence of aggressive behaviors. Methods The cluster sampling method was used to select patients with schizophrenia who were hospitalized in our hospital from July 2019 to August 2021 as the survey objects, and they were divided into an aggressive behavior group (611 cases) and a non-aggressive behavior group (1,426 cases) according to whether they experienced obvious aggressive behaviors during hospitalization. Self-administered General Condition Questionnaire, Insight and Treatment Attitude Questionnaire (ITAQ), Family APGAR (Adaptation, Partnership, Growth, Affection, Resolve) Questionnaire (APGAR), Social Support Rating Scale Questionnaire (SSRS) and Family Burden Scale of Disease Questionnaire (FBS) were used for the survey. The Multi-layer Perceptron, Lasso, Support Vector Machine and Random Forest algorithms were used to build a predictive model for the occurrence of aggressive behaviors from hospitalized patients with schizophrenia and to evaluate its predictive effect. Nomogram was used to build a clinical application tool. Results The area under the receiver operating characteristic curve (AUC) values of the Multi-Layer Perceptron, Lasso, Support Vector Machine, and Random Forest were 0.904 (95% CI: 0.877-0.926), 0.901 (95% CI: 0.874-0.923), 0.902 (95% CI: 0.876-0.924), and 0.955 (95% CI: 0.935-0.970), where the AUCs of the Random Forest and the remaining three models were statistically different (p < 0.0001), and the remaining three models were not statistically different in pair comparisons (p > 0.5). Conclusion Machine learning models can fairly predict aggressive behaviors in hospitalized patients with schizophrenia, among which Random Forest has the best predictive effect and has some value in clinical application.
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Affiliation(s)
- Nuo Cheng
- Department of Clinical Medicine, Zhengzhou University, Zhengzhou, Henan, China
| | - Meihao Guo
- Department of Infection Prevention and Control, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Fang Yan
- Department of Infection Prevention and Control, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Zhengjun Guo
- Henan Mental Disease Prevention and Control Center, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Jun Meng
- Editorial Department of Journal of Clinical Psychosomatic Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Kui Ning
- Department of Medical Administration, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Yanping Zhang
- Department of Medicine, Zhengzhou University, Zhengzhou, Henan, China
| | - Zitian Duan
- The Seventh Psychiatric Department, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Yong Han
- Henan Key Laboratory of Biological Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
- *Correspondence: Han Yong,
| | - Changhong Wang
- Department of Clinical Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
- Wang Changhong,
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Kirchebner J, Lau S, Machetanz L. Offenders and non-offenders with schizophrenia spectrum disorders: Do they really differ in known risk factors for aggression? Front Psychiatry 2023; 14:1145644. [PMID: 37139319 PMCID: PMC10150953 DOI: 10.3389/fpsyt.2023.1145644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/17/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Individuals with schizophrenia spectrum disorders (SSD) have an elevated risk for aggressive behavior, and several factors contributing to this risk have been identified, e. g. comorbid substance use disorders. From this knowledge, it could be inferred that offender patients show a higher expression of said risk factors than non-offender patients. Yet, there is a lack of comparative studies between those two groups, and findings gathered from one of the two are not directly applicable to the other due to numerous structural differences. The aim of this study therefore was to identify key differences in offender patients and non-offender patients regarding aggressive behavior through application of supervised machine learning, and to quantify the performance of the model. Methods For this purpose, we applied seven different (ML) algorithms on a dataset comprising 370 offender patients and a comparison group of 370 non-offender patients, both with a schizophrenia spectrum disorder. Results With a balanced accuracy of 79.9%, an AUC of 0.87, a sensitivity of 77.3% and a specificity of 82.5%, gradient boosting emerged as best performing model and was able to correctly identify offender patients in over 4/5 the cases. Out of 69 possible predictor variables, the following emerged as the ones with the most indicative power in distinguishing between the two groups: olanzapine equivalent dose at the time of discharge from the referenced hospitalization, failures during temporary leave, being born outside of Switzerland, lack of compulsory school graduation, out- and inpatient treatment(s) prior to the referenced hospitalization, physical or neurological illness as well as medication compliance. Discussion Interestingly, both factors related to psychopathology and to the frequency and expression of aggression itself did not yield a high indicative power in the interplay of variables, thus suggesting that while they individually contribute to aggression as a negative outcome, they are compensable through certain interventions. The findings contribute to our understanding of differences between offenders and non-offenders with SSD, showing that previously described risk factors of aggression may be counteracted through sufficient treatment and integration in the mental health care system.
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Omelchenko MA, Zinkevich AS, Vares AY. [Impulsivity and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:83-92. [PMID: 38147387 DOI: 10.17116/jnevro202312312183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To study the phenomenon of impulsivity, its components and aggression in patients at risk for schizophrenia at the stage of remission after the first depressive episode. MATERIAL AND METHODS Forty-eight male patients (mean age 19.4±2.9 years) with the first depressive episode (ICD-10 F32.1, F32.2) with attenuated positive, negative and/or disorganized symptoms were examined. According to the severity of impulsivity, the patients were divided into the clinical group (n=26) with pathological impulsivity and the comparison group (n=27) without it. The control group consisted of 41 mentally healthy young men, students of higher education of 1-3 courses, (mean age 19.7±1.6 years). HDRS, SOPS, SANS, Barratt Impulsiveness Scale (BIS-11) and Buss Perry Aggression Questionnaire (BPAQ) were used. Statistical analysis was carried out using the Statistica 12 software. RESULTS The differences between the clinical group and the comparison group were determined by the total score of the subscale of general symptoms of SOPS at admission (53 [41.75; 56] and 45.5 [41.75; 51.25], respectively) (U=187.5; p=0.037) and at discharge (28 [19; 37] and 25 [17.75; 29.25] points respectively) (U=166.5; p=0.012), according to the total HDRS score at admission (35 [31; 38] and 29 [26; 34.25]) (U=191.0; p=0.046). In the clinical group, the motor component of impulsivity and the factor of general impulsivity on the BIS-11 correlated with the severity of aggression on the BPAQ (r=0.395, p<0.05 and r=0.635, p<0.05, respectively). Significant differences were revealed in the clinical group depending on the presence of negative symptoms on the corresponding SOPS subscale according to the total BPAQ score (p=0.01). Correlation analysis showed numerous connections: positive between the total aggressiveness score and the duration of depression (p<0.05), negative between the factors of self-control, consistency, attention, and total scores on the SANS and SOPS (p<0.05). CONCLUSION We identify the differences in the structure of impulsivity in patients at risk of developing schizophrenia at the stage of remission after the first depressive state, the comparison group and the control group, as well as the relationship of impulsivity factors with individual clusters of psychopathological disorders.
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Affiliation(s)
| | | | - A Y Vares
- Lomonosov Moscow State Univesity, Moscow, Russia
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Fazel S, Toynbee M, Ryland H, Vazquez-Montes M, Al-Taiar H, Wolf A, Aziz O, Khosla V, Gulati G, Fanshawe T. Modifiable risk factors for inpatient violence in psychiatric hospital: prospective study and prediction model. Psychol Med 2023; 53:590-596. [PMID: 34024292 PMCID: PMC9899559 DOI: 10.1017/s0033291721002063] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/08/2021] [Accepted: 05/04/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Violence perpetrated by psychiatric inpatients is associated with modifiable factors. Current structured approaches to assess inpatient violence risk lack predictive validity and linkage to interventions. METHODS Adult psychiatric inpatients on forensic and general wards in three psychiatric hospitals were recruited and followed up prospectively for 6 months. Information on modifiable (dynamic) risk factors were collected every 1-4 weeks, and baseline background factors. Data were transferred to a web-based monitoring system (FOxWeb) to calculate a total dynamic risk score. Outcomes were extracted from an incident-reporting system recording aggression and interpersonal violence. The association between total dynamic score and violent incidents was assessed by multilevel logistic regression and compared with dynamic score excluded. RESULTS We recruited 89 patients and conducted 624 separate assessments (median 5/patient). Mean age was 39 (s.d. 12.5) years with 20% (n = 18) female. Common diagnoses were schizophrenia-spectrum disorders (70%, n = 62) and personality disorders (20%, n = 18). There were 93 violent incidents. Factors contributing to violence risk were a total dynamic score of ⩾1 (OR 3.39, 95% CI 1.25-9.20), 10-year increase in age (OR 0.67, 0.47-0.96), and female sex (OR 2.78, 1.04-7.40). Non-significant associations with schizophrenia-spectrum disorder were found (OR 0.50, 0.20-1.21). In a fixed-effect model using all covariates, AUC was 0.77 (0.72-0.82) and 0.75 (0.70-0.80) when the dynamic score was excluded. CONCLUSIONS In predicting violence risk in individuals with psychiatric disorders, modifiable factors added little incremental value beyond static ones in a psychiatric inpatient setting. Future work should make a clear distinction between risk factors that assist in prediction and those linked to needs.
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Affiliation(s)
- Seena Fazel
- University of Oxford, University Dept, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mark Toynbee
- University of Oxford, University Dept, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Howard Ryland
- University of Oxford, University Dept, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Maria Vazquez-Montes
- University of Oxford, University Dept, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Hasanen Al-Taiar
- University of Oxford, University Dept, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Achim Wolf
- University of Oxford, University Dept, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Omar Aziz
- University of Oxford, University Dept, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Vivek Khosla
- University of Oxford, University Dept, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Gautam Gulati
- University of Oxford, University Dept, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Thomas Fanshawe
- University of Oxford, University Dept, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Gao L, Yang R, Fan HZ, Wang LL, Zhao YL, Tan SP, Xiao CL, Zhou SJ. Correlation Between Aggressive Behavior and Impulsive and Aggressive Personality Traits in Stable Patients with Schizophrenia. Neuropsychiatr Dis Treat 2023; 19:801-809. [PMID: 37077708 PMCID: PMC10106313 DOI: 10.2147/ndt.s404176] [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: 01/11/2023] [Accepted: 04/05/2023] [Indexed: 04/21/2023] Open
Abstract
Purpose To explore the correlation between aggressive behavior and impulsive and aggressive personality traits in inpatients with schizophrenia. Methods In total, 367 inpatients with schizophrenia were divided into two groups: the aggressive group and the non-aggressive group. We assessed inpatients' psychotic symptoms as well as their aggressive and impulsive personality traits using the Positive and Negative Symptom Scale, the Barratt Impulsiveness Scale, and the Buss-Perry Aggression Questionnaire. Results Compared with the scores of inpatients in the non-aggressive group, the total Buss-Perry Aggression Questionnaire, subscale, and Barratt Impulsiveness Scale behavioral factor scores in those in the aggressive group were higher (p < 0.05). The results of logistic regression analysis suggested that a high Positive and Negative Symptom Scale positive factor score (odds ratio = 1.07) and a high Buss-Perry Aggression Questionnaire physical aggression score (odds ratio = 1.02) were risk factors for aggressive behavior. Conclusion Hospitalized patients with schizophrenia with more severe positive symptoms and aggressive traits may be more prone to aggressive behavior.
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Affiliation(s)
- Lan Gao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, People’s Republic of China
| | - Rui Yang
- Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hong-Zhen Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, People’s Republic of China
| | - Lei-Lei Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, People’s Republic of China
| | - Yan-Li Zhao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, People’s Republic of China
| | - Shu-Ping Tan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, People’s Republic of China
| | - Chun-Ling Xiao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, People’s Republic of China
- Correspondence: Chun-Ling Xiao; Shuang-Jiang Zhou, Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 10096, People’s Republic of China, Email ;
| | - Shuang-Jiang Zhou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, People’s Republic of China
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BEATVIC, a body-oriented resilience therapy for individuals with psychosis: Short term results of a multi-center RCT. PLoS One 2022; 17:e0279185. [PMID: 36542671 PMCID: PMC9770373 DOI: 10.1371/journal.pone.0279185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Individuals with a psychotic disorder are at an increased risk of victimization, but evidenced-based interventions are lacking. AIMS A body-oriented resilience therapy ('BEATVIC') aimed at preventing victimization was developed and its effectiveness was assessed in a multicenter randomized controlled trial. METHODS 105 people with a psychotic disorder were recruited from six mental health centers. Participants were randomly allocated to 20 BEATVIC group sessions (n = 53) or befriending group sessions (n = 52). Short term effects on risk factors for victimization (e.g. social cognitive deficits, inadequate interpersonal behavior, low self-esteem, internalized stigma, aggression regulation problems), physical fitness and secondary outcomes were expected. At six-month follow-up, the effect on victimization (either a 50% reduction or an absence of victimization incidents) was examined. RESULTS Intervention-dropout was 28.30% for BEATVIC and 39.62% for befriending. In both conditions the majority of participants (60.5% BEATVIC vs 62.9% befriending) showed a reduction or absence of victimization incidents at six months follow-up, which was not significantly different according to condition. Multilevel analyses revealed no main effect of time and no significant time x group interaction on other outcome measures. Per protocol analyses (participants attending ≥ 75% of the sessions) did not change these results. CONCLUSIONS Although a reduction or absence of victimization was found at short term follow-up for the majority of participants, BEATVIC was not more effective than the active control condition. No short-term additional effects on risk factors of victimization were found. Analysis of the data at 2-year follow-up is warranted to investigate possible effects in the long-term. TRIAL REGISTRATION NUMBER Current Controlled Trials: ISRCTN21423535.
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48
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Sorkhou M, Johnstone S, Kivlichan AE, Castle DJ, George TP. Does cannabis use predict aggressive or violent behavior in psychiatric populations? A systematic review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:631-643. [PMID: 36137273 DOI: 10.1080/00952990.2022.2118060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Despite an increase in information evaluating the therapeutic and adverse effects of cannabinoids, many potentially important clinical correlates, including violence or aggression, have not been adequately investigated.Objectives: In this systematic review, we examine the published evidence for the relationship between cannabis and aggression or violence in individuals with psychiatric disorders.Methods: Following PRISMA guidelines, articles in English were searched on PubMed, Google Scholar, MEDLINE, and PsycINFO from database inception to January 2022. Data for aggression and violence in people with psychiatric diagnoses were identified during the searches.Results: Of 391 papers identified within the initial search, 15 studies met inclusion criteria. Cross-sectional associations between cannabis use and aggression or violence in samples with post-traumatic stress disorder (PTSD) were found. Moreover, a longitudinal association between cannabis use and violence and aggression was observed in psychotic-spectrum disorders. However, the presence of uncontrolled confounding factors in the majority of included studies precludes any causal conclusions.Conclusion: Although cannabis use is associated with aggression or violence in individuals with PTSD or psychotic-spectrum disorders, causal conclusions cannot be drawn due to methodological limitations observed in the current literature. Well-controlled, longitudinal studies are needed to ascertain whether cannabis plays a causal role on subsequent violence or aggression in mental health disorders.
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Affiliation(s)
- Maryam Sorkhou
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada.,Institute of Medical Sciences (IMS) and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Samantha Johnstone
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada
| | | | - David J Castle
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada.,Institute of Medical Sciences (IMS) and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tony P George
- Centre for Complex Interventions, Centre for Addictions and Mental Health, Toronto, Canada.,Institute of Medical Sciences (IMS) and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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49
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Yu T, Pei W, Xu C, Zhang X, Deng C. Prediction of violence in male schizophrenia using sMRI, based on machine learning algorithms. BMC Psychiatry 2022; 22:676. [PMID: 36320010 PMCID: PMC9628088 DOI: 10.1186/s12888-022-04331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Violent behavior in patients with schizophrenia (SCZ) is a major social problem. The early identification of SCZ patients with violence can facilitate implementation of targeted intervention. METHODS A total of 57 male SCZ patients were recruited into this study. The general linear model was utilized to compare differences in structural magnetic resonance imaging (sMRI) including gray matter volume, cortical surface area, and cortical thickness between 30 SCZ patients who had exhibited violence and 27 SCZ patients without a history of violence. Based on machine learning algorithms, the different sMRI features between groups were integrated into the models for prediction of violence in SCZ patients. RESULTS After controlling for the whole brain volume and age, the general linear model showed significant reductions in right bankssts thickness, inferior parietal thickness as well as left frontal pole volume in the patients with SCZ and violence relative to those without violence. Among seven machine learning algorithms, Support Vector Machine (SVM) have better performance in differentiating patients with violence from those without violence, with its balanced accuracy and area under curve (AUC) reaching 0.8231 and 0.841, respectively. CONCLUSIONS Patients with SCZ who had a history of violence displayed reduced cortical thickness and volume in several brain regions. Based on machine learning algorithms, structural MRI features are useful to improve predictive ability of SCZ patients at particular risk of violence.
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Affiliation(s)
- Tao Yu
- grid.452190.b0000 0004 1782 5367Anhui Mental Health Center; Affiliated Psychological Hospital of Anhui Medical University; Hefei Fourth People’s Hospital; Anhui Clinical Research Center for Mental Disorders, Hefei, 230022 Anhui China
| | - Wenzhi Pei
- grid.452190.b0000 0004 1782 5367Anhui Mental Health Center; Affiliated Psychological Hospital of Anhui Medical University; Hefei Fourth People’s Hospital; Anhui Clinical Research Center for Mental Disorders, Hefei, 230022 Anhui China
| | - Chunyuan Xu
- grid.452190.b0000 0004 1782 5367Anhui Mental Health Center; Affiliated Psychological Hospital of Anhui Medical University; Hefei Fourth People’s Hospital; Anhui Clinical Research Center for Mental Disorders, Hefei, 230022 Anhui China
| | - Xulai Zhang
- Anhui Mental Health Center; Affiliated Psychological Hospital of Anhui Medical University; Hefei Fourth People's Hospital; Anhui Clinical Research Center for Mental Disorders, Hefei, 230022, Anhui, China.
| | - Chenchen Deng
- Anhui Province Maternity & Child Health Hospital, Hefei, 230022, Anhui, China.
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50
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Fekih-Romdhane F, Abboud C, Kossaify M, El Khoury N, Sleiman YB, Hachem D, Haddad G, Hallit S. Child abuse and aggressiveness in individuals diagnosed with schizophrenia in Lebanon. Perspect Psychiatr Care 2022; 58:2872-2880. [PMID: 35767392 DOI: 10.1111/ppc.13135] [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: 02/01/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To identify individual and clinical risk factors of aggressiveness, including exposure to different forms of childhood trauma, in a sample of Lebanese patients with schizophrenia. METHODS A total of 131 patients diagnosed with schizophrenia participated in this cross-sectional study. RESULTS Higher physical (Beta = 0.24, p < 0.001) and sexual (Beta = 0.29, p = 0.003) abuse, alcohol drinking (Beta = 1.46, p = 0.008), having a history of head trauma (Beta = 1.10, p = 0.041), and male gender (Beta = -1.59, p = 0.009) were significantly associated with higher mean aggression scores. PRACTICAL IMPLICATIONS Our investigation of the factors linked to aggressiveness in patients with schizophrenia complement those of earlier findings, showing that the relationship between interacting individual and environmental risk factors and later aggressiveness is quite complex, and needs further longitudinal and prospective studies.
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Affiliation(s)
- Feten Fekih-Romdhane
- Department of Psychiatry "Ibn Omrane", The Tunisian Center of Early Intervention in Psychosis, Razi Hospital, Manouba, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Cedric Abboud
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Mikhael Kossaify
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Nour El Khoury
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Yara Bou Sleiman
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Dory Hachem
- Research and Psychiatry Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Georges Haddad
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.,Research and Psychiatry Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.,Research and Psychiatry Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Psychology Department, College of Humanities, Effat University, Jeddah, Saudi Arabia
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