Predictors of violent behavior among acute psychiatric patients: Clinical study

Psychiatry and Clinical Neurosciences (Impact Factor: 1.63). 05/2008; 62(3):247 - 255. DOI: 10.1111/j.1440-1819.2008.01790.x


Aim: Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders. The aim of the present study was to determine violence risk factors in acute psychiatric inpatients.
Methods: The study was conducted in a locked, short-term psychiatric inpatient unit and involved 374 patients consecutively admitted in a 1-year period. Sociodemographic and clinical data were obtained through a review of the medical records and patient interviews. Psychiatric symptoms at admission were assessed using the Brief Psychiatric Rating Scale (BPRS). Psychiatric diagnosis was formulated using the Structured Clinical Interview for DSM-IV. Past aggressive behavior was evaluated by interviewing patients, caregivers or other collateral informants. Aggressive behaviors in the ward were assessed using the Overt Aggression Scale. Patients who perpetrated verbal and against-object aggression or physical aggression in the month before admission were compared to non-aggressive patients, moreover, aggressive behavior during hospitalization and persistence of physical violence after admission were evaluated.
Results: Violent behavior in the month before admission was associated with male sex, substance abuse and positive symptoms. The most significant risk factor for physical violence was a past history of physically aggressive behavior. The persistent physical assaultiveness before and during hospitalization was related to higher BPRS total scores and to more severe thought disturbances. Higher levels of hostility–suspiciousness BPRS scores predicted a change for the worse in violent behavior, from verbal to physical.
Conclusion: A comprehensive evaluation of the history of past aggressive behavior and psychopathological variables has important implications for the prediction of violence in psychiatric settings.

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Available from: Marco Menchetti, Oct 26, 2014
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    • ") that play an important role in inpatient aggression and its management, including: alcohol or substance use (Amore et al., 2008; Biancosino et al., 2009; Bowers et al., 2009; Steadman et al., 1998); diagnoses of schizophrenia, bipolar or personality disorder (Biancosino et al., 2009; Ketelsen et al., 2007); a history of prior violence (Cornaggia et al., 2011); poor psychosocial living status (Ketelsen et al., 2007); high levels of hostility– suspiciousness (Amore et al., 2008; Biancosino et al., 2009); and younger age, male gender, being unmarried and longer hospitalisation (Amore et al., 2008; Biancosino et al., 2009). "
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    ABSTRACT: A retrospective case-control study was conducted examining relationships between patients’ socio-demographic, clinical and admission characteristics and inpatient aggression. Patients aged 18–64 years with a recent offence episode, who were admitted to a regional acute mental health unit, were included as cases (N = 82), while controls comprised the next available admission, matched for age and gender (N = 82). The prototypical patient was a young, single male, with a diagnosis of schizophrenia, a history of substance use and previous psychiatric admissions. The majority of cases had a history of aggression and recent offences against public order. They also revealed a higher likelihood of involvement in ‘less serious’ aggressive incidents (e.g. verbal threats or demands) during the index admission. Clinically, knowledge of each patient’s recent offence history, arrival mode and observed characteristics on admission (including any verbal aggression) may be important in the management of subsequent inpatient aggression.
    Journal of Forensic Psychiatry and Psychology 04/2014; 25(4-4):464-479. DOI:10.1080/14789949.2014.933861 · 0.88 Impact Factor
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    • "Discussing a trial of medication discontinuation requires a clear articulation of the risks and costs of relapse. A second episode of schizophrenia may be experienced as a major setback for patients who have made a good recovery from their FEP; it can lead to losses in hard-won social and vocational gains, and may increase the risk of violence and suicide (Amore et al., 2008; Hor and Taylor, 2010; Llorca, 2008; Masand et al., 2009). Tragically, some patients are not able to achieve a remission following their second episode and develop chronic treatment resistant symptoms (Lieberman, 1993; Wiersma et al., 1998). "
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    Schizophrenia Research 08/2013; 153(2-3). DOI:10.1016/j.schres.2013.08.001 · 3.92 Impact Factor
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    • "Sur les 471 résumés initiaux identifiés, 41 répondaient aux critères d'inclusion [7,8,14,17–53]. Après examen, 27 ont e ´té exclus car l'homicide n'e ´tait pas spécifiquement exploré (n = 10) [17,19–21,29,39,41,44–46], le design de l'e ´tude ne répondait pas exactement aux critères d'inclusion (n = 12) [18] [25] [26] [32] [33] [35] [38] [40] [43] [50] [51] [54] ou encore l'e ´tude e ´tait non prospective (n = 5) [8] [36] [37] [42] [47]. Six revues de la littérature ou méta-analyses [7] [14] [24] [31] [52] [55] et huit e ´tudes longitudinales [22] [23] [27] [28] [30] [34] [49] [53] ont e ´té retenues. "
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    ABSTRACT: The prevalence of homicide perpetrators with a diagnosis of schizophrenia is 6% in Western countries populations. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link. The aim of this systematic review was to clarify the role of substance abuse in the commission of murder in people suffering from schizophrenia. A systematic English-French Medline and EMBASE literature search of cohort studies, case-control studies and transversal studies published between January 2001 and December 2011 was performed, combining the MeSH terms "schizophrenia", "psychotic disorders", "homicide", "violence", "substance use disorder", and the TIAB term "alcohol". Abstract selection was based on the STROBE and PRISMA checklist for observational studies and systematic and meta-analysis studies, respectively. Of the 471 selected studies, eight prospective studies and six systematic reviews and meta-analysis studies met the selection criteria and were included in the final analysis. Homicide committed by a schizophrenic person is associated with socio-demographic (young age, male gender, low socioeconomic status), historical (history of violence against others), contextual (a stressful event in the year prior to the homicide), and clinical risk factors (severe psychotic symptoms, long duration of untreated psychosis, poor adherence to medication). In comparison to the general population, the risk of homicide is increased 8-fold in schizophrenics with a substance abuse disorder (mainly alcohol abuse) and 2-fold in schizophrenics without any comorbidities. A co-diagnosis of substance abuse allows us to divide the violent schizophrenics into "early-starters" and "late-starters" according to the age of onset of their antisocial and violent behavior. The violence of the "early-starters" is unplanned, usually affects an acquaintance and is not necessarily associated with the schizophrenic symptoms. Substance abuse is frequent and plays an important role in the homicide commission. In addition, the risk of reoffending is high. In the "late-starters", the violence is linked to the psychotic symptoms and is directed to a member of the family. The reoffence risk is low and it depends on the pursuit of care or not. Defining subgroups of violent schizophrenic patients would avoid stigmatization and would help to prevent the risk of homicide by offering a multidisciplinary care which would take into account any substance abuse.
    Revue d Épidémiologie et de Santé Publique 06/2013; 61(4). DOI:10.1016/j.respe.2013.01.096 · 0.59 Impact Factor
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