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Violence and phases of illness: Differential risk and predictors

Published online by Cambridge University Press:  16 April 2020

S. Hodgins  and
M. Riaz
S. Hodgins*
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry at Kings College London, 16 De Crespigny Park, LondonSE5 8AF, United Kingdom
M. Riaz
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry at Kings College London, 16 De Crespigny Park, LondonSE5 8AF, United Kingdom
*
*Corresponding author. Tel.: +44 0 20 7848 0123; fax: +44 020 7848 0754. E-mail address: s.hodgins@kcl.ac.uk (S. Hodgins).
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Abstract

This study tested the hypothesis that among patients with schizophrenia the risk and correlates of aggressive behavior differ depending on the level of positive symptoms. Two hundred and fifty-one adults with schizophrenia who were living in the community were assessed by psychiatrists using validated instruments. Patients and collaterals reported aggressive behavior. In a final multivariate model, aggressive behavior was significantly and positively associated with childhood conduct disorder, current use of illicit drugs, positive, threat-control-override (TCO), and depression symptoms. While 16% of the patients with two or fewer positive symptoms engaged in aggressive behavior in the previous six months, this was true of 28.4% of those with three or more positive symptoms (X2(n = 251,1) = 5.48, P = 0.019). Among patients with high positive symptoms, even univariate analyses failed to detect any factors associated with aggressive behavior other than medication non-compliance, typical antipsychotic medication, and clozapine. By contrast, among patients with few positive symptoms, aggressive behavior was associated with TCO and depression symptoms, young age, male sex, the number of childhood conduct disorder symptoms, prior aggressive behavior, and current illicit drug use. In phases of illness characterized by different levels of positive symptoms, the risk of aggressive behavior and the associated factors differ.

Keywords

Aggressive behaviorRisk assessmentPositive symptomsNegative symptomsDepression
Type
Original article
Information
European Psychiatry , Volume 26 , Issue 8 , November 2011 , pp. 518 - 524
Copyright
Copyright © Elsevier Masson SAS 2011

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References

Appelbaum, PS, Robbins, PC, Monahan, JViolence and delusions: data from the MacArthur Violence Risk Assessment Study. Am J Psychiatry 2000;157(4):566–572.Google ScholarPubMed
Appelbaum, PS, Robbins, PC, Roth, LHDimensional approach to delusions: comparison across types and diagnoses. Am J Psychiatry 1999;156(12):1938–1943.Google ScholarPubMed
Arseneault, L, Canon, M, Murray, R, Poulton, T, Caspi, A, Moffitt, TEChildhood origins of violent behaviour in adults with schizophreniform disorder. Br J Psychiatry 2003; 183: 520–525.Google ScholarPubMed
Berman, AH, Bergman, H, Palmstierna, T, Schlyter, FEvaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish Population sample. Eur Addict Res 2005; 11: 22–31.Google Scholar
Bjørkley, SPsychotic symptoms and violence towards others – a literature review of some preliminary findings: Part 2. Hallucinations. Aggression Violent Behav 2002; 7: 605–615.Google Scholar
Bjørkley S, Psychotic symptoms and violence towards others – A literature review of some preliminary findings: Part 1. Delusions. Aggression Violent Behav 2002; 7: 617–631.CrossRefGoogle Scholar
Bjørkly, SSCL-90-R profiles in a sample of severely violent psychiatric inpatients. Aggression Behav 2002; 28: 446–457.CrossRefGoogle Scholar
Bond, GR, Drade, RE, Mueser, KT, Latimer, EAssertive community treatment for people with severe mental illness: critical ingredients and impact on patients. Dis Manag Health Outcomes 2001; 9: 141–159.CrossRefGoogle Scholar
Calsyn, RJ, Yonker, BD, Lemming, MR, Morse, GA, Klinkenberg, WDImpact of assertive community treatment and client characteristics on criminal justice outcomes in dual disorder homeless individuals. Crim Behav Ment Health 2005; 15: 236–248.Google ScholarPubMed
Crocker, AG, Mueser, KT, Drake, RE, Clark, RE, Mchugo, GJ, Ackerson, TH, et al.Antisocial personality, psychopathy, and violence in persons with dual disorders: A longitudinal analysis. Criminal Justice and Behavior 2005;32(4):452–476.CrossRefGoogle Scholar
Cuddeback, GS, Morrissey, JP, Cusack, KJHow many forensic assertive community treatment teams do we need? Psychiatr Serv 2008;59(2):205–208.Google ScholarPubMed
Douglas, KS, Guy, LS, Hart, SDPsychosis as a risk factor for violence in others: a meta-analysis. Psychol Bull 2009;135(5):679–706.Google ScholarPubMed
Fatemi, SH, Folsom, TDThe neurodevelopmental hypothesis of schizophrenia, revisited. Schizophr Bull 2009;35(3):528–548.Google ScholarPubMed
Green, AI, Drake, RE, Brunette, MF, Noordsy, DLSchizophrenia and co-occurring substance use disorder. Am J Psychiatry 2007;164(3):402–408.CrossRefGoogle ScholarPubMed
Hamilton, MA rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–62.CrossRefGoogle ScholarPubMed
Hodgins, S, Alderton, J, Cree, A, Aboud, A, Mak, TAggressive behaviour, victimization, and crime among severely mentally ill patients requiring hospitalization. Br J Psychiatry 2007; 191: 343–350.CrossRefGoogle Scholar
Hodgins, S, Cree, A, Alderton, J, Mak, TFrom conduct disorder to severe mental illness: Associations with aggressive behaviour, crime and victimisation. Psychol Med 2008; 38: 975–987.Google Scholar
Hodgins, S, Hiscoke, UL, Freese, RThe antecedents of aggressive behavior among men with schizophrenia: a prospective investigation of patients in community treatment. Behav Sci Law 2003; 21: 523–546.CrossRefGoogle ScholarPubMed
Hodgins, S, Lincoln, T, Mak, TExperience of victimisation and depression are associated with community functioning among men with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2009;44(6):448–457.Google Scholar
Hodgins, S, Muller-Isberner, R, Tiihonen, J, Repo-Tiihonem, E, Eronen, M, Eaves, D, et al.A comparison of general and forensic patients with schizophrenia living in the community. Int J Forensic Mental Health 2007;6(1):63–75.Google Scholar
Hodgins, S, Tiihonen, J, Ross, DThe consequences of conduct disorder for males who develop schizophrenia: Associations with criminality, aggressive behavior, substance use, and psychiatric services. Schizophr Res 2005; 78: 323–335.CrossRefGoogle ScholarPubMed
Illi, A, Mattila, KM, Kampion, O, Antilla, S, Roivas, M, Lehtimäki, T, et al.Catechol-O-Methyltranferase and Monoamine Oxidase A genotypes and drug response to conventional neuroleptics in schizophrenia. J Clin Psychopharmacol 2003;23(5):429–434.Google Scholar
Kay, SR, Fiszbein, A, Opler, AThe positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261–276.Google Scholar
Kim-Cohen, J, Caspi, A, Moffitt, TE, Harrington, HL, Milne, BJ, Poulton, RPrior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry 2003; 60: 709–717.CrossRefGoogle ScholarPubMed
Krakowski, M, Czobor, PGender differences in violent behaviors: relationship to clinical symptoms and psychosocial factors. Am J Psychiatry 2004;161(3):459–465.CrossRefGoogle ScholarPubMed
Leifker, FR, Bowie, CR, Harvey, PDDeterminants of everyday outcomes in schizophrenia: the influences of cognitive impairment, functional capacity, and symptoms. Schizophr Res 2009; 115: 82–87.CrossRefGoogle ScholarPubMed
Link, BG, Stueve, APsychotic symptoms and the violent/illegal behavior of mental patients compared to community controls in violence and mental disorders.Monahan, JSteadman, HViolence and mental disorders Chicago: University of Chicago Press; 1994.137–159.Google Scholar
McNiel, DE, Binder, RLThe relationship between acute psychiatric symptoms, diagnosis, and short term-risk of violence. Hosp Community Psychiatry 1994; 45: 133–137.Google Scholar
Monahan, J, Steadman, HJ, Silver, E, Appelbaum, PS, Robbins, PC, Mulvey, EP, et al.Rethinking risk assessment. The MacArthur study of mental disorder and violence. New York: Oxford University Press; 2001Google Scholar
Nielssen, O, Large, MRates of homicide during the first episode of psychosis and after treatment: A systematic review and meta-analysis. Schiz Bull 2010;36(4):702–712.CrossRefGoogle ScholarPubMed
Potvin, A, Sepehry, AM, Stip, EComorbid substance-use in schizophrenia: the file drawer effect. Schizophr Res 2007; 90: 351–352.CrossRefGoogle ScholarPubMed
Steinert, TPrediction of inpatient violence. Acta Psychiatr Scand 2002; 106: 133–141.CrossRefGoogle Scholar
Swanson, JW, Swartz, MS, Elbogen, EBEffectiveness of a typical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment. Schizophr Bull 2004;30(1):3–20.Google Scholar
Swanson, JW, Swartz, MS, Elbogen, EB, Van Dorn, RAReducing violence risk in persons with schizophrenia: olanzapine versus risperidone. J Clin Psychiatry 2004;65(12):1666–1673.CrossRefGoogle ScholarPubMed
Swanson, JW, Swartz, MS, Van Dorn, RA, Elbogen, EB, Wagner, HR, Rosenbeck, RA, et al.A national study of violent behavior in persons with schizophrenia. Arch Gen Psychiatry 2006;63(5):490–499.CrossRefGoogle ScholarPubMed
Swanson, JW, Swartz, MS, Van Dorn, RA, Volavka, J, Monahan, J, Stroup, TS, et al.Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia. Br J Psychiatry 2008; 193: 37–43.CrossRefGoogle ScholarPubMed
Swartz, MS, Swanson, JWInvoluntary outpatient commitment, community treatment orders and assisted outpatient treatment: what's in the data? Can J Psychiatry 2004; 49: 585–591.CrossRefGoogle ScholarPubMed
Taylor, PJMotives for offending among violent and psychotic men. Br J Psychiatry 1985; 147: 491–498.Google ScholarPubMed
Volavka, J, Czobor, P, Nolan, KA, et al.Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzaphin, risperidone, or haloperidol. J Clin Psychopharmacol 2004; 24: 225–228.Google ScholarPubMed
Wallace, C, Mullen, PE, Burgess, PCriminal offending in schizophrenia over a 25-year period marked by deinstitutionalization and increasing prevalence of comorbid substance use disorders. Am J Psychiatry 2004;161(4):716–727.CrossRefGoogle Scholar
Walsh, E, Gilvarry, C, Samele, C, Harvey, K, Manley, C, Tyrer, P, et al.Reducing violence in severe mental illness: randomized controlled trial of intensive case management compared with standard care. BMJ 2001;323(10):1093–1097.CrossRefGoogle ScholarPubMed
Welham, J, Isohanni, M, Jones, P, McGrath, JThe antecedents of schizophrenia: a review of birth cohort studies. Schizophr Bull 2009;35(3):603–623.CrossRefGoogle ScholarPubMed
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