Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample

Abstract

Violence towards others by a minority of psychotic individuals is a significant public health concern. The severity of this otherdirected violence (ODV) in the community may be influenced by insight into illness and adherence to psychotropic medications; however, few studies have tested these associations. Sixty male psychotic inpatients, legally detained at a forensic unit in New York City, were assessed with semi-structured interviews, supplemented with information from hospital and official records, family members and the treating clinician. Results indicated that in this unique sample of detained persons with psychotic disorders; (1) increase in the severity of community violence is associated with medication non-adherence, all dimensions of poor insight into illness, and several previously reported covariates such as substance use comorbidity; (2) no relationship was found between insight and adherence in this particular sample; (3) multivariate analyses showed that select covariates, along with medication adherence, and select insight domains predicted a total of 73% of the magnitude of ODV behavior in this sample. Overall, medication nonadherence explained a large amount of how violently participants behaved toward others. Since non-adherence was independent of poor insight, it may be more worthwhile for clinicians to develop treatment strategies to target medication adherence without directly addressing an elusive target such as insight into illness. Treatment addressing medication adherence needs to concomitantly target substance use behaviors since the latter was responsible for a substantial increase in ODV. Aggr. Behav. 33:86-96, 2007. r

Aggression in Psychoses

“…History of childhood physical abuse was one of the factors associated with the occurrence of incidents of assaultive behavior among 183 male patients of a forensic psychiatric hospital, 106 of whom were diagnosed with schizophrenia [30]. A group of 60 male psychotic patients legally detained at a forensic unit was assessed for history of violence; the participants were also asked about any history of childhood abuse, substance use, medication adherence, and current insight in terms of awareness of mental illness [60]. Multiple regression analysis indicated that the history of childhood abuse was associated with the severity of violence independently of substance use, medication adherence, and insight (beta = 0.18, < 0.01) [60].…”

“…A group of 60 male psychotic patients legally detained at a forensic unit was assessed for history of violence; the participants were also asked about any history of childhood abuse, substance use, medication adherence, and current insight in terms of awareness of mental illness [60]. Multiple regression analysis indicated that the history of childhood abuse was associated with the severity of violence independently of substance use, medication adherence, and insight (beta = 0.18, < 0.01) [60]. In a group of 28 schizophrenia patients with a history of violence, 46% had experienced child abuse and/or neglect [61].…”

“…In a study of pretrial detainees that was described in the segment on childhood maltreatment [60], impaired insight (lack of awareness of having a mental illness) was significantly related to the severity of reported violence, and that relationship was statistically independent of the effects of substance use, medication adherence, and childhood abuse. Schizophrenia patients without concomitant substance abuse or Axis II disorders ( = 133) were recruited for a Turkish study of violence [85].…”

“…Non-adherence to pharmacological treatment and substance abuse elevate the risk of relapse and violence in schizophrenia [60,134,135].…”

Violence in Schizophrenia

“…[34,35] Genellikle şizofreninin pozitif bulguları artmış şiddet davranışı ile ilişkilendirilirken, negatif bulguları tersi şekilde ilişkilendirilir. [36] Son olarak, içgörü eksikliği ile şiddet davranışı ilişkisi arasında tutarlılık gösteren kanıtlar mevcuttur. [37][38][39][40] Bu etki içgörü eksikliğinden ötürü düzensiz tedaviye yönelimin sonucunda meydana gelen şiddet davranışı ile ilişkilendirilen dolaylı bir etkidir.…”