Violence risk and mental disorders (VIORMED-2): A prospective multicenter study in Italy

Abstract

Background The management of mentally ill offenders in the community is one of the great challenges imposed on community psychiatry. Aim The aim of this study was to analyze the association between sociodemographic, clinical, and psychosocial factors and violent behavior in a sample of outpatients with severe mental disorders. Method This was a prospective cohort study with a baseline cross-sectional design used to provide a detailed analysis of patients’ profiles, followed by a longitudinal design to measure aggressive and violent behavior during a 1-year follow-up. Patients with severe mental disorders, with or without a history of violence, were enrolled in four Italian Departments of Mental Health and underwent a comprehensive multidimensional assessment. Results The sample included 247 outpatients, for a total of 126 cases and 121 controls. Compared to controls, patients with a history of violence had a greater frequency of lifetime domestic violence, a greater lifetime propensity to misuse substances, and a higher number of compulsory admissions. The forthnightly monitoring during the 1-year follow-up did show statistically significant differences in aggressive and violent behavior rates between the two groups. Verbal aggression was significantly associated with aggression against objects and physical aggression. Moreover, outpatients with an history of violence showed statistically significant higher MOAS scores compared to both residential patients with an history of violence, assessed in the first wave of this project, and all controls. Conclusions Patients with a history of violence had specific characteristics and showed a greater occurrence of additional community violence during a 1-year observation period. Our results may assist clinicians in implementing standardized methods of patient assessment and violence monitoring in outpatient mental health services and may prompt improved collaboration between different community services.

An exploration of the sleep quality and potential violence among patients with schizophrenia in community

“…A previous study has also indicated that patients with a history of violent behavior have a high risk of exhibiting aggressive behavior again. 31 This result is in agreement with the findings of the present study.…”

“…30 Patients with a history of violent behaviors have a relatively high risk of exhibiting violent behavior. 31 The violent behaviors of patients with schizophrenia include physical aggression, verbal aggression, anger, and hostility, which correlate with physiological changes in the brain. Sleep disorders may reduce emotional control, thereby increasing the frequency of violent behaviors.…”

Staff Perception of Respect for Human Rights of Users and Organizational Well-being: A Study in Four Different Countries of the Mediterranean Area

“…However, it is surprising that, although resources are probably more important in Italy than in other countries, staff still requires a larger number of doctors, psychologists and, to a lesser extent, of rehabilitation staff (such as Occupational Therapists, Educators or Rehabilitation Technicians). This likely reflects the emphasis in Italy on a healthcare model focused on medical treatment, rather than on an integrative approach [ 15 ]. In addition, in the region of Sardinia, where the study was conducted, a recent objective evaluation of staff numbers shows that there is an insufficient number of psychologists and rehabilitation workers [ 5 ].…”

Aggressive Behavior and Psychiatric Inpatients: a Narrative Review of the Literature with a Focus on the European Experience

“…However, in an Italian study, inpatients with a history of violence did not show at MOAS higher rates of aggressiveness compared to patients without such a history [85]. Interestingly, a second part of the study, exploring patients' behavior in the community, found that subjects with a lifetime history of violence engaged in more aggressive enactments than patients without [86]. The Authors speculated that when adequate treatment and management are available, a history of physical aggressiveness does not link with an increased risk of violence.…”