Violent behaviour in early psychosis patients: Can we identify clinical risk profiles?

Moulin, Valérie; Palix, Julie; Golay, Philippe; Dumais, Alexandre; Gholamrezaee, M.M.; Azzola, A.; Baumann, Philipp; Alameda, Luis; Conus, Philippe

doi:10.1111/eip.12512

Cited by 27 publications

(20 citation statements)

References 70 publications

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“…Second, CMs gathered any additional information through contact with parents, significant others and forensic psychiatric services (heteroreporting of aggression) over the entire duration of treatment. Finally, episodes of VB occurring during the treatment phase were identified on the basis of the Staff Observation Aggression Scale (SOAS-R [46]), which lists all critical events related to a VB during hospitalizations [47].…”

Section: Identification Of Episodes Of Violent Behaviormentioning

confidence: 99%

Early onset of cannabis use and violent behavior in psychosis

et al. 2020

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Background: Although evidence from psychosis patients demonstrates the adverse effects of cannabis use (CU) at a young age and that the rate of CU is high in subgroups of young violent patients with psychotic disorders, little is known about the possible effect of the age of onset of CU on later violent behaviors (VB). So, we aimed to explore the impact of age at onset of CU on the risk of displaying VB in a cohort of early psychosis patients. Method: Data were collected prospectively over a 36-month period in the context of an early psychosis cohort study. A total of 265 patients, aged 18–35 years, were included in the study. Logistic regression was performed to assess the link between age of onset of substance use and VB. Results: Among the 265 patients, 72 had displayed VB and 193 had not. While violent patients began using cannabis on average at age 15.29 (0.45), nonviolent patients had started on average at age 16.97 (0.35) (p = 0.004). Early-onset CU (up to age 15) was a risk factor for VB (odds ratio = 4.47, confidence interval [CI]: 1.13–20.06) when the model was adjusted for age group, other types of substance use, being a user or a nonuser and various violence risk factors and covariates. History of violence and early CU (until 15) were the two main risk factors for VB. Conclusions: Our results suggest that early-onset CU may play a role in the emergence of VB in early psychosis.

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Section: Identification Of Episodes Of Violent Behaviormentioning

confidence: 99%

Early onset of cannabis use and violent behavior in psychosis

et al. 2020

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“…Further, Ekinci ( 79 ) mentions that the combination of lack of insight and lack of treatment adherence may increase VB, by impeding the recognition of psychotic symptoms. Based on the above-mentioned work ( 79 ), we can hypothesize that difficulty induced by the combination of these three factors could contribute to increase cognitive distortions and difficulties in social interactions which in turn could lead to aggressive reactions against others ( 44 , 50 ). If this were to be proven in future research, the complex intrication of these factors would justify the development of an integrated treatment strategy targeting these three dimensions simultaneously ( 48 ).…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, case managers gathered any additional information through contact with parents, significant others and the forensic psychiatric services (hetero reporting of aggression) over the entire duration of treatment. Finally, episodes of VB occurring during the treatment phase were identified on the basis of the Staff Observation Aggression Scale [SOAS-R scale ( 61 ), a structured assessment tool], which lists all critical events related to a VB during hospitalisations ( 44 ).…”

Section: Methodsmentioning

confidence: 99%

“…Hence, studies on the impact of comorbid substance use (alcohol, cannabis, other substances) and psychosis ( 29 – 31 ) should take into account possible interactions between substance use and main dynamic risk factors of VB identified in the literature, such as positive symptoms ( 32 – 34 ), level of insight ( 21 , 35 – 37 ), impulsivity ( 12 , 38 , 39 ), affective instability ( 40 , 41 ), and treatment adherence ( 33 , 35 ). Various studies have shown that there are subgroups of patients in which these factors may interact ( 24 , 42 – 44 ). Along these lines, Lapworth et al ( 45 ) showed that positive symptoms interact with impulsivity to increase the risk of VB in psychotic patients with comorbid substance use.…”

Section: Introductionmentioning

confidence: 99%

“…Identifying such interactions between risk factors and their impact on the occurrence of VB is particularly important in the early phase of psychosis, as it would allow early identification of patients at risk of such behaviors and the development of preventive strategies that could be adapted to subgroups of patient ( 22 , 23 , 25 , 44 ).…”

Section: Introductionmentioning

confidence: 99%

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Cannabis, a Significant Risk Factor for Violent Behavior in the Early Phase Psychosis. Two Patterns of Interaction of Factors Increase the Risk of Violent Behavior: Cannabis Use Disorder and Impulsivity; Cannabis Use Disorder, Lack of Insight and Treatment Adherence

et al. 2018

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Background: Previous literature suggests that prevalence of cannabis use in the early phase of psychosis is high, and that early psychosis patients are at high-risk for violent behavior. However, the link between cannabis use and violent behavior in early psychosis patients is unclear. We carried out a study on a sample of early psychosis patients, in order to explore the impact of cannabis use on the risk of violent behavior (VB), while taking into account (1) potential confounding factors and, (2) interactions with other dynamic risk factors of VB.Method: In a sample of 265 early psychosis patients, treated at the Treatment and Early Intervention in Psychosis Program (TIPP) in Lausanne, we used logistic regression models to explore the link between various dynamic risk factors of VB [positive symptoms, substance use disorder (drugs including cannabis, alcohol and others drugs), insight, impulsivity, affective instability, and treatment adherence], and VB occurring during treatment. In order to understand hierarchical effects attributable to the combinations of risk factors on VB we conducted a Classification and Regression Tree (CART).Results: Our results show that cannabis use disorder is a risk factor for VB. The associations among risk factors suggest the presence of two patient profiles with an increased rate of VB: the first is composed of patients with cannabis use disorder and impulsivity, and the second of patients combining cannabis use disorder, absence of insight and non-adherence to treatment. The results also show the moderating role of insight and adherence to treatment on the rate of VB in patients with cannabis use disorder.Conclusion: This study suggests that cannabis use disorder is a significant risk factor for VB amongst early psychosis patients, particularly when combined with either impulsivity, lack of insight and non-adherence to treatment. These results suggest that preventive strategies could be developed on the basis of such patient profiles.

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