Citation

Dugré JR, Guay JP, Dumais A. Schizophr. Res. 2018; 195: 115-121.

Affiliation

Institut Philippe-Pinel de Montréal, Montréal H1C 1H1, Canada; Department of Psychiatry, Faculty of Medicine, Université de Montréal, Pavillon Roger-Gaudry, Montreal H3T 1J4, Canada. Electronic address: alexandre.dumais@umontreal.ca.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.schres.2017.09.001

PMID

28911915

Abstract

Clinicians are often left with the difficult task of assessing and managing the risk of violent behaviors in individuals having command hallucinations, which may result in substantial rates of false positive or false negative. Moreover, findings on the association between command hallucinations and suicidal behaviors are limited. In an attempt to better understand compliance to this hallucinatory phenomenon, our objective was to identify the risk factors of compliance with self-harm command hallucinations. Secondary analyses from the MacArthur Study were performed on 82 participants with psychosis reporting such commands. Univariate logistic regression was used to examine the classification value of each characteristic associated with compliance with such commands. Seriousness and frequency of childhood physical abuse, a current comorbid substance use disorder, emotional distress, general symptomatology, history of compliance, and belief about compliance in the future were found to be significant risk factors of compliance with self-harm commands in the week preceding psychiatric inpatient. Multivariate analyses revealed that severity of childhood physical abuse, belief about compliance in the future, and a current comorbid substance use disorder were independent risk factors. The final model showed excellent classification accuracy as suggest by the receiver operating characteristic curve (AUC=0.84, 95% CI: 0.75-0.92, p<0.001). Our results suggest considerable clinical implications in regard to the assessment of risk of compliance to self-harm command hallucinations in individuals with psychosis.

Copyright © 2017. Published by Elsevier B.V.

Language: en

Keywords

Command hallucinations; Compliance; Logistic regression; Self-harm; Suicide