Citation

Faay MDM, Sommer IE. Am. J. Psychiatry 2021; 178(3): 218-220.

Copyright

(Copyright © 2021, American Psychiatric Association)

DOI

10.1176/appi.ajp.2020.21010035

PMID

unavailable

Abstract

Aggression is an important negative outcome, and its prediction and prevention are among the top priorities in psychosis care. In their contribution in this issue of the Journal, Krakowski et al. (1) compare the effects of antipsychotics on violent schizophrenia patients with and without comorbid conduct disorder. As expected, patients with a history of comorbid conduct disorders had more frequent and severe physical assaults compared with patients without conduct disorders. Interestingly, clozapine and olanzapine had more pronounced antiaggressive effects compared with haloperidol in patients with conduct disorders than in patients without this comorbidity. We put this new, important finding into perspective.

The exact magnitude of the problem at hand is not completely clear because studies use different definitions, methods, populations, and settings. In a 38-year follow-up study that included the total population in Sweden, the adjusted odds ratio for convictions of any violent offense--including homicide, sexual offenses, assault, and intimidation--in patients with psychotic disorders (N=24,297) was 7.4 (95% CI=7.1-7.8) compared with the general population (2). A recent study in two U.K. regions that used police data of patients with first-episode psychosis (N=177) found that 14.7% were arrested or charged for violent offenses within 12 months after their first contact with specialized mental health care (3). In contrast to increased rates of violence, patients with psychotic disorders are also more vulnerable for victimization. A meta-analysis found that 20% of patients with psychotic disorders reported violent victimization over a 3-year period, some five times higher than in the general community (4). For a national census in Norway, mental health clinicians performed an unstructured risk assessment on inpatients and outpatients in psychiatric treatment, which included 60%−65% of all patients. Risk was rated as none, low to moderate, high, or very high.

RESULTS showed that 7% of outpatients and 27% of inpatients were considered to be at low to moderate risk and that 5% of inpatients and less than 1% of outpatients were at high or very high risk (5). These risk assessments are considerably lower than the actual odds ratio for violent offenses...

Language: en

Keywords

Risk; Preventions; Schizophrenia Spectrum and Other Psychotic Disorders; Violence/Aggression