PurposeTo prevent violence among persons with psychosis, further knowledge of the correlates and risk factors is needed. These risk factors may vary by nation.Patients and methodsThis study examined factors associated with violent assaults in 158 patients with psychosis and in a matched control sample of 158 adults without psychosis in the Czech Republic. Participants completed interviews and questionnaires to confirm diagnoses, report on aggressive behavior, current and past victimization, and substance use. Additional information was collected from collateral informants and clinical files. Multiple regression analyses were conducted to identify factors that were independently associated with committing an assault in past 6 months.ResultsThe presence of a psychotic disorder was associated with an increased risk of assaults (OR =3.80; 95% CI 2.060–7.014). Additional risk factors in persons with and without psychosis included recent physical victimization (OR =7.09; 95% CI 3.922–12.819), childhood maltreatment (OR =3.15; 95% CI 1.877–5.271), the level of drug use (OR =1.13; 95% CI 1.063–1.197), and the level of alcohol use (OR =1.04; 95% CI 1.000–1.084). Increasing age (OR =0.96; 95% CI 0.942–0.978) and employment (OR =0.30; 95% CI 0.166–0.540) were protective factors. Except for drug use, which appeared to have greater effect on violence in the group without psychosis, there were no major differences between patients and controls in these risk and protective factors. To our knowledge, this is the first published comparison of assault predictors between schizophrenia patients and matched controls.ConclusionRecent physical victimization was the strongest predictor of assaults. Our findings are consistent with the emerging empirical evidence pointing to the very important role of victimization in eliciting violent behavior by the victims. Some current prediction instruments may underestimate the risk of violent behavior as they take little account of current victimization. Although psychosis per se elevates the risk of violence, other risk and protective factors for violence in persons with psychosis and comparison group are largely similar.

It is suggested that limited access to appropriate care forces psychiatric patients towards forensic treatment or to the prison system. According to our data, the number of prisoners, the number of hospitalized psychiatric patients (from 1987 to 2007), the number of court ordered forensic treatments in the Czech Republic (from 1991 to 2007), and the rate of people in psychiatric and sex offender forensic treatment has remained constant. However, an increase (162%) in number of treatments imposed for abusing illicit drugs did occur during this period. This increase contributed to the correlation between both the number of sentences given for protective treatment and the number of all sentenced persons (Pearson cor. 0.647, p < 0,001) and the number of prisoners (Pearson cor. 0.798, p < 0,001). The analysis of all admissions to a forensic facility from a catchment area of 1,260,318 inhabitants shows no increase in number of admission between 2002 and 2007. The same data prove that the number of patients ordered to psychiatric and sexology treatment remained steady and did not reflect changes in the number of prisoners or number of hospitalized patients. This could be explained by a high number of psychiatric hospitalizations protecting the patients from deteriorating to criminal behaviour.

Kazuistika demonstruje úspěšnou ambulantní léčbu pacientky s duální diagnózou -závislostí na více psychoaktivních látkách, depresí a osobnostní problematikou. Zdůrazňuje význam spolupráce ambulantního psychiatra a psychoterapeuta.

Relative to controls, FEP subjects showed volume reduction in a cluster located in the anterior CC genu (Z¼3.77, p<0.001 uncorrected), which retained significance when analyses were restricted to the schizophrenia/schizophreniform subgroup (n¼62) compared to controls (Z¼3.16, p<0.001 uncorrected). In the subsample of FEP subjects who performed the finger localization task, there were two clusters of significant positive correlation between performance on the CFLT and CC volumes, respectively in the anterior genu (Z¼3.77, p<0.001 uncorrected) and the posterior genu (Z¼3.30, p<0.001 uncorrected). Conclusion: These findings indicate the presence of circumscribed foci of reduced CC volumes in association with FEP, and suggest that such abnormalities are related to deficits in interhemispheric transfer of information.