Schizophrénie et violence : incidence et facteurs de risque à propos d’une population tunisienne

Ellouze, F.; Ayedi, S.; Masmoudi, S.; Bakri, L.; Chérif, W.; Zramdini, R.; Larguèche, Myriam; Amri, H.; Abla, T. Ben; M’rad, M.F.

doi:10.1016/j.encep.2008.04.006

Cited by 14 publications

(4 citation statements)

References 12 publications

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“…The olanzapine equivalent upon discharge from the referenced psychiatric hospitalization emerged as variable with by far the highest indicative power in our model: With a mean cumulative dose of 22 mg, OP were subjected to higher doses of antipsychotic substances than NOP. The finding of higher antipsychotic doses is in line with previous literature: In a comparative study of violent and non-violent inpatients with SSD, Ellouze et al found the former to be characterized by significantly higher neuroleptic doses ( 28 ). From a clinical perspective, it seems logical at first glance that patients with a tendency of aggressive behavior receive higher antipsychotic doses.…”

Section: Discussionsupporting

confidence: 91%

Offenders and non-offenders with schizophrenia spectrum disorders: Do they really differ in known risk factors for aggression?

2023

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IntroductionIndividuals with schizophrenia spectrum disorders (SSD) have an elevated risk for aggressive behavior, and several factors contributing to this risk have been identified, e. g. comorbid substance use disorders. From this knowledge, it could be inferred that offender patients show a higher expression of said risk factors than non-offender patients. Yet, there is a lack of comparative studies between those two groups, and findings gathered from one of the two are not directly applicable to the other due to numerous structural differences. The aim of this study therefore was to identify key differences in offender patients and non-offender patients regarding aggressive behavior through application of supervised machine learning, and to quantify the performance of the model.MethodsFor this purpose, we applied seven different (ML) algorithms on a dataset comprising 370 offender patients and a comparison group of 370 non-offender patients, both with a schizophrenia spectrum disorder.ResultsWith a balanced accuracy of 79.9%, an AUC of 0.87, a sensitivity of 77.3% and a specificity of 82.5%, gradient boosting emerged as best performing model and was able to correctly identify offender patients in over 4/5 the cases. Out of 69 possible predictor variables, the following emerged as the ones with the most indicative power in distinguishing between the two groups: olanzapine equivalent dose at the time of discharge from the referenced hospitalization, failures during temporary leave, being born outside of Switzerland, lack of compulsory school graduation, out- and inpatient treatment(s) prior to the referenced hospitalization, physical or neurological illness as well as medication compliance.DiscussionInterestingly, both factors related to psychopathology and to the frequency and expression of aggression itself did not yield a high indicative power in the interplay of variables, thus suggesting that while they individually contribute to aggression as a negative outcome, they are compensable through certain interventions. The findings contribute to our understanding of differences between offenders and non-offenders with SSD, showing that previously described risk factors of aggression may be counteracted through sufficient treatment and integration in the mental health care system.

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Section: Discussionsupporting

confidence: 91%

Offenders and non-offenders with schizophrenia spectrum disorders: Do they really differ in known risk factors for aggression?

2023

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“…The findings of substance abuse studies suggest that the risk of criminality and violent behaviors in comorbid patients with schizophrenia with substance abuse is similar to that of substance abusing individuals without schizophrenia, suggesting that violence reduction efforts should consider focusing on primary and secondary substance abuse prevention strategies. 10 , 31 Also, since crime is most often the offender’s response to delusions or hallucinations 25 the significance of early treatment of delusions and hallucinations should be underscored. 32…”

Section: Discussionmentioning

confidence: 99%

“… 9 Existing research also indicates that the prevalence of crime in patients with schizophrenia is significantly associated with male sex, being single, refusing to accept treatment, substance abuse and duration of illness. 10 - 12 …”

Section: Introductionmentioning

confidence: 99%

Prevalence and attributes of criminality in schizophrenic patients

Ghoreishi¹,

Kabootvand²,

Zangani³

et al. 2014

J Inj Violence Res

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Abstract:Background:Existing research in law and psychiatry point to schizophrenia as a risk factor for violence and offense behaviors. The present study aims to: 1) report on the prevalence and types of offensive or criminal acts in patients with schizophrenia; 2) identify attributes of schizophrenic offenders; and 3) examine factors associated with offensive or criminal behaviors within a sample of schizophrenic offenders.Methods:This was a cross-sectional study of 358 patients with schizophrenia who were admitted to a psychiatric ward in Iran between 2004 and 2008. Study data was collected using patients’ medical, criminal records, as well as via personal interview with the family member. Study variables included criminality or offensive behavior, types of schizophrenia (paranoid vs. nonparanoid), experiencing hallucination, disease onset, and patients’ demographics. Results:Of the sample, 64.8% were male, 80.7% were 45 years old or younger, and 74.1% were either single or divorced. Slightly over 59 % were offenders with criminal status, of which, 9.8% were legal offenders and 48.6% were hidden offenders. The results of unadjusted logistic regression between these variables and criminality show, except for employment, marital status, and opium use, all other variables were statically associated with criminality.Conclusions:Methodological difficulties arising from this study, as well as, the role of mental health professionals, family, and legal system for prevention of violence in and by patients with schizophrenia are discussed.

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“…The comorbidities are also known risk factors for violent behavior, which also makes a consequential involvement with the criminal justice system more likely ( 20 , 71 ). The same goes for the prevalence of certain symptoms of SSD, which are considered to increase the likelihood of offending, such as a higher expression of positive symptoms and general severity of symptoms—although there is still controversy over which types of symptoms exactly promote criminal behavior in SSD, and corresponding findings are oftentimes inconsistent ( 72 , 73 ). The fact that our findings diverge from these previous results by no means indicates that known and well-established risk factors for problematic and potentially illegal behavior are contradicted.…”

Section: Discussionmentioning

confidence: 99%

Offenders and non-offenders with schizophrenia spectrum disorders: the crime-preventive potential of sufficient embedment in the mental healthcare and support system

Machetanz,

Hofmann,

Möhrke

et al. 2023

Front. Psychiatry

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BackgroundSuffering from schizophrenia spectrum disorder (SSD) has been well-established as a risk factor for offending. However, the majority of patients with an SSD do not show aggressive or criminal behavior. Yet, there is little research on clinical key features distinguishing offender from non-offender patients. Previous results point to poorer impulse control, higher levels of excitement, tension, and hostility, and worse overall cognitive functioning in offender populations. This study aimed to detect the most indicative distinguishing clinical features between forensic and general psychiatric patients with SSD based on the course of illness and the referenced hospitalization in order to facilitate a better understanding of the relationship between violent and non-violent offenses and SSD.MethodsOur study population consisted of forensic psychiatric patients (FPPs) with a diagnosis of F2x (ICD-10) or 295.x (ICD-9) and a control group of general psychiatric patients (GPPs) with the same diagnosis, totaling 740 patients. Patients were evaluated regarding their medical (and, if applicable, criminal) history and the referenced psychiatric hospitalization. Supervised machine learning (ML) was used to exploratively evaluate predictor variables and their interplay and rank them in accordance with their discriminative power.ResultsOut of 194 possible predictor variables, the following 6 turned out to have the highest influence on the model: olanzapine equivalent at discharge from the referenced hospitalization, a history of antipsychotic prescription, a history of antidepressant, benzodiazepine or mood stabilizer prescription, medication compliance, outpatient treatment(s) in the past, and the necessity of compulsory measures. Out of the seven algorithms applied, gradient boosting emerged as the most suitable, with an AUC of 0.86 and a balanced accuracy of 77.5%.DiscussionOur study aimed to identify the most influential illness-related predictors, distinguishing between FPP and GPP with SSD, thus shedding light on key differences between the two groups. To our knowledge, this is the first study to compare a homogenous sample of FPP and GPP with SSD regarding their symptom severity and course of illness using highly sophisticated statistical approaches with the possibility of evaluating the interplay of all factors at play.

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Schizophrénie et violence : incidence et facteurs de risque à propos d’une population tunisienne

Cited by 14 publications

References 12 publications

Offenders and non-offenders with schizophrenia spectrum disorders: Do they really differ in known risk factors for aggression?

Offenders and non-offenders with schizophrenia spectrum disorders: Do they really differ in known risk factors for aggression?

Prevalence and attributes of criminality in schizophrenic patients

Offenders and non-offenders with schizophrenia spectrum disorders: the crime-preventive potential of sufficient embedment in the mental healthcare and support system

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