Treatment of Psychosis and Risk Assessment for Violence

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

“…Our results suggest that the two first subgroups described above may be specific to EPP and that various preventive strategies could be developed on this basis: first, a high‐risk group of VB with high impulsivity and SUD, that could be potentiated by positive symptoms and lack of insight during this period. In line with Large (), our results suggest that VB is associated with SUD (Large et al, ), and that this co‐morbidity should therefore be targeted for early screening and specific treatment (Langeveld et al, ; Large et al, ; Mullin et al, ). The same is true for impulsivity, which should be explored thoroughly considering it may be amenable to treatment and evolve positively.…”

“…Unfortunately, very little research has been conducted on this topic in early psychosis patients (EPP) despite its potential usefulness in adapting treatment and developing specific early preventive strategies (Douglas & Skeem, 2005;Hodgins et al, 2011;Large, Dall, & Nielssen, 2014;Large & Nielssen, 2011;Witt, Van Dorn, & Fazel, 2013). The literature has shown that among patients with schizophrenia and first episode psychosis (FEP), the presence of isolated dynamic risk factors such as substance abuse or dependency (Fazel et al, 2009;Large, 2014;Latalova, 2014;Vacheron & Cornic, 2010), antisocial personality disorders (APDs) (Putkonen, Kotilainen, Joyal, & Tiihonen, 2004) or positive psychotic symptoms (Elbogen & Johnson, 2009;Lincoln, Lüllmann, & Rief, 2007;Nolan et al, 2005;Swanson et al, 2006;Witt, Lichtenstein, & Fazel, 2015) increases the risk of VB. More recently, several studies have shown that lack of insight (Bjørkly, 2006;Foley et al, 2005;Reinharth, Reynolds, Dill, & Serper, 2014;Verma, Poon, Subramaniam, & Chong, 2005;Voyer, Jaafari, & Senon, 2011) and the presence of impulsivity (Bjørkly, 2013) could also play a critical role in the risk of VB in schizophrenia and FEP (Bjørkly, 2013;Nielssen et al, 2012;Silverstein et al, 2015;Volavka & Citrome, 2008;Witt et al, 2013).…”

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

“…After controlling for the impact of alcohol abuse, other forms of substance abuse, dynamic risk factors, diagnosis and personality disorder comorbidity, our results confirm previous data ( 5 ) showing that CUD is a significant risk factor for the occurrence of VB ( 51 ), and show this specifically in an early psychosis population. Previous research in similar populations showed that substance abuse in general is a risk for VB ( 17 , 18 , 22 , 27 ). Establishing that CUD plays a specific role in this matter is important considering its high prevalence in EPP and it's early onset at age 15 in violent patients ( 6 , 7 , 64 , 65 ), and the fact that it can be influenced by treatment, especially in young patients ( 7 , 66 ).…”

“…This means exploring the complex patterns of interactions between factors where the effect of one factor can be neutralized or amplified by the impact of another ( 26 ). In order to develop preventive strategies for VB, it is therefore particularly important to analyze the patterns of interaction between dynamic risk factors (features that therapeutic interventions can modify) ( 12 , 21 , 27 , 28 ).…”

“…Other studies on the risk of VB in psychosis revealed the complex interactions between substance use, impulsivity and comorbid antisocial personnality disorder ( 38 , 43 , 46 ), the effect of the interaction between substance use and insight ( 47 , 48 ) and the links between substance use and poor adherence to treatment ( 49 ). Finally, both the lack of clarity about the link between insight and VB, which remains controversial in the literature ( 35 , 50 ), and the fact that insight has sometimes been considered a risk factor or a protective factor ( 22 , 27 ), may be due to the way in which insight interacts with other factors.…”