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Is violence at presentation by patients with first-episode psychosis associated with duration of untreated psychosis?
Soc Psychiatry Psychiatr Epidemiol. 2007 Aug; 42(8):606-10.SP

Abstract

INTRODUCTION

Violence in first episode psychosis poses significant challenges for mental health staff and patients' families. Violence has been shown to be related to psychopathology. Duration of untreated psychosis (DUP) has been shown to influence psychopathology at presentation in first-episode psychosis, but little is known about the direct relationship between violence at presentation and DUP. We therefore sought to examine the relationship between these two variables.

METHODS

Patients were all individuals aged between 16 and 65 years, with a DSM-III-R diagnosis of psychotic illness, taking part in a First Episode study. We used the Structured Clinical Interview (SCID-I), Positive and Negative Symptom Scale (PANSS), Beiser Scale and the Modified Overt Aggression Scale (MOAS) to evaluate diagnosis, psychopathology, DUP and violent behaviour respectively. Data for each case were retrospectively examined for violence, for the week prior to and week following first contact with psychiatric services, blind to diagnosis, DUP and psychopathology scores.

RESULTS

We assessed 157 patients. About 46 patients (29%) were violent. Violence rates did not differ across diagnostic groups, while DUP varied significantly across diagnostic groups (P = 0.001). Violence was not associated with DUP across all psychoses (P = 0.41). In the schizophrenia subgroup (n = 94), thirty individuals (32%) were violent. In a logistic regression, logDUP was not associated with violence (P = 0.11). Violence was predicted by involuntary admission status (P = 0.04) and global positive symptoms (P = 0.03). DUP was associated weakly with negative symptoms (P = 0.01) but not associated with positive or general psychopathology. Neither pre nor post-contact violence was associated (P = 0.79 and P = 0.09 respectively) with DUP.

DISCUSSION

Contrary to a recent study, we did not find an association between violence at presentation and DUP. The relationships between violence, DUP and psychopathology are complex and may be compounded by potential difficulties inherent in the PANSS.

CONCLUSION

Programs to reduce DUP may not impact on rates of violence at presentation in First Episode Psychosis (FEP).

Authors+Show Affiliations

DETECT, 1 Marine Terrace, Dun Laoghaire, Dublin, Ireland. sharonrachelfoley@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17598060

Citation

Foley, Sharon R., et al. "Is Violence at Presentation By Patients With First-episode Psychosis Associated With Duration of Untreated Psychosis?" Social Psychiatry and Psychiatric Epidemiology, vol. 42, no. 8, 2007, pp. 606-10.
Foley SR, Browne S, Clarke M, et al. Is violence at presentation by patients with first-episode psychosis associated with duration of untreated psychosis? Soc Psychiatry Psychiatr Epidemiol. 2007;42(8):606-10.
Foley, S. R., Browne, S., Clarke, M., Kinsella, A., Larkin, C., & O'Callaghan, E. (2007). Is violence at presentation by patients with first-episode psychosis associated with duration of untreated psychosis? Social Psychiatry and Psychiatric Epidemiology, 42(8), 606-10.
Foley SR, et al. Is Violence at Presentation By Patients With First-episode Psychosis Associated With Duration of Untreated Psychosis. Soc Psychiatry Psychiatr Epidemiol. 2007;42(8):606-10. PubMed PMID: 17598060.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is violence at presentation by patients with first-episode psychosis associated with duration of untreated psychosis? AU - Foley,Sharon R, AU - Browne,Stephen, AU - Clarke,Mary, AU - Kinsella,Anthony, AU - Larkin,Conall, AU - O'Callaghan,Eadbhard, Y1 - 2007/06/27/ PY - 2007/01/24/received PY - 2007/05/29/accepted PY - 2007/6/29/pubmed PY - 2007/11/6/medline PY - 2007/6/29/entrez SP - 606 EP - 10 JF - Social psychiatry and psychiatric epidemiology JO - Soc Psychiatry Psychiatr Epidemiol VL - 42 IS - 8 N2 - INTRODUCTION: Violence in first episode psychosis poses significant challenges for mental health staff and patients' families. Violence has been shown to be related to psychopathology. Duration of untreated psychosis (DUP) has been shown to influence psychopathology at presentation in first-episode psychosis, but little is known about the direct relationship between violence at presentation and DUP. We therefore sought to examine the relationship between these two variables. METHODS: Patients were all individuals aged between 16 and 65 years, with a DSM-III-R diagnosis of psychotic illness, taking part in a First Episode study. We used the Structured Clinical Interview (SCID-I), Positive and Negative Symptom Scale (PANSS), Beiser Scale and the Modified Overt Aggression Scale (MOAS) to evaluate diagnosis, psychopathology, DUP and violent behaviour respectively. Data for each case were retrospectively examined for violence, for the week prior to and week following first contact with psychiatric services, blind to diagnosis, DUP and psychopathology scores. RESULTS: We assessed 157 patients. About 46 patients (29%) were violent. Violence rates did not differ across diagnostic groups, while DUP varied significantly across diagnostic groups (P = 0.001). Violence was not associated with DUP across all psychoses (P = 0.41). In the schizophrenia subgroup (n = 94), thirty individuals (32%) were violent. In a logistic regression, logDUP was not associated with violence (P = 0.11). Violence was predicted by involuntary admission status (P = 0.04) and global positive symptoms (P = 0.03). DUP was associated weakly with negative symptoms (P = 0.01) but not associated with positive or general psychopathology. Neither pre nor post-contact violence was associated (P = 0.79 and P = 0.09 respectively) with DUP. DISCUSSION: Contrary to a recent study, we did not find an association between violence at presentation and DUP. The relationships between violence, DUP and psychopathology are complex and may be compounded by potential difficulties inherent in the PANSS. CONCLUSION: Programs to reduce DUP may not impact on rates of violence at presentation in First Episode Psychosis (FEP). SN - 0933-7954 UR - https://www.unboundmedicine.com/medline/citation/17598060/Is_violence_at_presentation_by_patients_with_first_episode_psychosis_associated_with_duration_of_untreated_psychosis L2 - https://dx.doi.org/10.1007/s00127-007-0217-9 DB - PRIME DP - Unbound Medicine ER -