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Screening may prevent violence in individuals at risk for psychosis
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Violent ideation and behavior were significant predictors of subsequent violent behavior and psychosis diagnosis among individuals at high risk for psychosis, according to recent findings.
“It is important that we acknowledge that violence can be fueled by mental illness and that steps be taken to identify those people who might be prone and treat them accordingly. That is why these findings are so important as they demonstrate that screening people with sensitive instruments can detect which people in the incipient stages of mental disorders are at greatest risk of violence,” study researcher Jeffrey A. Lieberman, MD, of Columbia University College of Physicians and Surgeons, said in a press release.
To assess associations between violent behavior and violent ideation at baseline and violent behavior outcomes and conversion to psychosis in at-risk individuals, researchers conducted a longitudinal evaluation of 200 individuals with clinical high risk for psychosis for violent ideation and violent behavior.
At baseline, 28% of participants reported violent ideation and 6% reported violent behavior within the past 6 months.
Four percent of the cohort committed acts of violence during follow-up.
Violent ideation (RR = 13.9; P = .001) and violent behavior (RR = 8.3; P = .003) at baseline were predictors of violent behavior at follow-up.
Further, baseline violent ideation (RR = 2.3; P < .001) and violent behavior (RR = 2.4; P < .001) predicted psychosis diagnosis during follow-up.
These associations remained when adjusting for more than 40 clinical and demographic variables.
Targets of violent ideation at baseline were “completely different” than subsequent targets of violent behavior, according to researchers.
The researchers noted that information regarding violent ideation was obtained only from indirect inquiry about violent ideation.
“These findings indicate that presymptomatic individuals at-risk for psychosis should be screened for violent ideation, and, importantly, demonstrate how to do the screening effectively,” study researcher Ragy Girgis, MD, of Columbia University Medical Center, said in the release. “We hope this finding and means of assessment will move the field to develop a more nuanced understanding of violent ideation in the context of psychotic symptoms. Much like suicidal ideation in depression, destigmatizing the experience of violent ideation in the attenuated phase of psychosis will allow patients to freely report it.” – by Amanda Oldt
Disclosure: Lieberman reports receiving research funding from or serving as a member of the advisory board of Allon, Alkermes Bioline, GlaxoSmithKline Intracellular Therapies, Lilly, Merck, Novartis, Pfizer, Pierre Fabre, Psychogenics, F HoffmanLa Roche Ltd, Sunovion, and Targacept. RRG has received research support from Otsuka, Genentech, BioAdvantex, and Allergan. The other researchers report no relevant financial disclosures.