[Three clinical risk profiles of violent behavior in a cohort of early psychosis patients].
- Moulin V Unité de recherche en psychiatrie et psychologie légales, institut de psychiatrie légale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), site de Cery, bâtiment Les Cèdres, 1008 Prilly-Lausanne, Suisse. Electronic address: Valerie.Moulin@chuv.ch.
- Alameda L Service de psychiatrie générale, centre de neuroscience psychiatrique, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Baumann PS Service de psychiatrie générale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse.
- Gholamrezaee MM Centre d'épidémiologie psychiatrique et psychopathologie, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse.
- Palix J Unité de recherche en psychiatrie et psychologie légales, institut de psychiatrie légale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), site de Cery, bâtiment Les Cèdres, 1008 Prilly-Lausanne, Suisse.
- Gasser J Institut de psychiatrie légale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse.
- Conus P Service de psychiatrie générale, département de psychiatrie du centre hospitalier universitaire Vaudois (CHUV), Lausanne, Suisse.
- 2018-11-18
Published in:
- L'Encephale. - 2019
Clinical profiles
Comportement violent
Early phase of psychotic disorders
Phase précoce de psychose
Profils cliniques
Psychose
Psychosis
Schizophrenia
Schizophrénie
Violent behaviors
Adolescent
Adult
Age of Onset
Behavior
Cohort Studies
Female
Humans
Male
Neuropsychological Tests
Prevalence
Psychiatric Status Rating Scales
Psychotic Disorders
Risk Assessment
Risk Factors
Violence
Young Adult
English
OBJECTIVE
This study aims to determine whether it is possible to identify clinical profiles at risk of violent behaviors (VB) in the early phase of psychotic disorders, on the basis of the main dynamic psychopathological risk factors and describe characteristics of the groups with highest levels of violent behaviors.
METHOD
A total of 265 patients, aged 18 to 35, treated at the Treatment and early Intervention in Psychosis Program (TIPP-Lausanne), a specialized early psychosis program, were included in this study. We conducted a latent-class analysis and a discriminative analysis on the basis of the main dynamic VB risk factors: substance use disorder, impulsivity, positive symptoms, insight, aggression, hostility, anger, emotional instability and adherence to treatment. These factors were evaluated by specialized scales and on the basis of the Positive and Negative Syndrome Scale (PANSS). VB were restricted to physical aggression against people, defined as "serious violence". They were assessed on the basis of a questionnaire listing violent offenses (Swiss Criminal Code) and VB such as assault and battery, information through the forensic psychiatric services and on the basis of the Staff Observation Aggression Scale (SOAS-R scale) during inpatient treatment phase.
RESULTS
Four heterogeneous subgroups were identified with respect to the studied clinical characteristics, including two groups with high rates of VB. The first group, comprising 46% of patients with VB, is distinguished by the prevalence of a range of dimensions related to hostility, impulsivity and emotional instability, associated with high levels of substance abuse and positive symptoms. These clinical dimensions are very significant at the statistical level, since they explain 70% of the construction of subgroups (discriminant analysis). The second group with 37% of patients with VB, is characterized by a lack of insight, lack of adherence to treatment and substance use. These two clinical profiles could increase the impairment of cognitive, functional and relational abilities and contribute to the development of VB in this early phase of psychosis. The third subgroup, with a violent behaviors rate of 28.6%, is distinguished by its high proportion of diagnoses of substance abuse (100%) and women (54%). A last subgroup of patients, the largest quantitatively, has a low proportion of VB (15%) and the lowest levels on the studied factors, suggesting that the majority of patients with this profile commit few VB.
CONCLUSION
Our results show that it is possible to identify groups at risk of violent behaviors during the early phase of psychosis on the basis of clinical characteristics that may evolve and therefore be the focus of preventive care. These results highlight the need to target substance use, impulsivity and lack of insight at follow-up in order to prevent VB.
This study aims to determine whether it is possible to identify clinical profiles at risk of violent behaviors (VB) in the early phase of psychotic disorders, on the basis of the main dynamic psychopathological risk factors and describe characteristics of the groups with highest levels of violent behaviors.
METHOD
A total of 265 patients, aged 18 to 35, treated at the Treatment and early Intervention in Psychosis Program (TIPP-Lausanne), a specialized early psychosis program, were included in this study. We conducted a latent-class analysis and a discriminative analysis on the basis of the main dynamic VB risk factors: substance use disorder, impulsivity, positive symptoms, insight, aggression, hostility, anger, emotional instability and adherence to treatment. These factors were evaluated by specialized scales and on the basis of the Positive and Negative Syndrome Scale (PANSS). VB were restricted to physical aggression against people, defined as "serious violence". They were assessed on the basis of a questionnaire listing violent offenses (Swiss Criminal Code) and VB such as assault and battery, information through the forensic psychiatric services and on the basis of the Staff Observation Aggression Scale (SOAS-R scale) during inpatient treatment phase.
RESULTS
Four heterogeneous subgroups were identified with respect to the studied clinical characteristics, including two groups with high rates of VB. The first group, comprising 46% of patients with VB, is distinguished by the prevalence of a range of dimensions related to hostility, impulsivity and emotional instability, associated with high levels of substance abuse and positive symptoms. These clinical dimensions are very significant at the statistical level, since they explain 70% of the construction of subgroups (discriminant analysis). The second group with 37% of patients with VB, is characterized by a lack of insight, lack of adherence to treatment and substance use. These two clinical profiles could increase the impairment of cognitive, functional and relational abilities and contribute to the development of VB in this early phase of psychosis. The third subgroup, with a violent behaviors rate of 28.6%, is distinguished by its high proportion of diagnoses of substance abuse (100%) and women (54%). A last subgroup of patients, the largest quantitatively, has a low proportion of VB (15%) and the lowest levels on the studied factors, suggesting that the majority of patients with this profile commit few VB.
CONCLUSION
Our results show that it is possible to identify groups at risk of violent behaviors during the early phase of psychosis on the basis of clinical characteristics that may evolve and therefore be the focus of preventive care. These results highlight the need to target substance use, impulsivity and lack of insight at follow-up in order to prevent VB.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.encep.2018.08.003
- PMID 30446287
- Persistent URL
- https://sonar.ch/global/documents/20617
Statistics
Document views: 36
File downloads:
- Full-text: 0