Johannes Langeveld1, Stål Bjørkly2, Bjørn Auestad3, Helene Barder4, Julie Evensen5, Wenche Ten Velden Hegelstad6, Inge Joa7, Jan Olav Johannessen7, Tor Ketil Larsen8, Ingrid Melle5, Stein Opjordsmoen5, Jan Ivar Røssberg5, Bjørn Rishovd Rund9, Erik Simonsen10, Per Vaglum11, Thomas McGlashan12, Svein Friis5. 1. Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway. Electronic address: jhl@sus.no. 2. Molde University College, PO. Box 2110, 6402 Molde, Norway; Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway. 3. Faculty of Science and Mathematics, University of Stavanger, 4036 Stavanger, Norway. 4. Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway. 5. Division of Mental Health and Addiction, Oslo University Hospital, P.O. 4959 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. 1171 Blindern, 0318 Oslo, Norway. 6. Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway. 7. Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway. 8. Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway; Institute of Psychiatry, University of Bergen, Jonas Lies vei 65, 5021 Bergen, Norway. 9. Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway. 10. Psychiatric Research Unit, Zealand Region, Toftebakken 9, 4000 Roskilde, Denmark; University of Copenhagen, P.O. box 2177, Copenhagen, Denmark. 11. Department of Behavioral Sciences in Medicine, University of Oslo, P.O. 1130 Blindern, 0318 Oslo, Norway. 12. Department of Psychiatry, Yale University School of Medicine, Yale Psychiatric Research at Congress Place, 301 Cedar St., New Haven, CT 06519, USA.
Abstract
BACKGROUND: First episode psychosis (FEP) patients have an increased risk for violence and criminal activity prior to initial treatment. However, little is known about the prevalence of criminality and acts of violence many years after implementation of treatment for a first episode psychosis. AIM: To assess the prevalence of criminal and violent behaviors during a 10-year follow-up period after the debut of a first psychosis episode, and to identify early predictors and concomitant risk factors of violent behavior. METHOD: A prospective design was used with comprehensive assessments of criminal behavior, drug abuse, clinical, social and treatment variables at baseline, five, and 10-year follow-up. Additionally, threatening and violent behavior was assessed at 10-year follow-up. A clinical epidemiological sample of first-episode psychosis patients (n=178) was studied. RESULTS: During the 10-year follow-up period, 20% of subjects had been apprehended or incarcerated. At 10-year follow-up, 15% of subjects had exposed others to threats or violence during the year before assessment. Illegal drug use at baseline and five-year follow-up, and a longer duration of psychotic symptoms were found to be predictive of violent behavior during the year preceding the 10-year follow-up. CONCLUSION: After treatment initiation, the overall prevalence of violence in psychotic patients drops gradually to rates close to those of the general population. However, persistent illicit drug abuse is a serious risk factor for violent behavior, even long after the start of treatment. Achieving remission early and reducing substance abuse may contribute to a lower long-term risk for violent behavior in FEP patients.
BACKGROUND: First episode psychosis (FEP) patients have an increased risk for violence and criminal activity prior to initial treatment. However, little is known about the prevalence of criminality and acts of violence many years after implementation of treatment for a first episode psychosis. AIM: To assess the prevalence of criminal and violent behaviors during a 10-year follow-up period after the debut of a first psychosis episode, and to identify early predictors and concomitant risk factors of violent behavior. METHOD: A prospective design was used with comprehensive assessments of criminal behavior, drug abuse, clinical, social and treatment variables at baseline, five, and 10-year follow-up. Additionally, threatening and violent behavior was assessed at 10-year follow-up. A clinical epidemiological sample of first-episode psychosispatients (n=178) was studied. RESULTS: During the 10-year follow-up period, 20% of subjects had been apprehended or incarcerated. At 10-year follow-up, 15% of subjects had exposed others to threats or violence during the year before assessment. Illegal drug use at baseline and five-year follow-up, and a longer duration of psychotic symptoms were found to be predictive of violent behavior during the year preceding the 10-year follow-up. CONCLUSION: After treatment initiation, the overall prevalence of violence in psychoticpatients drops gradually to rates close to those of the general population. However, persistent illicit drug abuse is a serious risk factor for violent behavior, even long after the start of treatment. Achieving remission early and reducing substance abuse may contribute to a lower long-term risk for violent behavior in FEP patients.
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Authors: Nabila Z Chowdhury; Olayan Albalawi; Handan Wand; Armita Adily; Azar Kariminia; Stephen Allnutt; Grant Sara; Kimberlie Dean; Julia Lappin; Colman O'Driscoll; Luke Grant; Peter W Schofield; David Greenberg; Tony Butler Journal: BJPsych Open Date: 2019-10-14