Screening Those at Risk of Psychosis May Help Prevent Violence, Reduce Stigma

Study shows that violent ideation before first psychotic episode highly correlates with violent acts

Article ID: 677924

Released: 14-Jul-2017 5:05 PM EDT

Source Newsroom: Columbia University Medical Center

A new study of young persons at clinical high-risk of developing psychosis has identified measures of violence potential that may be useful in predicting both the increased risk of future violent behavior and the actual development of psychosis.

 

The article, A Longitudinal Study of Violent Behavior in a Psychosis-Risk Cohort, by Gary Brucato, PhD, Ragy Girgis, MD and colleagues at Columbia University Medical Center, was published today in Neuropsychopharmacology.

 

In the public imagination, individuals with psychosis are often identified with acts of violence. However, the reality is that persons with mental illness account for a very small proportion of violent crime in the U.S. But studies have shown that people with psychotic disorders are more prone to acts of mass violence involving strangers or intrafamily violence if they have not received effective treatment.

 

“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,” noted Jeffrey A. Lieberman, MD, Lawrence C. Kolb professor and chair of psychiatry at Columbia University College of Physicians and Surgeons.

 

The study followed 200 individuals at high-risk of psychosis over a period of two years.  Twelve (6%) of them reported acts of violent behavior in the six months before joining the study, fifty-six (28%) reported violent ideation at the time of entry into the study, and eight (4%) committed acts of violence during the two-year follow-up period. As a result of the study evaluation, the study staff provided treatment and took preemptive action for ten additional individuals whose thoughts had developed into plans for violent acts.

 

The results of the study showed that both thoughts of violence and recent violent behavior were associated with future incidents of violence, which occurred within an average of seven days of when the person developed psychotic symptoms.

 

Only information contained in the description of the person’s symptoms predicted the violent behavior, and not direct questions of “whether you want to hurt anyone”. The authors suggest that this is likely why prior studies of violence in mental illness did not predict violent behavior. The direct question “have you had thoughts of harming anyone else?,” elicited zero responses of violent ideation from any of the 200 participants.  However, the indirect question “have you felt that you are not in control of your own ideas or thoughts?” elicited reports of violent ideation from 56 individuals.

 

Also, the targets of the violent thoughts at the beginning of the study were not those that the person subsequently. This suggests that the attacks may have been impulsive and opportunistic rather than planned, and the result of the person’s psychotic symptoms.

 

“These individuals feel that they themselves are not having violent fantasies, “said Dr. Gary Brucato, clinical psychologist and researcher in the department of psychiatry and first author on the paper. “They feel that the thoughts they are having are intrusive and not their own. Since they are not convinced that these thoughts are real, they tend not to report them or consider them meaningful.”

 

A variety of factors, including alcohol and drug abuse, failure to take antipsychotic medications regularly, younger age, and psychotic symptoms such as delusions and hallucinations have been shown to have some effect on the risk of violence among people with psychosis. Earlier research has also indicated that the period around the time of a first psychotic episode is a time of high risk for violent behavior, and that violent behavior peaks at this time.

 

“These findings indicate that pre-symptomatic individuals at-risk for psychosis should be screened for violent ideation, and, importantly, demonstrate how to do the screening effectively,” said Ragy Girgis, MD, assistant professor of psychiatry at Columbia University Medical Center and senior author on the paper. “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.”

 

“A Longitudinal Study of Violent Behavior in a Psychosis-Risk Cohort” was published July 17, 2017 in Neuropsychopharmacology. The authors are Gary Brucato, PhD, Paul S. Appelbaum, MD, Jeffrey A. Lieberman MD, Melanie M. Wall, PhD, Tianshu Feng, MS, Michael D. Masucci MA, Rebecca Altschuler MA, Ragy R. Girgis MD at the Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.

 

The project was supported by the National Institute of Mental Health grants R01MH093398 and K23MH106746.

 

JAL has received research funding from and/or is a member of the advisory board of Allon, Alkermes Bioline, GlaxoSmith‐Kline Intracellular Therapies, Lilly, Merck, Novartis, Pfizer, Pierre Fabre, Psychogenics, F Hoffman‐La Roche Ltd, Sunovion, and Targacept. RRG has received research support from Otsuka, Genentech, BioAdvantex, and Allergan.

 

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Columbia University Department of Psychiatry

Columbia Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at Columbia University’s College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.

 

Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. The campus that Columbia University Medical Center shares with its hospital partner, NewYork-Presbyterian, is now called the Columbia University Irving Medical Center.  For more information, visit cumc.columbia.edu or columbiadoctors.org.

 


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