title: Incidence and clinical correlates of aggression and violence at presentation in patients with first episode psychosis.
abstract: This study aimed to identify the incidence and clinical correlates of aggression and violence in first episode psychosis. We prospectively recruited subjects with a first episode of DSM-psychosis presenting from a geographically defined catchment area to a secondary referral psychiatric service over a four-year period (n = 157). We used the Modified Overt Aggression Scale to retrospectively assess aggression (a hostile or destructive mental attitude, including verbal aggression, physical aggression and/or violence) and violence (the exercise of physical force), blind to diagnosis. One in three patients with psychosis was aggressive at the time of presentation. One patient in 14 engaged in violence that caused, or was likely to cause, injury to other people. Aggression was independently associated with drug misuse (odds ratio (OR) 2.80, 95% confidence interval 1.12-6.99) and involuntary admission status (OR = 3.62, 95% CI 1.45-9.01). Violence in the week prior to presentation was associated with drug misuse (OR = 2.75, CI 1.04-7.24) and involuntary admission status (OR = 3.21, CI 1.21-8.50). Violence in the week following presentation was associated with poor insight (OR 2.97, CI 1.03-8.56) and pre-contact violence (OR 3,82, CI 1.34-10.88). In patients with schizophrenia, violence in the week following presentation was associated with drug misuse (OR = 7.81, CI 1.33-45.95) and high psychopathology scores (OR = 20.59, CI 1.66-254.96). Overall, despite a high rate of verbal aggression, physical violence towards other people is uncommon in individuals presenting with first episode psychosis.
authors.affiliation: The Stanley Research Unit, Department of Adult Psychiatry, Hospitaller Order of St. John of God, Cluain Mhuire Service, Co Dublin, Ireland.
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Foley
authors.forename: Brendan D
authors.initials: BD
authors.lastname: Kelly
authors.forename: Mary
authors.initials: M
authors.lastname: Clarke
authors.forename: Orfhlaith
authors.initials: O
authors.lastname: McTigue
authors.forename: Maurice
authors.initials: M
authors.lastname: Gervin
authors.forename: Moyyad
authors.initials: M
authors.lastname: Kamali
authors.forename: Conall
authors.initials: C
authors.lastname: Larkin
authors.forename: Eadbhard
authors.initials: E
authors.lastname: O'Callaghan
authors.forename: Stephen
authors.initials: S
authors.lastname: Browne
mesh_terms: D000374:Aggression / Q000523:psychology*; D001364:Awareness; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology* / Q000534:rehabilitation; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data*