title: Is violence at presentation by patients with first-episode psychosis associated with duration of untreated psychosis?
abstract: BACKGROUND
  Violence in first episode psychosis poses significant challenges for mental health staff and patients' families. Violence has been shown to be related to psychopathology. Duration of untreated psychosis (DUP) has been shown to influence psychopathology at presentation in first-episode psychosis, but little is known about the direct relationship between violence at presentation and DUP. We therefore sought to examine the relationship between these two variables.
  
  
  METHODS
  Patients were all individuals aged between 16 and 65 years, with a DSM-III-R diagnosis of psychotic illness, taking part in a First Episode study. We used the Structured Clinical Interview (SCID-I), Positive and Negative Symptom Scale (PANSS), Beiser Scale and the Modified Overt Aggression Scale (MOAS) to evaluate diagnosis, psychopathology, DUP and violent behaviour respectively. Data for each case were retrospectively examined for violence, for the week prior to and week following first contact with psychiatric services, blind to diagnosis, DUP and psychopathology scores.
  
  
  RESULTS
  We assessed 157 patients. About 46 patients (29%) were violent. Violence rates did not differ across diagnostic groups, while DUP varied significantly across diagnostic groups (P = 0.001). Violence was not associated with DUP across all psychoses (P = 0.41). In the schizophrenia subgroup (n = 94), thirty individuals (32%) were violent. In a logistic regression, logDUP was not associated with violence (P = 0.11). Violence was predicted by involuntary admission status (P = 0.04) and global positive symptoms (P = 0.03). DUP was associated weakly with negative symptoms (P = 0.01) but not associated with positive or general psychopathology. Neither pre nor post-contact violence was associated (P = 0.79 and P = 0.09 respectively) with DUP.
  
  
  CONCLUSIONS
  Contrary to a recent study, we did not find an association between violence at presentation and DUP. The relationships between violence, DUP and psychopathology are complex and may be compounded by potential difficulties inherent in the PANSS.
  
  
  CONCLUSIONS
  Programs to reduce DUP may not impact on rates of violence at presentation in First Episode Psychosis (FEP).
authors.affiliation: DETECT, 1 Marine Terrace, Dun Laoghaire, Dublin, Ireland. sharonrachelfoley@gmail.com
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Foley
authors.forename: Stephen
authors.initials: S
authors.lastname: Browne
authors.forename: Mary
authors.initials: M
authors.lastname: Clarke
authors.forename: Anthony
authors.initials: A
authors.lastname: Kinsella
authors.forename: Conall
authors.initials: C
authors.lastname: Larkin
authors.forename: Eadbhard
authors.initials: E
authors.lastname: O'Callaghan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011599:Psychopathology / Q000379:methods; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis; D012565:Schizophrenic Psychology; D013997:Time Factors; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data