Treatment and violent behavior in persons with first episode psychosis during a 10-year prospective follow-up study.
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.


OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway. Electronic address: jhl@sus.no.
Johannes
J
Langeveld
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.
Stål
S
Bjørkly
Faculty of Science and Mathematics, University of Stavanger, 4036 Stavanger, Norway.
Bjørn
B
Auestad
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.
Helene
H
Barder
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.
Julie
J
Evensen
Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, P.O. 8100, 4068 Stavanger, Norway.
Wenche
W
Ten Velden Hegelstad
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.
Inge
I
Joa
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.
Jan Olav
JO
Johannessen
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.
Tor Ketil
TK
Larsen
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.
Ingrid
I
Melle
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.
Stein
S
Opjordsmoen
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.
Jan Ivar
JI
Røssberg
Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway.
Bjørn Rishovd
BR
Rund
Psychiatric Research Unit, Zealand Region, Toftebakken 9, 4000 Roskilde, Denmark; University of Copenhagen, P.O. box 2177, Copenhagen, Denmark.
Erik
E
Simonsen
Department of Behavioral Sciences in Medicine, University of Oslo, P.O. 1130 Blindern, 0318 Oslo, Norway.
Per
P
Vaglum
Department of Psychiatry, Yale University School of Medicine, Yale Psychiatric Research at Congress Place, 301 Cedar St., New Haven, CT 06519, USA.
Thomas
T
McGlashan
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.
Svein
S
Friis
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003415:Crime; D003718:Denmark / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012306:Risk; D019966:Substance-Related Disorders / Q000453:epidemiology; D014754:Violence; D055815:Young Adult
D014150:Antipsychotic Agents
First-episode psychosis; Prevention; Treatment; Violence