title: Substance use is a risk factor for violent behavior in male patients with bipolar disorder.
abstract: BACKGROUND
  To determine the factors involved in violent behavior in patients with bipolar disorder (BD) and to investigate the relationship between violence and substance use disorder (SUD).
  
  
  METHODS
  A sample of 100 male inpatients diagnosed with BD type I who were experiencing a current mood episode participated in the study. Violent behavior was defined as physical aggression against others. All patients were evaluated using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale-positive subscale (PANSS-p), Barratt Impulsivity Scale-11 (BIS-11), Buss-Perry Aggression Questionnaire (BPAQ) and Overt Aggression Scale (OAS). Lifetime SUD and current use of substances were evaluated. Logistic regression analysis was conducted to predict violent behavior.
  
  
  RESULTS
  Current substance use (CSU) rather than lifetime SUD was found to be related to violent behavior in patients with BD, and CSU was associated with a threefold increase in the risk of violence. The rate of lifetime SUD in our sample was 59%, and the rate of CSU was 39%. The most commonly abused substances were cannabis and alcohol, followed by synthetic cannabinoids, in both groups of patients with lifetime SUD and CSU. Individuals abusing any substance were more likely to have a criminal record and history of incarceration than other patients. One of the most significant risk factors for violence was a previous history of violent behavior.
  
  
  CONCLUSIONS
  The sample was limited to male patients. Data on some participants' recent substance use from standard urine analysis was not obtained. The data on the use of synthetic cannabinoids was obtained from patients and their families owing to the lack of equipment for detecting synthetic cannabinoids using laboratory analysis.
  
  
  CONCLUSIONS
  CSU appears to be a significant predictive factor in violent behavior in male patients. Further investigation of co-occurrence of violence with CSU and improvement in treatment strategies might reduce or prevent violence in patients with BD.
authors.affiliation: Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Turkey. Electronic address: dr_izgi@hotmail.com.
authors.forename: İzgi
authors.initials: İ
authors.lastname: Alnıak
authors.affiliation: Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Turkey. Electronic address: muraterkiran@gmail.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Erkıran
authors.affiliation: İstanbul Gelişim University, Department of Psychology, Turkey. Electronic address: elifmutlu@yahoo.com.
authors.forename: Elif
authors.initials: E
authors.lastname: Mutlu
mesh_terms: D000328:Adult; D000368:Aged; D000374:Aggression / Q000523:psychology*; D001714:Bipolar Disorder / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014754:Violence / Q000523:psychology*; D055815:Young Adult
keywords: Bipolar disorder; Substance use; Violent behavior