Fazel Seena, Lichtenstein Paul, Grann Martin, Goodwin Guy M, Långström Niklas
Department of Psychiatry, University of Oxford, Warneford Hospital, England.
Arch Gen Psychiatry. 2010 Sep;67(9):931-8. doi: 10.1001/archgenpsychiatry.2010.97.
Although bipolar disorder is associated with various adverse health outcomes, the relationship with violent crime is uncertain.
To determine the risk of violent crime in bipolar disorder and to contextualize the findings with a systematic review.
Longitudinal investigations using general population and unaffected sibling control individuals.
Population-based registers of hospital discharge diagnoses, sociodemographic information, and violent crime in Sweden from January 1, 1973, through December 31, 2004.
Individuals with 2 or more discharge diagnoses of bipolar disorder (n = 3743), general population controls (n = 37 429), and unaffected full siblings of individuals with bipolar disorder (n = 4059).
Violent crime (actions resulting in convictions for homicide, assault, robbery, arson, any sexual offense, illegal threats, or intimidation).
During follow-up, 314 individuals with bipolar disorder (8.4%) committed violent crime compared with 1312 general population controls (3.5%) (adjusted odds ratio, 2.3; 95% confidence interval, 2.0-2.6). The risk was mostly confined to patients with substance abuse comorbidity (adjusted odds ratio, 6.4; 95% confidence interval, 5.1-8.1). The risk increase was minimal in patients without substance abuse comorbidity (adjusted odds ratio, 1.3; 95% confidence interval, 1.0-1.5), which was further attenuated when unaffected full siblings of individuals with bipolar disorder were used as controls (1.1; 0.7-1.6). We found no differences in rates of violent crime by clinical subgroups (manic vs depressive or psychotic vs nonpsychotic). The systematic review identified 8 previous studies (n = 6383), with high heterogeneity between studies. Odds ratio for violence risk ranged from 2 to 9.
Although current guidelines for the management of individuals with bipolar disorder do not recommend routine risk assessment for violence, this assertion may need review in patients with comorbid substance abuse.
尽管双相情感障碍与多种不良健康后果相关，但与暴力犯罪的关系尚不确定。
确定双相情感障碍患者暴力犯罪的风险，并通过系统评价将研究结果置于背景中。
使用普通人群和未受影响的同胞对照个体进行纵向调查。
基于瑞典1973年1月1日至2004年12月31日期间的医院出院诊断、社会人口统计学信息和暴力犯罪的人口登记册。
有2次或更多次双相情感障碍出院诊断的个体（n = 3743）、普通人群对照（n = 37429）以及双相情感障碍患者未受影响的同胞（n = 4059）。
暴力犯罪（导致因杀人、袭击、抢劫、纵火、任何性犯罪、非法威胁或恐吓而被定罪的行为）。
在随访期间，314名双相情感障碍患者（8.4%）实施了暴力犯罪，而普通人群对照中有1312人（3.5%）（调整后的优势比为2.3；95%置信区间为2.0 - 2.6）。风险主要局限于伴有物质滥用合并症的患者（调整后的优势比为6.4；95%置信区间为5.1 - 8.1）。在没有物质滥用合并症的患者中，风险增加最小（调整后的优势比为1.3；95%置信区间为1.0 - 1.5），当使用双相情感障碍患者未受影响的同胞作为对照时，风险进一步降低（1.1；0.7 - 1.6）。我们发现临床亚组（躁狂与抑郁或精神病性与非精神病性）的暴力犯罪率没有差异。系统评价确定了8项先前的研究（n = 6383），研究之间存在高度异质性。暴力风险的优势比范围为2至9。
尽管目前双相情感障碍患者管理指南不建议对暴力进行常规风险评估，但对于伴有物质滥用合并症的患者，这一主张可能需要重新审视。
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