St Vincent's Hospital, Darlinghurst, New South Wales, Australia.
J Clin Psychiatry. 2012 May;73(5):e580-7. doi: 10.4088/JCP.11r07036.
We aimed to review the evidence for an association between the first episode of psychosis and violence and to consider the possible explanations for this association and the implications for clinicians and service providers.
We searched for published studies in English describing an association between violence and first-episode psychosis using the subject headings, key words, abstracts, and titles in PubMed/MEDLINE from 1970 to 2010, using the terms first-episode schizophrenia OR first-episode psychosis OR early schizophrenia AND suicide OR self harm OR suicide attempt OR homicide OR violence.
We identified 20 studies reporting data on violent suicide attempts, self-mutilation, minor violence, severe nonlethal interpersonal violence, or homicide in first-episode and previously treated psychosis.
The number of people committing acts of violence prior to initial treatment for psychosis and after initial treatment was extracted from the relevant studies.
The proportion of people found to be in the first episode of psychosis at the time of an act of violence was compared to the expected ratio of first-episode to previously treated patients. A substantial proportion of psychotic patients examined after violent suicide attempts (49%), major self-mutilation (54%), homicide (39%), and assault resulting in serious injury (38%) are in their first episode of psychosis. Moreover, a substantial proportion of first-episode patients commit an act of less serious violence or attempt suicide prior to initial treatment.
The findings support the need for early intervention and community-wide programs to reduce the duration of untreated psychosis.
我们旨在回顾首发精神病与暴力之间关联的证据，并考虑这种关联的可能解释及其对临床医生和服务提供者的影响。
我们使用 PubMed/MEDLINE 中的主题词、关键词、摘要和标题，从 1970 年至 2010 年，检索了描述首发精神病与暴力之间关联的英文文献，检索词为首发精神分裂症或首发精神病或早期精神分裂症和自杀或自残或自杀未遂或凶杀或暴力。
我们确定了 20 项研究，这些研究报告了首发和既往治疗的精神病患者中暴力自杀未遂、自我伤害、轻微暴力、严重非致命人际暴力或凶杀方面的数据。
从相关研究中提取了首发精神病初始治疗前和初始治疗后实施暴力行为的人数。
在暴力行为发生时被诊断为首发精神病的人数与预期的首发与既往治疗患者比例进行了比较。在暴力自杀未遂（49%）、严重自残（54%）、凶杀（39%）和导致严重伤害的攻击（38%）后接受检查的精神病患者中，相当一部分人处于首发精神病阶段。此外，相当一部分首发精神病患者在初始治疗前实施了不太严重的暴力行为或企图自杀。
这些发现支持需要进行早期干预和全社区计划，以缩短未治疗精神病的持续时间。
