Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Early Interv Psychiatry. 2019 Jun;13(3):517-524. doi: 10.1111/eip.12512. Epub 2017 Nov 15.
The objective of this study is to explore, within a sample of early psychosis patients (EPP), if subgroups regarding rate of violent behaviour (VB) against others can be identified on the basis of dynamic risk factors (treatment modifiable characteristics).
In a sample of 265 EPP, treated at the Treatment and Early Intervention in Psychosis Program in Lausanne, we conducted a latent-class analysis on the basis of the main dynamic VB risk factors (substance use disorder [SUD], positive symptoms, insight, and impulsivity). VB were restricted to "serious violence" and were assessed through patients self-report, interview with relatives or forensic services and with a standardized instrument.
The analysis confirmed the heterogeneity of the sample regarding rate of VB. Patients could be stratified within 4 subgroups, 3 of which were at increased risk of VB. The two groups with the highest rates of VB displayed specific clinical profiles. The first one was characterized by high levels of impulsivity, hostility, positive symptoms and SUD, and the second, by low level of insight and low social functioning. These patterns suggest that significant difficulties in social interaction may contribute to the emergence of aggressive reactions against others.
Identification of EPP at increased risk of VB seems possible on the basis of dynamic risk factors. If confirmed prospectively, this could pave the way to the development of preventive strategies and specific interventions.
本研究旨在探讨精神早期患者（EPP）中是否可以根据动态风险因素（可治疗的特征）确定针对他人暴力行为（VB）发生率的亚组。
在洛桑精神病治疗和早期干预计划治疗的 265 名 EPP 样本中，我们根据主要的动态 VB 风险因素（物质使用障碍[ SUD ]，阳性症状，洞察力和冲动性）进行潜在类别分析。VB 仅限于“严重暴力”，并通过患者自我报告，与亲属或法医服务的访谈以及标准化工具进行评估。
分析证实了样本中 VB 发生率的异质性。可以将患者分为 4 个亚组，其中 3 个亚组具有更高的 VB 风险。VB 发生率最高的两组具有特定的临床特征。第一个亚组的特点是冲动性，敌意，阳性症状和 SUD 水平高，第二个亚组的特点是洞察力和社交功能低下。这些模式表明，社交互动中的重大困难可能会导致对他人产生攻击性反应。
基于动态风险因素，确定具有更高 VB 风险的 EPP 似乎是可行的。如果前瞻性地得到证实，这可能为制定预防策略和特定干预措施铺平道路。
