Department of Psychology, Catholic University of the Sacred Heart, Milano, Italy.
Department of Mental Health, ASST Ovest Milanese, Milano, Italy.
Aust N Z J Psychiatry. 2020 Dec;54(12):1212-1223. doi: 10.1177/0004867420963732. Epub 2020 Oct 13.
The relationship between alcohol and substance use and the risk of violence exhibited by patients with mental disorders is under-researched. This prospective cohort study aims to compare patients with severe mental disorders and with different substance use behaviors in terms of sociodemographic and clinical characteristics, hostility, impulsivity and aggressive behaviors. Furthermore, this study aims to assess differences in violent behaviors during a 1-year monitoring follow-up.
A total of 378 participants with severe mental disorders from Italian residential facilities and from four Departments of Mental Health (244 outpatients and 134 residential patients) were enrolled. Participants were categorized as Persons with Current Substance Use, Persons with Former Substance Use and Persons with Non-Substance Use. All these patients underwent a complex multidimensional assessment, including the lifetime and current substance use; a subsample of outpatients was also assessed with a laboratory substance assay including the testing for specific substances. We assessed the differences among these three groups in hostility, impulsivity and aggressive behaviors.
The results of the close 1-year monitoring show a significantly higher risk of violence for patients with severe mental disorders Persons with Current Substance Use compared to Persons with Former Substance Use and Persons with Non-Substance Use. Persons with Current Substance Use showed significantly higher scores for irritability, negativism and verbal assault compared to Persons with Non-Substance Use. Persons with Former Substance Use showed significantly higher scores for lifetime history of aggressive behaviors compared with patients with Persons with Non-Substance Use.
These findings suggest that patients with comorbid mental illness and substance use disorders should be referred for specific interventions to reduce aggressive behavior and ensure patient well-being and community safety.
精神障碍患者的酒精和物质使用与暴力风险之间的关系研究不足。本前瞻性队列研究旨在比较具有严重精神障碍和不同物质使用行为的患者在社会人口学和临床特征、敌意、冲动和攻击行为方面的差异。此外，本研究旨在评估在 1 年监测随访期间暴力行为的差异。
共有来自意大利住宿设施和四个精神卫生部门的 378 名严重精神障碍患者（244 名门诊患者和 134 名住院患者）入组。参与者分为当前物质使用者、既往物质使用者和非物质使用者。所有这些患者都接受了复杂的多维评估，包括一生中的物质使用和当前物质使用；门诊患者的一个亚组还接受了实验室物质检测，包括特定物质的检测。我们评估了这三组在敌意、冲动和攻击行为方面的差异。
接近 1 年的监测结果显示，与既往物质使用者和非物质使用者相比，具有严重精神障碍的当前物质使用者发生暴力的风险显著更高。与非物质使用者相比，当前物质使用者的易怒、消极和言语攻击得分明显更高。与非物质使用者相比，既往物质使用者的一生中攻击行为史得分明显更高。
这些发现表明，患有共病精神疾病和物质使用障碍的患者应转介接受特定干预，以减少攻击行为，确保患者福祉和社区安全。
