Université du Québec en Outaouais, Gatineau.
Division of Neuroscience, San Raffaele Scientific Institute and Vita-Salute University, Milan.
J Clin Psychopharmacol. 2021;41(6):623-628. doi: 10.1097/JCP.0000000000001493.
PURPOSE/BACKGROUND: The link between substances of abuse, impulsivity, and violence in psychotic patients remains unclear. This study aims at unraveling whether cannabis use disorder is associated with violent and/or psychotic behavior in patients who are hospitalized in a high-security hospital.
METHODS/PROCEDURES: We conducted a cross-sectional retrospective study in 124 patients with schizophrenia spectrum disorders admitted to a high-security hospital. Lifetime violent behavior was assessed using the History of Aggressive Behavior Form-Subject of the MacArthur Violence Risk Assessment Study and impulsivity using the Psychopathy Checklist-Revised (considering items: "proneness to boredom," "lack of self-control," and "impulsive thoughtless gestures"). Substance use disorder was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Positive and Negative Syndrome Scale was also administered.
FINDINGS/RESULTS: Violent and nonviolent psychotic patients showed similar prevalence of cannabis use disorder. Alcohol and cocaine use disorders were more prevalent among violent psychotic patients. Cannabis use disorder was not associated with any dimension of impulsivity, whereas alcohol use disorder was positively correlated to impulsive thoughtless gestures (standardized β = 0.213, P = 0.027) and cocaine use disorder with proneness to boredom (standardized β = 0.290, P = 0.002). Finally, logistic regression analysis revealed that, unlike cannabis and cocaine use disorders, alcohol use disorder (odds ratio, 3.964; 95% confidence interval, 1.729-9.087; P = 0.001) was a factor associated with violence.
IMPLICATIONS/CONCLUSIONS: These findings show that cannabis and alcohol are largely abused and coabused by psychotic patients with a propsensity for violence, but only alcohol is associated with impulsive and violent behavior. Therefore, especially alcohol abuse should be seriously considered by practitioners when evaluating the dangerousness of patients with schizophrenia spectrum disorders.
目的/背景：滥用物质、冲动和精神病患者暴力之间的联系仍不清楚。本研究旨在探讨在被收入高度安全医院的精神病患者中，是否存在大麻使用障碍与暴力和/或精神病行为相关。
方法/程序：我们对 124 名被收入高度安全医院的精神分裂症谱系障碍患者进行了横断面回顾性研究。使用《麦克阿瑟暴力风险评估研究行为史问卷》评估终生暴力行为，使用《精神病态检查表修订版》评估冲动性（考虑项目：“易无聊”、“缺乏自我控制”和“冲动轻率的手势”）。根据《精神障碍诊断与统计手册》第五版标准诊断物质使用障碍。还进行了阳性和阴性综合征量表评估。
结果/发现：暴力和非暴力精神病患者的大麻使用障碍患病率相似。酒精和可卡因使用障碍在暴力精神病患者中更为常见。大麻使用障碍与任何冲动维度均无关，而酒精使用障碍与冲动轻率的手势呈正相关（标准化β=0.213，P=0.027），可卡因使用障碍与易无聊相关（标准化β=0.290，P=0.002）。最后，逻辑回归分析显示，与大麻和可卡因使用障碍不同，酒精使用障碍（优势比，3.964；95%置信区间，1.729-9.087；P=0.001）是与暴力相关的因素。
意义/结论：这些发现表明，大麻和酒精在有暴力倾向的精神病患者中大量滥用和共滥用，但只有酒精与冲动和暴力行为相关。因此，在评估精神分裂症谱系障碍患者的危险性时，从业者尤其应认真考虑酒精滥用问题。
