Orygen, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia.
Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, Victoria 3052, Australia.
Schizophr Bull. 2024 Jul 27;50(4):757-770. doi: 10.1093/schbul/sbae010.
Most people with psychotic disorders will never commit an act of violence. However, the risk of violence committed by people with schizophrenia is higher than the general population. Violence risk is also known to be highest during the first episode of psychosis compared to later stages of illness. Despite this, there have been no comprehensive reviews conducted in the past 10 years examining rates of violence during FEP. We aimed to provide an updated review of the rate of violence in people with FEP.
Meta-analytical techniques were used to identify pooled proportions of violence according to severity (less serious, serious, severe) and timing of violence (before presentation, at first presentation, after presentation to services).
Twenty-two studies were included. The pooled prevalence was 13.4% (95% CI [9.0%-19.5%]) for any violence, 16.3% (95% CI [9.1%-27.4%]) for less serious violence, 9.7% (95% CI [5.4%-17.0%]) for serious violence and 2.7% for severe violence, regardless of time point. The pooled prevalence of any violence was 11.6% (95% CI [6.8%-18.9%]) before presentation, 20.8% (95% CI [9.8%-38.7%]) at first presentation and 13.3% (95% CI [7.3%-23.0%]) after presentation to services.
Overall, rates of violence appear to be lower in more recent years. However, due to the high between-study heterogeneity related to study design, the findings must be interpreted with consideration of sample characteristics and other contextual factors. The prevalence of violence remained high at all-time points, suggesting that more targeted, holistic, and early interventions are needed for clinical FEP groups.
大多数精神障碍患者不会实施暴力行为。然而，精神分裂症患者的暴力风险高于一般人群。精神疾病首次发作时的暴力风险也被认为高于疾病后期。尽管如此，过去 10 年中，没有全面审查首次发作精神分裂症患者的暴力发生率。我们旨在提供最新的首次发作精神分裂症患者暴力发生率的综述。
采用荟萃分析技术，根据严重程度（较轻、严重、严重）和暴力发生时间（发病前、首次发病时、发病后），确定暴力发生率的汇总比例。
共纳入 22 项研究。任何暴力的汇总患病率为 13.4%（95%可信区间[9.0%-19.5%]），较轻暴力为 16.3%（95%可信区间[9.1%-27.4%]），严重暴力为 9.7%（95%可信区间[5.4%-17.0%]），严重暴力为 2.7%，无论时间点如何。发病前任何暴力的汇总患病率为 11.6%（95%可信区间[6.8%-18.9%]），首次发病时为 20.8%（95%可信区间[9.8%-38.7%]），发病后就诊时为 13.3%（95%可信区间[7.3%-23.0%]）。
总体而言，近年来暴力发生率似乎较低。然而，由于与研究设计相关的研究间异质性较高，必须考虑样本特征和其他背景因素来解释这些发现。所有时间点的暴力发生率仍然较高，这表明需要针对临床首发精神分裂症患者进行更有针对性、全面和早期的干预。
