Fischer-Vieler Thomas, Ringen Petter Andreas, Kvig Erling, Bell Christina, Hjell Gabriela, Tesli Natalia, Rokicki Jaroslav, Melle Ingrid, Andreassen Ole Andreas, Friestad Christine, Haukvik Unn Kristin
Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway.
Schizophr Bull Open. 2023 Apr 2;4(1):sgad011. doi: 10.1093/schizbullopen/sgad011. eCollection 2023 Jan.
Violence is more prevalent in patients with psychotic disorders compared to the general population. Hence, adequate violence risk assessment is of high clinical importance. Impaired insight is suggested as a risk factor for violence in psychosis, but studies have yielded conflicting results. We hypothesized that impaired insight was associated with a history of severe violence in patients with psychotic disorders.
Clinical insight was assessed both using the Birchwood Insight Scale (BIS) and the Positive and Negative Symptom Scale (PANSS) item G12 (lack of judgment and insight). The degree of impaired clinical insight was compared between psychosis patients with ( = 51) and without ( = 178) a history of severe violence. Multiple linear regression analyses were performed to investigate the effects of putative confounders.
We found that a history of severe violence was significantly associated with lower insight in one of the three BIS components (the relabeling of symptoms) ( = .03, R = 0.02) and the PANSS item G12 ( = .03, R = 0.02) also after controlling for putative confounders.
The results suggest there is an association between impaired insight and severe violence in psychosis patients. We propose that examination of insight by validated instruments comprising different components may add useful information to clinical violence risk assessment in psychosis patients.
与普通人群相比，暴力行为在精神障碍患者中更为普遍。因此，进行充分的暴力风险评估具有高度的临床重要性。有研究表明，自知力受损是精神病患者暴力行为的一个风险因素，但研究结果相互矛盾。我们假设自知力受损与精神障碍患者的严重暴力史有关。
使用伯奇伍德自知力量表（BIS）和阳性与阴性症状量表（PANSS）的G12项（缺乏判断力和自知力）对临床自知力进行评估。比较有（n = 51）和无（n = 178）严重暴力史的精神病患者的临床自知力受损程度。进行多元线性回归分析以研究潜在混杂因素的影响。
我们发现，在控制潜在混杂因素后，严重暴力史与BIS三个分量表之一（症状重新标记）的较低自知力显著相关（p = .03，R = 0.02），PANSS的G12项也是如此（p = .03，R = 0.02）。
结果表明，精神病患者的自知力受损与严重暴力行为之间存在关联。我们建议，通过包含不同分量表的有效工具来检查自知力，可能会为精神病患者的临床暴力风险评估提供有用信息。
