Singh Angad, Pereira William, Birk Sapriya, Kaggwa Mark Mohan, Bradford John M W, Chaimowitz Gary, Olagunju Andrew Toyin
Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
CNS Spectr. 2024 Nov 19:1-12. doi: 10.1017/S1092852924000488.
The relationship between psychosis and violence is often construed focusing on a narrow panel of factors; however, recent evidence suggests violence might be linked to a complex interplay of biopsychosocial factors among forensic psychiatric patients with psychosis (FPPP). This review describes violence incidents in FPPP, the factors associated with violence, and relevant implications.
This review was conducted following the preferred reporting items for systematic reviews and meta-analyses guideline. Databases, including CINAHL, EMBASE, Medline/PubMed, PsycINFO, and Web of Science, were searched for eligible studies that examined violence among adult FPPP. Screening of reports and data extraction were completed by at least two independent reviewers.
Across the 29 included studies, violence was consistently related to prior contact with psychiatric services, active psychotic symptoms, impulsivity, adverse experiences, and low social support. However, FPPP who reported violence varied in most other biopsychosocial domains, suggesting the underlying combinatorial effects of multiple risk factors for violence rather than individual factors. Variability in violence was addressed by stratifying FPPP into subgroups using composite/aggregate of identifiable factors (including gender, onset/course of illness, system-related, and other biopsychosocial factors) to identify FPPP with similar risk profiles.
There are multiple explanatory pathways to violence in FPPP. Recent studies identify subgroups with underlying similarities or risk profiles for violence. There is a need for future prospective studies to replicate the clinical utility of stratifying FPPP into subgroups and integrate emerging evidence using recent advancements in technology and data mining to improve risk assessment, prediction, and management.
精神病与暴力之间的关系常常被限定在少数几个因素上；然而，最近的证据表明，暴力可能与患有精神病的法医精神病患者（FPPP）的生物心理社会因素的复杂相互作用有关。本综述描述了FPPP中的暴力事件、与暴力相关的因素以及相关影响。
本综述按照系统评价和Meta分析的首选报告项目指南进行。在包括CINAHL、EMBASE、Medline/PubMed、PsycINFO和Web of Science在内的数据库中搜索符合条件的研究，这些研究调查了成年FPPP中的暴力情况。报告筛选和数据提取由至少两名独立评审员完成。
在纳入的29项研究中，暴力始终与之前接触精神科服务、活跃的精神病症状、冲动性、不良经历和低社会支持有关。然而，报告有暴力行为的FPPP在大多数其他生物心理社会领域存在差异，这表明暴力的多种风险因素的潜在综合作用而非个别因素。通过使用可识别因素（包括性别、疾病发作/病程、系统相关因素和其他生物心理社会因素）的组合/汇总将FPPP分层为亚组，以识别具有相似风险特征的FPPP，从而解决了暴力行为的变异性问题。
FPPP中暴力行为存在多种解释途径。最近的研究确定了具有潜在相似性或暴力风险特征的亚组。未来需要进行前瞻性研究，以复制将FPPP分层为亚组的临床效用，并利用技术和数据挖掘的最新进展整合新出现的证据，以改善风险评估、预测和管理。
