Association of Violence With Emergence of Persecutory Delusions in Untreated Schizophrenia
Association of Violence With Emergence of Persecutory Delusions in Untreated Schizophrenia
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DOI：
10.1176/appi.ajp.2013.13010134
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发表时间：
2014-03-01
影响因子：
17.7
通讯作者：
Coid, Jeremy W.
中科院分区：
文献类型：
--
作者：
Keers, Robert;Ullrich, Simone;Coid, Jeremy W.
目的：精神病被认为是暴力的一个重要危险因素，但研究结果不一致。精神障碍影响暴力的机制也仍然不确定。作者调查了精神病是否会增加获释囚犯暴力行为的风险，以及治疗是否会降低这种风险。他们还探讨了暴力行为发生时精神病的活跃症状是否可以解释未经治疗的精神病与暴力之间的联系。囚犯队列研究是一项前瞻性的纵向研究，对囚犯获释后在社区进行跟踪调查。成年男性和女性罪犯服刑2年或以上的性或暴力犯罪分为四组：无精神病（N=742），精神分裂症（N=94），妄想障碍（N=29），药物引起的精神病（N=102）。精神病的症状，包括幻觉，思想插入，奇怪的经验，和迫害的妄想，被释放之前和之后进行了测量。结果：精神分裂症与暴力行为有关，但仅在没有治疗的情况下（优势比=3.76，95%CI =1.39-10.19）。未接受治疗的精神分裂症患者在随访时与迫害妄想的出现相关（比值比=3.52，95%CI =1.18-10.52），后者与暴力相关（比值比=3.68，95%CI =2.44-5.55）。在中介分析中证实了迫害妄想的中介作用（13=0.02，95%CI =0.01-0.04）。结论：未经治疗的精神分裂症患者出现迫害妄想可以解释暴力行为。释放后继续接受精神病治疗可以大大减少精神分裂症囚犯的暴力再犯。因此，更好地甄别和对待囚犯对于防止暴力至关重要。
Objective: Psychosis is considered an important risk factor for violence, but studies show inconsistent results. The mechanism through which psychotic disorders influence violence also remains uncertain. The authors investigated whether psychosis increased the risk of violent behavior among released prisoners and whether treatment reduced this risk. They also explored whether active symptoms of psychosis at the time of violent behavior explained associations between untreated psychosis and violence.Method: The U.K. Prisoner Cohort Study is a prospective longitudinal study of prisoners followed up in the community after release. Adult male and female offenders serving sentences of 2 or more years for a sexual Or violent offense were classified into four groups: no psychosis (N=742), schizophrenia (N=94), delusional disorder (N=29), and drug-induced psychosis (N=102). Symptoms of psychosis, including hallucinations, thought insertion, strange experiences, and delusions of persecution, were measured before and after release. Information on violence between release and follow-up was collected through self-report and police records.Results: Schizophrenia was associated with violence but only in the absence of treatment (odds ratio=3.76, 95%" CI=1.39-10.19). Untreated schizophrenia was associated with the emergence of persecutory delusions at follow-up (odds ratio=3.52, 95% CI=1.18-10.52), which were associated with violence (odds ratio=3.68, 95% CI=2.44-5.55). The mediating effects of persecutory delusions were confirmed in mediation analyses (13=0.02, 95% CI=0.01-0.04).Conclusions: The results indicate that the emergence of persecutory delusions in untreated schizophrenia explains violent behavior. Maintaining psychiatric treatment after release cart substantially reduce violent recidivism among prisoners with schizophrenia. Better screening and treatment of prisoners is therefore essential to prevent violence.