Abstract
Background: Hostility and aggressive behavior in patients with psychotic disorders are associated with demographic and clinical risk factors, as well as with childhood adversity and neglect. Care needs are an essential concept in clinical practice; care needs in the domain of safety for others reflect the actual problem the patient has. Hostility, aggressive behavior, and associated care needs, however, are often studied in retrospect. Method: In a sample of 1,119 patients with non-affective psychotic disorders, who were interviewed three times over a period of 6 years, we calculated the incidence of hostility, self-reported maltreatment to others and care needs associated with safety for other people (safety-to-others). Regression analysis was used to analyze the association between these outcomes and risk factors. The population attributable fraction (PAF) was used to calculate the proportion of the outcome that could potentially be prevented if previous expressions of adverse behavior were eliminated. Results: The yearly incidence of hostility was 2.8%, for safety-to-others 0.8% and for maltreatment this was 1.8%. Safety-to-others was associated with previous hostility and vice versa, but, assuming causality, only 18% of the safety-to-others needs was attributable to previous hostility while 26% was attributable to impulsivity. Hostility, maltreatment and safety-to-others were all associated with number of unmet needs, suicidal ideation and male sex. Hostility and maltreatment, but not safety-to-others, were associated with childhood adversity. Neither safety-to-others, maltreatment nor hostility were associated with premorbid adjustment problems. Conclusion: The incidence of hostility, self-reported aggressive behaviors, and associated care needs is low and linked to childhood adversity. Known risk factors for prevalence also apply to incidence and for care needs associated with safety for other people. Clinical symptoms can index aggressive behaviors years later, providing clinicians with some opportunity for preventing future incidents.
Highlights
Most patients with psychosis are not violent but there is an increased risk compared with the general public [1]
We report the analyses of violence, hostility and associated care needs of the Genetic Risk and Outcome of Psychosis (GROUP) study, a naturalistic multicenter, six-year prospective cohort study in a sample of patients with nonaffective psychotic disorders
Six patients had a missing diagnosis but fulfilled inclusion criteria, and 11 patients had a final diagnosis of affective psychosis but fulfilled criteria of clinical diagnosis of nonaffective psychosis at study entry; these individuals were retained in the sample assuming subtle diagnostic changes between the time of identification for inclusion and actual assessment that could occur in any patient included in the cohort at any time
Summary
Most patients with psychosis are not violent but there is an increased risk compared with the general public [1]. In addition to demographic and clinical risk factors, factors in childhood may increase the risk for adult aggressive and hostile behavior. Physical and sexual adversity during childhood was significantly associated with later violence in patients with psychotic disorders [4, 9, 10]. Aspects of premorbid social adjustment, such as difficulties in social relationships during the stages of childhood and adolescent development, could increase the risk of future violent behavior among patients diagnosed with schizophrenia [11]. Hostility and aggressive behavior in patients with psychotic disorders are associated with demographic and clinical risk factors, as well as with childhood adversity and neglect. Aggressive behavior, and associated care needs, are often studied in retrospect
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