Electronic Letters to:
|
|
eLetters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
NEED FOR PREDICTORS OF VIOLENCE IN PSYCHIATRY
- RAGURAMAN JANAKIRAMAN, OVAIS WADOO, KALYAN SEELAM (18 November 2005)
-
Insight and violent behaviour in schizophrenia: revisited!
- Dr. Naseem A. Qureshi MD, PhD, IMAPA, LMIPS (6 December 2005)
|
|
|||
|
RAGURAMAN JANAKIRAMAN, SENIOR HOUSE OFFICER DONCASTER ROYAL INFIRMARY, SHEFFIELD CARE TRUST, OVAIS WADOO, KALYAN SEELAM
Send letter to journal:
psychiatrist4u{at}gmail.com RAGURAMAN JANAKIRAMAN, et al.
|
Violence and Aggression are important factors that need to be assessed in every psychologically ill patient before commencing treatment or admitting to hospital. This helps us to decide appropriate management and nursing care at the hospital set up to prevent further violent outbursts. By carefully studying their premorbid personality traits, course and nature of illness and medication compliance, aggression could be predicted to some extent. Previous studies have shown that nature and severity of aggression depend on several other factors like premorbid personality (Conduct disorder in childhood, Anti social personality, a personality style indexed by lack of remorse or guilt, shallow affect, lack of empathy, and failure to accept responsibility for one's own actions) (Fresan A et al, Moran P et al), episode of illness (less in first episode), gender (Male>Female), provoking factors, target population (more towards relatives), diurnal factors, socio-cultural factors, substance abuse, presence of organic conditions like epilepsy, frontal lobe tumors etc:- and lack of insight (Buckley PF etal). Overall, despite a high rate of verbal aggression, physical violence towards other people is uncommon in individuals presenting with first episode psychosis ( Foley SR et al). Patients with schizophrenia who commit violent acts have insight deficits, including lack of awareness of the legal implications of their behavior. Targeted interventions to improve insight and treatment compliance in this population are warranted (Buckley PF et al). Early prediction of aggression and intensive management could bring down admission to Psychiatry intensive care units. Economou M et al,supports the hypothesis that effective treatment reduces aggressive and sexual misconduct in schizophrenic disorders. I feel that a need for prediction of aggression is mandatory to intervene at an early stage and prevent further consequences. 1. Fresan A ,Apiquian R ,de la Fuente-Sandoval C ,Garcia-Anaya M ,Loyzaga C ,Nicolini H (2004) Premorbid adjustment and violent behavior in schizophrenic patients Schizophr Res. 2004 Aug 1;69(2-3):143-8. 2. Buckley PF,Friedman L ,Resnick PJ ,Camlin-Shingler K (2004), Insight and its relationship to violent behavior in patients with schizophrenia Am J Psychiatry. Sep; 161(9): 1712-4. 3. Foley SR ,Clarke M ,Gervin M ,Larkin C ,, O'Callaghan E (2005) Incidence and clinical correlates of aggression and violence at presentation in patients with first episode psychosis. Schizophr Res. Jan 1;72(2-3):161-8. 4. Moran P ,Hodgins S (2004) The correlates of comorbid antisocial personality disorder in schizophrenia Schizophr Bull.;30(4):791-802. 5. Economou M ,Palli A,Falloon IR (2005)Violence, misconduct and schizophrenia: Outcome after four years of optimal treatment, Clin Pract Epidemol Ment Health. Apr 28; 1(1): 3. |
|||
|
|
|||
|
Dr. Naseem A. Qureshi MD, PhD, IMAPA, LMIPS, Specialist Senior Registrar Rashid Hospital, Dubai, UAE.
Send letter to journal:
qureshinaseem{at}hotmail.com Dr. Naseem A. Qureshi MD, PhD, IMAPA, LMIPS
|
To the editor: In response to a pleasing article by Vevera and associates (1), Janakiraman, Wadoo and Seelam (2) highlighted in an e-letter the need for predictors of violence in psychiatry in particular schizophrenia and mentioned various known predictors. However, there are two persistent problems;(1) the prediction of violence in patients with schizophrenia still remains a very difficult task for mental health professionals, and (2) the research literature on the association between deficits in awareness and aggression in patients diagnosed with schizophrenia is limited. With particular reference to insight into mental illness, it may vary according to the clinical differences among patients-outpatients, inpatients and institutionalized, and prison. Among all patients, mostly outpatient schizophrenic population is better characterized by higher insight, and better awareness as they live functionally well in society and probably score low on lack of insight whether or not they are violent. There are several studies which have demonstrated lack of awareness and prediction of violent behavior in inpatients with schizophrenia(3,4), severely mentally ill forensic patients (5), and outpatients (6). Thus, deficits both in awareness and legal implications of their violent acts are probably the most important determinants of violence in patients with severe psychosis. References 1. Vevera`J, Hubbard A, Vesely A, Papezova H. Violent behaviour in schizophrenia: Retrospective study of four independent samples from Prague, 1949 to 2000. Br J Psychiatry 2005; 187: 426-430. 2. Janakiraman R, Wadoo O, Seelam K. Need for predictors of violence in psychiatry(18 November 2005). 3. Arango C, Calcedo BA, Gonzalez S, Calcedo OA. Violence in inpatients with schizophrenia: a prospective study. Schizophr Bull 1999; 25:493–503. 4. Swartz MS, Swanson JW, Hiday VA, Borum R, Wagner HR, Burns BJ: Violence and severe mental illness: the effects of substance abuse and nonadherence to medication. Am J Psychiatry 1998; 155:226–231 5. Carroll A, Pantelis C, Harvey C: Insight and hopelessness in forensic patients with schizophrenia. Aust NZ J Psychiatry 2004; 38:169–173. 6.Yen CF, Yeh ML, Chen CS, Chung HH: Predictive value of insight for suicide, violence, hospitalization, and social adjustment for outpatients with schizophrenia: a prospective study. Compr Psychiatry 2002; 43:443–447. Declaration of interest: None Contact No. +971502551453 |
|||