Such clinics are becoming more widely available in the United States and provide another platform for clinician engagement with the justice system.Įarly Psychosis and the Criminal Justice SystemĬriminal justice system involvement is common in many early psychosis samples. Early treatment initiation, such as provided in coordinated specialty care clinics, can reduce the risk of violence and incarceration ( 4, 5). Longer duration of untreated psychosis, a factor known to correlate robustly with poorer outcomes in this population, has also been associated with violence. Several authors have identified potential risk factors for aggression in first-episode psychosis, including male gender, substance use, high levels of criminal behavior, lower education level, reduced behavioral inhibition, history of childhood abuse, anger spurred by a delusion, and persecutory or paranoid delusions. Thus, although available evidence suggests that patients with a first episode of psychosis are unlikely to cause others serious physical harm, consistently measured associations with milder aggression validate the need for preventive efforts. Another, prospective study with similarly careful categorization of aggression confirmed a low incidence of serious violence (.6%) but reported that aggression, when defined broadly to include verbal infractions, was present in as many as one in three situations ( 3). 6% committing severe violence (resulting in serious injury that led to hospitalization or to permanent physical harm) ( 2). A meta-analysis with more widely representative samples reported that about one-third of first-episode psychosis patients had engaged in some form of violence, with 16.6% committing serious violence (specifically, assault causing any degree of injury, any use of a weapon, or a sexual assault) but only. A population-based study of 495 cases of first contacts with treatment in the United Kingdom reported that 40% of the individuals had a history of aggression, and of these, approximately half were physically violent ( 1). Violence Risk and First-Episode PsychosisĪ growing body of evidence suggests a heightened risk of violence in first-episode psychosis.
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