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Substance use in psychiatric crisis: relationship to violence

Published online by Cambridge University Press:  05 November 2020

Nicola J. Kalk*
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
John E. Robins
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
Kezia R. Ross
Affiliation:
Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
Megan Pritchard
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
Michael T. Lynskey
Affiliation:
Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
Vivienne A. Curtis
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
Katherine I. Morley
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, Australia RAND Europe, Westbrook Centre, Cambridge, UK
*
Author for correspondence: Nicola J. Kalk, E-mail: nicola.kalk@kcl.ac.uk

Abstract

Background

Substance use and psychiatric illness, particularly psychotic disorders, contribute to violence in emergency healthcare settings. However, there is limited research regarding the relationship between specific substances, psychotic symptoms and violent behaviour in such settings. We investigated the interaction between recent cannabinoid and stimulant use, and acute psychotic symptoms, in relation to violent behaviour in a British emergency healthcare setting.

Methods

We used electronic medical records from detentions of 1089 individuals under Section 136 of the UK Mental Health Act (1983 amended 2007), an emergency police power used to detain people for 24–36 h for psychiatric assessment. The relationship between recent cannabinoids and/or stimulant use, psychotic symptoms, and violent behaviour, was estimated using logistic regression.

Findings

There was evidence of recent alcohol or drug use in 64.5% of detentions. Violent incidents occurred in 12.6% of detentions. Psychotic symptoms increased the odds of violence by 4.0 [95% confidence intervals (CI) 2.2–7.4; p < 0.0001]. Cannabinoid use combined with psychotic symptoms increased the odds of violence further [odds ratios (OR) 7.1, 95% CI 3.7–13.6; p < 0.0001]. Recent use of cannabinoids with stimulants but without psychotic symptoms was also associated with increased odds of violence (OR 3.3, 95% CI 1.4–7.9; p < 0.0001).

Interpretation

In the emergency setting, patients who have recently used cannabinoids and exhibit psychotic symptoms are at higher risk of violent behaviour. Those who have used both stimulants and cannabinoids without psychotic symptoms may also be at increased risk. De-escalation protocols in emergency healthcare settings should account explicitly for substance use.

Type
Original Articles
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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