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Shifts in positive and negative psychotic symptoms and anger: effects on violence

  • Jeremy W. Coid (a1), Constantinos Kallis (a1), Mike Doyle (a2), Jenny Shaw (a2) and Simone Ullrich (a1)...

Abstract

Background

Changes in positive and negative symptom profiles during acute psychotic episodes may be key drivers in the pathway to violence. Acute episodes are often preceded by fluctuations in affect before psychotic symptoms appear and affective symptoms may play a more important role in the pathway than previously recognised.

Methods

We carried out a prospective cohort study of 409 male and female patients discharged from medium secure services in England and Wales to the community. Measures were taken at baseline (pre-discharge), 6 and 12 months post-discharge using the Positive and Negative Syndrome Scale. Information on violence was obtained using the McArthur Community Violence Instrument and Police National Computer.

Results

The larger the shift in positive symptoms the more likely violence occurred in each 6-month period. However, shifts in angry affect were the main driving factor for positive symptom shifts associated with violence. Shifts in negative symptoms co-occurred with positive and conveyed protective effects, but these were overcome by co-occurring shifts in anger. Severe but stable delusions were independently associated with violence.

Conclusions

Intensification of angry affect during acute episodes of psychosis indicates the need for interventions to prevent violence and is a key driver of associated positive symptoms in the pathway to violence. Protective effects against violence exerted by negative symptoms are not clinically observable during symptom shifts because they are overcome by co-occurring anger.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is included and the original work is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use.

Corresponding author

Author for correspondence: Simone Ullrich, E-mail: s.ullrich@qmul.ac.uk

References

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Bebbington, P (2015) Unravelling psychosis: psychosocial epidemiology, mechanism, and meaning. Shanghai Archives of Psychiatry 27, 70.
Bebbington, PE, Craig, T, Garety, P, Fowler, D, Dunn, G, Colbert, S et al. (2006) Remission and relapse in psychosis: operational definitions based on case-note data. Psychological Medicine 36, 15511562.
Bonta, J, Law, M and Hanson, K (1998) The prediction of criminal and violent recidivism among mentally disordered offenders: a meta-analysis. Psychological Bulletin 123, 123.
Coid, J, Yang, M, Roberts, A, Ullrich, S, Moran, P, Bebbington, P et al. (2006) Violence and psychiatric morbidity in a national household population – a report from the British Household Survey. American Journal of Epidemiology 164, 11991208.
Coid, JW, Kallis, C, Doyle, M, Shaw, J and Ullrich, S (2015) Identifying causal risk factors for violence among discharged patients. PLoS ONE 10, e0142493.
Coid, JW, Ullrich, S, Kallis, C, Keers, R, Barker, D, Cowden, F et al. (2013) The relationship between delusions and violence: findings from the East London first episode psychosis study. JAMA Psychiatry 70, 465471.
Czobor, P and Volavka, J (1996) Positive and negative symptoms: is their change related? Schizophrenia Bulletin 22, 577.
Delespaul, P (1995) Assessing schizophrenia in daily life: the Experience Sampling Method, PhD Thesis, Maastricht University Medical Centre, Maastricht.
Douglas, KS, Guy, LS and Hart, SD (2009) Psychosis as a risk factor for violence to others: a meta-analysis. Psychological Bulletin 135, 679.
Elbogen, EB and Johnson, SC (2009) The intricate link between violence and mental disorder: results from the National Epidemiologic Survey on alcohol and related conditions. Archives of General Psychiatry 66, 152161.
Fazel, S, Buxrud, P, Ruchkin, V and Grann, M (2010) Homicide in discharged patients with schizophrenia and other psychoses: a national case-control study. Schizophrenia Research 123, 263269.
Fazel, S, Gulati, G, Linsell, L, Geddes, JR and Grann, M (2009) Schizophrenia and violence: systematic review and meta-analysis. PLoS Medicine 6, e1000120.
Freestone, M, Ullrich, S and Coid, JW (2017) External trigger factors for violent offending: findings from the UK Prisoner Cohort Study. Criminal Justice and Behavior 44, 13891412.
Garety, P and Freeman, D (2013) The past and future of delusions research: from the inexplicable to the treatable. The British Journal of Psychiatry 203, 327333.
Glaser, JP, van Os, J, Thewissen, V and Myin-Germeys, I (2010) Psychotic reactivity in borderline personality disorder. Acta Psychiatrica Scandinavica 121, 125134.
Gueorguieva, R and Krystal, JH (2004) Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Archives of General Psychiatry 61, 310317.
Haddock, G, Barrowclough, C, Shaw, JJ, Dunn, G, Novaco, RW and Tarrier, N (2009) Cognitive–behavioural therapy v. social activity therapy for people with psychosis and a history of violence: randomised controlled trial. The British Journal of Psychiatry 194, 152157.
Häfner, H, Maurer, K and An Der Heiden, W (2013) ABC schizophrenia study: an overview of results since 1996. Social Psychiatry and Psychiatric Epidemiology 48, 10211031.
Hankin, CS, Bronstone, A and Koran, L (2011) Agitation in the inpatient psychiatric setting: a review of clinical presentation, burden and treatment. Journal of Psychiatric Practice 17, 170185.
Hill, AB (1965) The environment and disease: association or causation? Proceedings of the Royal Society of Medicine 58, 295300.
Kay, SR, Fiszbein, A and Opfer, LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261.
Keers, R, Ullrich, S, DeStavola, BL and Coid, JW (2014) Association of violence with emergence of persecutory delusions in untreated schizophrenia. American Journal of Psychiatry 171, 332339.
Large, MM and Nielsson, O (2011) Violence in first-episode psychosis: a systematic review and meta-analysis. Schizophrenia Research 125, 209220.
Lataster, T, Valmaggia, L, Lardinois, M, van Os, J, Myin-Germeys, I (2013) Increased stress reactivity: a mechanism specifically associated with the positive symptoms of psychotic disorder. Psychological Medicine 43, 13891400.
Marwaha, S, Broome, MR, Bebbington, PE, Kuipers, E and Freeman, D (2014) Mood instability and psychosis: analyses of British national survey data. Schizophrenia Bulletin 40, 269277.
Monahan, J, Steadman, H, Silver, S, Appelbaum, P, Robbins, P, Mulvey, E et al. (2001) Rethinking Risk Assessment: The MacArthur Study of Mental Illness and Violence. New York, NY: Oxford University Press.
Montoya, A, Valladares, A, Lizan, L, San, L, Escobar, R and Paz, S (2011) Validation of the excited component of the positive and negative scale (PANNS-EC) in a naturalistic sample of 278 patients with acute psychosis and citation in a psychiatric emergency room. Health and Quality Life Outcomes 9, 18.
Myin-Germeys, I, Oorschot, M, Collip, D, Lataster, J, Delespaul, P and van Os, J (2009) Experience sampling research in psychopathology: opening the black box of life. Psychological Medicine 39, 15331547.
Myin-Germeys, I and van Os, J (2007) Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review 27, 409424.
Myin-Germeys, I, van Os, J, Schwartz, JE, Stone, AA and Delespaul, PA (2001) Emotional reactivity to daily life stress in psychosis. Archives of General Psychiatry 58, 11371144.
Nielsson, O and Large, M (2010) Rates of homicide during the first episode of psychosis and after treatment: a systematic review and meta-analysis. Schizophrenia Bulletin 36, 702712.
Novaco, RW (2013) Reducing anger-related offending: what works. In Craig, LA, Dixon, L and Ganon, TA (eds). What Works in Offender Rehabilitation: An Evidence-based Approach to Assessment and Treatment. Chichester, UK: John Wiley & Sons, pp. 211236.
Novaco, RW and Whittington, R (2013) Anger regulation for psychotic patients. In Fernandez, E (ed.), Treatments for Anger in Specific Populations: Theory, Application, and Outcome. New York: Oxford University Press, pp. 114137.
Odgers, CL, Mulvey, EP, Skeem, JL, Gardner, W, Lidz, CW and Schubert, C (2009) Capturing the ebb and flow of psychiatric symptoms with dynamical systems models. American Journal of Psychiatry 166, 575582.
Overall, JE (1974) The Brief Psychiatric Rating Scale in psychopharmacology research. In Oliver-Martin, R (ed.). Psychological Measurements in Psychopharmacology. Oxford: Karger, pp. 6778.
Reagu, S, Jones, R, Kumari, V and Taylor, PJ (2013) Angry affect and violence in the context of a psychotic illness: a systematic review and meta-analysis of the literature. Schizophrenia Research 146, 4652.
Skeem, JL, Schubert, C, Odgers, C, Mulvey, EP, Gardner, W and Lidz, C (2006) Psychiatric symptoms and community violence among high-risk patients: a test of the relationship at the weekly level. Journal of Consulting and Clinical Psychology 74, 967.
Swanson, JW, Swartz, MS, Elbogen, EB (2004) Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment. Schizophrenia Bulletin 30, 3.
Swanson, JW, Swartz, MS, Van Dorn, RA, Elbogen, EB, Wagner, HR, Rosenheck, RA et al. (2006) A national study of violent behavior in persons with schizophrenia. Archives of General Psychiatry 63, 490499.
Thewissen, V, Bentall, RP, Oorschot, M, Van Lierop, T, van Os, J and Myin-Germeys, I (2011) Emotions, self-esteem, and paranoid episodes: an experience sampling study. British Journal of Clinical Psychology 50, 178195.
Tueller, SJ, Johnson, KL, Grimm, KJ, Desmarais, SL, Sellers, BG and Van Dorn, RA (2017) Effects of sample size and distributional assumptions on competing models of the factor structure of the PANSS and BPRS. International Journal of Methods in Psychiatric Research 26, e1549.
Ullrich, S, Keers, R and Coid, JW (2013) Delusions, anger, and serious violence: new findings from the MacArthur violence risk assessment study. Schizophrenia Bulletin 40, 11741181.
Van Dorn, R, Volavka, J and Johnson, N (2012) Mental disorder and violence: is there a relationship beyond substance use? Social Psychiatry and Psychiatric Epidemiology 47, 487503.
Van Dorn, RA, Desmarais, SL, Grimm, KJ, Tueller, SJ, Johnson, KL, Sellers, BG et al. (2016) The latent structure of psychiatric symptoms across mental disorders as measured with the PANSS and BPRS-18. Psychiatry Research 245, 8390.
Van Dorn, RA, Grimm, KJ, Desmarais, SL, Tueller, SJ, Johnson, KL and Swartz, MS (2017) Leading indicators of community-based violent events among adults with mental illness. Psychological Medicine 47, 11701191.
Witt, K, Van Dorn, R and Fazel, S (2013) Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies. PLoS ONE 8, e55942.

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