medwireNews: Nearly a third of patients with a first episode of psychosis (FEP) show aggressive behavior, reveals a meta-analysis.
"Thus, the early stages of the illness seem to be a period of heightened risk for aggression," say Swaran Singh (University of Warwick, Coventry, UK) and team. "Positive symptomatology often dominates during this stage and patients are likely to be younger, both of which have been associated with an increased risk of hostility and aggression."
Rates of any aggression ranged from 17% to 49% among 3294 FEP patients in 15 studies, and rates of serious aggression, reported by 12 studies, ranged from 5% to 27%. Rates varied according to the assessment tools used, the reporting method, the study duration, and the geographic location.
Notably, the pooled rate of any aggression did not differ before and after first contact with mental health services, at 28% and 31%, respectively, and the corresponding rates of serious aggression were 16% and 13%. Furthermore, individual studies that measured aggression rates in the same cohort before and after first contact found no differences.
"These results suggest that initial contact with mental health services does not alter aggression in FEP," Singh et al write in Acta Psychiatrica Scandinavica.
They say the finding is "consistent with previous reviews highlighting the lack of efficacy of existing interventions in reducing aggressive behaviours associated with psychosis, and reports that community mental health teams do not adjust their treatment approach accordingly for patients displaying antisocial or criminal behaviour."
Previous studies have suggested that contact with mental health services may actually trigger aggressive behavior, say the researchers, noting that "involuntary admissions and repeated assessments may be especially challenging for psychotic individuals during FEP."
They also note the likely contribution of comorbid conditions such as alcohol abuse, cognitive impairments, and other personality disorders.
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