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Delusions, anger, and serious violence: new findings from the MacArthur Violence
Risk Assessment Study
#MMPMID24048345
Ullrich S
; Keers R
; Coid JW
Schizophr Bull
2014[Sep]; 40
(5
): 1174-81
PMID24048345
show ga
INTRODUCTION: Recent research on the association between delusions and violence
has suggested complex and differing pathways. Furthermore, it has been emphasized
that temporal proximity is fundamental when investigating these relationships. We
reanalyzed data from the MacArthur Violence Risk Assessment Study utilizing a
different methodological approach to investigate associations between specific
delusions and violence. METHODS: Longitudinal study of 1136 male and female civil
psychiatric inpatients after discharge. Delusions, affect due to delusions, and
violence were measured at baseline and in 5 follow-up assessments. Serious
violence was established using the MacArthur Community Violence Interview.
Logistic mixed-effect models for repeated measures were performed. RESULTS: A
"prospective" model confirmed previous findings that delusions do not predict
later violence. However, reanalysis, considering temporal proximity, indicated a
relationship between specific delusions and outcome including: being spied upon
(adjusted OR [AOR] = 1.62, 95% CI = 1.06-2.47, P = .027), being followed (AOR =
1.90, 95% CI = 1.29-2.80, P = .001), being plotted against (AOR = 1.70, 95% CI =
1.14-2.52, P = .009), being under control of person/force (AOR = 1.92, 95% CI =
1.24-2.97, P = .003), thought insertion (AOR = 1.63, 95% CI = 1.00-2.66, P =
.048), and having special gifts/powers (AOR = 1.95, 95% CI = 1.31-2.92, P =
.001). All these delusions were associated with angry affect (P < .05). Inclusion
of anger in the model significantly attenuated the main effects (except grandiose
delusions), indicating an indirect pathway. CONCLUSIONS: Temporal proximity is
crucial when investigating relationships between delusions and violence. Anger
due to delusions is the key factor in this pathway. Our findings have important
implications for identification of psychotic patients at risk for violent
behavior and, most importantly, management of their risk.
|Adolescent
[MESH]
|Adult
[MESH]
|Anger/*physiology
[MESH]
|Delusions/epidemiology/*physiopathology
[MESH]
|Fear/*physiology
[MESH]
|Female
[MESH]
|Follow-Up Studies
[MESH]
|Hospitals, Psychiatric/statistics & numerical data
[MESH]
|Humans
[MESH]
|Male
[MESH]
|Risk Assessment
[MESH]
|Time Factors
[MESH]
|Violence/*psychology/statistics & numerical data
[MESH]
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