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Current treatment practice guidelines in a number of countries mandate the assessment of violence risk in all patients diagnosed with schizophrenia. Although more than 100 different instruments have been developed to facilitate the assessment of violence risk, few have been specifically validated for use in those with schizophrenia. Recent work instead suggests that these instruments are typically associated with lower predictive validity in samples with schizophrenia when compared to that achieved in diagnostically heterogeneous samples, leading to concerns that these instruments omit risk factors that may be specific to the prediction of violence risk in this population. The present thesis therefore aimed to investigate the predictive validity of a number of risk factors for violence in those with schizophrenia. Firstly, to identify key risk factors for violence, a meta-analysis was undertaken, finding that although a number of criminal history risk factors are strongly associated with violence risk, nonetheless a number of risk factors rarely assessed by existing violence risk assessment instruments were significantly associated with violence in those with schizophrenia; most notably a history of attempted suicide. Results of this review also suggested that although the criminal history domain is most strongly associated with violence risk, nonetheless, there is considerable variability in the magnitude of association for the individual risk factors. Study two therefore aimed to investigate this variability and found that a history of violence was most strongly associated with subsequent violence. Study three aimed to identify whether suicidal behaviour, which has rarely been considered risk factors for violence in previous work, incrementally contributes to the prediction of violence. A simple risk model composed of young age, comorbid substance use disorder, previous violence, and a history of suicidal threats, explained as much predictive validity, as measured by the area under the receiver operating characteristic curve, as established risk assessment instruments such as the HCR–20, LSI–R, PCL–R, and VRAG. Current risk assessment approaches may therefore need revision in light of these findings.

MMed, Psychiatry, University of the Witwatersrand, Faculty of Health Sciences / Introduction Antipsychotics are used for the treatment of psychotic disorders, most commonly schizophrenia, as well as mood disorders e.g. bipolar mood d isorder. The efficacy of the newer second generation (atypical) antipsychotics is equivalent to first generation antipsychotics. The apparent advantage of the second generation antipsychotics is related to their purported reduced side effect profile, thus making them more desirable due to improved compliance and relapse prevention. The limiting factor with this class of drugs, especially in the state sector in South Africa, has been the cost. However, reports of treatment-emergent adverse events such as diabetes mellitus, diabetic ketoacidosis, hyperglycaemia and dyslipidaemia in patients receiving second generation antipsychotics have increased in recent times. This has lead to growing concern about the link between metabolic complications and their use, with consequent reconsideration of the implications of prescribing. Aims The study aimed to establish the extent to which metabolic and cardiovascular screening and monitoring has been undertaken on patients who have been prescribed olanzapine, a second generation antipsychotic. Specifically the extent to which the American Diabetes Association Consensus Conference monitoring protocols were being implemented in a specialist psychiatric South African setting i.e.: at Tara: The H. Moross Centre’s outpatient department. Objectives The study objectives were to describe the demographic profile, clinical diagnosis and risk factors for metabolic complications in a sample of patients receiving olanzapine. Further, to establish the extent to which metabolic and cardiovascular screening and monitoring has been undertaken on patients prescribed olanzapine as well as to what extent the patients’s demographics, diagnosis and metabolic risk factors influenced the treating doctor’s adherence to screening guidelines. Method This study was undertaken at Tara: The H. Moross Centre (outpatient department). A convenience sample of patients prescribed olanzapine were selected as the study group. The study involved a review of case records. It was a retrospective descriptive study. Relevant data was entered on a data sheet, designed for the study in accordance with the objectives and adapted from the American Diabetes Association Consensus Development Conference on Antipsychotic Drugs, Obesity and Diabetes. The data sheet is based on an existing protocol for monitoring metabolic status. v Frequencies for the presence or absence of evidence of screening or monitoring for metabolic complications were established, as per American Diabetes Association monitoring protocol requirements. Although the study involved outpatients, not all patients were intiated on olanzapine as outpatients i.e. some of the prescribing was inpatient initiated. Results The sample comprised of 19 females and 20 males. 48.72% female and 51.28% male. The mean age of females in the sample was 52.38 years (SD=16.20) and the mean age of males was 41.28 (SD=17.05) years. The sample were predominantly single ( 61.54% n=24 ) with the majority being white (79.49% n=31 ); most had either tertiarty (43% n=17 ) or secondary (53.85% n =21 ) level of education. Only 2.56% (n=1) had only primary level education. With regards to the diagnoses of patients in the sample, 17,95% (n=7) were diagnosed with bipolar 1 disorder, 7.69% (n=3) with major depressive disorder with psychosis, 20,51% (n=8) schizoaffective disorder and 53,84% (n=21) with schizophrenia. The percentage of screening for all the parameters was generally less than 20% and it continued to decline to less than 20% until 4 months. The exception was weight, where frequency increased slightly over time. Comparing inpatient vesus outpatient initiated treatment there were apparent differences in the extent of screening i.e. greater for inpatient initiated treatment, specifically with respect to weight and blood pressure. Conclusion The current study was conducted in a very specific setting, but the findings demonstrated an area requiring attention i.e. adherence to acceptable clinical guidelines. Whilst one can only speculate on the basis for non-adherence, having established the status quo, there is a requirement for an appropriate strategy to address the deficit, given the implications of inadequate monitoring.

The purpose of this thesis was to synthesize evidence on symptoms of psychosis in post-secondary students, including participant characteristics, prevalence, risk factors, interventions, and reported experiences. The design was a mixed-methods systematic review, modeled on the Joanna Briggs Institute and PRISMA guidelines, with all standard systematic review procedures followed. A search in nine databases yielded 26 (published between 2006 and 2018) articles for inclusion. Data were analyzed according to objectives and reported using synthesis tables and narrative summaries. Average age of participants was 21 years and most identified as female and Caucasian. Prevalence of psychosis across the included studies was inconclusive. Risk factors associated with symptoms of psychosis included substance use, depression, and younger age. There were five interventions with mixed results and three studies about experiences. While five promising interventions exist, inadequate testing and replication limits confidence in their effectiveness. There is a notable deficit in qualitative evidence exploring the experiences of students with symptoms of psychosis.

There has been concern about the impact of cannabis use on the onset, course and relapse of psychosis. Evidence from retrospective and a small number of prospective studies has suggested that cannabis use may precipitate a latent psychosis, exacerbate psychotic symptoms and increase the likelihood of psychotic relapse. The purpose of the current study was to examine the influence of cannabis use on psychotic symptom exacerbation and relapse within the stress vulnerability-coping model of psychosis. Two studies were conducted. The influence of cannabis use on the onset and course of psychosis was retrospectively examined in the first study. The second study prospectively examined the influence of cannabis use on psychotic symptom exacerbation and relapse over a 6-month period. The influence of the severity of psychotic symptoms on a relapse in cannabis use was also explored. Eighty-four participants were assessed at admission, 81 of whom were followed up for a 6-month period. Measures consisted of structured diagnostic interviews and self-report measures of stress, medication compliance, family functioning, premorbid adjustment, quality of life, substance use and psychotic symptoms. The onset of cannabis use clearly preceded the onset of psychosis. Cannabis use was predictive of the severity of psychotic and general psychopathology symptoms at admission. Both the frequency and quantity of cannabis use was predictive of time to psychotic relapse over the 6-month follow up period. Psychotic symptom severity was predictive of a substantial increase in the quantity but not the frequency of cannabis use. Cannabis use was related to the onset, course and relapse of psychosis.

Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 5 uppsatser.

Afhandling--Københavns universitet. / Summaries in Danish and German. Bibliography: p. 153-156.

Orientador: Paulo Dalgalarrondo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Medicas / Made available in DSpace on 2018-08-08T11:26:57Z (GMT). No. of bitstreams: 1 Teixeira_EduardoHenrique_M.pdf: 2378711 bytes, checksum: 73d59583c19a26a22f8da5b55f2524c8 (MD5) Previous issue date: 2007 / Resumo: Introdução: Aspectos da psicopatologia do delírio e do perfil dos pacientes delirantes parecem relacionados à ocorrência de crime violento. Objetivo: Descrever o perfil sócio-demográfico e psicopatológico de sujeitos delirantes que cometeram crimes violentos. Métodos: Estudo retrospectivo do tipo caso-controle, comparando dois grupos de trinta pacientes delirantes. Todos pacientes apresentaram transtorno psicótico com atividade delirante definida. Os pacientes do grupo caso cometeram crimes violentos e foram selecionados da Casa de Custódia do município de Franco da Rocha-SP, nos anos de 2004 a 2006. Os pacientes do grupo controle foram selecionados de enfermaria psiquiátrica do Hospital das Clínicas da Unicamp, do Hospital e Maternidade Celso Pierro (Puc-Campinas) e do Instituto Américo Bairral do município de Itapira-SP. Foram utilizadas as escalas PANSS (Escala das Síndromes Positiva e Negativa), MINI (Entrevista Neuropsiquiátrica Mini-Internacional) e MMDAS (Escala de Avaliação de Delírio Macarthur-Maudsley). Resultados: Os dois grupos foram muito parecidos em relação ao perfil sócio-demográfico, história da doença, comorbidade de substâncias psicoativas e conteúdo do delírio. Os pacientes do grupo caso apresentaram mais antecedentes criminais, embora tenham cometido menos freqüentemente agressões leves. As vítimas dos crimes foram com mais frequência parentes ou conhecidos. Em relação às dimensões do delírio, o grupo caso teve menor pontuação em â?¿inibição de açãoâ?? e â?¿afeto negativoâ??. Conclusões: Fatores intrínsecos do delírio parecem ser mais relevantes do que o perfil sócio-demográfico nos sujeitos delirantes que cometem crimes. Delírios que induzem a inibição de ações aparentemente também reduzem o potencial de ações violentas. Ao contrário do que se afirma correntemente, pacientes delirantes assustados e com outros afetos negativos associados ao delírio parecem cometer menos atos violentos / Abstract: Introduction: Some aspects of the psychopathology of delusion and the profile of the delirious patients seem to be related to the occurrence of violent crime. Objective: To describe the social-demographic and psychopathologic profile of delirious patients who have committed violent crimes. Methods: Retrospective case-control study, comparing two groups of thirty delusional patients. All patients had presented psychotic disorders with definite delusion activity. The patients of the case group had committed violent crimes and have been selected out of the criminal-psychiatric ward Franco da Rocha-SP, from 2004 to 2006. The patients of the control group have been selected out of psychiatric ward of the Hospital das Clínicas da Unicamp, of the Hospital e Maternidade Celso Pierro (PUC-Campinas) and of the Instituto Américo Bairral of the city of Itapira-SP. Scales PANSS (Positive and Negative Syndrome Scale), MINI (Mini International Neuropsychiatric Interview) and MMDAS (Macarthur-Maudsley Delusion Assessment Scale) have been used. Results: The two groups were very similar as far as social-demographic profile, history of the illnesses, substance abuse and content of the delusion. The patients of the case group had greater criminal records, although a smaller frequency of light aggressions. The victims of the crimes had been more often acquaintances or relatives. In relation to the dimensions of the delusion, the patients in the study group scored less in "action inhibition" and "negative affection". Conclusions: Intrinsic factors of the delusion seem to be more relevant than social-demographic profile in the delusional patients who commit crimes. Delusions that induce action inhibition apparently also reduce the potential for violent actions. In contrast to what is commonly said, delusional patients with fear and other negative affection associated to the delusion seem to commit less violent acts / Mestrado / Saude Mental / Mestre em Ciências Médicas

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Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 5 uppsatser.