Antisocial Behavior Prior to Psychosis Points to Later Risk for Violence, Study Suggests

Individuals who engage in antisocial behavior before showing symptoms of schizophrenia are more likely to be violent after a first schizophrenia episode occurs, a new prospective study reported in JAMA Psychiatry has found. The study was conducted by Catherine Winsper, Ph.D., and psychiatrist Swaran Singh, M.D., of the University of Warwick in England and colleagues.

The study included 670 young adults being treated for a first episode of psychosis. The subjects were divided into four groups depending on whether they had engaged in antisocial behavior before their first psychotic episode or not, and if so, to what degree. The researchers then followed up to see which subjects committed violence and  compared the four groups regarding their antisocial behavior histories. Subjects who had engaged in moderate or high levels of antisocial behavior on a regular basis before their first psychotic episode were four times as likely to engage in violence as were subjects who had engaged in little or no antisocial behavior before experiencing their first psychotic episode.

 "These data have implications for violence prediction and treatment in patients with schizophrenia," Paul Appelbaum, M.D., told Psychiatric News. "[They] suggest that treatment targeting psychotic symptoms in higher-risk patients may not be enough to prevent violent behavior—interventions aimed specifically at propensities for violence may be needed as well." Appelbaum is a former APA president and is the Dollard Professor of Psychiatry, Medicine, and Law at Columbia University. He is chair of the APA Committee on Judicial Action.

"Simply put, these data point out that youth with a history of delinquent behaviors and a vulnerability for psychosis are clearly at risk for behaving violently once that vulnerability becomes expressed as a first episode of schizophrenia," Thomas McGlashan, M.D., observed. McGlashan is a professor of psychiatry at Yale University and an expert on the prodromal phase of schizophrenia. "For this subsample of young people, early detection and intervention at the pre-onset of prodromal phase of the disorder may be doubly protective by preventing not only the onset of psychosis, but also the perpetration of any associated...antisocial behaviors."

More information about the link between antisocial behavior, violence, and psychosis can be found in the Psychiatric News articles "High Rates of Mental Illness Associated With Gang Membership" and "Threat Delusions Linked to Violence in First Episode Psychosis."

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