(4A) Schizophrenia (15:10:19) PDF

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Schizophrenia...

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Offender Mental Health: Week 4A (15 t h October 2019) Schizophrenia -

Psychotic disorder increased risk of violence from 49% (no disorder) to 68% Substance abuse comorbidity plays a role in violence Although a significant risk factor, it only explains between 5-40% of violent behaviour Psychosis and violence are more weakly correlated in clinical than community samples

Those with psychosis, are most likely to kill their parents (40% of 2% schizophrenic homicides) Methodological Problems: - No true consistent definition of violence - Major Mental Illness: historically poor distinctions between disorders, necessity of analyses at symptom level, how the diagnosis was achieved - Confounding factors: Substance abuse, PD DSM: 2 of the following: - Delusions: Belief held even if evidence to prove it is false o Bizarre: clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences (all organs have been removed but no scar) o Non-bizarre: though false, at least technically possible o Mood-congruent: content consistent with either a depressive or manic state o Mood-neutral: does not relate to the sufferer’s emotional state - Hallucinations: auditory, visual and tactile hallucinations - Positive symptoms are too much behaviour - Disorganised Speech - Grossly disorganised or catatonic behaviour - Disorganised symptoms: lack of something - Negative Symptoms -

Level of functioning across areas affected Continuous disturbance for at least 6 months Rule out: schizoaffective, mood disorder with psychotic symptoms Not due to substance abuse or medical condition

Causality - A preceded B in time - A covaries with B - No other plausible explanation for the relationship Cofounding variables - Comorbid Substance abuse - Low Socioeconomic status – geographic drift hypothesis - Comorbid antisocial personality disorder Timing of Violence is key in schizophrenia: - Most offending by patients with schizophrenias occurs in first-episode psychosis and prior contact with mental health systems (72%) o Risk of homicide is 15.5x higher in individuals experiencing a first episode of psychosis compared to the general population - Disproportionate levels of violence and severity during the first-episode psychosis Etiological Factors:

Offender Mental Health: Week 4A (15 t h October 2019) -

Schizophrenia is highly heritable, gene-environment interaction results in abnormal development visible in children who will go on to develop schizophrenia Conduct disorder in children and psychosis results in an increased risk of violence

If psychosis causes violence: - Focusing decision and behaviour: principle of rationality without irrationality - … - … Nature of violence in psychosis: - When persons with MMI … Familiarity symptoms Fregoli: different people are in fact a single person who changes appearance or is in disguise Capgras: a close family member or pet has been replaced by an identical impostor Patients are placed at risk of maladaptive behaviours and their medico-legal …

Who is at risk: Young, male, single, unemployed, homeless, low SES, ethnic minority, hospitalisation or arrest Disadvantaged family history abuse …...