A Reassessment of the Link between Mental Disorder and Violent Behaviour, and its Implications for Clinical Practice

1997 ◽  
Vol 31 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Paul E. Mullen
Keyword(s):  
Public Policy ◽  
Mental Illness ◽  
Clinical Practice ◽  
Mentally Ill ◽  
Policy Implications ◽  
Violent Behaviour ◽  
Effective Response ◽  
Increased Risk ◽  
Care Support

Objective and Method: This review examines the central studies which, over the last decade, have investigated the association between mental illness and rates of violent behaviours. The clinical and public policy implications of such research is then examined. Results:Recent research appears to have established a modest association between having a mental illness and an increased propensity to violence. Conclusions:The increased risk of violence is mediated, in part at least, by the active symptoms of illness. The most effective response to the risks of dangerous behaviour in the mentally ill is not to return to policies of greater control and containment but to improve the care, support and treatment delivered to patients in the community. Those at high risk need to be targeted for priority follow-up and intensive support. We need, as a profession, to become as aware of the risks in our patients of violence towards others as we currently are of the risks of suicidal behaviour. We also need to develop responses which effectively manage such patients, to their benefit and ultimately to the benefit of potential victims.

scholarly journals Mood disorders and violence: a new focus

2009 ◽  
Vol 15 (4) ◽  
pp. 263-270 ◽  
Author(s):  
Clare Oakley ◽  
Fiona Hynes ◽  
Tom Clark
Keyword(s):  
Mental Illness ◽  
Clinical Practice ◽  
Psychiatric Disorder ◽  
Mood Disorders ◽  
Good Evidence ◽  
Public Concern ◽  
Violent Behaviour ◽  
People With Mental Illness

SummaryViolent behaviour in people with a psychiatric disorder causes great public concern and leads to stigma for people with mental illness. There is good evidence for a correlation between schizophrenia and increased rates of violence but any association between mood disorders and violence has been comparatively overlooked. It appears that there may be more evidence relating mood disorders and violence than many clinicians realise. This article highlights the difficulties in assessing this, summarises what is known and discusses what this means for clinical practice.

Social Dimensions of Mental Illness among Rural Elderly Populations

1988 ◽  
Vol 26 (3) ◽  
pp. 169-190 ◽  
Author(s):  
Jon Hendricks ◽  
Howard B. Turner
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Physical Health ◽  
Elderly People ◽  
The Elderly ◽  
Rural Elderly ◽  
Policy Implications ◽  
Elderly Persons ◽  
Increased Risk ◽  
Elderly Populations

Despite growing concern with rural elderly populations, little attention has focused on their mental health, ways it may correlate with physical health, or how rural mental health patterns compare to urban. Popular wisdom contends that elderly people in general, and rural elderly persons in particular, are at increased risk for mental illness. This article examines these questions. A review of available literature suggests that elderly people may be at only slightly greater risk of mental illness than the population at large, though there are some indications that rates of depression may be somewhat higher among the elderly population. Much of this same literature implies that objective environmental conditions play a significant role in the incidence of depression. Analysis of data gathered in a statewide random poll ( N = 743) indicates that while physical health tends to be poorer among rural populations, when health is held constant there is actually an inverse relationship between age and depression. Therefore, rural elderly persons are no more likely to be depressed than their urban counterparts despite harsher living conditions. Both conceptual and policy implications are discussed.

Cultural Perceptions of the Mentally Ill: Australian and Papua New Guinean High School Youth

1983 ◽  
Vol 17 (3) ◽  
pp. 280-285 ◽  
Author(s):  
Victor J. Callan ◽  
Jeffrey Wilks ◽  
Stewart Forsyth
Keyword(s):  
High School ◽  
Mental Illness ◽  
High School Students ◽  
Mentally Ill ◽  
Violent Behaviour ◽  
School Students ◽  
Cultural Perceptions ◽  
Environmental Causes ◽  
Papua New Guinean ◽  
School Youth

One hundred and thirty-three (76 male, 57 female) Papua New Guinean (PNG) and 144 (93 male, 51 female) Australian high school students completed a series of structured and open-ended measures on attitudes to the mentally ill, especially opinions about the nature of mental illness, characteristics of the mentally ill, and treatment. Both groups of students suggested hereditary and environmental causes, with PNG students citing more often witchcraft and sorcery. Australian students generally presented more favourable attitudes to mental illness, in that they were more willing to work with or marry the mentally ill. PNG students, however, were more likely to highlight the disruptive, violent behaviour of the long long and possibly held a much narrower view of the types of persons labelled mentally ill.

Coping with the Dual Demands of Severe Mental Illness and Parenting: The Parents' Perspective

2003 ◽  
Vol 84 (1) ◽  
pp. 109-118 ◽  
Author(s):  
Barry J. Ackerson
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Interpersonal Relationships ◽  
Mentally Ill ◽  
Role Reversal ◽  
Future Research ◽  
Single Parenthood ◽  
Sources Of Support ◽  
Boundary Issues

The experience of parenthood by individuals with severe mental illness has not been well studied. Research on mentally ill parents has focused on their pathology and the potential risk for their children without considering the parents' perspective. This qualitative study used interviews to explore how these parents coped with the dual demands of parenthood and their illness. Participants included individuals whose children are now young adults as well as those with younger children. Themes that emerged were problems with diagnosis and treatment, stigma, chaotic interpersonal relationships, the strain of single parenthood, custody issues, relationship with children, social support, and pride in being a parent. Follow-up interviews focused on the themes of relationship with children, strain of single parenthood, and sources of support. Relationship with children contained three specific topics: discipline, boundary issues, and role reversal. Implications for practice are discussed along with recommendations for future research involving other family members.

scholarly journals Prolonged periods of waiting for an asylum decision and the risk of psychiatric diagnoses: a 22-year longitudinal cohort study from Denmark

2019 ◽  
Vol 49 (2) ◽  
pp. 400-409 ◽  
Author(s):  
Camilla Hvidtfeldt ◽  
Jørgen Holm Petersen ◽  
Marie Norredam
Keyword(s):  
Mental Illness ◽  
Cohort Study ◽  
Psychiatric Disorders ◽  
Psychotic Disorders ◽  
Longitudinal Cohort Study ◽  
Registration System ◽  
Longitudinal Cohort ◽  
Increased Risk ◽  
Waiting Periods

Abstract Background The high prevalence of psychiatric disorders among resettled refugees necessitates identification of factors that reduce the risk of mental illness. In this 22-year longitudinal cohort study, we assessed whether the length of asylum-decision waiting periods is associated with resettled refugees’ risk of being diagnosed with a psychiatric disorder. Methods We used full-population data from the Danish Civil Registration System to establish a cohort of 46 104 refugees resettled in Denmark during 1995–2016. Hazard ratios (HRs) for first-time psychiatric hospital contact (ICD-10) after residence permit issuance across varying lengths of asylum-decision waiting periods were estimated by cross-linkage with the Danish National Patient Register. Results Long asylum-decision waiting periods were associated with an increased risk of psychiatric disorders. Compared with refugees who waited 0–6 months for their asylum decision, the HRs of any psychiatric diagnosis were 1.22 [95% confidence interval (CI): 1.12–1.33] for those who waited 13–24 months and 1.46 (95% CI: 1.27–1.69) for those who waited 25–71 months. Associations varied across diagnoses and length of follow-up: whereas the risk of nervous disorders increased with longer asylum-decision waiting periods in the follow-ups of 0–2.9, 3–5.9 and 6–11.9 years, the risk of psychotic disorders was associated with longer asylum-decision procedures only in the 0–2.9-year follow-up. Conclusion Resettled refugees who waited longer than 1 year for an asylum decision face an increased risk of psychiatric disorders. Host countries should consider that long asylum-decision waiting periods could lead to mental illness among refugees.

scholarly journals Examining the Relationships between Cumulative Childhood Adversity and the Risk of Criminal Justice Involvement and Victimization among Homeless Adults with Mental Illnesses after Receiving Housing First Intervention

2020 ◽  
Vol 65 (6) ◽  
pp. 409-417
Author(s):  
Hanie Edalati ◽  
Tonia L. Nicholls ◽  
Christian G. Schütz ◽  
Julian M. Somers ◽  
Jino Distasio ◽  
...  
Keyword(s):  
Mental Illness ◽  
Criminal Justice ◽  
Mental Illnesses ◽  
Housing First ◽  
Criminal Justice Involvement ◽  
Homeless Adults ◽  
Treatment As Usual ◽  
Increased Risk ◽  
The Relationship

Objectives: Exposure to adverse childhood experiences (ACEs) is associated with increased risk of criminal justice involvement and repeated victimization among homeless individuals. This study aimed to (1) examine whether the relationship between cumulative ACE score and odds of experiencing criminal justice involvement and victimization remains significant over time after receiving the Housing First (HF) intervention and (2) investigate the moderating effect of cumulative ACE score on the effectiveness of the HF intervention on the likelihood of experiencing these outcomes among homeless individuals with mental illnesses. Methods: We used longitudinal data over the 2-year follow-up period from the At Home/ Chez Soi demonstration project that provided HF versus treatment as usual (TAU) to homeless adults with mental illness in five Canadian cities (N = 1,888). Results: In all 4 follow-up time points, the relationship between cumulative ACE score and both outcomes remained significant, regardless of study arm (HF vs. TAU) and other confounding factors. However, cumulative ACE score did not moderate intervention effects on odds of experiencing either outcome, suggesting that the effectiveness of HF versus TAU, with regard to the odds of being victimized or criminal justice involvement, did not differ by cumulative ACE scores over the course of study. Conclusions: Findings suggest that providing services for homeless individuals with mental illness should be trauma informed and include specialized treatment strategies targeting the experience of ACEs and trauma to improve their treatment outcomes. An intensive approach is required to directly address the problem of criminal justice involvement and victimization in these individuals.

The future of services for the chronically mentally ill: a priority case?

1993 ◽  
Vol 17 (10) ◽  
pp. 582-585 ◽  
Author(s):  
Som D. Soni ◽  
Rafeek F. Mahmood ◽  
Anant Shah
Keyword(s):  
Mental Illness ◽  
National Health Service ◽  
Health Service ◽  
Royal College ◽  
Mentally Ill ◽  
Psychiatric Care ◽  
Economic Cost ◽  
High Quality ◽  
High Prevalence

Research into delivery of psychiatric care has shown that the chronic mentally ill (CMI) patients continue to pose major difficulties not only in terms of economic cost to patients, their families and the state but also in the ability of authorities to provide adequate facilities in the community. The latter is especially important now because of rapid discharge of patients into the community from long-stay wards of mental hospitals, often with little rehabilitative preparation and even less consideration of the effects of the environment into which they are relocated. Although follow-up in some cases has been of exceptionally high quality, a majority have filtered through the network into inadequate residence; this surely is unacceptable. The high prevalence of mental illness among the homeless and the difficulties of providing care for them by an inflexible health service have been highlighted by a recent report of the Royal College of Psychiatrists (Bhugra et al, 1991). This paper attempts to define the possible adverse consequences of the recent reorganisation of National Health Service (NHS) on the care of the chronic mentally ill.

Clinical and subclinical findings in heterozygous ABCC6 carriers: results from a Belgian cohort and clinical practice guidelines

2021 ◽  
pp. jmedgenet-2020-107565
Author(s):  
Lukas Nollet ◽  
Laurence Campens ◽  
Julie De Zaeytijd ◽  
Bart Leroy ◽  
Dimitri Hemelsoet ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Diastolic Dysfunction ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Manifestations ◽  
Ectopic Calcification ◽  
Imaging Data ◽  
Variable Expression ◽  
Increased Risk

BackgroundBiallelic pathogenic variants in the ATP-binding cassette subfamily C member 6 (ABCC6) gene cause pseudoxanthoma elasticum, a multisystemic ectopic calcification disorder, while heterozygous ABCC6 variants are associated with an increased risk of cardiovascular and cerebrovascular disease. As the prevalence of pathogenic ABCC6 variants in the general population is estimated at ~1%, identifying additional ABCC6-related (sub)clinical manifestations in heterozygous carriers is of the utmost importance to reduce this burden of disease. Here, we present a large Belgian cohort of heterozygous ABCC6 carriers with comprehensive clinical, biochemical and imaging data. Based on these results, we formulate clinical practice guidelines regarding screening, preventive measures and follow-up of ABCC6 carriers.MethodsThe phenotype of 56 individuals carrying heterozygous pathogenic ABCC6 variants was assessed using clinical (eg, detailed ophthalmological examinations), biochemical, imaging (eg, cardiovascular and abdominal ultrasound) and genetic data. Clinical practice guidelines were then drawn up.ResultsWe found that ABCC6 heterozygosity is associated with distinct retinal alterations (‘comet-like’) (24%), high prevalence of hypercholesterolaemia (>75%) and diastolic dysfunction (33%), accelerated lower limb atherosclerosis and medial vascular disease, abdominal organ calcification (26%) and testicular microlithiasis (28%), though with highly variable expression.ConclusionIn this study, we delineated the multisystemic ABCC6 heterozygosity phenotype characterised by retinal alterations, aberrant lipid metabolism, diastolic dysfunction and increased vascular, abdominal and testicular calcifications. Our clinical practice guidelines aimed to improve early diagnosis, treatment and follow-up of ABCC6-related health problems.

Psychiatric Admission of Mentally Ill Mothers with their Infants

1989 ◽  
Vol 34 (1) ◽  
pp. 34-38 ◽  
Author(s):  
D.E. Stewart
Keyword(s):  
Mentally Ill ◽  
Theoretical Basis ◽  
Psychiatric Illness ◽  
Postpartum Women ◽  
Psychotic Illness ◽  
Psychiatric Admission ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Increased Risk

There is a greatly increased risk of a woman developing a psychiatric illness requiring hospital admission during the early postpartum period. Admission of the mother has usually meant separating her from her infant at a time when bonding and attachment are developing. Nearly 40 years ago English psychiatrists began admitting infants with their mentally ill mothers, and although the theoretical basis for this is sound, there are few systematic studies of the practical problems encountered, or the outcomes. This paper compares a group of 32 psychiatrically ill postpartum women who were admitted to a Canadian general hospital psychiatric unit with their infants to a group of 26 psychiatrically ill postpartum women hospitalized on the same unit who refused admission of their infants. The women admitted with their infants were more likely to be older, living with the infants' father, in a stable residence and job, in hospital for a longer time, and caring for their babies at 2 year follow-up in contrast to the women who were admitted without their infants. The two groups were diagnostically different with joint admission mothers likely to suffer from an affective psychotic illness, while the mothers without infants were more likely to suffer from personality disorder or substance abuse. The effects of mother-infant admission and some of the practical problems encountered are discussed.

Acquired Angioedema due to C1 Inhibitor Deficiency Preceding Splenic Marginal Zone Lymphoma: Further Insights from Clinical Practice

2020 ◽  
Vol 181 (12) ◽  
pp. 941-946
Author(s):  
Mariana Paes Leme Ferriani ◽  
Orlando Trevisan-Neto ◽  
Julia S. Costa ◽  
Janaina M.L. Melo ◽  
Adriana S. Moreno ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Marginal Zone ◽  
Marginal Zone Lymphoma ◽  
Splenic Marginal Zone Lymphoma ◽  
C1 Inhibitor ◽  
C1 Inhibitor Deficiency ◽  
Acquired Angioedema ◽  
Risk Of Death ◽  
Increased Risk

<b><i>Background:</i></b> Acquired angioedema due to C1 inhibitor deficiency (AAE-C1-INH) is a very rare disease. In clinical practice, it may be difficult to differentiate AAE-C1-INH from hereditary angioedema due to C1-INH deficiency (HAE-C1-INH). In both conditions, patients are at an increased risk of death from asphyxiation due to upper airway obstruction. The association of AAE-C1-INH with lymphoproliferative and autoimmune diseases, and with presence of anti-C1-INH antibodies has been well documented, and treatment of the underlying condition may result in complete remission of angioedema. <b><i>Objectives:</i></b> To discuss the clinical evaluation, diagnosis, and treatment outcomes of AAE-C1-INH in the context of the care of 2 patients with recurrent isolated angioedema. <b><i>Methods:</i></b> Two patients were followed up prospectively at our clinic. Measurements of C3, C4, C1-INH, and C1q levels were carried out by nephelometry, and the functional activity of C1-INH was determined by a chromogenic assay. Hematological investigation included morphological and immunophenotyping analysis of peripheral blood, bone marrow, and spleen histopathology. Sequencing of the 8 exons and adjacent intronic regions of the <i>SERPING1</i> gene was performed using the Sanger method. <b><i>Results:</i></b> Two patients were diagnosed with AAE-C1-INH associated with splenic marginal zone lymphoma during follow-up. <b><i>Conclusions:</i></b> Close follow-up, including detailed clinical history, physical examination, and laboratory tests, of our patients with AAE-C1-INH was essential for the early diagnosis and successful treatment of the lymphoproliferative disease, leading to the resolution of the angioedema attacks.

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