Psychological Medicine



Original Article

Aggressive behaviour at first contact with services: findings from the AESOP First Episode Psychosis Study


K. DEAN a1c1, E. WALSH a1, C. MORGAN a1, A. DEMJAHA a1, P. DAZZAN a1, K. MORGAN a1, T. LLOYD a2, P. FEARON a1, P. B. JONES a3 and R. M. MURRAY a1
a1 Institute of Psychiatry, Kings College London, UK
a2 University of Nottingham, UK
a3 Department of Psychiatry, University of Cambridge, UK

Article author query
dean k   [PubMed][Google Scholar] 
walsh e   [PubMed][Google Scholar] 
morgan c   [PubMed][Google Scholar] 
demjaha a   [PubMed][Google Scholar] 
dazzan p   [PubMed][Google Scholar] 
morgan k   [PubMed][Google Scholar] 
lloyd t   [PubMed][Google Scholar] 
fearon p   [PubMed][Google Scholar] 
jones pb   [PubMed][Google Scholar] 
murray rm   [PubMed][Google Scholar] 

Abstract

Background. Aggressive behaviour is increased among those with schizophrenia but less is known about those with affective psychoses. Similarly, little is known about aggressive behaviour occurring at the onset of illness.

Method. The main reasons for presentation to services were examined among those recruited to a UK-based first episode psychosis study. The proportion of individuals presenting with aggressive behaviour was determined and these individuals were compared to those who were not aggressive on a range of variables including sociodemographic, clinical, criminal history, service contact, and symptom characteristics. Among the aggressive group, those who were physically violent were distinguished from those who were not violent but who were still perceived to present a risk of violence to others.

Results. Almost 40% (n=194) of the sample were aggressive at first contact with services; approximately half of these were physically violent (n=103). Younger age, African-Caribbean ethnicity and a history of previous violent offending were independently associated with aggression. Aggressive behaviour was associated with a diagnosis of mania and individual manic symptoms were also associated with aggression both for the whole sample and for those with schizophrenia. Factors differentiating violent from non-violent aggressive patients included male gender, lower social class and past violent offending.

Conclusions. Aggressive behaviour is not an uncommon feature in those presenting with first episode psychosis. Sociodemographic and past offending factors are associated with aggression and further differentiate those presenting with more serious violence. A diagnosis of mania and the presence of manic symptoms are associated with aggression.


Correspondence:
c1 Department of Forensic Mental Health Science (PO23), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email: k.dean@iop.kcl.ac.uk)


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