Violent Behavior in Mental Illness: The Role of Substance Abuse

摘要: THAT COMORBID SUBSTANCE USE DISORDERS SUBSTANtially increase the risk for violence in mental illness has been known decades. However, prevailing view, based on US and Scandinavian epidemiologic studies, that serious also confers a significant relative even absence of such comorbidity. Accordingly, broad clinical consensus emerged management psychiatric patients with dual diagnoses requires treatment both underlying psychopathology comorbid substance abuse. Recent studies have prompted reexamination this view. These new report little if any increased associated (such as schizophrenia, bipolar disorder, or major depressive disorder) unless there is comorbidity use disorder. substantial evidence only one several factors may violent behavior individuals severe illness. Converging lines indicate schizophrenia heterogeneous its etiology manifestation, can neither be fully understood nor successfully managed without specifying different causal pathways perhaps types behavior. Thus, attempts to characterize general relationship between disorder are inherently inadequate, conceptually empirically. Emerging suggests irrespective abuse at least 2 alternative occur schizophrenia: pathway history long-standing antisocial problems typically beginning childhood, another history. Antipsychotic medications do reduce first type violence, but highly effective reducing second type, which more related acute psychotic symptoms. Along these same lines, factor analysis suggested etiological subtypes inpatients. The (antisocial) consistent literature personality For complicated by Acute pharmacological effects alcohol certain drugs cocaine risk. In illness, other substances inherent exacerbating Specifically, become much likely when added combinations impaired impulse control symptoms hostility, threat perception, grandiosity, dysphoria. Substance disorders nonadherence, well outpatients Several criminogenic mechanisms lead independently tandem example, illicit drug trade occurs poorest neighborhoods predatory social environments respect achieved violence. Criminogenic studied. Most discussions relation pertain living community. secure wards inpatient facilities. Some persistently inpatients abuse, persist months years after ingested metabolized. Continued access unlikely. fact responds antipsychotic medications, particularly clozapine, makes it unlikely occurring closed explained could prevented treatment. Such treatment, however, should provided