mental illness and violence_unit present ion

8/9/2019 Mental Illness and Violence_unit Present Ion

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Mental illness and

violence

Brief overview

By

Dr Adeyemis unit, FNPH Kaduna

03/03/10


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Definition of Violence

The intentional use of physical force or

power, threatened or actual, against oneself,

another person, or against a group orcommunity, that either results in or has a

high likelihood of resulting in injury, death,

psychological harm, maldevelopment or

deprivation (WHO).


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Types of violence

Self-directed

1. Suicidal behaviour : attempted suicide,suicide

2. Self abuse e.g. self mutilation

Interpersonal

1. Family & intimate partner violence e.g.child abuse, elder abuse, spouse/intimate

partner violence2. Community violence: b/w unrelated

individuals


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Types of violence

Collective violence

Violence committed by larger groups

of people or state:

1. To advance a particular socialagenda e.g.

Crimes of hate by large groups Terrorist acts

Mob violence


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Types of violence

2. Political violence

War and related violent conflicts

State violence

3. Economic violence

Attacks by larger groups motivated by

economic gain

purpose is to disrupt economic activity, denyaccess to essential services, or create

economic division and fragmentation


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Nature of violent acts

Physical

Sexual

Psychological

Involving deprivation or neglect


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Demographic variables

Sex:

In general population: M>F

Among psychiatric population: lessclear

Male sex significant predictor:community based epid studies of self

reported violence & studies ofviolence among psych patients (Bontaet al. 1998, Lovell et al 2002).


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Males not more likely than Females:

retrospective & prospective studies

utilizing samples psychiatric patientsrecently admitted or discharged

(Hiday et al. 1998; Robbins et al

2003).


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mental disorder have more of an

effect on the criminal potential of

females than of males.Among people with a major mental

illness, the risk of criminality is

increased M:F =2x:5x Hodgins (1992)


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Sex differences have also been found

in the severity and consequences of

violence perpetrated by persons withmental disorder

males more likely to commit serious

injury and to be arrested (Hiday et al.,

1998; Robbins et al., 2003).


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Age:

incidence and prevalence of violent

behaviour and offending is highest in thelate teens and early twenties among

persons with mental disorders as with the

general population

a significant number of males with majormental illness began their criminal behaviour

across all age groups (Hodgins 1992).


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Race:

Higher rates of violence & crime amongAfrican-American mentally ill

Neighbourhood disadvantage eliminated thisassociation (Silver2000b).

African-Americans were at greater risk for

perpetrating violence but only when theythemselves have previously been the victimsof violence (Swartz et al. 1998b).


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Socioeconomic status

The relationship btw SES & violence

among mentally ill people is complex& less clear than in general population

Some studies showed an associationbtw SES & violence among mentally ill

offenders while others did not


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Historical factors

Prior violence and criminality have

been found to be the best predictors

of future violence and criminality

Prior arrests,

Prior convictions, and self-reported prior violence


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Historical factors

A violent incidence increase the odds of

violence occurring in the following week by

1.4 times (Skeem et al. 2006).

Violence on any given day increase theodds of violence occurring the next day by

5.4 times (Mulvey et al. 2006).


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Historical factors

History of delinquencyprior to adulthood

Early arrests

Young age at indexoffence

Parental crime

Parental substanceabuse

Separation fromparents before age16yrs

Childhood abuse

Victim of violence asan adult


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Clinical factors

Significant association has been found btw

violence & certain psychiatric disorders:

Antisocial personality disorder

Substance use disorders

Comorbid substance use disorder

BAD Schizophrenia

Major depressive disorder


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Clinical factors

Though several studies support this

association, others do not

This led to studies that have tried to

find the link btw specific

psychopathology and violence


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Clinical factors

positive psychotic symptoms

significantly increased the risk of

violence among individuals diagnosed

with schizophrenia but only when

negative psychotic symptoms were

minimal or absent (Swanson et al.

2006) .


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Clinical factors

Commanding auditory hallucinations

Persecutory delusions

Assigning an identity to a hallucinatedvoice was also found to be related tocompliance with commandhallucinations

Hallucination-related delusions Non-adherence to medication


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Clinical factors

the most common feelings

experienced at the time of the

commission of a violent act are:

Feelings of rage,

anxiety, and fear of harm


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Contextual factors

Contextual factors may exacerbate or

restrain the expression of violence.

family illness, change in financial status,

Change in employment status,

significant change in family situation

Residential instability

concentrated neighbourhood

poverty


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Contextual factors

the risk of violence among psychiatric

patients with serious mental illness

toward a family member increased

fourfold when subjects were

financially dependent on the family

member ( Estroff et al.1998) .


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Contextual factors

individuals at highest risk of violence

are

family members: >50%,( most werethe mother )

Friends

Males are more likely to targetstrangers in public


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THANK YOU.

mental illness and violence_unit present ion

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