Skip to main content Accessibility help
×
Home

Use of illicit substances and violent behaviour in psychotic disorders: two nationwide case-control studies and meta-analyses

  • Jelle Lamsma (a1) (a2), Wiepke Cahn (a2), Seena Fazel (a1) and GROUP and NEDEN investigators (a1) (a2)

Abstract

Background

Substance use disorder explains much of the excess risk of violent behaviour in psychotic disorders. However, it is unclear to what extent the pharmacological properties and subthreshold use of illicit substances are associated with violence.

Methods

Individuals with psychotic disorders were recruited for two nationwide projects: GROUP (N = 871) in the Netherlands and NEDEN (N = 921) in the United Kingdom. Substance use and violent behaviour were assessed with standardized instruments and multiple sources of information. First, we used logistic regression models to estimate the associations of daily and nondaily use with violence for cannabis, stimulants, depressants and hallucinogens in the GROUP and NEDEN samples separately. Adjustments were made for age, sex and educational level. We then combined the results in random-effects meta-analyses.

Results

Daily use, compared with nondaily or no use, and nondaily use, compared with no use, increased the pooled odds of violence in people with psychotic disorders for all substance categories. The increases were significant for daily use of cannabis [pooled odds ratio (pOR) 1.6, 95% confidence interval (CI) 1.2–2.0), stimulants (pOR 2.8, 95% CI 1.7–4.5) and depressants (pOR 2.2, 95% CI 1.1–4.5), and nondaily use of stimulants (pOR 1.6, 95% CI 1.2–2.0) and hallucinogens (pOR 1.5, 95% CI 1.1–2.1). Daily use of hallucinogens, which could only be analysed in the NEDEN sample, significantly increased the risk of violence (adjusted odds ratio 3.3, 95% CI 1.2–9.3).

Conclusions

Strategies to prevent violent behaviour in psychotic disorders should target any substance use.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Use of illicit substances and violent behaviour in psychotic disorders: two nationwide case-control studies and meta-analyses
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Use of illicit substances and violent behaviour in psychotic disorders: two nationwide case-control studies and meta-analyses
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Use of illicit substances and violent behaviour in psychotic disorders: two nationwide case-control studies and meta-analyses
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Seena Fazel, E-mail: seena.fazel@psych.ox.ac.uk

Footnotes

Hide All
*

See supplement.

Footnotes

References

Hide All
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington: Author.
Andreasen, NC, Flaum, M and Arndt, S (1992) The Comprehensive Assessment of Symptoms and History (CASH). An instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry 49, 615623.
Bell, M, Greig, T, Gill, P, Whelahan, H and Bryson, G (2002) Work rehabilitation and patterns of substance use among persons with schizophrenia. Psychiatric Services 53, 6369.
Birchwood, M, Lester, H, McCarthy, L, Jones, P, Fowler, D, Amos, T, Freemantle, N, Sharma, V, Lavis, A, Singh, S and Marshall, M (2014) The UK national evaluation of the development and impact of Early Intervention Services (the National EDEN studies): study rationale, design and baseline characteristics. Early Intervention in Psychiatry 8, 5967.
Borenstein, M, Hedges, LV, Higgins, JP and Rothstein, HR (2009) Introduction to meta-analysis. Chichester: Wiley.
Chang, Z, Lichtenstein, P, Langstrom, N, Larsson, H and Fazel, S (2016) Association between prescription of major psychotropic medications and violent reoffending after prison release. JAMA 316, 17981807.
Dellazizzo, L, Potvin, S, Beaudoin, M, Luigi, M, Dou, BY, Giguère, and Dumais, A (2019) Cannabis use and violence in patients with severe mental illnesses: a meta-analytical investigation. Psychiatry Research 274, 4248.
Di Forti, M, Quattrone, D, Freeman, TP, Tripoli, G, Gayer-Anderson, C, Quigley, H, Rodriguez, V, Jongsma, HE, Ferraro, L, La Cascia, C, La Barbera, D, Tarricone, I, Berardi, D, Szöke, A, Arango, C, Tortelli, A, Velthorst, E, Bernardo, M, Del-Ben, CM, Menezes, PR, Selten, JP, Jones, PB, Kirkbride, JB, Rutten, BP, de Haan, L, Sham, PC, van Os, J, Lewis, CM, Lynskey, M, Morgan, C, Murray, RM and EU-GEI WP2 Group (2019) The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study. The Lancet Psychiatry 6, 427436.
Fazel, S, Gulati, G, Linsell, L, Geddes, JR and Grann, M (2009) Schizophrenia and violence: systematic review and meta-analysis. PLoS Medicine 6, e1000120.
Furtwaengler, NA and de Visser, RO (2013) Lack of international consensus in low-risk drinking guidelines. Drug and Alcohol Review 32, 1118.
Gregg, L, Barrowclough, C and Haddock, G (2007) Reasons for increased substance use in psychosis. Clinical Psychology Review 27, 494510.
Harris, AW, Large, MM, Redoblado-Hodge, A, Nielssen, O, Anderson, J and Brennan, J (2010) Clinical and cognitive associations with aggression in the first episode of psychosis. Australian and New Zealand Journal of Psychiatry 44, 8593.
Higgins, J, Thompson, S, Deeks, J and Altman, D (2003) Measuring inconsistency in meta-analyses. BMJ 327, 557560.
Hill, SL and Thomas, SH (2016) Drugs of abuse. Medicine 44, 160169.
Hodgins, S (2008) Violent behaviour among people with schizophrenia: a framework for investigations of causes, and effective treatment, and prevention. Philosophical Transactions of the Royal Society B: Biological Sciences 363, 25052518.
Koen, L, Kinnear, CJ, Corfield, VA, Emsley, RA, Jordaan, E, Keyter, N, Moolman-Smook, JC, Stein, DJ and Niehaus, DJ (2004) Violence in male patients with schizophrenia: risk markers in a South African population. Australian and New Zealand Journal of Psychiatry 38, 254259.
Korver, N, Quee, PJ, Boos, HB, Simons, CJ, de Haan, L and GROUP investigators (2012). Genetic Risk and Outcome of Psychosis (GROUP), a multi-site longitudinal cohort study focused on gene-environment interaction: objectives, sample characteristics, recruitment and assessment methods. International Journal of Methods in Psychiatric Research 21, 205221.
Kuhns, JB and Clodfelter, TA (2009) Illicit drug-related psychopharmacological violence: the current understanding within a causal context. Aggression and Violent Behavior 14, 6978.
Lamsma, J and Harte, JM (2015) Violence in psychosis: conceptualizing its causal relationship with risk factors. Aggression and Violent Behavior 24, 7582.
Lindsey, WT, Stewart, D and Childress, D (2012) Drug interactions between common illicit drugs and prescription therapies. The American Journal of Drug and Alcohol Abuse 38, 334343.
Maksimović, , Vlajinac, HD, Radak, ĐJ, Maksimović, JM, Marinković, JM and Jorga, JB (2008) Association of socioeconomic status measured by education and risk factors for carotid atherosclerosis: cross-sectional study. Croatian Medical Journal 49, 824831.
McGinty, EE, Choksy, S and Wintemute, GJ (2016) The relationship between controlled substances and violence. Epidemiological Reviews 38, 531.
McGuffin, P, Farmer, A and Harvey, I (1991) A polydiagnostic application of operational criteria in studies of psychotic illness. Archives of General Psychiatry 48, 764770.
Miles, H, Johnson, S, Amponsah-Afuwape, S, Finch, E, Leese, M and Thornicroft, G (2003) Characteristics of subgroups of individuals with psychotic illness and a comorbid substance use disorder. Psychiatric Services 54, 554561.
Miliano, C, Serpelloni, G, Rimondo, C, Mereu, M, Marti, M and De Luca, MA (2016) Neuropharmacology of new psychoactive substances (NPS): focus on the rewarding and reinforcing properties of cannabimimetics and amphetamine-like stimulants. Frontiers in Neuroscience 10, 153.
Moulin, V, Baumann, P, Gholamrezaee, M, Alameda, L, Palix, J, Gasser, J and Conus, P (2018) Cannabis, a significant risk factor for violent behavior in the early phase psychosis. Two patterns of interaction of factors increase the risk of violent behavior: cannabis use disorder and impulsivity; cannabis use disorder, lack of insight and treatment adherence. Frontiers in Psychiatry 9, 294.
Oluwoye, O, Monroe-DeVita, M, Burduli, E, Chwastiak, L, McPherson, S, McClellan, JM and McDonell, MG (2019) Impact of tobacco, alcohol and cannabis use on treatment outcomes among patients experiencing first episode psychosis: data from the national RAISE-ETP study. Early Intervention in Psychiatry 13, 142146.
Steadman, HJ, Mulvey, EP, Monahan, J, Robbins, PC, Appelbaum, PS, Grisso, T, Roth, LH and Silver, E (1998) Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry 55, 393401.
Susser, E, Finnerty, M, Mojtabai, R, Yale, S, Conover, S, Goetz, R and Amador, X (2000) Reliability of the life chart schedule for assessment of the long-term course of schizophrenia. Schizophrenia Research 42, 6777.
Swartz, MS, Swanson, JE, Hiday, VA, Borum, R, Wagner, HR and Burns, BJ (1998) Violence and severe mental illness: the effects of substance abuse and nonadherence to medication. The American Journal of Psychiatry 155, 226231.
Tomlinson, MF, Brown, M and Hoaken, PN (2016) Recreational drug use and human aggressive behavior: a comprehensive review since 2003. Aggression and Violent Behavior 27, 929.
Tracy, DK, Wood, DM and Baumeister, D (2017) Novel psychoactive substances: types, mechanisms of action, and effects. BMJ 356, i6848.
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, JE, Giel, R, Jablenski, A, Regier, D and Sartorius, N (1990) SCAN: schedules for clinical assessment in neuropsychiatry. Archives of General Psychiatry 47, 589593.
Winklbaur, B, Ebner, N, Sachs, G, Thau, K and Fischer, G (2006) Substance abuse in patients with schizophrenia. Dialogues in Clinical Neuroscience 8, 3743.
Witt, K, Van Dorn, RA and Fazel, S (2013) Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies. PLoS One 8, 115.
World Health Organization (1990) Composite International Diagnostic Interview. Geneva: World Health Organization.
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization.

Keywords

Type Description Title
WORD
Supplementary materials

Lamsma et al. supplementary material
Lamsma et al. supplementary material

 Word (34 KB)
34 KB

Use of illicit substances and violent behaviour in psychotic disorders: two nationwide case-control studies and meta-analyses

  • Jelle Lamsma (a1) (a2), Wiepke Cahn (a2), Seena Fazel (a1) and GROUP and NEDEN investigators (a1) (a2)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed