Evidence for a relationship between the duration of untreated psychosis and the proportion of psychotic homicides prior to treatment

ORIGINAL PAPER

Abstract

Background

Recent studies of homicide during psychotic illness have shown that the risk of homicide is greatest during the first episode of psychosis. It is also possible that the proportion of patients who commit homicide before they receive effective treatment may be associated with the length of time they were unwell. We aimed to establish whether there was an association between the average duration of untreated psychosis and the proportion of homicides committed during the first episode of psychosis in the same countries.

Methods

Systematic searches of published studies of homicide in psychosis and the duration of untreated psychosis were conducted. The results were combined to examine the relationship between the reported delay in receiving treatment and the proportion of homicides committed before initial treatment.

Results

We found 16 studies that reported the proportion of psychotic patients who committed homicide prior to treatment. The proportion of first episode patients ranged from 13% to 76%. We were able to match 13 of those studies with DUP studies from the same country. Longer average DUP was associated with a higher proportion of patients who committed homicide prior to receiving treatment.

Conclusions

The possibility that the proportion of patients who commit homicide before receiving treatment may be related to the average treatment delay in the region that the homicide occurs needs to be examined using a case controlled design. If this finding were confirmed, then any measure that reduced the delay in treating emerging psychosis would save lives.

Key words

first episode psychosis homicide treatment delay 

References

  1. 1.
    Addington J, Van Mastrigt S, Addington D (2004) Duration of untreated psychosis: impact on 2-year outcome. Psychol Med 34:277–284PubMedCrossRefGoogle Scholar
  2. 2.
    Anfang SA, Appelbaum PS (2006) Civil commitment–the American experience. Isr J Psychiatry Relat Sci 43:209–218PubMedGoogle Scholar
  3. 3.
    Appelbaum PS (1997) Almost a revolution: an international perspective on the law of involuntary commitment. J Am Acad Psychiatry Law 25:135–147PubMedGoogle Scholar
  4. 4.
    Appleby L, Shaw J (2006) Five year report of the national confidential inquiry into suicide and homicide by people with mental illness. http://www.medicine.manchester.ac.uk/suicideprevention/nci/Useful/avoidable_deaths_full_report.pdf. Accessed December 16, 2006
  5. 5.
    Atlas project in mental health (2005) Mental Health: Evidence and Research Department of Mental Health and Substance Abuse. World Health Organization, Geneva. http://www.who.int/mental_health/evidence/atlas/en/. Accessed May 10, 2007
  6. 6.
    Baldwin P, Browne D, Scully PJ, et al. (2005) Epidemiology of first-episode psychosis: illustrating the challenges across diagnostic boundaries through the Cavan-Monaghan study at 8 years. Schiz Bull 31:624–38CrossRefGoogle Scholar
  7. 7.
    Ballageer T, Malla A, Manchanda R, Takhar J, Haricharan R (2005) Is adolescent-onset first-episode psychosis different from adult onset? J Am Acad Child Adolesc Psychiatry 44:782–789PubMedCrossRefGoogle Scholar
  8. 8.
    Barnes TR, Hutton SB, Chapman MJ, Mutsatsa S, Puri BK, Joyce EM (2000) West London first-episode study of schizophrenia. Clinical correlates of duration of untreated psychosis Br J Psychiatry 177:207–211PubMedCrossRefGoogle Scholar
  9. 9.
    Beiser M, Erickson D, Fleming JA, Iacono WG (1993) Establishing the onset of psychotic illness. Am J Psychiatry 150:1349–1354PubMedGoogle Scholar
  10. 10.
    Benezech M, Yesavage JA, Addad M, et al. (1984) Homicide by psychotics in France: a five-year study. J Clin Psychiatry 45:85–86PubMedGoogle Scholar
  11. 11.
    Birchwood M, Cochrane R, Macmillan F, Copestake S, Kucharska J Carriss M (1992) The influence of ethnicity and family structure on relapse in first-episode schizophrenia. A comparison of Asian, Afro-Caribbean, and white patients. Br J Psychiatry 161:783–790PubMedCrossRefGoogle Scholar
  12. 12.
    Black K, Peters L, Rui Q, Milliken H, Whitehorn D, Kopala LC (2001) Duration of untreated psychosis predicts treatment outcome in an early psychosis program. Schizophr Res 47:215–222PubMedCrossRefGoogle Scholar
  13. 13.
    Bourget D, Labelle A, Gagne P, et al. (2004) First episode psychosis and Homicide: a diagnostic challenge. Can Psych Assoc Bull 36:6–9Google Scholar
  14. 14.
    Burgess P, Pirkis J, Jolley D, Whiteford H, Saxena S (2004) Do nations’ mental health policies, programs and legislation influence their suicide rates? An ecological study of 100 countries. Aust N Z J Psych 38:933–939CrossRefGoogle Scholar
  15. 15.
    Caton CL, Hasin DS, Shrout PE, et al. (2006) Predictors of psychosis remission in psychotic disorders that co-occur with substance use. Schizophr Bull 32:618–625PubMedCrossRefGoogle Scholar
  16. 16.
    Cohen RZ, Gotowiec A, Seeman MV (2000) Duration of pretreatment phases in schizophrenia: women and men. Can J Psychiatry 45:544–547PubMedGoogle Scholar
  17. 17.
    Compton MT, Esterberg ML, Druss BG, Walker EF, Kaslow NJ (2006) A descriptive study of pathways to care among hospitalized urban African American first-episode schizophrenia-spectrum patients. Soc Psychiatry Psychiatr Epidemiol. 41:566–573PubMedCrossRefGoogle Scholar
  18. 18.
    Craig TJ, Bromet EJ, Fennig S, Tanenberg-Karant M, Lavelle J, Galambos N (2000) Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series? Am J Psychiatry 157:60–66PubMedGoogle Scholar
  19. 19.
    Craig TK, Garety P, Power P, et al. (2004) The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. BMJ 329(7474):1067–72PubMedCrossRefGoogle Scholar
  20. 20.
    Dauvergne M Li G (2005) Homicide in Canada, Statistics Canada No. 26. http://www.statcan.ca/english/freepub/85-002-XIE/85-002-XIE2006006.pdf. Accessed May 7, 2007
  21. 21.
    Dolan M, Parry J (1996) A survey of male homicide cases resident in an English special hospital. Med Sci Law 36:249–258PubMedGoogle Scholar
  22. 22.
    Drake RJ, Haley CJ, Akhtar S, Lewis SW (2000) Causes and consequences of duration of untreated psychosis in schizophrenia. Br J Psychiatry 177:511–515PubMedCrossRefGoogle Scholar
  23. 23.
    Dressing H, Salize HJ (2004) Compulsory admission of mentally ill patients in European Union Member States. Soc Psychiatry Psychiatr Epidemiol 39:797–803PubMedGoogle Scholar
  24. 24.
    Erb M, Hodgins S, Freese R, Müller-Isberner R, Jöckel D (2001) Homicide and schizophrenia: maybe treatment does have a preventive effect. Crim Behav Ment Health. 11:6–26PubMedCrossRefGoogle Scholar
  25. 25.
    Eronen M, Tiihonen J, Hakola P (1996) Schizophrenia and homicidal behavior. Schizophr Bull. 22:83–89PubMedGoogle Scholar
  26. 26.
    Fannon D, Chitnis X, Doku V, et al. (2000) Features of structural brain abnormality detected in first-episode psychosis. Am J Psychiatry 157:1829–1834PubMedCrossRefGoogle Scholar
  27. 27.
    Farooq S, Deeba F, Ashfaque M, Iqbal M (2003) Mentally-ill patients charged with homicide. J Coll Physicians Surg Pak 13:223–225PubMedGoogle Scholar
  28. 28.
    Fazel S, Grann M (2004) Psychiatric morbidity among homicide offenders: a Swedish population study. Am J Psychiatry 161:2129–2131PubMedCrossRefGoogle Scholar
  29. 29.
    Foley SR, Browne S, Clarke M, Kinsella A, Larkin C, O’Callaghan E (2007) Is violence at presentation by patients with first-episode psychosis associated with duration of untreated psychosis? Soc Psychiatry Psychiatr Epidemiol 42:606–10PubMedCrossRefGoogle Scholar
  30. 30.
    Fuchs J, Steinert T (2004) Patients with a first episode of schizophrenia spectrum psychosis and their pathways to psychiatric hospital care in South Germany. Soc Psychiatry Psychiatr Epidemiol 39:375–380PubMedCrossRefGoogle Scholar
  31. 31.
    Gray JE, O’Reilly RL (2001) Clinically significant differences among Canadian mental health acts. Can J Psychiatry 46:315–321PubMedGoogle Scholar
  32. 32.
    Gray JE, O’Reilly RL (2005) Canadian compulsory community treatment laws: recent reforms. Int J Law Psychiatry 28:13–22PubMedCrossRefGoogle Scholar
  33. 33.
    Grunberg F, Klinger BI, Grumet BR (1978) Homicide and community-based psychiatry. J Nerv Ment Dis 166:868–874PubMedGoogle Scholar
  34. 34.
    Gunduz-Bruce H, McMeniman M, Robinson DG, et al. (2005) Duration of untreated psychosis and time to treatment response for delusions and hallucinations. Am J Psychiatry 162:1966–1969PubMedCrossRefGoogle Scholar
  35. 35.
    Haas GL, Sweeney JA (1992) Premorbid and onset features of first-episode schizophrenia. Schizophr Bull 18:373–386PubMedGoogle Scholar
  36. 36.
    Hafner H, Boker W (1982) Crimes of violence by mentally abnormal offenders: psychiatric epidemiological study in the German Federal Republic. Cambridge, Cambridge University Press 1982Google Scholar
  37. 37.
    Hafner H, Boker W (1973) Mentally Disordered Violent Offenders. Soc Psychiatry 8:220–229CrossRefGoogle Scholar
  38. 38.
    Hafner H, Maurer K, Loffler W, Riecher-Rossler A (1993) The influence of age and sex on the onset and early course of schizophrenia. Br J Psychiatry 162:80–86PubMedGoogle Scholar
  39. 39.
    Harris A, Brennan J, Anderson J, et al. (2005) Clinical profiles, scope and general findings of the western Sydney first episode psychosis project. Aust N Z J Psychiatry 39:36–43PubMedCrossRefGoogle Scholar
  40. 40.
    Ho BC, Alicata D, Ward J, et al. (2003) Untreated initial psychosis: relation to cognitive deficits and brain morphology in first-episode schizophrenia. Am J Psychiatry 160:142–148PubMedCrossRefGoogle Scholar
  41. 41.
    Humphreys MS, Johnstone EC, MacMillan JF, Taylor PJ (1992) Dangerous behaviour preceding first admissions for schizophrenia. Br J Psychiatry 161:501–505PubMedGoogle Scholar
  42. 42.
    Jablensky A (2000) Prevalence and incidence of schizophrenia spectrum disorders: implications for prevention. Aust N Z J Psychiatry 34:S26–34PubMedCrossRefGoogle Scholar
  43. 43.
    Kalla O, Aaltonen J, Wahlström J, et al. (2002) Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain. Acta Psychiatr Scand 106:265–275PubMedCrossRefGoogle Scholar
  44. 44.
    Laajasalo T, Häkkänen H (2006) Excessive violence and psychotic symptomatology among homicide offenders with schizophrenia. Crim Behav Ment Health 16:242–253PubMedCrossRefGoogle Scholar
  45. 45.
    Large M, Nielssen O (2007) Treating the first episode of schizophrenia earlier will save lives. Schizophr Res 92:276–7PubMedCrossRefGoogle Scholar
  46. 46.
    Leong GB, Silva JA (1995) A psychiatric-legal analysis of psychotic criminal defendants charged with murder. J Forensic Sci 40:445–448PubMedGoogle Scholar
  47. 47.
    Link BG, Stueve A, Phelan J (1998) Psychotic symptoms and violent behaviors: probing the components of “threat/control-override” symptoms. Soc Psychiatry Psychiatr Epidemiol. 33(Suppl 1):S55–S60PubMedCrossRefGoogle Scholar
  48. 48.
    Linszen D, Dingemans P, Lenior M (2001) Early intervention and a five year follow up in young adults with a short duration of untreated psychosis: ethical implications. Schizophr Res 51:55–61PubMedCrossRefGoogle Scholar
  49. 49.
    Loebel AD, Lieberman JA, Alvir JM, et al. (1992) Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry 149:1183–1188PubMedGoogle Scholar
  50. 50.
    Loranger AW (1984) Sex difference in age at onset of schizophrenia. Arch Gen Psychiatry 41:157–161PubMedGoogle Scholar
  51. 51.
    Meehan J, Flynn S, Hunt IM, et al. (2006) Perpetrators of homicide with schizophrenia: a national clinical survey in England and Wales. Psychiatr Serv 57:1648–1651PubMedCrossRefGoogle Scholar
  52. 52.
    Mental Health Ordinance For Pakistan (2001) http://www.Emro.Who.Int/Mnh/Whd/Pakistan-Ordinance.Pdf. Accessed May 10, 2007
  53. 53.
    Millaud F (1989) [Homicide in the psychotic patient: a study of 24 cases with reference to prediction of short-term outcome]. Can J Psychiatry 34:340–346PubMedGoogle Scholar
  54. 54.
    Milton J, Shazad A, Singh SP, et al. (2001) Aggressive incidents in first-episode psychosis. Br J Psychiatry 178:433–440PubMedCrossRefGoogle Scholar
  55. 55.
    Most serious crime rates are far higher in the United States than in Germany. US department of justice 1998 http://www.ojp.usdoj.gov/bjs/pub/press/gap.pr. Accessed May 7, 2007)
  56. 56.
    Mouzos J (2001) Homicide in Australia, Trends and issues in crime and criminal justice 1999–2000. Australian Institute of Criminology (http://www.aic.gov.au/publications/tandi/ti187.pdf. Accessed May 7. 2007)
  57. 57.
    Mojtabai R (2006) Psychotic-like experiences and interpersonal violence in the general population. Soc Psychiatry Psychiatr Epidemiol 41:183–90PubMedCrossRefGoogle Scholar
  58. 58.
    Naqvi H, Khan MM, Faizi A (2005) Gender differences in age at onset of schizophrenia. J Coll Physicians Surg Pak 15:345–348PubMedGoogle Scholar
  59. 59.
    Nielssen OB, Westmore BD, Large MM, Hayes RA (2007) Homicide during psychotic illness in New South Wales between 1993 and 2002. Med J Aust 186:301–304PubMedGoogle Scholar
  60. 60.
    Nijman H, Cima M, Merckelbach H (2003) Nature and antecedents of psychotic patients’ crimes. J Forensic Psych Psychol 14:542–553CrossRefGoogle Scholar
  61. 61.
    Norman RM, Malla AK (2001) Duration of untreated psychosis: a critical examination of the concept and its importance. Psychol Med 31:381–400PubMedCrossRefGoogle Scholar
  62. 62.
    Perkins D, Lieberman J, Gu H, et al. (2004) Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders. Br J Psychiatry 185:18–24PubMedCrossRefGoogle Scholar
  63. 63.
    Reilly JL, Harris MS, Keshavan MS, Sweeney JA (2006) Adverse effects of risperidone on spatial working memory in first-episode schizophrenia. Arch Gen Psychiatry 63:1189–1197PubMedCrossRefGoogle Scholar
  64. 64.
    Ropcke B, Eggers C (2005) Early-onset schizophrenia: a 15-year follow-up. Eur Child Adolesc Psychiatry 14:341–350PubMedCrossRefGoogle Scholar
  65. 65.
    Rosen K, Garety P (2005) Predicting recovery from schizophrenia: a retrospective comparison of characteristics at onset of people with single and multiple episodes. Schizophr Bull 31:735–750PubMedCrossRefGoogle Scholar
  66. 66.
    Salize HJ, Dressing H (2004) Epidemiology of involuntary placement of mentally ill people across the European Union. Br J Psychiatry 184:163–168PubMedCrossRefGoogle Scholar
  67. 67.
    Sartorius N, Jablensky A, Korten A, et al. (1986) Early manifestations and first-contact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO Collaborative Study on determinants of outcome of severe mental disorders. Psychol Med 16:909–928PubMedCrossRefGoogle Scholar
  68. 68.
    Schanda H, Knecht G, Schreinzer D, et al. (2004) Homicide and major mental disorders: a 25-year study. Acta Psychiatr Scand 110:98–107PubMedCrossRefGoogle Scholar
  69. 69.
    Seikkula J, Aaltonen J, Alakare B (2006) Five-year experience of first-episode non-affective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies. Psychother Res 16:214–228CrossRefGoogle Scholar
  70. 70.
    Simpson AI, Skipworth J, McKenna B, et al. (2006) Mentally abnormal homicide in New Zealand as defined by legal and clinical criteria: a national study. Aust N Z J Psych 40:804–9CrossRefGoogle Scholar
  71. 71.
    Singh SP, Cooper JE, Fisher HL, et al. (2005) Determining the chronology and components of psychosis onset: The Nottingham Onset Schedule (NOS). Schizophr Res 80:117–130PubMedCrossRefGoogle Scholar
  72. 72.
    Sipos A, Harrison G, Gunnell D, Amin S, Singh SP (2001) Patterns and predictors of hospitalisation in first-episode psychosis. Prospect Cohort Study. Br J Psychiatry 178:518–523Google Scholar
  73. 73.
    Skeate A, Jackson C, Birchwood M, Jones C (2002) Duration of untreated psychosis and pathways to care in first-episode psychosis. Investigation of help-seeking behaviour in primary care. Br J Psychiatry 43:s73–s77CrossRefGoogle Scholar
  74. 74.
    Smit PR, Bijleveld CCJH (2001) Homicide in the Netherlands; An Exploratory Study of the 1998 Cases. Homicide Studies 5:293–310CrossRefGoogle Scholar
  75. 75.
    Szymanski SR, Cannon TD, Gallacher F, Erwin RJ, Gur RE (1996) Course of treatment response in first-episode and chronic schizophrenia. Am J Psychiatry 53:519–525Google Scholar
  76. 76.
    Valevski A, Averbuch I, Radwan M, et al. (1999) Homicide by schizophrenic patients in Israel. Eur Psychiatry 14:89–92PubMedCrossRefGoogle Scholar
  77. 77.
    Verma S, Poon LY, Subramaniam M, Chong SA (2005) Aggression in asian patients with first-episode psychosis. Int J Soc Psych 51:365–371CrossRefGoogle Scholar
  78. 78.
    Wade D, Harrigan S, Harris MG, Edwards J, McGorry PD (2006) Pattern and correlates of inpatient admission during the initial acute phase of first-episode psychosis. Aust N Z J Psych 40:429–436CrossRefGoogle Scholar
  79. 79.
    Wellford C, Cronin J (2000) Analysis of variables affecting the clearance of Homicides: a multisite study. Department of Justice (http://www.ncjrs.gov/pdffiles1/nij/grants/181356.pdf. Accessed May 7, 2007)
  80. 80.
    Wunderink A, Nienhuis FJ, Sytema S, Wiersma D (2006) Treatment delay and response rate in first episode psychosis. Acta Psychiatr Scand 113:332–329PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.PaddingtonAustralia
  2. 2.Clinical Research Unit for Anxiety DisordersSchool of Psychiatry, UNSW at St Vincent’s HospitalSydneyAustralia

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