Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-23T00:40:34.143Z Has data issue: false hasContentIssue false
  • English
  • Français

Substance use in psychiatric crisis: relationship to violence

Published online by Cambridge University Press:  05 November 2020

Nicola J. Kalk Open the ORCID record for Nicola J. Kalk [Opens in a new window] ,
John E. Robins ,
Kezia R. Ross ,
Megan Pritchard ,
Michael T. Lynskey ,
Vivienne A. Curtis  and
Katherine I. Morley
Nicola J. Kalk*
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
John E. Robins
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
Kezia R. Ross
Affiliation:
Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
Megan Pritchard
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
Michael T. Lynskey
Affiliation:
Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
Vivienne A. Curtis
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK
Katherine I. Morley
Affiliation:
South London and Maudsley NHS Foundation Trust, London, UK Addictions Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK Centre for Epidemiology and Biostatistics, Melbourne School of Global and Population Health, The University of Melbourne, Melbourne, Australia RAND Europe, Westbrook Centre, Cambridge, UK
*
Author for correspondence: Nicola J. Kalk, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Substance use and psychiatric illness, particularly psychotic disorders, contribute to violence in emergency healthcare settings. However, there is limited research regarding the relationship between specific substances, psychotic symptoms and violent behaviour in such settings. We investigated the interaction between recent cannabinoid and stimulant use, and acute psychotic symptoms, in relation to violent behaviour in a British emergency healthcare setting.

Methods

We used electronic medical records from detentions of 1089 individuals under Section 136 of the UK Mental Health Act (1983 amended 2007), an emergency police power used to detain people for 24–36 h for psychiatric assessment. The relationship between recent cannabinoids and/or stimulant use, psychotic symptoms, and violent behaviour, was estimated using logistic regression.

Findings

There was evidence of recent alcohol or drug use in 64.5% of detentions. Violent incidents occurred in 12.6% of detentions. Psychotic symptoms increased the odds of violence by 4.0 [95% confidence intervals (CI) 2.2–7.4; p < 0.0001]. Cannabinoid use combined with psychotic symptoms increased the odds of violence further [odds ratios (OR) 7.1, 95% CI 3.7–13.6; p < 0.0001]. Recent use of cannabinoids with stimulants but without psychotic symptoms was also associated with increased odds of violence (OR 3.3, 95% CI 1.4–7.9; p < 0.0001).

Interpretation

In the emergency setting, patients who have recently used cannabinoids and exhibit psychotic symptoms are at higher risk of violent behaviour. Those who have used both stimulants and cannabinoids without psychotic symptoms may also be at increased risk. De-escalation protocols in emergency healthcare settings should account explicitly for substance use.

Keywords

Aggressioncannabinoidscannabisemergency psychiatrypsychosisstimulantsviolence
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 9 , July 2022 , pp. 1691 - 1697
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bassir Nia, A., Medrano, B., Perkel, C., Galynker, I., & Hurd, Y. L. (2016). Psychiatric comorbidity associated with synthetic cannabinoid use compared to cannabis. Journal of Psychopharmacology, 30(12), 1321–1330. doi:10.1177/0269881116658990.CrossRefGoogle ScholarPubMed
Bell, J., Kilic, C., Prabakaran, R., Wang, Y. Y., Wilson, R., Broadbent, M., … Curtis, V. (2013). Use of electronic health records in identifying drug and alcohol misuse among psychiatric in-patients. The Psychiatrist, 37, 15–20. doi:10.1192/pb.bp.111.038240.CrossRefGoogle Scholar
Bendelow, G., Warrington, C. A., Jones, A. M., & Markham, S. (2019). Police detentions of ‘mentally disordered persons’: A multi-method investigation of section 136 use in Sussex. Medicine, Science and the Law, 59(2), 95–103. doi:10.1177/0025802419830882.CrossRefGoogle ScholarPubMed
Cornaggia, C. M., Beghi, M., Pavone, F., & Barale, F. (2011). Aggression in psychiatry wards: A systematic review. Psychiatry Research, 189(1), 10–20. doi:10.1016/j.psychres.2010.12.024.CrossRefGoogle ScholarPubMed
Dack, C., Ross, J., Papadopoulos, C., Stewart, D., & Bowers, L. (2013). A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatrica Scandinavica, 127(4), 255–268. doi:10.1111/acps.12053.CrossRefGoogle ScholarPubMed
Dellazizzo, L., Potvin, S., Beaudoin, M., Luigi, M., Dou, B. Y., Giguère, CÉ, & Dumais, A. (2019). Cannabis use and violence in patients with severe mental illnesses: A meta-analytical investigation. Psychiatry Research, 274(December 2018), 42–48. doi:10.1016/j.psychres.2019.02.010.CrossRefGoogle ScholarPubMed
Fazel, S., Gulati, G., Linsell, L., Geddes, J. R., & Grann, M. (2009). Schizophrenia and violence: Systematic review and meta-analysis. PLoS Medicine, 6(8), e1000120. doi:10.1371/journal.pmed.1000120.CrossRefGoogle ScholarPubMed
Greenland, S., Senn, S. J., Rothman, K. J., Carlin, J. B., Poole, C., Goodman, S. N., & Altman, D. G. (2016). Statistical tests, p values, confidence intervals, and power: A guide to misinterpretations. European Journal of Epidemiology, 31(4), 337–350. doi:10.1007/s10654-016-0149-3.CrossRefGoogle ScholarPubMed
Haber, P., Lintzeris, N., Proude, E., & Lopatko, O. (2009). Alcohol withdrawal management. Guidelines for the Treatment of Alcohol Problems.Google Scholar
Hall, W., & Lynskey, M. (2016). Evaluating the public health impacts of legalizing recreational cannabis use in the United States. Addiction (Abingdon, England), 111(10), 1764–1773. doi:10.1111/add.13428.CrossRefGoogle ScholarPubMed
Healthy London Partnership (2017). Mental Health Crisis Care for Londoners: London's section 136 pathway and Health Based Place of safety specification.Google Scholar
Iozzino, L., Ferrari, C., Large, M., Nielssen, O., & de Girolamo, G. (2015). Prevalence and risk factors of violence by psychiatric acute inpatients: A systematic review and meta-analysis. PloS One, 10(6), e0128536. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26061796. Iozzino, L., Ferrari, C., Large, M., Nielssen, O., & De Girolamo, G. (2015). Prevalence and risk factors of violence by psychiatric acute inpatients: A systematic review and meta-analysis. PLoS ONE, 10(6). https://doi.org/10.1371/journal.pone.0128536.CrossRefGoogle ScholarPubMed
Kaeser, D., Guerra, R., Keidar, O., Lanz, U., Moses, M., Kobel, C., … Ricklin, M. E. (2018). Verbal and Non-verbal aggression in a Swiss university emergency room: A descriptive study. International Journal of Environmental Research and Public Health, 15(7), 1423. https://www.ncbi.nlm.nih.gov/pubmed/29986402.CrossRefGoogle Scholar
Lecomte, T., Dumais, A., Dugré, J. R., & Potvin, S. (2018). The prevalence of substance-induced psychotic disorder in methamphetamine misusers: A meta-analysis. Psychiatry Research, 268(May), 189–192. doi:10.1016/j.psychres.2018.05.033.CrossRefGoogle ScholarPubMed
Maharaj, R., Gillies, D., Andrew, S., & O'Brien, L. (2011). Characteristics of patients referred by police to a psychiatric hospital. Journal of Psychiatric and Mental Health Nursing, 18(3), 205–212. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21395912.CrossRefGoogle ScholarPubMed
Marconi, A., Di Forti, M., Lewis, C. M., Murray, R. M., & Vassos, E. (2016). Meta-Analysis of the association between the level of cannabis use and risk of psychosis. Schizophrenia Bulletin, 42(5), 1262–1269. doi:10.1093/schbul/sbw003.CrossRefGoogle ScholarPubMed
Moeller, K. E., Kissack, J. C., Atayee, R. S., & Lee, K. C. (2017). Clinical interpretation of urine drug tests: What clinicians need to know about urine drug screens. Mayo Clinic Proceedings, 92(5), 774–796. doi:10.1016/j.mayocp.2016.12.007.CrossRefGoogle ScholarPubMed
Nederlof, A. F., Muris, P., & Hovens, J. E. (2013). Aggression and violent behavior The epidemiology of violent behavior in patients with a psychotic disorder: A systematic review of studies since 1980. Aggression and Violent Behavior, 18(1), 183–189. doi:10.1016/j.avb.2012.11.018.CrossRefGoogle Scholar
Nikathil, S., Olaussen, A., Symons, E., Gocentas, R., O'Reilly, G., & Mitra, B. (2018). Increasing workplace violence in an Australian adult emergency department. Emergency Medicine Australasia: EMA, 30(2), 181–186. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29117641.CrossRefGoogle Scholar
Perera, G., Broadbent, M., Callard, F., Chang, C., Downs, J., Dutta, R., … Stewart, R. (2016). Cohort profile of the South London and Maudsley NHS foundation trust biomedical research centre (SLaM BRC) case register: Current status and recent enhancement of an electronic mental health record-derived data resource. BMJ Open, 6, e008721. doi:10.1136/bmjopen-2015-008721.CrossRefGoogle ScholarPubMed
Pich, J. V, Kable, A., & Hazelton, M. (2017). Antecedents and precipitants of patient-related violence in the emergency department: Results from the Australian VENT study (Violence in Emergency Nursing and Triage). Australasian Emergency Nursing Journal: AENJ, 20(3), 107–113. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28705687.CrossRefGoogle Scholar
Räsänen, P., Tiihonen, J., Isohanni, M., Rantakallio, P., Lehtonen, J., & Moring, J. (1998). Schizophrenia, alcohol abuse, and violent behavior: A 26-year followup study of an unselected birth cohort. Schizophrenia Bulletin, 24(3), 437–441.CrossRefGoogle ScholarPubMed
R Core Team (2016). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing.Google Scholar
Shafi, A., Gallagher, P., Stewart, N., Martinotti, G., & Corazza, O. (2017). The risk of violence associated with novel psychoactive substance misuse in patients presenting to acute mental health services. Human Psychopharmacology: Clinical and Experimental, 32(3), e2606. doi:10.1002/hup.2606.CrossRefGoogle ScholarPubMed
Speroni, K. G., Fitch, T., Dawson, E., Dugan, L., & Atherton, M. (2014). Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association, 40(3), 218–228; quiz 295. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24054728.CrossRefGoogle ScholarPubMed
Svoboda, T. (2014). Difficult behaviors in the emergency department: A cohort study of housed, homeless and alcohol dependent individuals. PloS One, 10(4), e0124528. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25919015.CrossRefGoogle ScholarPubMed
Tomlinson, M. F., Brown, M., & Hoaken, P. N. S. (2016). Recreational drug use and human aggressive behavior: A comprehensive review since 2003. Aggression and Violent Behavior, 27, 9–29. doi:10.1016/j.avb.2016.02.004.CrossRefGoogle Scholar
Unadkat, A., Subasinghe, S., Harvey, R. J., & Castle, D. J. (2019). Methamphetamine use in patients presenting to emergency departments and psychiatric inpatient facilities: What are the service implications? Australasian Psychiatry, 27(1), 14–17. doi:10.1177/1039856218810155.CrossRefGoogle ScholarPubMed
van Buuren, S. (2018). Flexible imputation of missing data (2nd ed.). Boca Raton, FL: CRC/Chapman & Hall.CrossRefGoogle Scholar
Van Buuren, S., & Groothuis-Oudshoorn, K. (2011). Multivariate imputation by chained equations in R. Journal Of Statistical Software, 45(3), 1–67. doi:10.1177/0962280206074463.Google Scholar
Vos, P. J., Cloete, K. J., Le Roux, A., Kidd, M., & Jordaan, G. P. (2010). A retrospective review of trends and clinical characteristics of methamphetamine-related acute psychiatric admissions in a South African context. African Journal of Psychiatry, 13(5), 390–394. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21390410.Google Scholar
White, I. R., Royston, P., & Wood, A. M. (2011). Multiple imputation using chained equations: Issues and guidance for practice. Statistics in Medicine, 30(4), 377–399. doi:10.1002/sim.4067.CrossRefGoogle ScholarPubMed
Wicomb, R., Jacobs, L., Ebrahim, N., Rensburg, M., & Macharia, M. (2018). Illicit drug use and violence in acute psychosis among acute adult admissions at a South African psychiatric hospital. African Health Sciences, 18(1), 132–136. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29977266.CrossRefGoogle Scholar
Yalcin, S., & Bilgin, H. (2019). Risk predictions of physical aggression in acute psychiatric wards: Findings of a prospective study. Nursing & Health Sciences, 2019, 1–7. doi: nhs.12599. 10.1111/nhs.12599.Google Scholar
Zisman, S., & O'Brien, A. (2015). A retrospective cohort study describing six months of admissions under section 136 of the Mental Health Act; the problem of alcohol misuse. Medicine, Science, and the Law, 55(3), 216–222. doi:10.1177/0025802414538247.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Kalk et al. supplementary material

Kalk et al. supplementary material

Download Kalk et al. supplementary material(PDF)
PDF 433.7 KB