a novel approach to determining violence risk in schizophrenia developing a stepped strategy in 13,806 discharged patients一个新颖的方法来确定暴力精神分裂症的风险制定了战略在13806年出院的病人.pdfVIP

A Novel Approach to Determining Violence Risk in Schizophrenia: Developing a Stepped Strategy in 13,806 Discharged Patients 1 2 3 ˚ ¨ 2 1 Jay P. Singh , Martin Grann , Paul Lichtenstein , Niklas Langstrom , Seena Fazel * 1 Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom, 2 Centre for Violence Prevention, Karolinska Institutet, Stockholm, Sweden, 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Abstract Clinical guidelines recommend that violence risk be assessed in schizophrenia. Current approaches are resource-intensive as they employ detailed clinical assessments of dangerousness for most patients. An alternative approach would be to first screen out patients at very low risk of future violence prior to more costly and time-consuming assessments. In order to implement such a stepped strategy, we developed a simple tool to screen out individuals with schizophrenia at very low risk of violent offending. We merged high quality Swedish national registers containing information on psychiatric diagnoses, socio-demographic factors, and violent crime. A cohort of 13,806 individuals with hospital discharge diagnoses of schizophrenia was identified and followed for up to 33 years for violent crime. Cox regression was used to determine risk factors for violent crime and construct the screening tool, the predictive validity of which was measured using four outcome statistics. The instrument was calibrated on 6,903 participants and cross-validated using three independent replication samples of 2,301 participants each. Regressi