Analisi del comportamento violento in una popolazione di pazienti psichiatrici in Puglia e Basilicata

A retrospective study has been conducted on the clinical files of four public psy- chiatric facilities in the South of Italy of all patients who were continuously trea- ted in the period of 1995-1999.The sample under consideration is made up of 1,582 subjects, mostly adults (48.4% between the ages of 30 and 49), divided almost equally between males (49%) and females (51%),with a quite low level of education.The most representative diagnoses are those of mood disorder (41.2%), psychotic disorders (27.3%),and disorders in the anxiety spectrum (17.6%);11.4% of our sample have used drugs.Patients with long clinical histories,more than 10 years in 70% of the cases,predominate.After first contact with the facility,almost all patients began psychopharmacological treatment (84%), and about a third (35.8%) of patients taken into care by the facility required hospitalisation over time:in 39.5% of cases,the reason for admission was the result of self and other- directed aggression. A positive correlation between the presence of a clinical history of admissions and occurrences of violent episodes (OR 9.0,IC 95% 7.1- 11.5;χ2=373.7,p<0.05) has emerged. Violent behaviour emerges in the clinical histories of more than a third (36.3%) of the patients in our sample,mostly males.In the majority of cases,was exclusi- vely other-directed (76.7%); violent behaviour which was either self or other- directed occurred 9.2% of the time,and that which was exclusively self-directed, 14.1%. Psychotic disorder is the most statistically common diagnosis in patients with vio- lent behaviour.Psychotic patients (27.3% of the total sample) make up 43.3%. In the subgroup of patients with violent behaviour,“suspension of therapy”seems to be correlated with episodes of other-directed violence (57.5%) (χ2 = 5.8 with p<0.05;OR = 1.8 with IC 95% 1.1 – 2.9),and against people (58.1%) (χ2 = 5.5 with p<0.05;OR = 1.6 with IC 95% 1.1 – 2.4). The existence of substance abuse constitutes a specific risk factor. Occurring in only a minority (11.4%) of the general sample of 1,582 patients,79.55% of sub- jects that abuse substances exhibit violent behaviour (OR = 8.7 with IC 95% 5.8 – 12.9; χ2 = 162.7 with p<0.05), especially that of the other-directed type (63.1%).A significant correlation exists with a positive family case history for both substance abuse (OR = 13.4,IC 95% 5.2 – 34.3,χ2=48.2) and violent behaviour (OR = 7.9,IC 95% 4.0 – 15.2,χ2=50.3. Beginning at first contact with the psychiatric facility,adequate psychopharmaco- logical treatment seems to be an important protective factor: only one third of patients under constant psychopharmacological treatment (35.0%) have,in fact,a positive clinical history of violent behaviour.A good level of compliance to treat- ment also seems to correlate positively.In this group of patients,only 11.95% of violent behaviour episodes had emerged.An other important protective factor against committing a violent act is a “good”level of psychosocial adaptation Among those who possess this (15.73% of the entire sample of 1,582 patients), there is a low incidence of it (8.83%); violent behaviour is markedly higher, in contrast, (70.8%) among patients with an adaptation level of “fair”or “poor” (8,65% of the entire sample).The extra-familial relationships constitute an impor- tant protective factor against committing a violent act. It has been pointed out that charges have been brought in only 8% of cases where violent behaviour has occurred:3% by relatives and 5% by other people,in parti- cular,neighbours.A total of 20 convictions for episodes of violent behaviour have been reported (3.5%).