R01MH113861-01 ? Girgis Research suggests that violence is uncommon in individuals with psychosis, and when it does happen, individuals with psychosis are more often the victims rather than the perpetrators. While risk factors for violence have been identified, such as untreated symptoms and substance use, huge knowledge gaps remain. Our lack of understanding of violence risk in psychosis, particularly during attenuated and early phases of psychosis, reflects that prior studies were performed in already psychotic individuals and/or did not possess longitudinal components. Additionally, the presumed antecedents of VB (i.e., violent ideation [VI]) were not measured in the majority of studies. These factors complicate the disentangling of links between VB and psychotic symptoms, and preclude an examination of the temporal progression from VI to VB. An understanding of the relationship between violence and psychosis is critical for developing interventions aimed at reducing the risk of violence in psychotic individuals. In order to address this need, we recently performed a preliminary study in which we longitudinally assessed 200 CHR individuals for VI and VB using the Structured Interview for Psychosis-Risk Syndromes (SIPS), and rated these according to MacArthur Community Violence categories. We found that VI was relatively common, and that both VI and VB at baseline strongly predicted VB during follow-up as well as conversion to psychosis, independent of all clinical and demographic variables. Additionally, no information about VI was obtained by directly asking about VI, but instead by specific prompts on the SIPS unrelated to violence but related to inquiry about psychotic thinking. In addition, we performed preliminary surface based morphometric analyses of 71 of these individuals and found relationships between amygdalar morphometry and baseline VI. These data support the potential for neurobiological and phenomenological links between incipient psychosis and VB and suggest the possibility of identification of a group of patients at elevated risk for violence that might benefit from closer monitoring and rapid treatment interventions. These important results need to be replicated and expounded upon as they have critical implications for the development of interventions aimed at reducing the risk of violence in psychotic individuals. In this grant application, we will focus on VI. To do so we will perform comprehensive assessments of VI, symptoms, and clinical measures that were not measured in the pilot study (e.g., psychopathy, criminal history) at baseline and follow them until conversion to full blown psychosis or two years, whichever comes first, to obtain information on conversion to psychosis and outcome VB. We will also obtain MRI at baseline and upon conversion to full blown psychosis or two years, whichever comes first.
The development of strategies and interventions for preventing or minimizing the impact of violent behavior in individuals with psychotic disorders has been limited, in part, by a lack of information about the relationships between violent ideation, neurobiology, and early psychosis. In this project we will determine how to best to ask about thoughts of violence, obtain comprehensive assessment of symptom correlates of violent thoughts and actions, and investigate relationships between violent thoughts and brain abnormalities. Examining these relationships will foster a better understanding of the causes of violent thoughts and behavior, setting the stage for early identification and the development of preventative and more targeted treatments, and as such has significant public health implications.