Violent aggression predicted by multiple pre-adult environmental hits.

Early exposure to negative environmental impact shapes individual behavior and potentially contributes to any mental disease. We reported previously that accumulated environmental risk markedly decreases age at schizophrenia onset. Follow-up of matched extreme group individuals (≤1 vs. ≥3 risks) unexpectedly revealed that high-risk subjects had >5 times greater probability of forensic hospitalization. In line with longstanding sociological theories, we hypothesized that risk accumulation before adulthood induces violent aggression and criminal conduct, independent of mental illness. We determined in 6 independent cohorts (4 schizophrenia and 2 general population samples) pre-adult risk exposure, comprising urbanicity, migration, physical and sexual abuse as primary, and cannabis or alcohol as secondary hits. All single hits by themselves were marginally associated with higher violent aggression. Most strikingly, however, their accumulation strongly predicted violent aggression (odds ratio 10.5). An epigenome-wide association scan to detect differential methylation of blood-derived DNA of selected extreme group individuals yielded overall negative results. Conversely, determination in peripheral blood mononuclear cells of histone-deacetylase1 mRNA as 'umbrella mediator' of epigenetic processes revealed an increase in the high-risk group, suggesting lasting epigenetic alterations. Together, we provide sound evidence of a disease-independent unfortunate relationship between well-defined pre-adult environmental hits and violent aggression, calling for more efficient prevention.

[Somatic side effects of psychopharmaceuticals]. / Diese Nebenwirkungen sollten Sie kennen.

Psychopharmaceutic drugs are among those most commonly prescribed by general practitioners. They include in particular antidepressants, neuroleptics/antipsychotics and mood stabilizers. Their wide indication window makes it necessary that the physician be familiar with potential somatic side effects. The group of antidementia drugs, tranquilizers and anxiolytics are unlikely to be associated with relevant somatic side effects. Routine controlling of laboratory parameters and ECG performed at regular intervals are indicated in particular in patients receiving neuroleptics. In the event of severe side effects or a suspected overdose, determination of plasma concentration (therapeutic drug monitoring) is recommended.

[Violence by Psychiatric In-Patients of the BZK Gabersee - First Results of a Standardized Documentation] / Aggressionen psychiatrischer Patienten - Erste Ergebnisse einer standardisierten Dokumentation des BZK Gabersee.

After a cluster of severe assaults against our staff we performed a standardized documentation concerning aggressive behaviour of in-patients at the BZK Gabersee, a major District Hospital with a typical spectrum of psychiatric patients. From July 1996 to March 2001 23 037 patients were admitted and 1618 cases of aggressive behaviour were documented. About 75 % of the patients were males, more than 50 % were treated involuntarily. The aggressions were most frequently directed against the nursing staff, severe injuries occured very rarely. We tried to analyse triggers and the individual motivations of aggressive behaviour. Countermeasures were often aggressive as well (reinforced medication, restraint e. g.). The results are discussed in the context of the literature, approaches to cope with and to reduce aggressions are mentioned briefly.

[Aggression of psychiatric patients--first results of a standardized documentation at the Gabersee district hospital]. / Aggressionen psychiatrischer Patienten--Erste Ergebnisse einer standardisierten Dokumentation des BZK Gabersee.

After a cluster of severe assaults against our staff we performed a standardized documentation concerning aggressive behaviour of in-patients at the BZK Gabersee, a major District Hospital with a typical spectrum of psychiatric patients. From July 1996 to March 2001 23037 patients were admitted and 1618 cases of aggressive behaviour were documented. About 75% of the patients were males, more than 50% were treated involuntarily. The aggressions were most frequently directed against the nursing staff, severe injuries occurred very rarely. We tried to analyse triggers and the individual motivations of aggressive behaviour. Countermeasures were often aggressive as well (reinforced medication, restraint e.g.). The results are discussed in the context of the literature, approaches to cope with and to reduce aggressions are mentioned briefly.