High Rates of Low-Intensity Aggressive, Suicidal Behavior in Early Psychosis

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man punching mirror
This is the first study to report an association between obstetric complications, atypical development, and aggressive behavior in first-episode psychosis.

Patients who are at the early stages of psychosis exhibit high rates of aggressive and suicidal behavior prior to their contact with clinical services, according to study results published in Schizophrenia Research. In addition, alcohol use disorders, neurodevelopmental adversities, and poverty symptoms have all been shown to be linked to a higher risk for aggression in individuals with early psychosis.

The investigators sought to evaluate the risk factors for and rates and characteristics of aggressive behavior among patients with first-episode psychosis (FEP). They initiated a retrospective chart review of 449 individuals with FEP who were seen at the University of California Davis Early Diagnosis and Preventive Treatment outpatient clinic for patients with early psychosis between October 13, 2004, and July 9, 2013. Clinical information and aggressive behavior were rated according to facts obtained from the chart review of data at baseline and after 6 months of follow-up. All participants were recruited for and voluntarily participated in a larger study of cognition in patients with psychotic disorders.

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The rate of aggressive behavior reported among patients with FEP was 54.3%. In these individuals, aggressive behavior was significantly associated with higher rates of birth complications (P =.016), developmental delays (P =.031), learning difficulties (P =.004), the clinical domain of poverty symptoms (P =.04), and alcohol use disorders (P =.007).

Moreover, along with aggressive behavior, 16.7% of individuals with FEP exhibited suicidal ideation or behaviors, and 11.4% displayed nonsuicidal self-injurious behavior. In contrast to baseline values, however, aggressive behaviors at the 6-month follow-up were almost completely absent.

The investigators concluded that early identification of neurodevelopmental adversities, substance use disorder, and negative symptoms among patients with FEP can help to inform risk assessment and can help tailor prevention and early intervention strategies to reduce the rates of aggression among individuals with psychosis.


Lopez-Garcia P, Ashby S, Patel P, et al. Clinical and neurodevelopmental correlates of aggression in early psychosis [published online August 3, 2019]. Schizophr Res. doi:10.1016/j.schres.2019.07.045