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Zwischenmenschliche Gewalt im Kontext affektiver und psychotischer Störungen

Interpersonal violence in the context of affective and psychotic disorders

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Zusammenfassung

Einige psychische und neurologische Erkrankungen gehen mit einem erhöhten Risiko für zwischenmenschliche Gewaltanwendung einher. Die verzerrte Wahrnehmung dieser Tatsache begründet wesentlich die Stigmatisierung psychisch erkrankter Menschen. Diese Übersicht fasst die vorliegende Literatur zu Einflussfaktoren, Präventions- und Therapiemöglichkeiten und zur Voraussage zwischenmenschlicher Gewalthandlungen durch psychisch Erkrankte zusammen. Die Gewaltrisiken variieren dabei erheblich über die verschiedenen Diagnosen. Schizophrenien und Manien tragen unter den psychischen Störungen vor allem zu Erkrankungsbeginn das höchste Risiko, dem aber auch therapeutisch wirksam begegnet werden kann. Die stärksten Risikofaktoren sind v. a. frühere Gewalt, Missbrauch von Alkohol und Drogen, männliches Geschlecht, jugendliches Alter. Die zukünftigen Gewaltrisiken in angereicherten Stichproben (v. a. Personen mit einer Gewaltanamnese) können auch im Einzelfall durch Prognoseskalen probabilistisch prädiziert werden. Voraussagen solcher seltenen Ereignisse in der Allgemeinbevölkerung oder in ausschließlich diagnostisch definierten Stichproben sind aber derzeit mit ausreichender Genauigkeit nicht realisierbar.

Summary

Some mental and neurobiological disorders are associated with an increased risk for violence against others. The stigmatization of people with mental illnesses essentially emerges from a distorted perception of this condition. This review article summarizes the available literature on the determinants, prevention, therapy and tools for prediction of serious interpersonal aggression in the context of people with mental disorders. The risks for violence against other people show substantial variation between the various diagnoses. Schizophrenia and mania carry a clearly increased risk particularly at the onset of the disorder but disease-specific pharmacological therapy can reduce these risks. The highest risk factors are in particular previous violence, misuse of alcohol and drugs, male gender and young age. Probabilistic predictions of subsequent aggression against others on an individual-specific basis are only feasible in enriched populations (especially persons with mental illnesses and a previous history of assaults). Valid individual-specific predictions of future violence in the general population or on the basis of diagnoses of mental illness are, however, currently not feasible with sufficient accuracy.

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Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland

    W. Maier

  2. Zentrum für Neurologie, Psychiatrie, Psychotherapie und Psychosomatik, St. Joseph-Krankenhaus Berlin, Berlin, Deutschland

    I. Hauth

  3. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland

    M. Berger

  4. Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinikum RWTH Aachen, Aachen, Deutschland

    H. Saß

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Maier, W., Hauth, I., Berger, M. et al. Zwischenmenschliche Gewalt im Kontext affektiver und psychotischer Störungen. Nervenarzt 87, 53–68 (2016). https://doi.org/10.1007/s00115-015-0040-6

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