Psychiatrists' view on the risk factors for aggressive behavior in psychotic patients

In meta-analytic studies it was found that patients diagnosed with a psychotic disorder are at increased risk for displaying violent behavior. However, it remains largely unclear which specific factors contribute to the heightened risk for aggression in this patient group, nor what the views of psychiatrists are on this issue. A cross-sectional survey study was carried out and a survey questionnaire was developed to investigate the view of 652 psychiatrists on the relative contributions of various factors (e.g., illness related, personality, social influences) that might explain aggression in psychosis. It was found that psychiatrists generally view illness-related features as the most important determinant of aggression in these patients, followed by impulsivity/lack of insight and social influences, whereas personality characteristics are considered as least relevant. Latent class cluster analysis revealed that there are several subgroups of psychiatrists who attach different levels of importance to various types of risk factors. In these subgroups, two cluster contrasts were found: one representing differences in response style, and one representing differences in the evaluation of personality characteristics. Overall, psychiatrists seem to adopt a medical model when interpreting aggression in psychotic patients, although several subgroups of psychiatrists can be identified who have different opinions of such behavior.