Violence and psychosis: critical timings

Three main themes are advanced in this paper — each referring to the importance of time with respect to acts of violence among people with a psychosis. The best substantiated theme is that observations of the relative timings of illness events and violent events, and particularly the relative onset of illness and violence careers, have been of fundamental importance in establishing the reality of a relationship between psychosis and violence. A second theme is much more tentative — that the frequency of association between violence and psychosis, or the rapidity with which it manifests, may be influenced by time because mental health policies and laws change over time and probably do have an impact on the presentation of disorder. There is a hint of this from studies conducted at different times, but they may not be strictly comparable. Serious violence is a rare event, and even using recent studies which take a long, retrospective view of homicide figures, this theme is harder to establish with confidence. In clinical practice the third theme is perhaps most important and yet requires much more elucidation. Risk of violence can be satisfactorily predicted only within specified time limits and indeed, in conjunction with seriousness of risk, it is its imminence that is of most concern to the public and practising clinicians alike. Too little is known about indicators of imminence of violence.