Clinical care for patients at risk of psychosis related violence

An NHS review into the clinical care of Valdo Calocane, who killed three people during a psychotic episode, found serious failings that contributed to his relapse and the tragic events that unfolded.12 Nottinghamshire Healthcare NHS Foundation Trust reported that Calocane, who had been admitted to psychiatric hospitals four times because of psychotic episodes linked to schizophrenia,2 was under the care of the early intervention psychosis (EIP) service, which provides standalone community support for people after their first psychotic episodes, including for those unwilling to engage with services.

Patients with schizophrenia require treatment owing to the risk of serious adverse events, including violence. In a Cochrane review, patients with schizophrenia treated with antipsychotics had more than 50% fewer violent outcomes compared with the placebo groups.3 Assessing and managing the risks of perpetrating violence are complicated in this patient group. One complication, almost unique in healthcare, is that the illness itself is associated with loss of insight into the need for treatment. This was the case for …