Facing Up to Unpalatable Evidence for the Sake of Our Patients 英文参考文献.docVIP

Perspective FacingUptoUnpalatableEvidencefortheSakeofOur Patients PaulE.Mullen1,2 * 1MonashUniversity,Melbourne,Victoria,Australia,2InstituteofPsychiatry,London,UnitedKingdom The paper of Seena Fazel and col- four to five times greater for general violence, and between 14 and 25 for homicide. The review also makes clear thatsubstanceabuseisamajorriskfactor forviolenceinschizophrenia. leagues published in this week’s PLoS Medicine [1] provides the most extensive and sophisticated analysis to date of the available data on the association between violent behaviour and having been diag- nosed with a schizophrenic disorder. The possibleassociationbetweenschizophrenia and violence remains a contentious issue in mental health. This question is partic- ularly emotive for those, like myself, who started their psychiatric careers at a time whenmassiveasylumsstilldominatedthe landscape of mental health care, or the lackofcare,andthestruggleforcivilrights for the compulsorily detained was just beginning. Those working for reform confronted the necessity of calming the exaggerated fears of the general popula- tion about the violent tendencies of the mad.Equallyitwasessentialtoovercome similar, though more politely articulated prejudices among those who controlled public mental health services, including mostofouroldercolleagues.Thequestion of an association was in those days as much a political as a scientific question, anditwasintheguiseofscientiststhatwe answered politically [2–4]. The efforts to minimise, or if possible explain away,the apparent association between schizophre- niaandviolencewasremarkablyeffective, and up to a point beneficial to patients. LinkedResearchArticle This Perspective discusses the fol- lowingnewstudypublishedinPLoS Medicine: Associations and risk factors are statis- ticallysignificantcorrelations;theydonot establish causality. At best they demon- stratearebuttablepresumptionofcausal- ity. Having established a correlation the questionimmediate