Violence Risk in First Episode Psychosis: Predictors, Practice Gaps, and Ethical Assessment Guidelines

Yveton Isnor (1)
1. Cambridge Health Alliance

First episode psychosis (FEP) is associated with an elevated risk of violence, particularly before treatment begins. Despite growing evidence linking violence risk in FEP to clinical, psychosocial, and historical factors (e.g., childhood trauma, substance use, delinquency), assessment and documentation practices remain inconsistent. This systematic literature review synthesizes current research on the prevalence and predictors of violence in FEP, examining patterns of delinquency, trauma exposure, symptom severity, and systemic risk factors. The review identifies gaps in clinical practice, emphasizing the limitations of unstructured assessments and the underutilization of validated tools. Findings show that while clients and caregivers support transparent discussions about violence, stigma and limited clinician training often hinder thorough evaluation. This review underscores the need for trauma-informed, culturally sensitive, and standardized approaches to violence risk assessment in FEP. Recommendations and ethical considerations are discussed