Meeting abstract

https://doi.org/10.24869/spsih.2026.340

The Importance of Recognizing Premorbid Signs of a First Psychotic Episode in Assessing the Risk of Violent Behavior: A Case Report

Milena Pernat ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Petra Tokić ; Mental Health Service, Teaching Institute for Public Health of Split-Dalmatia County, Vukovarska 46, 21000 Split, Croatia *
Marijeta Ivandić ; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia

* Corresponding author.

Abstract

Introduction: The first psychotic episode is often
preceded by a premorbid and prodromal period
marked by gradual changes in behavior, thinking,
and social functioning. Since these symptoms are
often nonspecific and only recognized retrospectively,
early identification of people at risk and
timely intervention are important clinical challenges.
This case report aims to highlight the importance
of recognizing these features. Case report:
An 18-year-old patient underwent a forensic
psychiatric evaluation ordered by the County
State Attorney’s Office in Split after committing
criminal offenses during his first psychotic episode.
Retrospectively, long-standing premorbid characteristics were established: hypersensitivity,
anxiety with panic attacks, perfectionism, social
withdrawal, and difficulties in peer relationships.
Immediately before the acute exacerbation of the
psychotic disorder, there was a deterioration in
functioning with concentration problems, isolation,
psychomotor agitation, ideas of persecution,
and religious delusions. On the day of the offense,
he underwent his first outpatient psychiatric examination,
was diagnosed with an acute psychotic
disorder, and started on antipsychotic therapy.
Several hours later, during psychotic decompensation,
he attempted to kill a police officer who
was trying to identify him, stabbing him multiple
times and causing life-threatening injuries.
While in a state of legal insanity, he committed
the criminal offenses of attempted aggravated
murder and unauthorized use of another person’s
motor vehicles. After being taken into custody, he
was hospitalized for four days at the Clinic of Psychiatry,
where religious and grandiose delusions,
persecutory ideas, and hallucinatory experiences
were confirmed, with a negative urine test for
psychoactive substances and a normal brain CT.
Forensic psychiatric evaluation determined that
at the time of the offenses he was suffering from
an acute schizophrenia-like psychotic disorder
(F23.2) and that he was not criminally responsible.
Conclusion: This case underscores the importance
of recognizing premorbid and prodromal
signs of a first psychotic episode. Greater
awareness among families, schools, and healthcare
professionals about early changes in behavior
and functioning can enable earlier diagnosis,
timely treatment, and a reduced risk of serious
consequences of untreated psychosis, including
potential aggressive behavior.

Keywords

forensic psychiatry; risk assessment; prodromal symptoms; premorbid symptoms; psychotic episode

Hrčak ID:

353110

URI

https://hrcak.srce.hr/353110

Publication date:

15.6.2026.

Article data in other languages: croatian

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