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2 May 2006
Study findings show a set of distinct, but overlapping, risk factors that may be linked to minor versus serious violent behavior in patients with schizophrenia.
"Serious violent behavior, although generally uncommon in people with mental disorder, carries a high human and social cost," note Jeffrey Swanson (Duke University Medical Center, Durham, North Carolina, USA) and colleagues.
"More informed and nuanced explanatory models, particularly in the clinical domain are needed to improve understanding of how and why violent behavior occurs in persons with schizophrenia with particular characteristics, under varying conditions of social life."
The researchers investigated the prevalence and correlates of violence in 1410 schizophrenia patients who were interviewed about such behavior in the past 6 months.
Violence was classified as minor violence, corresponding to simple assault without injury or weapon use; and serious violence, comprising assault resulting in injury or involving use of a lethal weapon, threat with a lethal weapon in hand, or sexual assault.
The 6-month prevalence of any violence was 19.1%, with 3.6% of participants reporting serious violent behavior.
"Positive" psychotic symptoms, such as persecutory ideation, increased the risk of both minor and serious violence, while "negative" psychotic symptoms, such as social withdrawal, lowered the risk of serious violence.
Serious violence was also associated with depressive symptoms, childhood conduct problems, and victimization.
Minor violence was linked to substance abuse, but in addition to clinical symptoms, Swanson et al also found a correlation between minor violence and interpersonal and social factors. These included being of female gender, residing in restrictive housing, residing with family or relatives, not feeling listened to by family members, and recent history of police contact, as well as functional impairment in the area of leisure activities and social interaction.
"To the extent that violence risk is significantly increased by positive psychotic symptoms, the crucial role of symptom management becomes clear (eg, through effective pharmacotherapy and patient adherence)," say the investigators.
"However, to the extent that risk of violence (particularly minor violence) is increased by other, nonclinical, variables… the clinical lesson is that violence risk management must include a focus on the whole person in the community environment."
Source: Arch Gen Psychiatry 2006; 63: 490–499
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