Journal List > Korean J Schizophr Res > v.18(1) > 1122200

Choi and Park: Correlates of Violence in Patients with Schizophrenia

Abstract

Therapeutic social environments contribute to the successful treatment and rehabilitation for patients with schizophrenia. However, social stigmata of psychiatric disorder in our society have kept away schizophrenic patients from their recovery and adaptation. Many persons have thought that psychiatric patients are more violent and criminal because of overwhelming prejudice on untreated or mistreated patients with schizophrenia. The purpose of this review is to propose the new and updated fundamentals of our knowledge on the relationship between schizophrenia and violence. In 1980s, many researchers have a belief that rates of criminal behavior vary independently on the rates of mental disorders. The following scientific studies on various population and metaanalyses of relevant data, overall violence rate have been higher in patients with schizophrenia and other psychotic disorders than in healthy controls. Even though schizophrenia and other psychotic disorders are associated with increased risk of homicide, the association has been not attributed to the psychopathology limited to schizophrenia. Most of all, co-occurrence of substance abuse has played an important role in increasing the possibility of violent behavior. The severe violent offending has been inclined to occur during the early period of psychotic episode before beginning the psychiatric treatment. Thus, most of the violent offending of schizophrenia patient can be prevented by prompt therapeutic interventions and treatments.

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Table 1.
Schizophrenia and violence : The summarized findings of several systemic reviews and metaanalyses
Authors, year (reference number) Number of literature Characteristics of subjects Comparison condition Outcome measure Results (effect size)
Fazel et al., 200931) 20 Schizophrenia and other psychoses (n=18,423) General population (n=1,714,904) Risks of interpersonal violence and/or violent criminality • Men; OR=4.0, 95% CI=3.0-5.3 (random effects) • Women; OR=7.9, 95% CI=4.0-15.4 (random effects) • Mixed gender; OR=5.0, 95% CI=3.4-7.4 (random effects) • Comorbid substance abuse; OR=8.9, 95% CI=5.4-14.7 (random effects)
Large et al., 201133) 9 Association with violence in firstepisode psychosis No association with violence in firstepisode psychosis Associations with any violence, serious violence, and severe violence • Violence of any severity; involuntary treatment (OR=3.84), forensic history (OR=3.28), hostile affect (OR=3.52), symptoms of mania (OR=2.86), illicit substance use (OR=2.33), lower levels of education (OR=1.99), younger age (OR=1.85), men (OR=1.61), DUP (OR=1.56) • Serious violence; forensic history (OR=4.42), DUP (OR=2.76), forensic history (OR=2.05)
Witt et al., 201334) 110 Association with violence in psychosis (n=8,439) No association with violence in psychosis (n=37,094) n Risk factors for violence • Dynamic risk factors; hostile behavior (OR=3.1), recent drug misuse (OR=2.2), non-adherence with psychological therapies (OR=6.7), high poor impulse control scores (OR=3.3), recent substance misuse (OR=2.9), recent alcohol misuse (OR=2.2), non-adherence with medication (OR=2.0)

CI : confidence interval, DUP : duration of untreated psychosis, OR : odds ratio

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