Violence in schizophrenia: Prevalence, correlates, and treatment effectiveness

Among the possible complications and adverse outcomes of schizophrenia, perhaps none is more troubling and tragic—albeit infrequent—than violence. Aside from causing physical harm to its victims, violent behavior is ruinous to its perpetrators and costly to the public. It precipitates the loss of personal liberty, necessitates expensive interventions, perpetuates stigma, and disrupts continuity of care. Despite a substantial amount of research literature, key questions remain about the link between schizophrenia and violence. Questions include: How common is serious violence compared to minor violence among schizophrenia patients, and what causes these different behaviors? To what extent is violence associated with acute psychopathology, rather than other factors, including those that may precede the onset of schizophrenia? How effective are various antipsychotic medications in reducing violence, and for which types of patients? Definitive answers to these questions remain elusive. However, the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study provides a wealth of new evidence about violence and schizophrenia. n this chapter, we present three sets of analyses, adapted from published primary reports. First, we examine baseline data to estimate the prevalence of serious and minor violence, and to identify significant correlates of each. We also develop an overarching explanatory model of any violence. With this first set of analyses we focus most specifically on clinical factors, particularly the link between violence and psychotic symptoms.

Duke Scholars

Author Jeffrey W. Swanson Psychiatry, Child & Family Mental Health & Community Psychia ...