Aggression in Psychoses

Abstract

Most individuals diagnosed with a mental illness are not violent, but some mentally ill patients commit violent acts. PubMed database was searched for articles published between 1980 and November 2013 using the combination of key words “schizophrenia” or “bipolar disorder” with “aggression” or “violence.” In comparison with the general population, there is approximately a twofold increase of risk of violence in schizophrenia without substance abuse comorbidity and ninefold with such comorbidity. The risk in bipolar disorder is at least as high as in schizophrenia. Most of the violence in bipolar disorder occurs during the manic phase. Violence among adults with schizophrenia may follow two distinct pathways: one associated with antisocial conduct and another associated with the acute psychopathology, particularly anger and delusions. Clozapine is the most effective treatment of aggressive behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second most effective treatment. Treatment nonadherence greatly increases the risk of violent behavior, and poor insight as well as hostility is associated with nonadherence. Nonpharmacological methods of treatment of aggression in schizophrenia and bipolar disorder are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone is not sufficient.

Non-pharmacological interventions for reducing aggression and violence in serious mental illness: A systematic review and narrative synthesis

“…People with personality disorder (PD) have similarly increased violence rates and this increases further if the diagnosis is antisocial PD (ASPD) [8]. Previous reviews have presented evidence supporting the efficacy of pharmacological treatments in reducing violence during psychosis [9, 10] but issues including non-adherence and non-response to anti-psychotic medications [11] and the aetiological heterogeneity of violence during psychosis [12] may limit the efficacy of pharmacological treatments across the spectrum of violent psychiatric patients and mentally disordered offenders (MDOs).…”

Exploring associations of clinical and social parameters with violent behaviors among psychiatric patients

“…Aggressiveness is strongly dependent on the type of disorder with which it is associated, as there are different disorders such as psychiatric disorders, neurological diseases, and personality disorders [34, 36]. Different studies have shown that psychopathic, psychotic symptoms and related factors relatively contribute to the development of aggressive behaviors [7]. In the field of suicidal behavior, major depression, impulsiveness, and aggressiveness are some of the main factors associated with suicide [37, 38].…”

“…For example, one study reported that the rate of violent reoffending was lower during periods in which individuals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders [5]. Use of substances, such as alcohol and drugs, has been linked with a direct increase in risks of violent incidents in psychiatric patients [3, 6, 7]. Diehl et al [8] showed that violent crime was strongly associated with various sexual behaviors and the severity of substance dependence [8], which are clinical manifestations of positive valence systems [9].…”

Preventing Violence in Patients with Schizophrenia

“…In reality, violence in patients with schizophrenia is a frequent reason for hospitalization; it may delay hospital discharge and increases the illness burden carried by patients' families [6]. The severity of violent behavior in patients with schizophrenia is variable, and homicide may rarely occur [7,8].…”

“…For all these reasons, efforts to prevent or reduce violence in patients with schizophrenia are worthwhile. The origins of violence in patients with schizophrenia are heterogeneous, with different pathways leading to the same phenotype of violent behavior [6,9,10]. This heterogeneity of origin will be reflected in preventative efforts.…”