Correlation Between Violence and Antipsychotic Dosage in Schizophrenia: A Secondary Analysis of The Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE) Dataset

Abstract

Introduction Violent behavior is more common in individuals with schizophrenia, compared to the general population. Studies suggest higher psychotic symptoms are predictive of greater violent behavior. On the other hand, violent behaviors are reduced with antipsychotic treatment. However, the relationship between antipsychotic dosage and violence has not been studied to date. Thus, we aimed to determine if there exists an association between antipsychotic dosage and violence scores and whether the maximum violence would be predictive of the final antipsychotic dosage. We hypothesized that the violence scores at the final assessment in the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE) would be correlated with the corresponding drug dosage and the maximum violence severity score would be predictive of the final dosage. Methods Antipsychotic dosage at the end of the trial was converted into defined daily dosage and chlorpromazine equivalents (CPZe). Final and maximum violence sum scores were analyzed from the final violence assessment interviews. Spearman’s rank-order correlation and linear regression analyses were used to analyze the relationship between the violence scores and standardized antipsychotic dosages. Results The analysis was on 952 individuals with schizophrenia. There was a significant association between maximum violence severity score and the final CPZe dosage (p=0.049). Exploratory analysis of age and ethnicity revealed younger non-white individuals to be at a higher risk of engaging in violent activities. Discussion Violence in schizophrenia is associated with poor illness course. Further studies focusing on violence in younger non-white individuals are warranted.

Effectiveness of Artificial Intelligence Methods in Personalized Aggression Risk Prediction within Inpatient Psychiatric Treatment Settings—A Systematic Review

“…In terms of predictors of aggression, patients with certain demographic and social characteristics were more prone to aggression. The findings in this review were congruent with previous findings which included younger age [37][38][39][40][41][42], older age [43], being unmarried [38,[44][45][46], being childless [47], lower education [44], unemployment [44,[48][49][50], lower intelligence [38], financial issues [51,52] and homelessness [53]. Of note, an earlier study found an association between homelessness and crimes, but not specifically aggressive crimes [54].…”

“…In terms of the management domain, the usage of haloperidol and high antipsychotic dosage were associated with aggression. The use of haloperidol and high antipsychotic dosage [39] were probably an effect, rather than a cause for aggression [67]. In addition, it was thought that poor compliance with pharmacological and non-pharmacological therapies were correlated with aggression [64], as well as the discontinuation of pharmacological treatment in patients with psychotic disorders such as schizophrenia [50].…”

Persistent cannabis use as an independent risk factor for violent behaviors in patients with schizophrenia

“…Violence within this population is associated with poor insight 13 , poor impulse control 13,14 , positive symptoms 15,16 , antisocial personality traits (including childhood conduct disorder) 16,17 , depression, anger, anxiety 18 , a history of physical and sexual victimization 15,19 , and previous episodes of violent behaviors 20 . Treatment with antipsychotic medications reduces the risk of violence 21 , whereas treatment nonadherence increases the aforementioned risk 20,22 . Although substance abuse exacerbates violence in schizophrenia 15,23 , very few studies have examined the role of each abused substance separately.…”

“…Based on findings in populations with severe mental illnesses, we hypothesized that cumulative cannabis use increases the risk of violence across time in a subsample from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial. Namely, this large randomized high-quality clinical trial has been used to study various issues relating to violence in schizophrenia 17,21,23 . Our study complements previous discoveries, as we used this database to investigate the impact of cannabis on violence over time.…”

Machine Learning for prediction of violent behaviors in schizophrenia spectrum disorders: a systematic review

“…It is logical to assume that higher doses of antipsychotics are prescribed to patients with more enduring symptoms, as they are reported to be more prone to engaging in VB in some studies (83). However, some previous studies found no significant association between the disease severity or prescribed dosage of antipsychotics and the risk of VB in patients with SSD (84,85). This highlights the need for further research to better comprehend the relationship between disease severity and prescribed antipsychotic dosages in the occurrence of VB among SSD patients.…”