Schizophrenia and violence: realities and recommendations

Abstract

Published findings on the relationship between schizophrenia and violence have been mixed, due to differences in study design and quality. In this review, we address the issue with an emphasis on characterizing who is most likely to be violent and when. We conclude that: (1) individuals with schizophrenia are at an increased risk for violence due to specific psychotic symptoms; (2) this risk is increased by brain abnormalities, psychiatric comorbidities, and demographic factors that are not specific to schizophrenia; (3) the majority of violent offenses committed by people with schizophrenia are indistinguishable from offenses committed by others; and (4) despite our knowledge of factors related to increased violence risk and the existence of effective treatments to mitigate this risk, valid risk assessment instruments for this population are lacking, and treatment strategies are rarely employed at any level of psychiatric care. In short, while most people with schizophrenia are not violent and violence committed by people with this condition accounts for only a small percentage of overall violent crime, there is nevertheless a significantly increased risk for violence among subgroups in this population. This has implications for people living with people with schizophrenia, mental health professionals, administrators of psychiatric care facilities, law enforcement personnel, the court system, and policymakers.

Paranoid individuals with schizophrenia show greater social cognitive bias and worse social functioning than non-paranoid individuals with schizophrenia

“…Taken together, these findings suggest that paranoid individuals possess the same level of functional skill as non-paranoid individuals but that the implementation of these skills in real-world settings is disrupted. Increased paranoid ideation among individuals with schizophrenia has previously been linked to greater incidences of violent behavior (Nestor, 2002; Silverstein et al, 2015), but this is the first time of which we are aware that paranoia has been linked to difficulties with more normative day-to-day function. Paranoia may therefore worsen the social impairments that are generally experienced by individuals with schizophrenia.…”

Anterior cingulate hyperactivations during negative emotion processing among men with schizophrenia and a history of violent behavior

“…Of particular concern is the evidence showing an increased risk of aggressive and violent behavior (severe assaults, attempted murder, homicide) among people with schizophrenia compared to the general population. 2 – 6 Although most people with schizophrenia are not violent, 7 , 8 individuals suffering from schizophrenia were found to be 2.1–4.6 times more likely to commit a violent crime or engage in violent behavior than the general population, even when taking into account socioeconomic status (SES), comorbid substance use, and personality disorders. 2 , 9 , 10 In addition to promoting stigmatization and victimization of all persons with mental health problems, 11 violent behavior by persons with schizophrenia has important consequences for the health and criminal justice systems, as shown by increasing numbers of forensic hospitals, longer periods in hospital, 12 , 13 and increased rates of incarceration, 14 all of which increase costs.…”

Violent behaviour in early psychosis patients: Can we identify clinical risk profiles?

“…The literature has shown that among patients with schizophrenia and first episode psychosis (FEP), the presence of isolated dynamic risk factors such as substance abuse or dependency (Fazel et al, 2009;Large, 2014;Latalova, 2014;Vacheron & Cornic, 2010), antisocial personality disorders (APDs) (Putkonen, Kotilainen, Joyal, & Tiihonen, 2004) or positive psychotic symptoms (Elbogen & Johnson, 2009;Lincoln, Lüllmann, & Rief, 2007;Nolan et al, 2005;Swanson et al, 2006;Witt, Lichtenstein, & Fazel, 2015) increases the risk of VB. More recently, several studies have shown that lack of insight (Bjørkly, 2006;Foley et al, 2005;Reinharth, Reynolds, Dill, & Serper, 2014;Verma, Poon, Subramaniam, & Chong, 2005;Voyer, Jaafari, & Senon, 2011) and the presence of impulsivity (Bjørkly, 2013) could also play a critical role in the risk of VB in schizophrenia and FEP (Bjørkly, 2013;Nielssen et al, 2012;Silverstein et al, 2015;Volavka & Citrome, 2008;Witt et al, 2013). In addition, various studies have shown that the levels of these factors may differ among subgroups of violent patients with chronic schizophrenia and a range of psychopathological profiles have been identified on this basis.…”