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New Factors Identified for Predicting Violence in Schizophrenia

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Science Update

A study of adults with schizophrenia showed that symptoms of losing contact with reality, such as delusions and hallucinations, increased the odds of serious violence nearly threefold. The odds were only about one-fourth as high in patients with symptoms of reduced emotions and behaviors, such as flat facial expression, social withdrawal, and infrequent speaking. Results of the study, which was conducted in patients in real-world community settings as part of the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), were published in the May 2006 issue of the Archives of General Psychiatry. Jeffrey A. Lieberman, M.D., of Columbia University, was the principal investigator.

Overall, the amount of violence committed by people with schizophrenia is small, and only 1 percent of the U.S. population has schizophrenia. Of the 1,140 participants in this analysis, 80.9 percent reported no violence, while 3.6 percent reported engaging in serious violence in the past six months. Serious violence was defined as assault resulting in injury, use of a lethal weapon, or sexual assault. During the same period, 15.5 percent of participants reported engaging in minor violence, such as simple assault without injury or weapon. By comparison, about 2 percent of the general population without psychiatric disorder engages in any violent behavior in a one-year period, according to the NIMH-funded Epidemiologic Catchment Area Study.

The researchers found that the odds of violence also varied with factors other than psychotic symptoms. For example, serious violence was associated with depressive symptoms, conduct problems in childhood, and having been victimized, physically or sexually; minor violence was associated with co-occurring substance abuse. Participants who lived alone had lower rates of violence than those living with families. However, participants living with families they felt "listened to them most of the time" had half the rate of violence of those living with less supportive families.

Serious violent behavior, while generally uncommon in people with schizophrenia, can have serious consequences. Knowledge about symptoms and characteristics that increase risk for violent behavior in individual patients is crucial for developing effective ways to manage schizophrenia and allow people with the illness to successfully engage in daily living.

Data from the CATIE project have been analyzed in a number of studies funded by NIMH. This analysis of CATIE-generated data was funded by the Foundation of Hope and an NIMH grant.

Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, Wagner HR, Rosenheck RA, Stroup TS, McEvoy JP, Lieberman JA. A national study of violent behavior in persons with schizophrenia . Arch Gen Psychiatry. 2006 May;63(5):490-9.