Violence in schizophrenia

392 Where is the evidence? Controlled studies in arrested offenders, inpatients, outpatients , and families with a mentally ill member, epidemiological surveys, and longitudinal cohort studies all report a relationship between violence and schizophre-nia. The relationship decreases, but remains highly significant , after controlling for sociodemographic factors and history of deinstitutionalization. When patients have an exacerbation of psychotic symptoms , the risk of violence increases and, therefore, clinical symptoms seem to superficially predict violence. However , it is not simply the presence of psychotic symptoms, but also some of the characteristics associated with them, that best predict violence. The best predictor of violence in schizophrenia, which is common to stable and relapsed populations, is the same as in the general population, ie, previous violence. In a prospective study, we evaluated several variables in the prediction of violence in 63 inpatients with schizo-phrenia. 2 Nurses rated violent incidents using the Overt Aggression Scale. Sociodemographic variables, clinical history, neurological soft signs, community alcohol or drug abuse, and electroencephalographic abnormalities did not differ between violent and nonviolent groups. Violent patients had significantly more positive symptoms , as measured by the Positive And Negative Syndrome Scale (PANSS), higher scores on the PANSS general psychopathology scale, and less insight into the different constructs assessed. In a logistic regression, three variables, ie, insight into symptoms, PANSS general psychopathology score, and violence in the previous week, correctly classified 84.13% of the sample into violent or nonviolent patients. The important finding was that clinical—and therefore amenable to therapeutic approaches—rather than sociodemographic variables were more predictive of violence, hence the importance of compiling this information when assessing a patient There is nothing more terrifying than unpredicted violence. Patients with mental illness sometimes commit bizarre, unexplained, and arbitrary acts of violence, which often provoke media attention. Recent, well-designed, large-scale studies controlling for the sociodemographic factors associated with violence in the general population show a significant, albeit modest, increased prevalence of violence in mental illness compared with the general population. 1 Although the vast majority of violent acts in today's society are not related to mental illness and a great majority of patients with schizophrenia have never been violent, studies have confirmed a relationship between schizophrenia and violence. The consequent stigma attached to the disease has negatively influenced both patients with schizophrenia and their relatives alike. • Type and characteristics of delusions-Delusions causing fear and anguish-Persecutory delusions-Active seeking of information to …