Mental illness and violence: myth and reality

ABSTRACT

To compare the frequency and risk factors of violent behaviour in psychiatric patients, non-psychiatric patients and healthy population with the violent criminal offenders. A cross-sectional analytical survey. The study was conducted at three tertiary care facilities in Lahore. The sample of criminal offenders was drawn from Kot Lakhpat jail, Lahore and the study was completed in six months. One hundred and twenty subjects between the ages of 18-60 years were included in the study with 30 subjects being drawn from each population group. The psychiatric patients were those admitted with a diagnosis of a major psychiatric disorder such as schizophrenia, affective disorder, personality disorder and substance abuse based on ICD-10. The variables were categorised into personal, historical, contextual and clinical and endorsed by trained rating staff at each facility after interviewing every subject. Psychopathy, anger and impulsiveness were measured by using the Psychopathy Checklist, Novaco Anger Inventory and Barrett Impulsiveness Scale respectively. Psychiatric morbidity was excluded from the non-psychiatric and criminal population by using the General Health Questionnaire [GHQ-12]. Amongst the demographic variables, age group [18-45 yrs 58.2%] and marital status [single 70%] were significantly associated with a history of violence. Other significant associations with violence included presence of violent fantasies [85%], ideas of self harm [70%], drug abuse [87%] and high scores on psychopathy and impulsiveness scales. The violent criminal population scored high on psychopathy [>12 SD=4.9] and impulsivity [>72 SD=10]. Mean scores of psychopathy and impulsiveness for the psychiatric population sample dropped significantly when cases of drug abuse and personality disorder were excluded. Patients with major psychiatric disorders as a group are not as violent as criminals. It is not the mental illness but history of drug abuse, deliberate self-harm, psychopathy and impulsiveness that are the common denominators in violent individuals, irrespective of a psychiatric diagnosis