Clinical Characteristics of Schizophrenic Patients who Committed Homicide / 신경정신의학

ABSTRACT

OBJECTIVES: Recent studies have shown that schizophrenic patients are at increased risk to commit acts of aggression, and aggressive behaviors have severe critical results for the patients and victims. The purpose of the present study is to assess the homicidal behaviors of schizophrenic patients as a extreme case of aggressiveness. METHODS: 93 homicidal schizophrenic patients and 93 non-homicidal schizophrenic patients participated in this study. Diagnostic evaluation was made with SCID (Structured Clinical Interview for DSM-IV), and personality trait was evaluated with SIDP (Structured Interview for DSM-IV Personality Disorders). Symptom evaluation was done with PANSS (Positive And Negative Syndrome Scale), and violent behaviors were assessed with LHA (Life History of Aggression) and OAS (Overt Aggression Scale). RESULTS: There were no significant differences in demographic variables, schizotypal personality trait and antisocial personality trait between two groups. Mean age at homicidal commitment was 34+/-8.9 years and 9.8+/-7.5 years after the onset of illness. The major criminal victims were the parents of the patients(N=49, 53.7%). The aggressiveness was higher in homicidal schizophrenic patients in LHA and OAS scales. There were statistical significances in separate items of the PANSS scale such as excitement (P4), poor rapport (N3), lack of judgement and insight (G12), disturbance of volition (G13), poor impulse control (G14) and active social avoidnance (G16), but not in the positive, negative, general subscales and the total scores of the PANSS scale. CONCLUSION: Excitement and poor impulse control persisted in homicidal schizophrenics, although overt psychotic symptoms decline after proper treatment. Homicidal behavior can be preventive if proper treatment for excitement and poor impulse control are given.