Violent behavior in individuals with schizophrenia

ABSTRACT

Violence in individuals with schizophrenia and other psychotic disorders is known to be higher than in the general population, according to various definitions of violence, although most people with schizophrenia are not violent. Various factors are reported to increase the risk of violence: demographic characteristics such as male gender, young age, and low socioeconomic status; antisocial personality and history of conduct disorder; comorbidity of substance abuse; psychopathological-clinical variables including positive psychotic symptoms, duration of the untreated psychosis, and the first episode of psychosis; and cognitive disorders. There are 3 types of violent patients with schizophrenia: 1) violent patients with a history of conduct disorder prior to the onset of schizophrenia; 2) violent patients in an acute psychotic episode, with no history of conduct disorder prior to the onset of schizophrenia; and 3) chronically violent patients who show no aggressive behavior prior to their thirties and early forties, and then are engaged in serious violence often including homicide. There are some identified triggering factors including exposure to violence, traumatic brain injury, self-harm, unintentional injury, substance intoxication and parental bereavement. The preventive and treatment strategies will be discussed according to the two different pathways of violence that are classified by the history of conduct disorder. A scientific approach is essential to reduce the rates of violent behaviors and potentially related stigma in patients with schizophrenia.