ARE PERSONS WITH SCHIZOPHRENIA MORE VIOLENT THAN THE
GENERAL POPULATION? – A LOOK TOWARDS THE STIGMA ON
Gameiro Z. 1, Freitas F. 1, Esteves H. 1
MENTAL ILLNESS
1 General and Transcultural Psychiatric Clinic, Centro Hospitalar Psiquiátrico de
Lisboa, Lisbon, Portugal
Introduction
Mental illness and mentally ill patients are surrounded by stigma and discrimination.
Stigmatizing views about mental illness include the belief that psychotic patients,
particularly those with schizophrenia, are violent persons. However, violent behaviour is
quite uncommon among patients with schizophrenia.
On the other hand, being object of society stigma and discrimination may increase the
unemployment and the feeling of not being part of anything and decrease the social
network, self-esteem and the financial income of patients. These findings have been related
with violence in the general population.
Objectives
The author’s goal is to review the literature concerning the prevalence rates of violent
behavior among schizophrenic patients in comparison with the same prevalence rates in
general population. Our aim is to understand whether there are grounds for the generic
attribution of violence to these patients. Additionally we try to find which factors increase
the risk of violence in schizophrenia patients.
Methods
A literature search was performed using the following key words schizophrenia, violent
behaviour, violence prevalence and stigma and retrieved papers were selected according to
their relevance.
References
- Fazel S, Gulati G, Linsell L et al. Schizophrenia and violence: systematic review and meta-analysis. PLoS Med. 2009 Aug;6(8):e1000120
- Ghoreishi A, Kabootvand S, Zangani E et al. Prevalence and attributes of criminality in patients with schizophrenia. J Inj Violence Res. 2015 Jan;7(1):7-12
- Jakhar K, Bhatia T, Saha R et al. A cross sectional study of prevalence and correlates of current and past risks in schizophrenia. Asian J Psychiatr. 2015
Apr;14:36-41
- Kudumija Slijepcevic M, Jukic V, Novalic D et al. Alcohol abuse as the strongest risk factor for violent offending in patients with paranoid schizophrenia.
Croat Med J. 2014 Apr;55(2):156-62
- Swanson JW, Swartz MS, Van Dor RA. A National Study of Violent Behavior in Persons With Schizophrenia. Arch Gen Psychiatry. 2006 May;63(5):490-9
- Volavka J. Violence in schizophrenia and bipolar disorder. Psychiatr Danub. 2013 Mar;25(1):24-33
Results
Patients diagnosed with schizophrenia are 4 to 6 times more likely to commit a violent crime than the general
population. However, less than 0,2% of patients commit homicide and less than 10% commit a violent act.
Due to the fact that schizophrenia is a disease with a prevalence of only 1%, even an increased risk of violent
behaviour still remains a low absolute risk. In Western countries the homicide acts committed by
schizophrenia patients are around 6%.
It has been reported that violent acts committed by patients may be due to at least two different pathways:
one associated with antisocial conduct, and another with the positive symptoms of schizophrenia.
Nevertheless violence directly related to psychotic symptoms seems to be rare, 5 from 7 symptom ratings of
PANSS positive subscale (hostility, suspiciousness/persecution, hallucinatory behavior, grandiosity, and
excitement) increase risk of serious violence.
On the other hand, younger age, male sex, being single, lower socioeconomic status, refusing treatment,
substance abuse (including alcohol abuse), premorbid affinity to violent behaviour and comorbid personality
disorders, as well as duration of untreated illness were associated with the risk of violence in these patients.
A significant amount of the excess risk appears to be mediated by substance abuse comorbidity. In fact, the
risk of violence in schizophrenia patients with substance abuse is similar to that of substance abusers without
psychosis.
The other side of the mirror are violent acts committed against severe mentally ill persons who are more
likely to be victimized than other community members. Also the self-violence including self-mutilation,
suicide attempts and completed suicide are more common than in the general population.
Discussion and Conclusions
Although studies on violence in patients with schizophrenia are quite heterogeneous, making it difficult to
generalize their results, we can conclude that the vast majority of schizophrenia patients are not violent
persons so they don’t deserve the stigma of being considered potential murderers. However, the community
and the mental health professionals in particular should reflect on the risk factors of violence and how to
prevent them. Additionally, we recommend psychiatrist to access the real risk in each patient.