Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia
ABSTRACT Violence is an uncommon but significant problem associated with schizophrenia.
To compare antipsychotic medications in reducing violence among patients with schizophrenia over 6 months, identify prospective predictors of violence and examine the impact of medication adherence on reduced violence.
Participants (n=1445) were randomly assigned to double-blinded treatment with one of five antipsychotic medications. Analyses are presented for the intention-to-treat sample and for patients completing 6 months on assigned medication.
Violence declined from 16% to 9% in the retained sample and from 19% to 14% in the intention-to-treat sample. No difference by medication group was found, except that perphenazine showed greater violence reduction than quetiapine in the retained sample. Medication adherence reduced violence, but not in patients with a history of childhood antisocial conduct. Prospective predictors of violence included childhood conduct problems, substance use, victimisation, economic deprivation and living situation. Negative psychotic symptoms predicted lower violence.
Newer antipsychotics did not reduce violence more than perphenazine. Effective antipsychotics are needed, but may not reduce violence unrelated to acute psychopathology.
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ABSTRACT: Violence is a major management issue for forensic mental health systems. Violence can be approached as a medical syndrome and deconstructed into psychotic, impulsive, and predatory subtypes, which are hypothetically mapped onto corresponding malfunctioning brain circuits. Rational management of violence balances treatment with security, while targeting each subtype of violence with approaches unique to the psychotic, impulsive, and predatory forms of violence.CNS spectrums 10/2014; 19(5):357-65. DOI:10.1017/S1092852914000522 · 1.30 Impact Factor
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ABSTRACT: Numerous studies have examined a wide range of risk factors associated with violence among patients with schizophrenia. However, risk factors linked to different socio-cultural backgrounds remain unclear.Objective The objectives were to investigate factors associated with violence among Japanese patients with schizophrenia prior to emergency hospitalizations and to compare them with factors found in studies on other populations.Methods We recruited 420 Japanese patients with schizophrenia who had committed violent acts immediately prior to emergency admission to a psychiatric hospital in Tokyo, during the period 1986 to 2005. Cases were compared with controls (non violent hospitalized patients with schizophrenia) matched for gender, age and admission year. All medical records were reviewed retrospectively. Inter-rater reliability tests of assessment were performed. Conditional logistic regression analysis was used to identify factors associated with violence.ResultsThe symptoms of gross excitement, prior violence, auditory hallucinations, systematization of delusions, incoherence of speech, delusions of reference, TCO symptoms, living with others and long duration of illness were found to be associated with violence. In contrast, antisocial traits such as substance abuse and antisocial episodes were not recognized as significant violence-associated factors.Conclusion Violence among Japanese patients with schizophrenia was strongly associated with elements of schizophrenia itself, rather than antisocial traits. This study highlighted associated factors for violence among Japanese patients with schizophrenia which differ distinctly from associated factors in other countries. This result demonstrates that future studies assessing the risk of violence among patients with schizophrenia need to consider cultural and racial differences in cohorts.Schizophrenia Research 11/2014; 160(1-3). DOI:10.1016/j.schres.2014.10.016 · 4.43 Impact Factor
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ABSTRACT: A small group of individuals with mental illness is repeatedly involved in violence. Little is known about how often and how consistently these high-risk individuals experience delusions or hallucinations just before a violent incident. To address these questions, data from the MacArthur Violence Risk Assessment Study were used to identify 305 violent incidents associated with 100 former inpatients with repeated violence (representing 50% of incidents and 9% of participants) and test whether psychosis-preceded incidents cluster within individuals. Results indicated that (a) psychosis immediately preceded 12% of incidents, (b) individuals were “fairly” consistent in their violence type (ICC = .42), and (c) those with exclusively “non-psychosis-preceded” violence (80%) could be distinguished from a small group who also had some psychosis-preceded violence (20%). These findings suggest that psychosis sometimes foreshadows violence for a fraction of high-risk individuals, but violence prevention efforts should also target factors like anger and social deviance.01/2015; DOI:10.1177/2167702615575879