Article

Psychiatric morbidity among homicide offenders: A Swedish population study

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, U.K.
American Journal of Psychiatry (Impact Factor: 13.56). 11/2004; 161(11):2129-31. DOI: 10.1176/appi.ajp.161.11.2129
Source: PubMed

ABSTRACT The authors examined psychiatric diagnoses of all individuals convicted of homicide and attempted homicide in Sweden from 1988 to 2001 (N=2,005).
High-quality national crime and hospital registers were linked to investigate standardized psychiatric diagnoses of homicide offenders.
The presence or absence of psychiatric diagnoses was ascertained for 1,625 (81%) of the homicide offenders; 1,464 (90%) of these offenders had a psychiatric diagnosis. Twenty percent (N=409) of all 2,005 offenders had a psychotic illness, and 54% (N=589) of a subgroup of 1,091 offenders with information on secondary diagnoses had a personality disorder as a principal or secondary diagnosis. Only 10% of the offenders for whom psychiatric diagnostic information was available had no diagnosis.
Using a comprehensive method for identifying psychiatric illness in homicide offenders, the authors found higher rates of psychiatric morbidity than previous studies. Their findings underline the importance of psychiatric assessment in homicide offenders and suggest that treatment might have a preventive role.

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    • "Pour autant, les patients souffrant d'une schizophrénie sont surreprésentés parmi les meurtriers. Globalement, 20 % des cas d'homicides des pays scandinaves sont attribuables a ` des patients souffrant de troubles mentaux graves (schizophrénie, trouble délirant ou troubles affectifs majeurs) [9] [10] [11] [12] [13]. La métaanalyse de Large et al. retrouve une prévalence de 6,6 % des meurtriers répondant aux critères diagnostiques de schizophrénie [14]. "
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    ABSTRACT: The prevalence of homicide perpetrators with a diagnosis of schizophrenia is 6% in Western countries populations. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link. The aim of this systematic review was to clarify the role of substance abuse in the commission of murder in people suffering from schizophrenia. A systematic English-French Medline and EMBASE literature search of cohort studies, case-control studies and transversal studies published between January 2001 and December 2011 was performed, combining the MeSH terms "schizophrenia", "psychotic disorders", "homicide", "violence", "substance use disorder", and the TIAB term "alcohol". Abstract selection was based on the STROBE and PRISMA checklist for observational studies and systematic and meta-analysis studies, respectively. Of the 471 selected studies, eight prospective studies and six systematic reviews and meta-analysis studies met the selection criteria and were included in the final analysis. Homicide committed by a schizophrenic person is associated with socio-demographic (young age, male gender, low socioeconomic status), historical (history of violence against others), contextual (a stressful event in the year prior to the homicide), and clinical risk factors (severe psychotic symptoms, long duration of untreated psychosis, poor adherence to medication). In comparison to the general population, the risk of homicide is increased 8-fold in schizophrenics with a substance abuse disorder (mainly alcohol abuse) and 2-fold in schizophrenics without any comorbidities. A co-diagnosis of substance abuse allows us to divide the violent schizophrenics into "early-starters" and "late-starters" according to the age of onset of their antisocial and violent behavior. The violence of the "early-starters" is unplanned, usually affects an acquaintance and is not necessarily associated with the schizophrenic symptoms. Substance abuse is frequent and plays an important role in the homicide commission. In addition, the risk of reoffending is high. In the "late-starters", the violence is linked to the psychotic symptoms and is directed to a member of the family. The reoffence risk is low and it depends on the pursuit of care or not. Defining subgroups of violent schizophrenic patients would avoid stigmatization and would help to prevent the risk of homicide by offering a multidisciplinary care which would take into account any substance abuse.
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    • "Since the early 1990s, several large studies (Tiihonen et al., 1997; Fazel and Grann, 2004; Swanson et al., 2006), summarised in a 2009 systematic review (Fazel et al., 2009) have shown a modest association between schizophrenia (and other psychoses) and violence. Subsequent studies whilst invoking substance misuse as an important mediator, have offered yet further support (Elbogen and Johnson, 2009; Fazel et al., 2009). "
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    ABSTRACT: A small but significant relationship between schizophrenia and violence is well established, but not yet fully explained. Research has highlighted anger as an important factor in precipitating actual violence in general and psychiatric populations. However, anger has not been extensively studied as a risk factor for violence in people with schizophrenia and related psychoses. We evaluated published evidence on the relationship between anger and violence in patients with schizophrenia and related psychoses by means of a systematic review of the literature. A search of main online databases from inception till January 2012 was performed and supplemented with correspondence with authors and data available online. 11 studies which measured angry affect in patients with schizophrenia who had been violent were included in the review. 5 studies with a total of 510 individuals had anger data that were suitable to be pooled in a meta-analysis in form of standardised mean difference values comparing the anger scores of the non-violent groups with violent groups. All the studies included showed significantly higher scores for anger in the violent group compared with the non-violent group with the pooled result expressed as standardised mean difference of 0.74 95% CI (0.53, 0.94) and the Z value for overall effect=7.01. The studies not included in the meta-analysis which looked at 610 individuals, were analysed descriptively and all of them reported higher scores for anger for individuals with schizophrenia who acted violently. There is a consistency of significant association between angry affect and violent behaviour in the context of psychotic illness across various study designs, settings and populations. Theoretical support already exists for this relationship and this review lends further support to explore this relationship further.
    Schizophrenia Research 02/2013; 146(1-3). DOI:10.1016/j.schres.2013.01.024 · 4.43 Impact Factor
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    • "We found this to be especially true for stereotypes and discriminating beliefs towards persons with schizophrenia, for which our data clearly indicated that identification of schizophrenia significantly increased stigmatizing attitudes. A preponderance of studies has shown that schizophrenia and substance-use disorders, but especially schizophrenia comorbid with substance use, are associated with higher rates of violent crimes and homicide (Swartz et al. 1998; Arseneault et al. 2000; Fazel & Grann, 2004). Thus, it appears that most stereotypes bear a kernel of truth. "
    Epidemiology and Psychiatric Sciences 07/2012; DOI:10.1017/S2045796012000376 · 3.36 Impact Factor
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