Alternative pathways to violence in persons with schizophrenia: The role of childhood antisocial behavior problems

Department of Psychiatry & Behavioral Sciences, Duke University, School of Medicine, 3071, Brightleaf Square, Suite 23-A, 905 West Main Street, Durham, NC 27710, USA.
Law and Human Behavior (Impact Factor: 2.16). 07/2008; 32(3):228-40. DOI: 10.1007/s10979-007-9095-7
Source: PubMed


Violence in schizophrenia patients may result from many factors besides the symptoms of schizophrenia. This study examined the relationship between childhood antisocial behavior and adult violence using data from the NIMH CATIE study. The prevalence of violence was higher among patients with a history of childhood conduct problems than among those without this history (28.2% vs. 14.6%; P < 0.001). In the conduct-problems group, violence was associated with current substance use at levels below diagnostic criteria. Positive psychotic symptoms were linked to violence only in the group without conduct problems. Findings suggest that violence among adults with schizophrenia may follow at least two distinct pathways-one associated with premorbid conditions, including antisocial conduct, and another associated with the acute psychopathology of schizophrenia.

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    • "Research examining the influence of ASPD and the associations between psychiatric illnesses, substance misuse, and criminal involvement suggest that ASPD forms a critical link between substance use and violence among mentally disordered offenders (Swanson et al., 2008). In fact, it has been suggested that ASPD in people with CODs accounts for involvement in the criminal justice system above and beyond the influence of CODs alone (Mueser et al., 2006). "
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    ABSTRACT: Despite the number of studies investigating co-occurring disorders, and more recently, co-occurring disorders and criminal offending, few studies have considered samples from forensic mental health services. The present study was conducted to investigate the relationship between mental illness, substance use disorders, antisocial personality disorder, and offending. The prevalence of co-occurring disorders was investigated in 130 male offenders who had contact with the statewide forensic mental health service in Victoria, Australia. Offense histories and severity of offending were compared among participants diagnosed with a single mental illness (or no mental illness), co-occurring mental illness and substance use, and co-occurring disorders plus antisocial personality disorder. The majority of participants had co-occurring mental and substance use disorders; a significant minority met the criteria for antisocial personality disorder. Participants with co-occurring mental illness and substance use disorders, and those who had an additional diagnosis of antisocial personality disorder, were responsible for more serious and frequent offending than those with mental illness alone. Forensic mental health services must take into account the effect that co-occurring disorders have on clients' functioning and offending. Those who work with people with psychiatric disabilities and co-occurring substance use disorders must ensure that the substance disorders are addressed to help ensure recovery from the mental illness and to reduce the likelihood of offending. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Psychiatric Rehabilitation Journal 03/2015; 38(1):16-23. DOI:10.1037/prj0000088 · 0.75 Impact Factor
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    • "Their violent behavior was not significantly correlated with acute psychotic symptoms such as delusions and hallucinations but rather was associated with a history of early life victimization and trauma. Furthermore, their risk of violence did not significantly decline when they were adherent with prescribed antipsychotic medications [42]. At the same time, it seems clear that psychosis clearly Fig. 1. "
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    ABSTRACT: Purpose This article describes epidemiological evidence concerning risk of gun violence and suicide linked to psychiatric disorders, in contrast to media-fueled public perceptions of the dangerousness of mentally ill individuals, and evaluates effectiveness of policies and laws designed to prevent firearms injury and mortality associated with serious mental illnesses and substance use disorders. Methods Research concerning public attitudes towards persons with mental illness is reviewed and juxtaposed with evidence from benchmark epidemiological and clinical studies of violence and mental illness and of the accuracy of psychiatrists’ risk assessments. Selected policies and laws designed to reduce gun violence in relation to mental illness are critically evaluated; evidence-based policy recommendations are presented. Results Media accounts of mass shootings by disturbed individuals galvanize public attention and reinforce popular belief that mental illness often results in violence. Epidemiological studies show that the large majority of people with serious mental illnesses are never violent. However, mental illness is strongly associated with increased risk of suicide, which accounts for over half of US firearms-related fatalities. Conclusion Policymaking at the interface of gun violence prevention and mental illness should be based on epidemiological data concerning risk, to improve the effectiveness, feasibility, and fairness of policy initiatives.
    Annals of Epidemiology 04/2014; 25(5). DOI:10.1016/j.annepidem.2014.03.004 · 2.00 Impact Factor
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    • "In addition, controls used for the calculation of ORs included people with a primary diagnosis of substance misuse disorder, which may have inflated the prevalence of violence among controls and obscured the potential relationship between psychiatric disorder and violence towards a partner. It was also not possible to control for other potential confounders, such as prior violence (Walsh et al. 2004), pre-morbid conditions (Swanson et al. 2008a), psychiatric treatment (Swanson et al. 2008b) or other clinical and social factors that may increase the risk of violence (Soyka, 2000; Alhusen et al. 2010). Owing to the limitations of the measures used in primary studies to assess the perpetration of physical Fig. 3. Forest plot displaying DerSimonian and Laird weighted random-effect pooled odds estimates for lifetime physical violence against a partner by women with diagnosed psychiatric disorders. "
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    ABSTRACT: Backgrounds. The extent to which psychiatric disorders are associated with an increased risk of violence to partners is unclear. This review aimed to establish risk of violence against partners among men and women with diagnosed psychiatric disorders. Methods. Systematic review and meta-analysis. Searches of eleven electronic databases were supplemented by hand searching, reference screening and citation tracking of included articles, and expert recommendations. Results. Seventeen studies were included, reporting on 72 585 participants, but only three reported on past year violence. Pooled risk estimates could not be calculated for past year violence against a partner and the three studies did not consistently report increased risk for any diagnosis. Pooled estimates showed an increased risk of having ever been physically violent towards a partner among men with depression (odds ratio (OR) 2.8, 95% confidence intervals (CI) 2.5-3.3), generalized anxiety disorder (GAD) (OR 3.2, 95% CI 2.3-4.4) and panic disorder (OR 2.5, 95% CI C% 1.7-3.6). Increased risk was also found among women with depression (OR 2.4, 95% CI 2.1-2.8), GAD (OR 2.4, 95% CI 1.9-3.0) and panic disorder (OR 1.9, 95% CI 1.4-2.5). Conclusions. Psychiatric disorders are associated with high prevalence and increased odds of having ever been physically violent against a partner. As history of violence is a predictor of current violence, mental health professionals should ask about previous partner violence when assessing risk.
    Epidemiology and Psychiatric Sciences 08/2013; 23(04):1-16. DOI:10.1017/S2045796013000450 · 3.91 Impact Factor
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