Violence in schizophrenia: A study of 60 cases
Epidemiological studies suggest a positive but controversial correlation between the major mental disorders, particularly schizophrenia and delinquent or criminal acting out. aim : To study the occurrence of violence in patients with schizophrenia according to demographic, clinical and disease progression features.
This retrospective study included all out-patients, consulting during a period of one month, suffering from schizophrenia for at least five years. The clinical and forensic history was obtained owing to a semi-structured interview with patients and their families, medical records and the passing of different scales.
Sixty patients were included. 46.7% (n=28) of patients had a violent behavior in the pre morbid period. Aggressiveness was noted as the first prodrome in 13.3% (n=8) of cases. 28 major acts of violence were committed by 30% (n=18) of patients regardless of the active period of disease. In 13.3% (n=8) of cases, these acts announced the disease. The majority of acts have been committed against a non-foreign person. Recurrence was noted in 44.4% (n=8) of patients. Several risk factors of violent behavior were found. Only prodromal aggression was associated with a poor prognosis.
Violences committed by patients with schizophrenia are attributed to a particular group of patients and do not have necessarily a pejorative prognostic value.
Available from: Chian-Jue Kuo
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ABSTRACT: Patients with schizophrenia suffer from excessive premature mortality, and sudden cardiac death (SCD) is receiving growing attention as a potential cause.
The present study investigated the incidence of SCD and its risk factors in a large schizophrenia cohort.
We enrolled a consecutive series of 8264 patients diagnosed with schizophrenia (according to DSM-III-R and DSM-IV criteria) who were admitted to a psychiatric center in northern Taiwan from January 1, 1985 through December 31, 2008. By linking with national mortality database, 64 cases of SCD were identified. The standardized mortality ratio (SMR) for SCD was estimated. The cases were matched with controls randomly selected using risk-set sampling in a 1:2 ratio. A standardized chart review process was used to collect socio-demographic and clinical characteristics and the prescribed drugs for each study subject. Multivariate conditional logistic regression analysis was used to identify correlates of SCD at the index admission and the latest admission.
The SMR for SCD was 4.5. For the clinical profiles at the index admission, physical disease (adjusted risk ratio [aRR]=2.91, P<.01) and aggressive behaviors (aRR=3.99, P<.01) were associated with the risk of SCD. Regarding the latest admission, electrocardiographic abnormalities (aRR=5.46, P<.05) and administration of first-generation antipsychotics (aRR=5.13, P<.01) elevated the risk for SCD. Consistently, aggressive behaviors (aRR=3.26, P<.05) were associated with increased risk as well.
Apart from cardiovascular profiles and antipsychotics, physical aggression is a crucial risk factor that deserves ongoing work for clarifying the mechanisms mediating SCD in schizophrenia.
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