Violence in Schizophrenia

Year 2014, Volume: 6 Issue: 1, - , 06.11.2014

Hatice İmer Aras

https://doi.org/10.5455/cap.20130522110439

Abstract

Although most psychiatric patients are not violent, serious mental illness is associated with increased risk of violent behavior. There was statistically significant increase of risk of violence in schizophrenia in comparison with general population. The risk of violence in schizophrenia is increased by comorbid substance use disorder. Violence among adults with schizophrenia may follow at least two distinct pathways one associated with antisocial conduct, and another associated with the acute psychopathology of schizophrenia. Clozapine is the most effective treatment of violence behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second line of treatment. Treatment adherence is of key importance. Non-pharmacological methods of treatment of violence in schizophrenia are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone does not suffice.

Keywords

schizophrenia, violence, substance use disorder, comorbidity.

Şizofrenide Şiddet

Abstract

Pek çok psikiyatrik hasta şiddet eğilimi sergilememekte ise de günümüz toplumunda ruhsal bozukluk ve şiddet biribiyle bağlantılı görülmektedir. Genel populasyon ile kıyaslandığında şiddet davranışı riski şizofrenide istatistiksel olarak anlamlı bir yükseklik göstermiştir. Şizofrenide şiddet davranışı riski madde kullanım eştanılılığı ile artmaktadır. Şizofreni tanılı yetişkinlerde şiddet davranışının ortaya çıkması, antisosyal kişilk bozukluğu ve şizofreninin akut psikopatolojisi ile ilişkili iki farklı yol izlemektedir. Klozapin şizofrenide şiddet davranışı tedavisinde en etkin tedavidir. Son kanıtlar olanzapini ikinci sıraya yerleştirmiştir. Tedavi uyumu son derece önemlidir. Farmakolojik olmayan tedavi yöntemleri giderek artmaktadır. Tek başına farmakoterapinin yetersiz kaldığı olgularda, bireysel davranışçı yöntemler etkili olmaktadır.

Keywords

şizofreni, şiddet, madde kötüye kullanımı, eştanı.

References

• Ural C, Öncü F, Belli H, Soysal H. Adli psikiyatrik süreç içindeki şizofreni hastalarının şiddet davranışı değişkenleri: bir olgu kontrol çalışması.Turk Psikiyatri Derg 2013; 24:17-24.
• Torrey EF. Stigma and violence. Psychiatr Serv 2002; 53:11-79.
• Torrey EP. Epidemiolological comparison of schizophrenia and bipolar disorder. Schizophr Res 1999; 39:101-106.
• World Health Organization. Violence and Health: Task Force on Violence and Health. Cenevre, WHO, 1998.
• Yudofsky SC, Silver JM, Jackson W, Endicott J, Williams D. The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry 1986; 143:35-39.
• Humphreys MS, Johnstone EC, MacMillan JF, Taylor PJ. Dangerous behaviour preceding first admissions for schizophrenia. Br J Psychiatry 1992; 161:501-505.
• Volavka J, Laska E, Baker S, Meisner M, Czobor P, Krivelevich I. History of violent behaviour and schizophrenia in different cultures: analyses based on theWHO study on Determinants of Outcome of Severe Mental Disorders. Br J Psychiatry 1997; 171: 9-14.
• Karson C, Bigelow LB. Violent behaviour in schizophrenic patients. J Nerv Ment Dis 1987; 175:161-164.
• Walker Z, Seiifert R. Violent incidents in a psychiatric intensive care unit. Br J Psychiatry 1994; 164:826-828.
• Lindqvist P, Allebeck P. Schizophrenia and crime: a longitudinal follow-up of 644 schizophrenics in Stockholm. Br J Psychiatry 1990; 157:345-350.
• Hodgins S. Mental disorder, intellectual deficiency, and crime: evidence from a birth cohort. Arch Gen Psychiatry 1992; 49:476-483.
• Swanson JW, Holzer CE, Ganju VK, Jono RT. Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys. Hosp Community Psychiatry 1990; 41:761-770.
• Volavka J. Neurobiology of Violence. Washington DC, American Psychiatric Publishing, 2002.
• Fazel S, Gulati G, Linsell L, Geddes JR, Grann M. Schizophrenia and violence: systematic review and metaanalysis. PLoS Med 2009; 6:e1000120.
• Aras Hİ. Erkek şizofreni hastalarında alkol ve/veya madde kullanımının yaşam kalitesine etkisi (Uzmanlık tezi). İstanbul, Bakırköy Ruh ve Sinir Hastalıkları Hastanesi, 2011.
• Meehan J, Flynn J, Hunt IM, Robinson J, Bickley H, Parsons R et al. Perpetrators of homicide with schizophrenia: a national clinical survey in England and Wales. Psychiatr Serv 2006; 57:1648-1651.
• Erkıran M, Erkıran Kartal G, Evren C, Şahinler İH. İlaç kullanmayan şizofreni hastalarında saldırganlık ve serum kolesterol düzeyi: kontrollü bir çalışma. Turk Psikiyatri Derg 2001; 12:261-272.
• Türkoğlu A. Suç İşlemiş ve işlememiş şizofrenik hastalarda bazı biyokimyasal parametrelerin karşılaştırılması (Uzmanlık tezi). Elazığ, Fırat Üniversitesi Tıp Fakültesi, 2008.
• Öncü F, Soysal H, Uygur N. Suç işlemiş şizofrenlerde zorunlu klinik tedavi sonrası yineleyici suç. 38. Ulusal Psikiyatri Kongresi Program ve Kongre Bildirileri Özet Kitabı, 2002.
• Belli H, Ozcetin A, Ertem U, Tuyluoğlu E, Namli M, Bayık Y et al. Perpetrators of homicide with schizophrenia: sociodemographic characteristics and clinical factors in the eastern region of Turkey. Compr Psychiatry 2010; 51:135-141. Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL. Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area Study. JAMA 1990; 264:2511-2518.
• Steadman HJ, Mulvey EP, Monahan J, Robbins PC, Appelbaum PS, Grisso T et al. Violence by people discharged from acute psychiatric in patient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 1998; 55:393-401.
• Elbogen EB, Johnson SC. The intricate link between violence and mental disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2009; 66:152-161.
• Asnis GM, Kaplan ML, Hundrorfean G, Saeed W. Violence and homicidal behaviors in psychiatric disorders. Psychiatr Clin North Am 1997; 20: 405-425.
• Tiihonen J, Isohanni M, Rasanen P, Koiranen M, Moring J. Specific major mental disorders and criminality: a 26-year prospective study of the 1966 northern Finland birth cohort. Am J Psychiatry 1997; 154:840-845.
• Eronen M, Angermeyer MC, Schulze B. The psychiatric epidemiology of violent behaviour. Soc Psychiatry Psychiatr Epidemiol 1998; 33(suppl 1):13-23.
• Fresan A, Apiquian R, de la FuentaSandoval C, Garcia-Anaya M, Loyzaga C, Nicolini H. Premorbid adjustment and violent behaviour in schizophrenic patients. Schizophr Res 2004; 69:143-148.
• Volavka J, Swanson J. Violent behavior in mental illness: the role of substance abuse. JAMA 2010; 304:563-564.
• Dean K, Walsh E, Moran P, Tyrer P, Creed F, Byford S et al. Violenve in women with psychosis in the community: prospective study. Br J Psychiatry 2006; 188:264-270.
• Asher-Svanum H, Faries D, Zhu B, Ernst F, Swartz M, Swanson JW. Medication adherence and long-term functional outcomes in the treatment in schizophrenia in usual care. J Clin Psychiatry 2006; 67:453-460.
• Swanson JW, Swartz MS, Van Dorn RA, Volavka J, Monahan J, Stroup TS et al. Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia. Br J Psychiatry 2008a; 193:37-43.
• Link BG, Stueve A. Psychotic symptoms and the violent/ illegal behavior of mental patients compared to community controls. In Violence and Mental Disorder. Developments in Risk Assessment (Eds J Monahan, HJ Steadman):137-159. Chicago, The University of Chicago Press, 1994.
• Appelbaum PS, Robbins PC, Monahan J. Violence and delusions: data from the MacArthur Violence Risk Assessment Study. Am J Psychiatry 2000; 157:566-572.
• Junginger J. Command hallucinations and the prediction of dangerousness. Psychiatr Serv 1995; 46:911-914.
• Junginger J, McGuire L. The paradox of command hallucinations. Psychiatr Serv 2001; 52:385.
• Alia-Klein N, O'Rourke TM, Goldstein RZ, Malaspina D. Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample. Aggress Behav 2007; 33:86-96.
• Antonius D. Insight and aggression in schizophrenia. Am J Psychiatry 2005; 162:2195.
• Ekinci O, Ekinci A. Association between insight, cognitive insight, positive symptoms and violence in patients with schizophrenia. Nord J Psychiatry 2013; 67:116-123.
• Lera CG, Herrero SN, Aguilar Garcia, Iturrospe E, Gonzalez Piqueras JC, Sanjuan AJ et al. Relationship between insight, violence and diagnoses in psychotic patients. Rev Psiquiatr Salud Ment 2012; 5:43-47.
• Coldham EL, Addington J, Addington D. Medication adherence of individuals with a first episode of psychosis. Acta Psychiatr Scand 2002; 106:286-290.
• Czobor P, Volavka J, Derks EM, Bitter I, Libiger J, Kahn RS et al. Insight and hostility as predictors and correlates of nonadherence in the European First Episode Schizophrenia Trial (EUFEST). J Clin Psychopharmacol 2013; 33:258-261.
• Gönen AG, Kaymak SU, Soygür AH. Şizofreni hastalarında şiddet. Turkiye Klinikleri J Psychiatry-Special Topics 2011; 4(2):57-65.
• Swanson JW, Van Dorn RA, Swartz MS, Smith A, Elbogen EB, Monahan J. Alternative pathways to violence in persons with schizophrenia: the role of childhood antisocial behavior problems. Law Hum Behav 2008; 32:228-240.
• Nolan KA, Czobor P, Roy BB, Platt MM, Shope CB, Citrome LL et al. Characteristics of assaultive behavior among psychiatric inpatients. Psychiatr Serv 2003; 54:1012-1016.
• Buckley PF, Noffsinger SG, Smith DA, Hrouda DR, Knoll JL 4th. Treatment of the psychotic patient who is violent. Psychiatr Clin North Am 2003; 26:231-272.
• Volavka J, Citrome L. Pathways to aggression in schizophrenia affect results of treatment. Schizophr Bull 2011; 37:9219
• Frogley C, Taylor D, Dickens G, Picchioni M. A systematic review of the evidence of clozapine's antiaggressive effects. Int J Neuropsychopharmacol 2012; 15:1351-1375.
• Topiwala A, Fazel S. The pharmacological management of violence in schizophrenia: a structured review. Expert Rev Neurother 2011; 11:53-63.
• Citrome L, Volavka J, Czobor P, Sheitman B, Lindenmayer JP, McEvoy J et al. Effects of clozapine, olanzapine, risperidone, and haloperidol on hostility in treatment-resistant patients with schizophrenia and schizoaffective disorder. Psychiatr Serv 2001; 52:1510-1514.
• Buckley P, Bartell J, Donenwirth K, Lee S, Torigoe F, Schutz SC. Violence and schizophrenia: clozapine as a specific antiaggressive agent. Bull Am Acad Psychiatry Law 1995; 23:607-611.
• Spivak B, Mester R, Wittenberg N, Maman Z, Weizman A. Reduction of aggressiveness and impulsiveness during clozapine treatment in chronic neuroleptic-resistant schizophrenic patients. Clin Neuropharmacol 1997; 20:442-446.
• Rabinowitz J, Avnon M, Rosenberg V. Effect of clozapine on physical and verbal aggression. Schizophr Res 1996; 22:2492
• Volavka J, Czobor P, Nolan K, Sheitman B, Lindenmayer JP, Citrome L et al. Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol. J Clin Psychopharmacol 2004; 24:225-228.
• Krakowski MI, Czobor P, Citrome L, Bark N, Cooper TB. Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Arch Gen Psychiatry 2006; 63:622-629.
• Chengappa KN, Levine J, Ulrich R, Parepally H, Brar JS, Atzert R et al. Impact of risperidone on seclusion and restraint at a state psychiatric hospital. Can J Psychiatry 2000; 45:827-832.
• Bitter I, Czobor P, Dossenbach M, Volavka J. Effectiveness of clozapine, olanzapine, quetiapine, risperidone, and haloperidol monotherapy in reducing hostile and aggressive behavior in outpatients treated for schizophrenia: a prospective naturalistic study (IC-SOHO). Eur Psychiatry 2005; 20:403-408.
• Czobor P, Volavka J, Meibach RC. Effect of risperidone on hostility in schizophrenia. J Clin Psychopharmacol 1995; 15:2432
• Volavka J, Czobor P, Citrome L, McQuade RD, Carson WH, Kostic D et al. Efficacy of aripiprazole against hostility in schizophrenia and schizoaffective disorder: data from 5 double-blind studies. J Clin Psychiatry 2005; 66:1362-1366.
• Petit J. Management of the acutely violent patient. Psychiatr Clin North Am 2005; 28:701-711.
• Mulvey E. Assesing the evidence of a link between mental illness and violence. Hosp Community Psychiatry 1994; 45:6636
• Citrome L, Krakowski M, Greenberg WM, Andrade E, Volavka J. Antiaggressive effect of quetiapine in a patient with schizoaffective disorder. J Clin Psychiatry 2001; 62:901.
• Villari V, Rocca P, Fonzo V, Montemagni C, Pandullo P, Bogetto F. Oral risperidone, olanzapine and quetiapine versus haloperidol in psychotic agitation. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:405-413.
• Arango C, Bernardo M. The effect of quetiapine on aggression and hostility in patients with schizophrenia. Hum Psychopharmacol 2005; 20:237-241.
• Citrome L, Volavka J, Czobor P, Brook S, Loebel A, Mandel FS. Efficacy of ziprasidone against hostility in schizophrenia: post hoc analysis of randomized, open label study data. J Clin Psychiatry 2006; 67:638-642.
• Citrome L. Adjunctive lithium and anticonvulsants for the treatment of schizophrenia: what is the evidence? Expert Rev Neurother 2009; 9:55-71.
• Sheppard GP. High-dose propranolol in schizophrenia. Br J Psychiatry 1979; 134:470-476.
• Whitman JR, Maier GJ, Eichelman B. Beta-adrenergic blockers for aggressive behavior in schizophrenia. Am J Psychiatry 1987; 144:538-539.
• Yorkston NJ, Zaki SA, Pitcher DR, Gruzelier JH, Hollander D, Sergeant HG. Propranolol as an adjunct to the treatment of schizophrenia. Lancet 1977; 2:575-578.
• Caspi N, Modai I, Barak P, Waisbourd A, Zbarsky H, Hirschmann S, et al. Pindolol augmentation in aggressive schizophrenic patients: a double- blind crossover randomized study. Int Clin Psychopharmacol 2001; 16:111-115.
• Newman WJ, McDermott BE. Beta blockers for violence prophylaxis: case reports. J Clin Psychopharmacol 2011; 31:7857
• Kane JM, Leucht S, Carpenter D, Docherty JP. The expert consensus guideline series: optimizing pharmacologic treatment of psychotic disorders. J Clin Psychiatry 2003; 64(suppl 12):1-100.
• Ratey JJ, Sorgi P, O’Driscoll GA, Sands S, Daehler ML, Fletcher JR et al. Nadolol to treat aggression and psychiatric symptomatology in chronic psychiatric inpatients: a double-blind, placebo-controlled study. J Clin Psychiatry 1992; 53:41
• Swartz MS, Swanson JW, Hiday VA, Borum R, Wagner R, Burns BJ. Taking the wrong drugs: the role of substance abuse and medication noncompliance in violence among severely mentally ill individuals. Soc Psychiatry Psychiatr Epidemiol 1998; 33(suppl 1):75-80.
• Ziedonis D, Williams J, Corrigan P, Smelson D. Management of substance abuse in schizophrenia. Psychiatr Ann 2000; 30:67-75.
• Yates KF, Kunz M, Khan A, Volavka J, Rabinowitz S. Psychiatric patients with histories of aggression and crime five years after discharge from a cognitive behavioral program. J Forens Psychiatry Psychol 2010; 21:167-188.
• Haddock G, Barrowclough C, Shaw JJ, Dunn G, Novaco RW, Tarrier N. Cognitive-behavioural therapy v. Social activity therapy for people with psychosis and a history of violence: randomised controlled trial. Br J Psychiatry 2009; 194:1521
• Cullen AE, Clarke AY, Kuipers E, Hodgins S, Dean K, Fahy T. A multisite randomized trial of a cognitive skills program for male mentally disordered offenders: violence and antisocial behavior outcomes. J Consult Clin Psychol 2012; 80:114-1120. Hatice İmer Aras, Uzm.Dr., Iğdır Devlet Hastanesi, Iğdır. Yazışma Adresi/Correspondence: Hatice İmer Aras, Iğdır Devlet Hastanesi, Iğdır, Turkey. E-mail: [e-mail] Yazar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemiştir. The author reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol6/no1/ Çevrimiçi yayım / Published online 22 Mayıs/May 22, 2013; doi: 10.5455/cap.20130522110439