demonstrates that there is an association between schizophrenia and
violence, but
shows that this association is greatly increased by drug and alcohol
abuse. Importantly, the study also finds that the risk of violence from
patients
with psychoses who also have substance use disorder is no greater than
those who have a substance use disorder but who do not have a psychotic
illness
- in other words, schizophrenia and other psychotic illnesses do not
appear to be responsible for any additional risk of violence above the
increased risk associated with substance abuse. Potentially this finding
has implications for attempts to reduce violence in society, suggesting
that
strategies aimed at reducing drug and alcohol abuse would be more
successful than focusing on mental illness.
Whether or not there is a link between psychotic illnesses and violence
has been disputed in the medical literature as well as being a
controversial
issue with far-reaching social and policy implications. Seena Fazel, of
the Department of Psychiatry at the University of Oxford, and colleagues
conducted a systematic review of all previous studies examining psychotic
illness and the risk of violence to try and resolve their varied
conclusions
- some of the previous studies concluded that there is no increased risk
of violence from patients with schizophrenia, whilst others have reported
that there is a marked increase in the risk of violence in individuals
with schizophrenia. The opinion emerging in the last couple of decades
that
there is a modest association between schizophrenia and violence is
thought to have influenced policy and legal developments, with the number
of
patients in secure hospitals increasing in Western countries. Many mental
health charities and clinicians specializing in mental health contest this
opinion - arguing that the perception that people with mental illness are
more violent is a myth reinforced by the media, contributing to a social
stigma around mental illness that damages many people and prevents
understanding.
In their systematic review, the researchers identified 20 studies that
compared the risk of violence among people with psychotic illness with
those in
the general population. Using statistical tools to allow for the
differences between the studies, the researchers found that the risk of
violent
outcomes did increase for individuals with schizophrenia or other
psychoses. Men with schizophrenia or other psychoses were typically four
to five
times as likely to commit a violent act as a man in the general
population; for women with schizophrenia or other psychoses there was an
eight times
greater risk of violence than women in the general population - although
the researchers suggest this might be explained by the lower prevalence of
alcohol and drug use in the general female population. When analysing the
characteristics that differed between the studies, including study
location
and whether the diagnosis was for schizophrenia or another psychotic
disorder, the researchers found that substance abuse was the only factor
causing
variation between the studies. Substance abuse greatly increased the risk
of violence for those with a psychotic illness, but this increased risk of
violence was similar to those in the general population with substance
abuse but no psychotic illness - suggesting that most of the excess risk
of
violence in psychotic patients appears to be mediated by the abuse of
drugs and alcohol.
The authors acknowledge that further research is needed to clarify the
relationship between schizophrenia and other psychoses, substance abuse,
medication adherence and violence. However, the authors suggest that their
findings could help redress the stigmatization of patients with
schizophrenia and other psychoses. They conclude: "As substance use
disorders are three to four times more common than the psychoses, public
health
strategies to reduce violence could focus on the prevention and treatment
of substance abuse at an individual, community and societal level."
Funding: No specific funding was received for this study.
Competing Interests: The authors have declared that no competing interests
exist.
Citation:
Fazel S, Gulati G, Linsell L, Geddes JR, Grann M (2009)
"Schizophrenia and Violence: Systematic Review and Meta-Analysis."
PLoS Med 6(8):e1000120.doi:10.1371/journal.pmed.1000120
SourcePLoS Substance Abuse, Schizophrenia And Risk Of ViolenceSource: Medical News Today
: http://alcoholdrugstreatment.info/substance-abuse-schizophrenia-and-risk-of-violence
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