|Violence in Schizophrenia Patients More Likely
Among Those with Childhood Conduct Problems
Some people with schizophrenia http://www.nimh.nih.gov/healthinformation/schizophreniamenu.cfm who
become violent may do so for reasons unrelated to their current
illness, according to a new study analyzing data from the Clinical
Antipsychotic Trials for Intervention Effectiveness (CATIE) http://www.nimh.nih.gov/healthinformation/catie.cfm.
CATIE was funded by the National Institutes of Health’s National
Institute of Mental Health (NIMH). The study was published online
on June 30, 2007, in the journal Law and Human Behavior.
“Most people with schizophrenia are not violent,” said NIMH Director
Thomas R. Insel, M.D. “But this study indicates that the likelihood
of violence is higher among people with schizophrenia who also
have a history of other disorders, namely childhood conduct problems.”
Using data from 1,445 CATIE participants, Jeffrey Swanson, Ph.D.,
of Duke University, and colleagues examined the relationship between
childhood antisocial behavior, including conduct disorder symptoms,
and adult violence among people with schizophrenia. The overall
percentage of participants who committed acts of violence was 19
percent. Those with a history of childhood conduct problems reported
violence twice as frequently (28 percent) as those without conduct
problems (14 percent). In both groups, violence was more likely
among those who were unemployed or underemployed, living with family
or in restrictive settings (such as a halfway house or hospital),
been recently arrested, or involved with the police.
Violence was associated with alcohol and substance abuse in both
groups. But unlike the group without childhood conduct
problems, violence in the group with childhood conduct
problems was associated even with levels of alcohol and substance
use considered below the threshold for abuse.
The researchers also found that psychotic symptoms were not significantly
associated with violence among those participants with a history
of childhood conduct problems. In contrast, the presence of psychotic
symptoms was associated with an increase in violence among participants
without a history of childhood conduct problems.
Swanson and colleagues theorize that there may be two pathways
in which adults with schizophrenia may become violent — one
in which pre-existing conditions like that of antisocial conduct
in childhood, regardless of the presence of psychotic symptoms,
may link to violence, and one in which psychotic symptoms of schizophrenia
themselves may link to violence.
Based on their theory, the researchers suggest that the antipsychotic
medications used to treat psychosis may not be sufficient to treat
violent symptoms in people who are at a higher risk due to pre-existing
antisocial conduct conditions.
The researchers note that other studies have already found a strong
link between childhood conduct problems and adult violence, with
or without the presence of schizophrenia. This study adds evidence
to the notion that a more targeted treatment should be employed
for schizophrenia patients with conduct disorder histories.
“Doctors should take into account their patients’ histories before
deciding on a treatment approach,” said Dr. Swanson. “They should
consider specific interventions aimed at preventing further violence,
especially among their schizophrenia patients who have a history
of childhood conduct problems.
The National Institute of Mental Health (NIMH) mission is to reduce
the burden of mental and behavioral disorders through research
on mind, brain, and behavior. More information is available at
the NIMH website, http://www.nimh.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.