NEW STUDY LINKS VIOLENCE AND SCHIZOPHRENIA
CATIE data show 19.1% of patients violent in six-month period

Arlington, VA, May 11, 2006 - A comprehensive new study confirms violence is not an anomaly for some patients with schizophrenia. Researchers, using data from the National Institute of Mental health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project, found that 19.1% of participants had a violent incident in a six-month period.

"This study joins a large body of scientific research confirming what we can too easily see each day in the newspaper," said Treatment Advocacy Center President Dr. E. Fuller Torrey. "Although most individuals with mental illnesses are not violent, violence by a subgroup of individuals with schizophenia is far from rare. And the violent behavior is almost always associated with the person not having received treatment for their illness. The only solution is treatment."

The study also found that the symptoms most predictive of violent behavior are positive symptoms, like hallucinations, paranoid delusions, and grandiosity. "Positive symptoms of schizophrenia are not only the ones most predictive of violence, but also the ones most responsive to medication," noted Dr. Torrey.

The study, published in the May edition of the Archives of General Psychiatry, included 1,410 patients with schizophrenia from 56 sites nationwide.

Researchers also found respondents living with family were more likely to report engaging in any violent behavior. Earlier studies confirm family members are commonly the victims of violence. The American Psychiatric Association notes: "Family members are most at risk of a violent act committed by a mentally ill person...among those who had attacked people prior to their admission [to a psychiatric hospital], 65%...had attacked a family member."

Studies show treatment noncompliance increases the risk of violence and lack of insight, called anosognosia, is the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications. This impaired awareness of illness is caused by damage to specific parts of the brain.

"Obviously, the best way to avert the dangers associated with lack of treatment is to improve treatment compliance," said TAC executive director Mary T. Zdanowicz. These results are a call to action for legislators and policymakers sitting on the fence about the value of tools like assisted outpatient treatment in reducing violence in people with schizophrenia."

Assisted outpatient treatment (AOT) allows a court to order a noncompliant individual who meets stringent criteria into treatment. AOT dramatically improves treatment compliance and reduces harmful behaviors. In New York, individuals in AOT exhibiting good service engagement increased 51% and individuals exhibiting good adherence to medication increased 103%. A North Carolina study found long-term AOT combined with routine outpatient services reduced the probability of violence 50%. In New York, 55% fewer recipients engaged in suicide attempts or harm to self; 47% fewer physically harmed others; 46% fewer damaged or destroyed property; and 43% fewer threatened physical harm to others. The study authors caution that the 19.1% estimate of incidence of violence in the CATIE study is likely an underestimate. "The rate of violence in reality thus could even be higher," noted Zdanowicz.

The Treatment Advocacy Center (www.treatmentadvocacycenter.org) is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. TAC promotes laws, policies, and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.

STUDY CITED: Swanson, Jeffrey W. et al. (May 2006). “A National Study of Violent Behavior in Persons with Schizophrenia.” Arch Gen Psychiatry, 63, 490-99. Read the abstract.

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