Wednesday, April 24, 2019

Study Looks at Predictors of Violence in High-Risk Schizophrenia Patients

A study published today in AJP in Advance confirms that patients with schizophrenia have low rates of violent behavior. While uncommon, the study found that a history of violence toward others is the strongest predictor of future violent behavior among this patient population. That said, the study authors concluded that improving medication adherence may be a better way to prevent violence than admitting potentially violent patients to a hospital.

“This study is … the first, to our knowledge, to describe the correlates of subsequent injurious violence among patients being treated for schizophrenia in which the independent variables include recent violence toward others,” wrote Alec Buchanan, Ph.D., M.D, of Yale University School of Medicine and colleagues.

The analysis included 1,435 participants in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. Researchers assessed participants’ clinical condition and violent behavior at baseline and every six months for the duration of the 18-month study.

Violent behavior was self-reported using the 19-item MacArthur Community Violence Interview, which included questions about behavior (“Have you pushed, grabbed, or shoved anyone?”) and injury (“Did you physically hurt or injure anyone?”). Based on initial responses, participants were placed into these categories: no violence, noninjurious violence, or injurious violence. Other potential predictors of violent behavior that were assessed included childhood abuse, alcohol and substance use, recent victimization, hospitalizations, arrests, and socioeconomic factors such as income and food or housing instability.

An analysis of all participants found that baseline injurious violence was the strongest predictor of future violence leading to injury. Other strong predictors included drug use severity and childhood sexual abuse. Medication nonadherence was the only clinical factor associated with future violent behavior.

When limiting the analysis to participants with no history of violence leading to injury, baseline noninjurious violence was the strongest predictor of future violent behavior. Other predictors included childhood sexual abuse, drug use severity, and medication nonadherence.

“The association with treatment adherence, while smaller in hazard ratio terms, … speaks to the important contribution of maintaining a therapeutic alliance in the management of violence risk,” Buchanan and colleagues wrote.

The researchers also found that self-reported violent behavior decreased over the course of the CATIE study, even among individuals with a history of violence. “[T]hese results … do not suggest that violence risk could be more successfully managed by identifying individuals who will act violently and by admitting them to the hospital,” the researchers concluded.

For related information, see the Psychiatric News article “Experts Advise Focus on Modifiable Risk Factors in Managing Violence Risk.”

(image: iStock/vadimguzhva)


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