May 11, 2006

Violence not an anomaly for some patients with schizophrenia

The Treatment Advocacy Center ( issued a press release today highlighting some information found in the recent new study that is based on theCATIE trials data.

The release notes:

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 pct. 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 schizophrenia 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 pct. ... 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 pct. and individuals exhibiting good adherence to medication increased 103 pct.. A North Carolina study found long-term AOT combined with routine outpatient services reduced the probability of violence 50 pct. In New York, 55 pct. fewer recipients engaged in suicide attempts or harm to self; 47 pct. fewer physically harmed others; 46 pct. fewer damaged or destroyed property; and 43 pct. fewer threatened physical harm to others.

The study authors caution that the 19.1 pct. 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 study - covered in Archives of General Psychiatry - suggested:

""Positive" psychotic symptoms, such as persecutory ideation, increased the risk of both minor and serious violence, while "negative" psychotic symptoms, such as social withdrawal, lowered the risk of serious violence.

Serious violence was also associated with depressive symptoms, childhood conduct problems, and victimization.

Minor violence was linked to substance abuse, but in addition to clinical symptoms, Swanson et al also found a correlation between minor violence and interpersonal and social factors. These included being of female gender, residing in restrictive housing, residing with family or relatives, not feeling listened to by family members, and recent history of police contact, as well as functional impairment in the area of leisure activities and social interaction.

"To the extent that violence risk is significantly increased by positive psychotic symptoms, the crucial role of symptom management becomes clear (eg, through effective pharmacotherapy and patient adherence)," say the investigators.

"However, to the extent that risk of violence (particularly minor violence) is increased by other, nonclinical, variables… the clinical lesson is that violence risk management must include a focus on the whole person in the community environment."

Source: Arch Gen Psychiatry 2006; 63: 490–499


The Treatment Advocacy Center ( is a national nonprofit organization dedicated to eliminating barriers to timely and humane treatment for millions of Americans with severe mental illnesses. TAC is funded by individual donations and does not accept funding from pharmaceutical companies.


My friend (now my former friend it seems) and coworker is paranoid schizophrenic. For the past few months, especially (though she has a long history of less frequent episodes) she has exploded with violent verbal behavior towards coworkers, and now that I've seen this, including with me, I know she had been exagerating, adding to, not quite telling the truth, in saying what others did to her. The whole workplace is in an uproar and none of us know what to do. We don't want to hurt her, but we can't keep on going this way, fearing an explosion from her. Some among us even fear for their lives. I don't think she would harm anyone, but I have heard of her doing things like cutting tires and damaging property in the past. I am scared, afraid for her, afraid for us all, still care for her, don't want her to be hurt, just confused and scared.

Posted by: Bre at May 12, 2006 07:25 PM

i had been an instigator of violence until it turned against me. i had thought it was a righteous effort without forethought of the consequences. i too had been victimzed as a child. and, falsely believed violence would have soothed my nerves. now, after reading several novels about misconduct during wartimes, especially by the japanese, i am begining to form an opinion that: people of ill will lose out; they're the ones who get killed. as the christmas jingle goes: "peace on earth to people of goodwill".

and, Bre-i suggest you take some action about the violent behavior by your co-worker. it is because of such types of behavior that i don't work full time. for one, the police can always be called in during such an episode. either that, or get a new job. martin

Posted by: martin baiada at May 14, 2006 07:16 PM

mentally ill people act like what you describe when they are frightened and ill.

"verbal violence" is not violence. violence is physical acts. the business of slashing tires is gossip, and unconfirmed. you all need to stop talking amongst yourselves and getting yourselves all worked up. you need to discuss the problem with someone who has some knowledge of mental illness, such as a social worker or psychiatrist. human resources people will just fire people, and know nothing, usually, of how to help them, and that ISN'T their first concern (helping the person). many employees in this situation will keep the situation under wraps til they can find out if they can help in any way - if there's nothing they can do and there actually IS some sort of danger, THEN they call in HR, get the person fired, etc.

first of all, try to remain calm, and realize that this is words, not someone getting beat up. remain very calm, speak clearly and distinctly, you don't have to shout, but speak firmly and simply and calmly to the person, and insist on basic behavior standards being followed. 'mary, i know you are angry, but there is a rule against yelling in this office', or more clearly and firmly, 'NO YELLING, MARY'. if the person makes a direct threat or hits someone, call the police. if the person is off medication and getting more ill, often the police, by taking her to a hospital, NOT jail, can help get her back on medication. arrests often wind up with the person in jail, off medication and more upset and more ill. rarely, an arrest becomes a way to get a person on medication (they usually don't need more than a brief hospitalization, the key is medication, not getting 'locked up') if the judge is knowledgeable and creative - not all are. some just fine or arrest, and the person is more ill in the long run.

think about what is important - getting the person help. you aren't seeing someone who is 'bad' or 'mean' or 'irritable', these are symptoms of an untreated illness. not her personality, and not her choice.

Posted by: slc at May 19, 2006 05:19 AM

dear friends
my elder brother suffring from last 14 years. he did not take medicines. he is not living with family. taking drugs.alcohole.
my family members very trubuled
what can u do.

Posted by: devendra at May 29, 2006 04:50 AM

Dear friends,
Why it is so necessary to say schizophernics are not violent.This ostrich like attitude of americans from 1960(when President kennedy abolished the asylums) has made a piquiant situation wherein the prisons serve as "mental asylums" for nearly 300,000 mentally ill prisoners who are convicted for violence.It also makes the honoured armed forces to send infantry into battle when they are taking anti/psychotic medications.USA which is the leader country for the world must come out of this hypocricy.

Posted by: captainjohann at May 30, 2006 05:43 AM

I want to know more about the "stringent criteria" for AOT. I'm sure you'd see a positive correllation in violence if you looked at the male gender, or the poverty stricken, or several downtrodden races in America. Does that mean that we should forcibly restrain (as non-voluntary medications are chemical restraints) all men or poor people, or blacks? It's rediculous that the mentally ill have to be treated like criminals because it is politically correct to do so.

Posted by: Kudzu at May 30, 2006 11:45 AM

I've posted info from the results of the CATIE on the message boards here and was promptly attacked and some of the posts were even removed.

But I guess its okay for Torrey to use the same Catie study and use it to draw erroneous conclusions while ignoring the main points of the study.

Also the NIMH(where torrey was a former assistant) has this to say :

Are people with schizophrenia violent?

People with schizophrenia are not especially prone to violence and often prefer to be left alone. Studies show that if people have no record of criminal violence before they develop schizophrenia and are not substance abusers, they are unlikely to commit crimes after they become ill. Most violent crimes are not committed by people with schizophrenia, and most people with schizophrenia do not commit violent crimes. Substance abuse always increases violent behavior, whether or not the person has schizophrenia (see sidebar). If someone with paranoid schizophrenia becomes violent, their violence is most often directed at family members and takes place at home.

Posted by: symptomatic at June 22, 2006 09:01 PM

Are the violent incidents that supposedly 19.1 percent of "participants" were engaged in all provoked by a violent mentally ill person. Last year I was travelling the country sometimes staying in homeless shelters and I was in about six violent encounters but I never once hit back and I was never once seriously hurt. I was not on medecine but had reason to believe that police were overly vigilant about getting me locked up in an asylum. Now I'm on medicine I have a job as a nurse aide, and that's fine. In fact it's a blessing from God. But there is a growing murmur in this country to lock up mentally ill people - involuntarily commit them even if they have committed no crime. Or alternatively to force them to take medication (and probably charge them for it.) Will the mentally ill have the right to treatment they deserve or only high doses of medication (because there are other effective treatments: psychological approaches, maybe acupuncture or homeopathy or meditation or prayer? Will they have the legal counsel they deserve? By the way the hospital I stayed in last time charged maybe around 1000 dollars a day- and I saw a doctor for a matter of minutes a day.

Posted by: Asher Radunsky at May 19, 2007 01:06 PM

I am Schizophrenic since I was 27 years old, now I am 34 years old. I never became physically violent towards anyone, but I admit that I was verbally aggressive towards my family members. When one is in a state of paranoia, one wants to be left alone. If people, on the other hand, do exactly the opposite and don’t leave one alone, violence may appear as a consequence of the frustration level one is suffering from. You must understand that schizophrenic patients, often rather than ever, believe that they are in their right to defend themselves from what it seems an aggression coming from others. The best is to stay away and seek treatment for that person. You are not dealing with someone normal; you are dealing with an ill person that requires treatment. Have some compassion for that person and don’t think you can deal with him or her, unless you are doctor in psychiatry. Being nice and patient to someone with schizophrenia is not a bad strategy, while getting him or her, necessary professional attention. Be wise and don’t push him around, that would only make things worse for everyone.

Posted by: another schizophrenic at August 20, 2007 06:02 AM

I just now had to bring the father of my 4 mnth old daughter ,to the ER. He cant eat or sleep, he is paranoid schizophrenic who has never been on medication. The new family stress sent him into an actue episode. I was yelled at pushed around and threatened when I try to tell him he needs to get help. I left him alone and took the baby out of the house. I started making phone calls. I found little to NO help. I listen to my baby's father talk about things I dont understand and memories that never happened. He plunged futher and futher into a deep delusional hole. Finaley I begged him and tricked him into coimg to the ER where he is still watiting 10 hrs later to see a dr. I have no reasoures to deal with this and a baby to take of. I live in HAwaii and have no family here. What else could I have done I luv him so much, I had to take him somewhere. His family misses him Will he ever be a good father with a present mind. I believe he didn't mean to hurt me I believe he doesn't know he is ill, I want to help him any way I can. We need to unprivitize our heath care system and get our communites the help it needs. Not TOday Not Tommorrow YESTERDAY.

Posted by: DaniLOVESJosh at February 23, 2008 02:47 AM

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