Schizophrenia Daily News Blog

Treatment Options When Violent Behavior is Present in Schizophrenia

Most people who have schizophrenia are not violent. But when violence is a factor in a person's illness, effective treatment options that take the aggression into account become imperative. Psychiatric admission, along with prolonged hospital stays are often precipitated by violent behavior. Violent behavior can take a toll on patient, family, and society, and prevent the person from reintegrating back into the community and leading a full life.

Current Psychiatry Online discusses therapeutic options available when a patient with major psychiatric illness, such as schizophrenia, exhibits violent behavior.

Dr. Menahem Krakowski, MD, PhD, says that options should depend on whether patient violence is brief (transient) or persistent in relation to his/her fixed or changing symptoms and cognitive problems.

In regards to transient violence, a high level of emotional turmoil is usually present. Dr. Krakowski writes:

Transient violence is limited to an acute psychotic episode; as psychotic symptoms abate, the violence resolves. Delusions, hallucinations, and conceptual disorganization are key triggers of transient violence. Excitement, anger, and agitation are its prominent symptoms.

Persistent violence, on the other hand, is less commonly associated with emotional turmoil, and more commonly associated with "neurocognitive impairments, antisocial traits, and specific psychotic symptoms". It is suggested that:

When a patient continues to be violent, consider poor treatment adherence or substance abuse, especially with outpatients.

Different strategies are discussed for transient and persistent violence, including cases in which substance abuse play a role.

In the same issue of Current Psychiatry Online, is a case study of one paient diagnosed with paranoid schizophrenia after a court-ordered admission into a psychiatric hospital. The patient had persistent hallucinations, delusions and violence even after months of aggressive treatment and two extended hospitalizations. In that case, it was found that the patient had been misdiagnosed, and actually had hypothyroidism.

Dr. Leonard Lachover, MD, warns that medical causes for persistent psychiatric symptoms should be carefully checked for. Some checks suggested include: Complete blood count, electrolytes, thyroid panel, urinalysis, urine drug screen, blood urea nitrogen, creatinine, anticholinergic syndrome, serum copper/ceruloplasmin and liver function (for Wilson's disease), systemic lupus erythematosus, lead, magnesium, mercury, or manganese (heavy metal poisoning), vitamin B12 deficiency, brain MRI, EEG (brain), and ECG (heart).

Read the full article: Violent behavior: Choosing antipsychotics and other agents (free registration may be required)

Related Reading:
Violence not an anomaly for some patients with schizophrenia

Hypothyroidism and Psychiatric Illness

US Supreme Court Weakens Insanity Defence, Affirms Importance of Early Treatment for people with Schizophrenia

Conduct Disorder Link to Schizophrenia Violence