Individuals with schizophrenia make a significant contribution to violence in our communities and often destroy their own lives. Approximately 10% of those who will become perpetrators and commit the majority of serious aggressive actions can be identified in advance. A structured program that deliberately influences the criminogenic personality and behavioral factors on the abuse of psychoactive The substance so – you, as well as a change in social status along with active psychopathology disorders, would help prevent violence. Such a system of medical care would significantly reduce the number of violent crimes and cases of murder, reduce the number of schizophrenic patients who are in prison, stop the increase in the number of forensic psychiatric beds and, most importantly, improve the lives of many mentally ill, most troubled people. and disadvantaged.
In this article, I intend to continue the discussion of schizophrenia and violence in order to find out what exactly mediates this connection and, more importantly, how to prevent violence. First, I will provide current data in support of the essential and clinically significant connection between schizophrenia and violence. Then I will review the research on the factors that serve as a link between the presence of schizophrenic syndrome and antisocial behavior. Finally, I will describe possible ways of modifying modern clinical practice and making additional changes to it in order to break the connection between the presence of schizophrenia and aggressive behavior.
There is a correlation between the presence of schizophrenic syndrome and more frequent manifestations of antisocial behavior in general and violence in particular ( Hodgins , 1992; Hodgins et al , 1996; Wallace et al , 1998; Angermeyer , 2000; Arsenault et al , 2000; Walsh et al , 2001). Currently, there is a huge amount of evidence that such correlations are significant not only statistically, but also clinically and socially ( Hodgins & Müller-Isberner , 2004).
Why is this connection, if it is so obvious, not widely recognized among doctors and service organizers? Equally puzzling, and why so many researchers and experts in this field (sometimes I) either made it difficult or minimized the significance of correlations in fact to nothing to do with the case?
Research results show that in prisons in all Western countries, 5–10% of people awaiting trial for murder suffer from schizophrenic disorder . The true incidence of schizophrenia among murderers seems to be closer to high swing rates, since almost all studies have systematic errors that underestimate the degree of connection. Taylor and Gunn (1984 a , b ) in their study, which remains one of the most methodologically robust, concluded that 11% of murderers and 9% found guilty of non- lethal violence suffered from schizophrenia. The results of follow-up studies using large samples of people suffering from schizophrenia confirm high rates of violent crime ( Soyka et al , 2004; Wallace et al , 2004; Vevera et al , 2005; Swanson et al , 2006).
On the contrary, doctors may never meet at their reception a patient who committed murder or brutal violence against other people. Up to 10% of murderers suffer from schizophrenia, but the annual risk that a schizophrenic individual will commit a murder is about 1 in 10,000, and the risk that he will be convicted of using violence is one out of 150 ( Wallace et al , 2004). There is an obvious paradox, because the manifestations of extreme aggressiveness, especially the murder, are much less common in our community than most people realize. The annual frequency of homicides in the UK is about 1 per 100,000 population, so even a tenfold increase in risk among individuals with schizophrenia will not necessarily impress the individual doctor, although it will most likely affect society as a whole.
People with schizophrenia often resort to minor verbal abuse and threats of physical violence or try to strike or threaten to do so (5–15% per year), but doctors often do not present this as manifestations of the disease, but as situational, due to personality characteristics or provoked by intoxication. The problems caused by antisocial behavior remain hidden from doctors in the future, because many of those who have committed an offense turn out to be invisible behind prison walls. In prisons, the frequency of schizophrenia is 10 times higher than the average ( Fazel & Danesh , 2002). Hopefully, thanks to the reforms recently carried out in the UK, which will attract outpatient psychiatric teams to prisons, these lost patients will once again be in the field of vision of services.
So, everyday experience tells the doctor one thing, epidemiology is something else. Time to listen to our science – or, as it were, the researchers said in concert, not to mention in unison.
It is more difficult to explain the minimization of the correlation between the presence of schizophrenia and the violence of researchers and scientists, or the rejection of it. This is partly due to good, but inappropriate intentions. Many of us have begun to conduct research in this area, trying to demonstrate that the public’s fear of violence from individuals with mental disorders is not fully justified. To a certain extent, they are exaggerated, but not quite, as it turned out, groundless. The desire to comprehend increased aggressiveness in the appropriate context too often slips unnoticed into denial, reducing its value.
Another problem in evaluating research related to this area is the confusion of fundamental methods. For example, which variables should be corrected before a correlation is calculated between the presence of schizophrenia and violence. Distorting factors create an apparent correlation, establishing a positive, but independent connection with both schizophrenia and aggressive behavior. Mediating factors are a product or consequence of a schizophrenic state that directly or indirectly exacerbates violence.
It may be logical to correct for distorting factors, but amending for mediating factors will weaken or hide statistically significant links. It is not easy to differentiate between distorting and mediating factors in advance. This is partly due to the fact that many factors of interest to us, such as substance abuse , socioeconomic status and even personality traits, can be both distorting and mediating. Therefore, in practice, it is necessary to take a sensible approach to the calculations of the full correlation, and then to ask the question why it exists.