Violence, misconduct and schizophrenia: Outcome after four years of optimal treatment

BACKGROUND: Aggressive behaviour in patients with schizophrenic disorders is an ongoing source of concern to community-based services. It has been suggested that optimal treatment may reduce the risk of serious misconduct. OBJECTIVE: To assess prospectively aggressive and sexual misconduct in a cohort of patients receiving continued evidence-based community treatment. METHOD: Fifty patients with a DSM-IV diagnosis of a schizophrenic disorder were treated for 4 years with integrated biomedical and psychosocial strategies. The frequency and context of all aggressive and sexually inappropriate behaviour were assessed throughout. Correlations between an index of misconduct and demographic and clinical variables were examined. RESULTS: Levels of serious misconduct were low at the start of the project and declined as treatment progressed. Close examination of predictors of misconduct supported larger epidemiological studies imputing persistent psychotic symptoms, personality disorders and substance use. CONCLUSION: The study supports the hypothesis that effective treatment reduces aggressive and sexual misconduct in schizophrenic disorders.