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[Homicide, schizophrenia and substance abuse: a complex interaction].

S Richard-Devantoy¹, A I Bouyer-Richard, F Jollant

¹McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, FBC building, 3rd floor, 6875, boulevard Lassalle, Montréal (Qc), H3W 2N1, Canada. richarddevantoy@orange.fr

Revue D'Epidemiologie Et De Sante Publique

|July 3, 2013

Summary

Schizophrenia and homicide risk are complex. Substance abuse significantly increases homicide risk in individuals with schizophrenia, particularly in "early-starters." Tailored care is crucial for prevention.

Keywords:

Alcohol abuse Alcool Facteur de risque Homicide Risk factors Schizophrenia Schizophrénie Substance abuse Substances toxiques

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Area of Science:

Forensic Psychiatry
Clinical Psychology
Public Health

Background:

Homicide perpetrators with schizophrenia represent 6% of Western populations.
The link between schizophrenia and homicide is intricate, not a simple cause-effect relationship.
Substance abuse is a significant factor in homicides committed by individuals with schizophrenia.

Purpose of the Study:

To systematically review and clarify the role of substance abuse in homicide commission among individuals with schizophrenia.
To identify risk factors associated with homicide in this population.
To differentiate subgroups of violent individuals with schizophrenia based on substance abuse.

Main Methods:

Systematic literature search of Medline and EMBASE (2001-2011) using terms for schizophrenia, psychotic disorders, homicide, violence, and substance use disorder.
Inclusion of cohort, case-control, and transversal studies, with abstract selection guided by STROBE and PRISMA checklists.
Analysis of eight prospective studies and six systematic reviews/meta-analyses.

Main Results:

Homicide by individuals with schizophrenia is linked to socio-demographic, historical, contextual, and clinical factors.
The homicide risk is 8-fold higher in schizophrenics with substance abuse (primarily alcohol) compared to the general population.
Substance abuse differentiates violent individuals into "early-starters" (unplanned violence, high reoffending risk) and "late-starters" (violence linked to psychosis, low reoffending risk).

Conclusions:

Identifying subgroups of violent schizophrenic patients can reduce stigmatization.
Multidisciplinary care, addressing substance abuse, is essential for homicide risk prevention.
Understanding the distinct profiles of "early" and "late" violent offenders with schizophrenia can inform targeted interventions.