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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.
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.
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