[Schizophrenia and violence]

There is now robust evidence that schizophrenia is associated with an increased risk of violence. Across Europe, the numbers of forensic hospital beds have dramatically increased largely due to admissions of men with schizophrenia.

This article critically reviews the extant literature on schizophrenia and violence.

A systematic review of the literature was carried out.

People with schizophrenia are at increased risk, as compared to the general population, to be convicted for violent crimes because they are more likely to engage in aggressive behaviour towards others. While psychotic symptoms explain aggressive behaviour during acute episodes, they do not explain such behaviour at other stages of the illness or prior to onset of illness. Three distinct phenotypes of offenders with schizophrenia have been identified: individuals with a childhood onset of conduct disorder who display antisocial and aggressive behaviour both before and after schizophrenia onset, individuals with no history of conduct problems who begin engaging in aggressive behaviour at the onset of illness, and individuals who engage in a severe physical assault after many years of illness. Little is known about the aetiology of the three types of offenders and about the neural mechanisms that initiate and maintain these forms of behaviour.

Mental health services need to assess the risk of violence among patients with schizophrenia and provide treatments that directly target antisocial and aggressive behaviour.