[Risk factors related to homicide in Moroccan patients with schizophrenia]

Persons with schizophrenia are thought to be at increased risk of committing violent crime - 4 to 6 times the level of general population individuals without this disorder. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link.

The objectives of this study were to describe the characteristics of homicide in Moroccan patients suffering from schizophrenia and to determine the correlated sociodemographic, clinical and toxic variables.

The study included two groups of patients with a DSM IV diagnosis of schizophrenia who attended the "Ibn Nafis" university psychiatric hospital of Marrakech in Morocco. The first group was composed of 30 patients hospitalized for homicide in the forensic unit between 1 January 2005 and 31 August 2015. The second group included 90 patients without any criminal record. These two groups have been matched according to age and gender. Demographic, clinical and therapeutic variables were analyzed and compared between the two groups.

Data analysis has objectified the following results: the mean of age in the first group was 37.03 (±9.09) and in the second group was 31.4 (±8.76). No significant differences were found between the two groups regarding the different sociodemographic variables and the age of onset of disease. Significant differences were found between the two groups regarding: personal antecedents of attempt of homicide (P=0.003), personal antecedents of attempt of suicide (P<0.001), a history of previous violence (P=0.005), untreated psychosis before the act (P<0.001), poor medication compliance and a low familial support (P<0.001), antisocial behavior (P<0.001) and addictive behavior (P=0.005).

Several studies identified some possible predictor factors for violent behavior: poor compliance, lack of insight impulsivity and paranoid-hallucinatory symptoms, systematized delusions and addictive behavior seem to considerably increase the risk of turning to violence. Demographic variables as suggested by other studies are less valuable predictors of homicide in patients with schizophrenia.

Awareness of these factors will allow us to provide improved prevention of violence within schizophrenic subjects. Interventions for reducing such behavior should focus on clinical variables and integrate an early diagnosis of the disease and an improvement of medication compliance.