Command Voices and Aggression in a Lebanese Sample Patients with Schizophrenia

The impact of command voices (CV) on violent behaviors in patients with schizophrenia remains unclear. The literature has produced mixed results, with no research existing on CV and violence among the Lebanese population. The study objecttives were to (1) evaluate the association between voice beliefs, psychosis severity, treatment, demographic factors and command voices, and (2) evaluate the association between command voices and violence among patients with schizophrenia in Lebanon.

A cross-sectional study, conducted between April and August 2019, enrolled 280 patients with schizophrenia.

The results showed that 111 (39.6%) patients with schizophrenia had auditory hallucinations, among whom 93 (83.8%) patients had command voices; from these 93 patients, 53 (57.0%) were compliant with voices. Higher positive (ORa=1.09) and general psychopathology (ORa=1.04) PANSS subscales scores were significantly associated with higher compliance to voices. A higher resistance to beliefs about voices (ORa=0.91) was significantly associated with lower compliance to voices.

The prevalence of CV in patients with schizophrenia that report auditory hallucinations, was high in our sample. The vast majority of violent acts committed by patients was in compliance to CV, with a significantly high rate of the violence committed being directed towards property. Our findings were able to connect positive symptoms to higher probability of compliance to CV.