A Study of Risk Factors for Violence in Schizophrenia

BACKGROUND: Violence has been linked to psychiatric illness from time immemorial. Schizophrenia has been the most common psychiatric illness linked with violence. From 1980’s various studies point to various results regarding violence due to schizophrenia and very few Indian studies have been done. Light can be thrown on darker sides of life of schizophrenics to search for various risk factors that underlie violence. AIM OF THE STUDY: To study various risk factors like socio-demographic, disorder related, symptom profile, alcohol use, insight, victimization, suicidal ideation, disability, social support for VIOLENCE IN SCHIZOPHRENIA. OBJECTIVES: 1. To compare socio-demographic, disorder related, symptom profile, alcohol use, insight, victimization, suicidal ideation, disability, social support between - violent and non-violent groups of schizophrenia. 2. To assess factors associated with severity of violence within the violent group. METHODS AND MATERIALS: After ethical committee approval, study was done in both inpatients and outpatients of IMH, diagnosed as Schizophrenia based on SCAN according to ICD-10 DCR. CASE-CONTROL study with 50 cases (VIOLENT) and 50 controls (NON-VIOLENT). Risk factors for violence was searched using socio-demographic data, disorder related factors, symptom profile of patient (PANSS, PSYRATS), alcohol use (AUDIT), insight (BCIS), victimization (QUESTIONNAIRE), suicidal ideations, disability (WHODAS), social support (SSQ). Data obtained were recorded and statistical analysis using SPSS 20. RESULTS: Increased risk of violence associated with Male sex, employed, divorced, active phase of the illness, higher duration of untreated psychosis, higher number of relapses, poor compliance- higher PANSS score, higher scores on hallucinatory and delusional PSYRATS Alcohol abuse, suicidal ideas, higher victimization, reduced insight Severity of violence was more with male sex, education, previous history, alcohol- severe dependence and non dependent, low insight, low social support, high positive PANSS score, high PSYRATS score. CONCLUSIONS: Various risk factors other than the disorder factors had significant roles in violence in schizophrenia. 1. Among socio-demographic factors- male sex, employed, divorced had increased risk of violence. 2. Among disease factors- active phase of the illness, higher duration of untreated psychosis, higher number of relapses, poor compliance had increased risk of violence. 3. Among symptom profile- higher PANSS score, higher scores on hallucinatory and delusional PSYRATS had high risk of violence. 4. Among tools used- Alcohol abuse, suicidal ideas, higher victimisation, reduced insight were associated with violence risk. 5. Severity of violence was more with male sex, education, previous history, alcohol- severe dependence and non dependent, low insight, low social support, high positive PANSS score, high PSYRATS score