Empathy and violence in schizophrenia

Background: Associations are recognised between impaired empathy and schizophrenia and, separately, violence, but a systematic literature review revealed little exploration of the three-way relationship. The Interpersonal Reactivity Index (IRI), widely used in such research, has been psychometrically established only with healthy students, so I tested it in my sample. My main aim was to examine the relationships between empathy and violence among schizophrenic men. Hypotheses: Among them, empathy would be 1) more impaired in the schizophrenic group with more serious violence and 2) stable over time. Methods: Participants were hospital inpatients in South Wales or Bristol. Sample size was estimated from prior empathy and violence studies. Inclusion criteria were diagnosis of schizophrenia, or similar psychotic disorders; exclusion criteria primary developmental disorders or specific empathy interventions. Competent, consenting men were interviewed up to three times over three months. Assessments included the IRI, which encompasses cognitive empathy – perspective taking and fantasy - and affective subscales – empathic concern and personal distress; the Comprehensive Psychopathological Rating Scale (CPRS), Maudsley Assessment of Delusions Scale (MADS) and modified Gunn-Robertson Criminal Profile violence subscale. Additional clinical and socio-demographic variables were obtained from records. The IRI was evaluated using principal component analysis (PCA). Correlations between IRI scores and violence relationships, using different violence thresholds, and all other variables were examined, using Pearson Spearman tests for parametric and non-parametric variables respectively. Empathy stability was tested by repeated measures ANOVA. SPSS v 22 was used throughout