Facing Up to Unpalatable Evidence for the Sake of Our Patients

Paul Mullen discusses Seena Fazel and colleagues' paper on the association between violent behavior and having been diagnosed with a schizophrenic disorder, and its implications for care of these individuals

Schizophrenia and Violence: Systematic Review and Meta-Analysis

Seena Fazel and colleagues investigate the association between schizophrenia and other psychoses and violence and violent offending, and show that the increased risk appears to be partly mediated by substance abuse comorbidity

Changes in the Provision of Institutionalized Mental Health Care in Post-Communist Countries

PMCID: PMC3371010This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Violence in persons with and without psychosis in the Czech Republic: risk and protective factors

Martin Černý,1,2 Sheilagh Hodgins,3 Radmila Kučíková,2,4 Ladislav Kážmér,5 Alena Lambertová,1 Alexander Nawka,1 Lucie Nawková,1 Anna Parzelka,1 Jiří Raboch,1 Petr Bob,1 Jan Vevera1,6–8 1Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic; 2Department of Psychiatry, Teaching Hospital Královské Vinohrady, Prague, Czech Republic; 3Institut Universitaire en Santé Mentale de Montréal, Département de Psychiatrie, Université de Montréal, Montréal, Quebec, Canada; 4Psychiatric Hospital Bohnice, Prague, Czech Republic; 5Center for Epidemiological and Clinical Research in Addictions, National Institute of Mental Health, Klecany, Czech Republic; 67th Field Hospital, Czech Armed Forces, Hradec Králové, Czech Republic; 7Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University, Prague, Czech Republic; 8Department of Psychiatry, Institute for Postgraduate Medical Education Prague, Prague, Czech Republic Purpose: To prevent violence among persons with psychosis, further knowledge of the correlates and risk factors is needed. These risk factors may vary by nation. Patients and methods: This study examined factors associated with violent assaults in 158 patients with psychosis and in a matched control sample of 158 adults without psychosis in the Czech Republic. Participants completed interviews and questionnaires to confirm diagnoses, report on aggressive behavior, current and past victimization, and substance use. Additional information was collected from collateral informants and clinical files. Multiple regression analyses were conducted to identify factors that were independently associated with committing an assault in past 6 months. Results: The presence of a psychotic disorder was associated with an increased risk of assaults (OR =3.80; 95% CI 2.060–7.014). Additional risk factors in persons with and without psychosis included recent physical victimization (OR =7.09; 95% CI 3.922–12.819), childhood maltreatment (OR =3.15; 95% CI 1.877–5.271), the level of drug use (OR =1.13; 95% CI 1.063–1.197), and the level of alcohol use (OR =1.04; 95% CI 1.000–1.084). Increasing age (OR =0.96; 95% CI 0.942–0.978) and employment (OR =0.30; 95% CI 0.166–0.540) were protective factors. Except for drug use, which appeared to have greater effect on violence in the group without psychosis, there were no major differences between patients and controls in these risk and protective factors. To our knowledge, this is the first published comparison of assault predictors between schizophrenia patients and matched controls. Conclusion: Recent physical victimization was the strongest predictor of assaults. Our findings are consistent with the emerging empirical evidence pointing to the very important role of victimization in eliciting violent behavior by the victims. Some current prediction instruments may underestimate the risk of violent behavior as they take little account of current victimization. Although psychosis per se elevates the risk of violence, other risk and protective factors for violence in persons with psychosis and comparison group are largely similar. Keywords: schizophrenia, psychosis, violence, victimization, ris