Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia.
BACKGROUND
Violence is an uncommon but significant problem associated with schizophrenia.


OBJECTIVE
To compare antipsychotic medications in reducing violence among patients with schizophrenia over 6 months, identify prospective predictors of violence and examine the impact of medication adherence on reduced violence.


METHODS
Participants (n=1445) were randomly assigned to double-blinded treatment with one of five antipsychotic medications. Analyses are presented for the intention-to-treat sample and for patients completing 6 months on assigned medication.


RESULTS
Violence declined from 16% to 9% in the retained sample and from 19% to 14% in the intention-to-treat sample. No difference by medication group was found, except that perphenazine showed greater violence reduction than quetiapine in the retained sample. Medication adherence reduced violence, but not in patients with a history of childhood antisocial conduct. Prospective predictors of violence included childhood conduct problems, substance use, victimisation, economic deprivation and living situation. Negative psychotic symptoms predicted lower violence.


CONCLUSIONS
Newer antipsychotics did not reduce violence more than perphenazine. Effective antipsychotics are needed, but may not reduce violence unrelated to acute psychopathology.
Swanson
Jeffrey W
JW
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 905 West Main Street, Durham, NC 27710, USA. jeffrey.swanson@duke.edu
Swartz
Marvin S
MS
Van Dorn
Richard A
RA
Volavka
Jan
J
Monahan
John
J
Stroup
T Scott
TS
McEvoy
Joseph P
JP
Wagner
H Ryan
HR
Elbogen
Eric B
EB
Lieberman
Jeffrey A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome; D014754:Violence
D014150:Antipsychotic Agents