title: Childhood adversity and conduct disorder: A developmental pathway to violence in schizophrenia.
abstract: BACKGROUND
  Both childhood adversity and conduct disorder are over-represented among adult patients with schizophrenia and have been proposed as significant factors that may increase the risk of violence. It is not known how childhood adversity and conduct disorder might interact to contribute towards an increased risk of violence in schizophrenia. This study aimed to explore the relationships between childhood adversity, conduct disorder and violence among men with schizophrenia.
  
  
  METHODS
  54 male patients with schizophrenia from a range of inpatient and outpatient mental health services were assessed for exposure to a variety of childhood adversities, conduct disorder before the age of 15 and later violent behaviour in adulthood.
  
  
  RESULTS
  Exposure to domestic violence during childhood was associated with an increased propensity to violence in adulthood. Symptoms of conduct disorder were associated both with cumulative exposure to childhood adversities and with later propensity to violence. The cumulative number of childhood adversities was associated with adult propensity to violence. This association was significantly attenuated by inclusion of conduct disorder in the model.
  
  
  CONCLUSIONS
  This is the first study to demonstrate an association between childhood exposure to domestic violence and later violent behaviour in schizophrenia. Conduct disorder may mediate the association between cumulative childhood adversities and adult propensity to violence, indicating an indirect pathway. These results indicate a complex interplay between childhood adversity, conduct disorder and later violent behaviour in schizophrenia, and suggest that there may be shared aetiological risk factors on a common developmental pathway to violence.
authors.affiliation: St Andrew's Academic Department, St Andrew's Healthcare, Cliftonville, Northampton NN1 5DG, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, 16 De Crespigny Park, London SE5 8AF, UK. Electronic address: clare.oakley@standrew.co.uk.
authors.forename: Clare
authors.initials: C
authors.lastname: Oakley
authors.affiliation: St Andrew's Academic Department, St Andrew's Healthcare, Cliftonville, Northampton NN1 5DG, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, 16 De Crespigny Park, London SE5 8AF, UK.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Harris
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, 16 De Crespigny Park, London SE5 8AF, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fahy
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, 16 De Crespigny Park, London SE5 8AF, UK.
authors.forename: Declan
authors.initials: D
authors.lastname: Murphy
authors.affiliation: St Andrew's Academic Department, St Andrew's Healthcare, Cliftonville, Northampton NN1 5DG, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, 16 De Crespigny Park, London SE5 8AF, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Picchioni
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D019955:Conduct Disorder / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology / Q000209:etiology*; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Childhood trauma; Conduct disorder; Risk assessment; Schizophrenia; Violence