Objective:

Violent behavior is infrequent among individuals with schizophrenia but is clinically important. The purpose of this study was to provide data on the correlates of violence, which may allow better risk assessment and care.

Methods:

A total of 1,435 individuals with schizophrenia who participated in the National Institute of Mental Health’s Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study and were followed for 18 months were examined. The dependent variables were self-reported injurious and noninjurious violence during follow-up. The independent variables, assessed at study entry, comprised participants' recent injurious and noninjurious violence, demographic and background variables, childhood risk factors, clinical condition, current circumstances, and recent contact with hospitals and prisons. Proportional hazards models of time to first injurious violence were used to generate bivariable and multivariable hazard ratios for all participants and, separately, for participants with no injurious violence at study entry.

Results:

Seventy-seven participants (5.4%) reported engaging in injurious violence during follow-up, and 119 (8.3%) reported engaging in exclusively noninjurious violence. In the multivariable analysis, baseline injurious violence (hazard ratio=4.02), recent violent victimization (hazard ratio=3.52), severity of drug use (hazard ratio=2.93), baseline noninjurious violence (hazard ratio=2.72), childhood sexual abuse (hazard ratio=1.85), and medication nonadherence (hazard ratio=1.39) were associated with future injurious violence. For participants with no history of injurious violence at study entry, baseline noninjurious violence was the strongest predictor (hazard ratio=3.02). Recent violent victimization was no longer a significant correlate. The remaining correlates and the strength of their association with future injurious violence were similar to those for all participants.

Conclusions:

This is the first longitudinal multivariable analysis of predictors of injurious violence in a large cohort of patients with schizophrenia followed over 18 months. The results revealed simultaneous strong effects of baseline injurious violence and recent violent victimization on future injurious violent behavior. Among clinical variables, poor medication adherence, but not baseline symptoms of psychosis or depression, significantly predicted injurious violence. Treatment strategies to reduce risk should emphasize medication adherence.

中文翻译：

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精神分裂症患者未来暴力的相关性

客观的：

精神分裂症患者的暴力行为很少见，但在临床上很重要。这项研究的目的是提供有关暴力相关性的数据，这可能有助于更好地进行风险评估和护理。

方法：

共有1,435名精神分裂症患者参加了美国国家心理健康研究所的干预效果的临床抗精神病药物临床试验（CATIE），并随访了18个月。因变量是在随访过程中自我报告的伤害性和非伤害性暴力。在研究开始时评估的独立变量包括参与者最近的伤害性和非伤害性暴力，人口和背景变量，儿童期危险因素，临床状况，当前情况以及最近与医院和监狱的接触。首次伤害性暴力发生时间的比例危害模型用于为所有参与者以及分别针对在研究进入时没有伤害性暴力的参与者生成双变量和多变量危害比。

结果：

77位参与者（5.4％）报告称在随访期间发生了伤害性暴力，而119名参与者（8.3％）报告了仅发生了非伤害性暴力。在多变量分析中，基线伤害性暴力（危险比= 4.02），近期暴力受害（危险比= 3.52），吸毒严重程度（危险比= 2.93），基线非伤害性暴力（危险比= 2.72），儿童性虐待（危险比= 1.85）和药物不依从（危险比= 1.39）与将来的伤害性暴力相关。对于在研究开始时没有伤害性暴力史的参与者，基线非伤害性暴力是最强的预测因子（危险比= 3.02）。最近的暴力受害不再是重要的相关因素。

结论：

这是对超过18个月的大量精神分裂症患者伤害暴力预测因子的首次纵向多变量分析。结果显示基线伤害性暴力和近期暴力受害对未来伤害性暴力行为的同时强大影响。在临床变量中，药物依从性差，而不是精神病或抑郁症的基本症状，可明显预示伤害性暴力。降低风险的治疗策略应强调药物依从性。