Violence declines with medication use

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Some schizophrenia patients become less prone to violence when taking medication, but those with a history of childhood conduct problems continue to pose a higher risk even with therapy, as per a new study by scientists at Duke University Medical Center.

"This is the first large randomized controlled study to compare the effectiveness of several commonly-prescribed medications for schizophrenia on reducing community violence," said Jeffrey Swanson, professor in psychiatry and behavioral sciences and the study's lead author. "Serious violent behavior is not frequent among people with schizophrenia, but when it does occur, the results can be costly and tragic".

The study observed that violence declined significantly when patients took antipsychotic medications as prescribed, but only among patients whose previous risk for violence could be associated with psychotic symptoms.

The scientists identified a subgroup of schizophrenia patients with a history of childhood conduct problems who were more likely to be violent at the beginning of the study. Among these patients, violence was not strongly correlation to psychotic symptoms, and did not significantly decline with adherence to prescribed antipsychotic medicine during the six-month study period.

The new results, which are from the National Institute of Mental Health's Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, are reported in the recent issue of The British Journal of Psychiatry
"In the past, we've not understood very well why a small proportion of patients with schizophrenia become seriously violent, while most do not--and why medicine seems to prevent violent behavior in some and not others," said Marvin Swartz, professor of psychiatry and coauthor of the study. "These findings tell us that people with schizophrenia may behave violently for reasons not directly correlation to their mental illness. If that's the case, then therapy for psychotic symptoms alone may not eliminate the risk of violence."

Scientists observed that many factors contributed to violent acts independently of the person's schizophrenia. In addition to childhood conduct problems, substance abuse, being the victim of past violent acts, poverty and living with others, rather than alone, were all predictors of violent behavior.

Medication is the primary course of schizophrenia therapy to reduce symptoms and hopefully prevent violent acts. This study observed that newer antipsychotics are as effective as older medications in reducing violence among people with schizophrenia.

"Contrary to the expectations of a number of clinicians and some research, this study found no benefit for newer medications over an older medicine in reducing the risk for violence over the six-month study period," Swanson said. "In fact, one of the newer medications, quetiapine, performed worse than the first-generation drug perphenanize".

The CATIE study included 1,445 patients with schizophrenia who were randomly assigned to therapy with one of five antipsychotic medications, including olanzapine, perphenanize, quetiapine, risperidone, or ziprasidone.

"Antipsychotic drugs may help reduce violence risk, but they don't address all of the causes of violent behavior and they don't help at all if people can't or won't take the medicine prescribed. We also need interventions to help patients stay engaged in therapy," Swartz added.


Posted by: JoAnn    Source