Clinical and social features of patients with schizophrenia with a history of socially dangerous acts against life and limb

Abstract

Patients with schizophrenia are characterized by high criminal activity and especially dangerous behavior. The aim of this study is to explore social, clinical, psychopathological and criminal data of patients with schizophrenia who have committed socially dangerous acts (SDA) against life and corporal integrity and provide a comparative analysis with a group of schizophrenic patients with a past history of other wrongful acts (mostly of a non-violent nature).

Material and methods. The main group comprised 302 patients with schizophrenia (278 men and 24 women) aged 15 to 71 years ( average age – 37.8±10.6 years old) who had committed socially dangerous acts against life and limb and undergone forensic psychiatric examination at the Cheboksary republican psychiatric hospital in 2001–2010. The comparison group was composed of 314 people (291 males and 23 females) aged 15 to 72 years (average age – 33.2±10.5 years old) with a record of other wrongful acts. A questionnaire was completed for each subject under examination with inclusion of social and demographic indicators, clinical profile and peculiarities of the wrongful act. The data were analyzed by means of descriptive statistics, Pearson chi-square (χ2), one-way ANOVA test and multiple regression analysis.

Results. High on the list of wrongful acts against life and limb were battery (31.1%), homicides (21.2%), grievious bodily injury (15.6%) and their combinations (18.5%). In the majority of cases (93.4%) the aggression focused on persons in the patient’s immediate circle (on strangers – in 6.6% of cases). These patients were characterized by older age, higher education and higher divorce rates, late-onset schizophrenia and its longer duration. Paranoid schizophrenia accounted for 66.9 percent of cases. Among the mechanisms of SDA predominated the positive and psychotic (delusional motivation) and among the negative personality mechanisms prevailed the lack of emotional control. These patients tended to commit wrongful acts more often under the influence of alcohol and while being alone. The multiple regression analysis model of socially dangerous acts (99.9% of prediction) included: SDA mechanisms, type of schizophrenia, onset and duration of the disease.

Conclusion. Recognition of the SDA psychopathological mechanisms (delusions of persecution, auditory hallucinations), family relationships, alcohol abuse are significant factors of primary and secondary prevention of aggressive behavior of patients with schizophrenia.