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Individuals with schizophrenia are more likely to kill themselves, die prematurely or commit a violent crime today than they were 38 years ago at the outset of deinstitutionalization, according to a study of 25,000 Swedish hospital patients published today in the Lancet Psychiatry.

The study led by Seena Fazel of Oxford University compared “adverse outcomes” for people with a diagnosis of schizophrenia or psychotic disorders without a mood component to both the general population and unaffected siblings. The first study of its kind, the report found:

  • At the end of five years after first being diagnosed, 10.7% of men and 2.7% of women had been convicted of a violent offense. This was defined to include homicide, attempted homicide, assault, robbery, arson, any sexual offense, or illegal threats or intimidation.
  • The rate of violent offense among patients with schizophrenia and related disease was 4.8 times higher than among their siblings and 6.6 times higher than matched individuals in the general population.
  • Three risk factors were found that predicted future violence, and these risk factors were present in all three groups (those with schizophrenia, their siblings and the general population): past violent behavior, substance abuse and past attempts at self-harm.
  • The incidence of violent offenses increased as hospitalization of the patients decreased, i.e., as patients spent less time in the hospital as a result of deinstitutionalizing psychiatric patients in Sweden, the incidence of violent offenses increased.

“It is important to remember that most individuals with schizophrenia and related disorders are not violent,” said E. Fuller Torrey, MD, founder of the Treatment Advocacy Center. “However, a small number of them, if not treated, do become violent because of the symptoms of their illness."

“This study shows that such violent behavior increased in Sweden over 38 years as the patients were being deinstitutionalized" Torrey continued. "The most disturbing thing about this study is that this level of violent behavior is taking place in Sweden, where psychiatric outpatient services are much better than in the United States, where the overall rate of violence is lower and also where deinstitutionalization has not progressed as far. This suggests that the level of violent behavior is quite likely even worse in the United States.”

The study looked at 24,297 patients in Sweden with these diagnoses discharged from hospitals between 1972 and 2009. It compared them with 26,357 of their siblings and with 485,940 matched individuals in the general population.

Read the abstract in the Lancet Psychiatry.

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