Anecdotally, it has been understood by mental health practitioners for some time that only a small number of schizophrenic individuals will be violent, and that medication will reduce violence only in some cases. There has been little exploration into the question of why until this month, when a team of researchers published the results of their work in the British Journal of Psychiatry. By analyzing data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) a team led by Dr. Jeffrey Swanson of Duke University came to the conclusion that several factors unrelated to an idividual's diagnosis of schizophrenia accounted for the prevelence of violent acts, and that only in cases where violence was a result of psychosis did medication help alleviate the problem.

The original CATIE investigation was comprised of nearly 1,500 individuals diagnosed with schizophrenia who were assigned randomly to one of five antipsychotic medications. Dr. Swanson's team found in their analysis that no one particular drug was more effective than any other in reducing violent acts, but that all were equally effective if a proper medication regimen was followed. The team also discovered that several factors accounted for violent behavior independent of severity of schizophrenia symptoms. Most significant among these risk factors for violence was childhood conduct problems, but substance abuse, being the victim of past violent acts, poverty and living with others as opposed to alone were also factors that contributed to violence.

One aspect of the research that differed from previous work was the success of the different medications in the study. "Contrary to the expectations of many clinicians and some research, this study found no benefit for newer medications over an older medication in reducing the risk for violence over the six-month study period," Dr. Swanson said in a release. "In fact, one of the newer medications, quetiapine, performed worse than the first-generation drug perphenanize."

Unlike other studies that highlight new possibilities, this work is more important for helping us to understand a relationship that does not exist. There is a minority of schizophrenic individuals for whom violence is an issue, but Dr. Swanson and his team have helped to illustrate that more often than not, treatment compliance is not the cause or solution to the violent behavior. Instead, schizophrenic individuals should be encouraged to stay consistent with their medication to suppress symptoms, while therapists and doctors work with the individual to identify other potential explanations for violence.