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Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina

Richard A. Van Dorn, PhD

College of Social Work, Justice, and Public Affairs, Miami, Florida International University

Jan Volavka, MD, PhD

New York University, New York

John Monahan, PhD

University of Virginia School of Law, Charlottesville, Virginia

T. Scott Stroup, MD, MPH

Department of Psychiatry and Behavioral Sciences, University of North Carolina at Chapel Hill, North Carolina

Joseph P. McEvoy, MD, PhD, H. Ryan Wagner, PhD and Eric B. Elbogen, PhD

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina

Jeffrey A. Lieberman, MD

Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, New York, USA

the CATIE investigators

Correspondence: Professor Jeffrey Swanson, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC Box 3071, Brightleaf Square Suite 23-A, 905 West Main Street, Durham, NC 27710, USA. Email jeffrey.swanson{at}duke.edu

Declaration of interest

J.W.S., M.S.S., R.A.V.D., T.S.S. and H.R.W. have received research support from Eli Lilly, M.S.S. has received consulting and educational fees from AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Pfizer. T.S.S. has received consulting fees from Janssen, GlaxoSmithKline and Bristol-Myers Squibb. J.P.McE. has received research funding from AstraZeneca, Eli Lilly, Janssen and Pfizer, consulting or advisory board fees from Pfizer and Bristol-Myers Squibb, and lecture fees from Janssen and Bristol-Myers Squibb. J.A.L. has received research funding from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen and Pfizer, and consulting and education fees from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest, GlaxoSmithKline, Janssen, Novartis, Pfizer and Solvay.

Background

Violence is an uncommon but significant problem associated with schizophrenia.

Aims

To compare antipsychotic medications in reducing violence among patients with schizophrenia over 6 months, identify prospective predictors of violence and examine the impact of medication adherence on reduced violence.

Method

Participants (n=1445) were randomly assigned to double-blinded treatment with one of five antipsychotic medications. Analyses are presented for the intention-to-treat sample and for patients completing 6 months on assigned medication.

Results

Violence declined from 16% to 9% in the retained sample and from 19% to 14% in the intention-to-treat sample. No difference by medication group was found, except that perphenazine showed greater violence reduction than quetiapine in the retained sample. Medication adherence reduced violence, but not in patients with a history of childhood antisocial conduct. Prospective predictors of violence included childhood conduct problems, substance use, victimisation, economic deprivation and living situation. Negative psychotic symptoms predicted lower violence.

Conclusions

Newer antipsychotics did not reduce violence more than perphenazine. Effective antipsychotics are needed, but may not reduce violence unrelated to acute psychopathology.