The short answer to the question of whether someone with paranoid schizophrenia is likely to be violent or dangerous is usually "no". Schizophrenia, particularly the paranoid form, has for a long time been associated in the public mind with violence. This view has been reinforced by media reports of violent actions by persons who are purportedly mentally ill. Approximately 40 studies have been published in psychiatric journals since 1990 focusing on the associations between severe mental illness and violence: 30 have focused on the perpetration of violence by mentally ill people and 10 have addressed the likelihood that people with mental illness will become victims of violence. People with schizophrenia are more likely to be the victims than the perpetrators of violence in a community living and mental health setting: one study found that they had a 14 times greater likelihood of suffering violence than of being arrested for a violent act. Other studies have suggested that people with poorly-controlled schizophrenia are more likely to think about, and sometimes to attempt, harm to themselves than to others.
A focus on criminal records and suicide, however, may underestimate the amount of aggressive behavior associated with schizophrenia, and the burden of caring for and coping with aggressive behavior, threats of violence and violent acts by schizophrenic patients that falls on family members, those who share housing, clinical care personnel and the staffs of emergency facilities, hospitals and jails. Authorities in the field of schizophrenia have suggested that the problems and potential of violence may not currently be adequately addressed because of a desire to reduce the stigma that has long been attached to the illness.
Schizophrenia is a disorder with highly variable symptoms and severity, and aggressive thoughts and behavior also vary considerably from one person to another. Many factors influence the likelihood of aggressive behavior and the potential for its escalation into violent acts: the personality traits of the person before developing schizophrenia, the presence and degree of paranoid delusions and whether auditory hallucinations involve threats of violence or orders to commit violence, whether someone has engaged in violent or suicidal acts in the past, age and sex, social circumstances and living situation and the degree to which the person is excited or agitated. Negative symptoms, such as loss of motivation, are less often associated with the potential for violence, while this likelihood may be greater with positive symptoms, like hallucinations and delusions.
A pattern of more continuous hostility of demeanor, accusatory comments toward others and verbal aggression is more often associated with aggressive behavior, and if this happens in an unsafe or insufficiently supervised environment, the risk of violent acts may be greater. The antipsychotic medications have contributed to a decrease risk of aggressive behavior, and therefore of violent acts, in people who are being treated. The older drugs such as Haldol or Thorazine are effective for this, but patients often do not take them or take them incorrectly; depot or injectable medications can be given less frequently and with certainty of compliance, but are not as widely used. The newer generation of medications, such as Risperdal or Clozaril, significantly reduce the likelihood of violent behavior. This suggests that a patient who is prescribed medications for delusions and hallucinations and who is taking them properly, who is in a safe living situation with supervision by his family or is receiving regular care has a low likelihood of becoming angry or aggressive, and a lower risk of violent behavior developing.
Most studies suggest that social interactions with people with schizophrenia who are in the situation described above will not result in problems and will actually improve their mood and adjustment. If a hostile demeanor or verbal aggression is present, this may be a sign that family members or care givers need to check in and possibly intervene. An environment low in stress has been suggested to be the best protection against psychosis, self-harm and violence, and a relationship with neighbors may contribute to this.
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