Violence in inpatients with schizophrenia: A prospective study

Accurate evaluations of the dangers posed by psychiatric inpatients are nec essary, although a number of studies have questioned the accuracy of violen ce prediction. In this prospective study, we evaluated several variables in the prediction of violence in 63 inpatients with a DSM-IV diagnosis of sch izophrenia or schizoaffective disorder. Nurses rated violent incidents with the Overt Aggression Scale. During hospitalization, sociodemographic varia bles, clinical history, neurological soft signs, community alcohol or drug abuse, and electroencephalographic abnormalities did not differ between vio lent and nonviolent groups. Violent patients had significantly more positiv e symptoms as measured by the Positive and Negative Syndrome Scale (PANSS), higher scores on the PANSS general psychopathology scale, and less insight in the different constructs assessed. A logistic regression was performed to discriminate between violent and nonviolent patients. Three variables en tered the model: insight into symptoms, PANSS general psychopathology score , and violence in the previous week. The actuarial model correctly classifi ed 84.13 percent of the sample; this result is significantly better than ch ance for the base rate of violence in this study. At hospital admission, cl inical rather than sociodemographic variables were more predictive of viole nce. This finding has practical importance because clinical symptoms are am enable to therapeutic approaches. This study is the first to demonstrate th at insight into psychotic symptoms is a predictor of violence in inpatients with schizophrenia.