How common is violence in schizophrenia despite neuroleptic treatment?

There is a large body of literature about increased figures for violence in schizophrenic in-patients and out-patients. The therapeutic efficacy of ne uroleptics in coping with violent behaviour in schizophrenics is well docum ented. However, little data is available about the treatment given to schiz ophrenics who behave violently. We performed an extensive chart review in a n unselected sample of n = 138 patients with schizophrenic or schizoaffecti ve disorder (ICD10) and first admission between 1990 and 1993, including in -patient episodes in the first two years after first admission. Staff recor ds were reviewed for all notes on aggressive behaviour (threats, physical a ggression against persons and objects, selfdirected aggression) and coerciv e measures. For each incident, the number of days after the beginning of ne uroleptic treatment was coded. 258 inpatient treatment periods with an aver age length of 78.5 days were evaluated; 226 lasted more than one week. 142 aggressive incidents were observed, of these 66% within the first week of n euroleptic treatment, 9% within the second. The day-by-day decline of aggre ssive incidents after the start of neuroleptic treatment was highly signifi cant (trend-test: Spearman rank correlation r = 0.964; df = 5; t < - 8.1; p < 0.001). The results support the assumption that the increased figures fo r violence by schizophrenics are, at least in part, due to the lack of adeq uate treatment.