While people with schizophrenia are much more likely to be victims of criminal behavior than perpetrators, there is a small percentage of people who have schizophrenia that are more violent; especially those who have a history of violence and who are abusing drugs or alcohol, and in those cases it is family members who are most at risk.  A new study looks at the small subset of people who have schizophrenia (as well as other disorders that antipsychotic medications are prescribed for) and have violent tendencies.

People who use antipsychotic medication (such as clozapine or risperidone) to treat psychiatric illness are nearly half as likely to commit a violent crime compared to when they are not using such medication, according to new results published in The Lancet.  The use of mood stabilising drugs (such as lithium or carbamazepine) is also associated with a reduced rate of violent crime, although the reduction is less pronounced, and only in patients with bipolar disorder.

Antipsychotic and mood stabilising medication are used to treat a variety of disorders, but are most commonly associated with the treatment of schizophrenia, bipolar disorder, and related disorders that affect up to 2% of the general population.  Although evidence suggests that people who use these medications are at less risk of relapse and re-hospitalisation for their illness, until now, there has been very little evidence for these drugs’ effects on real-world adverse outcomes, such as reducing violent behaviour, despite increasing prescription rates in many countries.

In this study, a team of researchers in the UK and Sweden, led by Dr Seena Fazel of Oxford University, UK, used Swedish national health registries to study the psychiatric diagnoses, and any subsequent criminal convictions, in over 80,000 patients (40,937 men and 41,710 women) who were prescribed antipsychotic or mood stabilising medication, from 2006 to 2009.

In the three years studied, 6.5% (2657) of the men, and 1.4% (604) of women were convicted of a violent crime. Compared with periods when participants were not on medication, violent crime fell by 45% in patients receiving antipsychotics, and by 24% in patients prescribed mood stabilisers.

Although the two types of medication are often combined, the researchers found no evidence that combining the drugs has any further effect on reducing violent crime, and for patients prescribed mood stabilisers, the medication was associated with reductions in violent crime only in male patients with bipolar disorder.

Moreover, although antipsychotic and mood stabilising medications are generally associated with treatment of schizophrenia or bipolar disorder, the researchers found that many people in the study were prescribed these drugs for other disorders, such as depression or alcohol and drug misuse.

According to Dr Fazel, “Patients with psychiatric disorders are at risk of perpetrating violent acts, as well as being victims. Until now, we have not known whether antipsychotics and mood stabilizers reduce risks of violence.  By comparing the same people when they are on medication compared to when they are not, our study provides evidence of potentially substantial reductions in risk of violence, and suggests that violence is to a large extent preventable in patients with psychiatric disorders.”*

In a linked Comment, Professor Sheilagh Hodgins of Université de Montréal, Canada, and Karolinska Institutet, Stockholm, Sweden, writes that “[This] well executed study provides a basis for future clinical studies aiming to establish how antipsychotics and mood stabilisers can be used to reduce aggressive behaviour. The study illustrates again that de-identified data from national registers that were established for administrative reasons can be used by epidemiologists to identify potential strategies to reduce health-related social problems.”

• Detailed Research Study Information: Antipsychotics, mood stabilisers, and risk of violent crime
  Seena Fazel, Johan Zetterqvist, Henrik Larsson, Niklas Långström, Paul Lichtenstein
  The Lancet
  Published Online May 8, 2014