Criminal activities and substance use of patients with major affective disorders and schizophrenia: a 2-year follow-up.

BACKGROUND: Compelling findings demonstrate that persons who develop major mental disorders, as compared to those who do not, are at increased risk to commit non-violent and violent crimes. This conclusion has recently been shown to apply to persons with major affective disorders.
METHODS: Thirty males with major affective disorders and 74 with schizophrenia were followed for 2 years. At discharge, patients were intensively assessed including diagnoses using SADs and RDC. During follow-up, alcohol and drug use were measured, subjectively and objectively. At discharge, the two groups were similar as to secondary diagnoses of antisocial personality disorder, drug abuse/dependence, socio-demographic characteristics, and criminal history, but more of the patients with major affective disorders than those with schizophrenia had a history of alcohol abuse/dependence. During the follow-up period, the two groups were similar as to rehospitalization, treatment intensity, and substance use.
RESULTS: By the end of the follow-up period, 33% of the patients with major affective disorders and only 15% of those with schizophrenia had committed crimes, most violent. Co-morbid antisocial personality disorder was associated with criminality among the patients with schizophrenia but not among those with major affective disorders. Among these latter patients, drug use and the intensity of out-patient care were associated with violent criminality. LIMITATIONS: The small number of subjects limited the conclusions.
CONCLUSIONS: Violent behavior among patients with major affective disorders may not be uncommon and may be preventable by out-patient treatment which limits drug use.