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 neuroleptics in coping with violent behaviour in schizophrenics is well documented. However, little data is available about the treatment given to schizophrenics who behave violently. We performed an extensive chart review in an unselected sample of n = 138 patients with schizophrenic or schizoaffective disorder (ICD10) and first admission between 1990 and 1993, including in-patient episodes in the first two years after first admission. Staff records were reviewed for all notes on aggressive behaviour (threats, physical aggression against persons and objects, selfdirected aggression) and coercive measures. For each incident, the number of days after the beginning of neuroleptic treatment was coded. 258 inpatient treatment periods with an average 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 neuroleptic treatment, 9% within the second. The day-by-day decline of aggressive incidents after the start of neuroleptic treatment was highly significant (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 for violence by schizophrenics are, at least in part, due to the lack of adequate treatment.