Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment.

This study prospectively compared the effectiveness of atypical antipsychotic medications to that of conventional neuroleptics in reducing violent behavior among patients with schizophrenia under "usual care" conditions in the community. Participants (n = 229) were adults with schizophrenia spectrum disorders receiving inpatient or outpatient services in public sector mental health systems in North Carolina. Subjects were followed for 2 years in an observational study using multiple methods of data collection at 6-month intervals to assess treatment, sociodemographic characteristics, clinical features, and violence outcomes. Treatment with atypical antipsychotic medications (clozapine, risperidone, or olanzapine) was found to significantly reduce the risk of violent behavior, whereas treatment with conventional neuroleptics did not have this same beneficial effect. A cumulative effect on reduced violence was attributable to consistent compliance with atypical antipsychotic medications over a 2-year period. Concurrent reductions in psychotic symptoms, substance abuse, and adverse medication side effects were found to mediate the association between adherence with atypicals and lower violence risk. Treatment with atypical antipsychotic medications should be considered as an important component of violence risk management for schizophrenia patients at risk for violent behavior.