Abstract
We conducted a meta-analysis of studies examining the association between the Val158Met COMT polymorphism and violence against others in schizophrenia. A systematic search current to November 1, 2011 was conducted using MEDLINE, EMBASE, CINAHL, PsycINFO, ProQuest, and the National Criminal Justice Reference Service and identified 15 studies comprising 2,370 individuals with schizophrenia for inclusion. Bivariate analyses of study sensitivities and specificities were conducted. This methodology allowed for the calculation of pooled diagnostic odds ratios (DOR). Evidence of a significant association between the presence of a Met allele and violence was found such that men's violence risk increased by approximately 50% for those with at least one Met allele compared with homozygous Val individuals (DOR = 1.45; 95% CI = 1.05–2.00; z = 2.37, p = 0.02). No significant association between the presence of a Met allele and violence was found for women or when outcome was restricted to homicide. We conclude that male schizophrenia patients who carry the low activity Met allele in the COMT gene are at a modestly elevated risk of violence. This finding has potential implications for the pharmacogenetics of violent behavior in schizophrenia.
Highlights
IntroductionViolence risk is a frequent reason for hospital admission, delays hospital discharge, complicates patient care, increases caregiver burden, leads to arrest and incarceration, and increases the stigma as well as the financial cost of the disease
Schizophrenia elevates the risk of violent behavior [1]
We present a meta-analysis of these studies focused on one diagnosis and one outcome
Summary
Violence risk is a frequent reason for hospital admission, delays hospital discharge, complicates patient care, increases caregiver burden, leads to arrest and incarceration, and increases the stigma as well as the financial cost of the disease. For these reasons, violence in schizophrenia constitutes a major public health concern [2]. Enhancement of central dopaminergic or noradrenergic function facilitates aggressive behavior in most (but not all) animal studies [4]. Drugs that increase central dopaminergic transmission, such as amphetamines and cocaine, may elicit psychosis with violent behavior [2]. The preponderance of the evidence suggests that catecholamines generally enhance violence
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