Violence in childhood-onset schizophrenia.

Randal G Ross,Susan Lurie,Jonathan Kusumi,Julia Maximon

doi:10.4081/mi.2013.e2

Abstract

Violence is elevated in older adolescents and adults with schizophrenia; however, little is known about younger children. This report focuses on rates of violence in younger children with schizophrenic-spectrum illnesses. A retrospective review of structured diagnostic interviews from a case series of 81 children, ages 4-15 years of age, with childhood onset of schizophrenic-spectrum illness is reported. Seventy-two percent of children had a history of violent behavior, including 25 children (31%) with a history of severe violence. Of those with a history of violence, 60% had a least one episode of violence that did not appear to be in response to an external stimulus (internally driven violence). There was no significant impact of age or gender. For many children, these internally driven violent episodes were rare and unpredictable, but severe. Similar to what is found in adolescents and adults, violence is common in children with schizophrenic-spectrum illnesses. General violence prevention strategies combined with early identification and treatment of childhood psychotic illnesses may decrease the morbidity associated with childhood psychotic violence.

Highlights

General violence prevention strategies comm bined with early identification and treatment o of childhood psychotic illnesses may decrease c the morbidity associated with childhood psy- chotic violence
There were very few differences of eighty-two sequentially identified children toms. These cases generate a strong interest between psychotic children with and without with schizophrenia or related illnesses in both the scientific and lay communities aggression, with positive findings limited to recruited as part of an ongoing study of childabout the relationship between violence and psychotic children with aggression having hood schizophrenia
We have reported on the have caused such injury if no intervention had internally driven violence began was noted in process by which we identify psychosis in occurred

Summary

Results

The two reviewers agreed on the presence or absence of violence in 93% of cases. When violence was present, the two reviewers agreed on the presence or absence of internally driven violence in 89% of cases. Driven violence was identified in thirty-five children (43% of the entire sample); Almost three-quarters of the psychotic children had been violent with one-third having been severely violent: approximately two-fifths of children had been violent towards themselves including several with suicide attempts; approximately half of case reviews included episodes of violence towards others. These rates showed very little reduction even when psychotic children with a history of being the victim of abuse or with comorbid conduct disorder were removed from the analysis. There is always a risk of an ascertainment bias where violent youth are more likely to be brought to clinical attention; this rate of lifetime

Gender Male Female

Comorbidity Conduct disorder Victim of abuse

Conduct disorder

Clinical implications

Conclusions