Baird Alison, Webb Roger T, Hunt Isabelle M, Appleby Louis, Shaw Jenny
Centre for Mental Health and Safety, University of Manchester, UK.
Centre for Mental Health and Safety, University of Manchester; and NIHR Greater Manchester Patient Safety Translational Research Centre, UK.
BJPsych Open. 2020 Nov 16;6(6):e143. doi: 10.1192/bjo.2020.129.
Some people diagnosed with schizophrenia are more prone to committing acts of serious violence, especially in the presence of drug or alcohol misuse. The rarity of homicide has meant that no large controlled study has previously examined clinical risk factors.
To determine the risk factors for homicide by males diagnosed with schizophrenia.
A national nested case-control study of all previously admitted males diagnosed with schizophrenia, convicted of homicide between 1 January 1997 and 31 December 2012. Univariate and multivariable conditional logistic regression models were fitted to identify predictors of homicide in this population.
During the observation period 160 male patients with schizophrenia and a history of psychiatric admission were convicted of homicide, and they were matched with 542 male control patients who had not been convicted of homicide. Patients who committed homicide were more likely to have a history of violence and comorbid personality disorder or drug misuse. They were more likely to have missed their last contact with services prior to the offence and to have been non-adherent with their treatment plan. Almost all (94%) of homicides were committed by patients who had a history of alcohol or drug misuse and/or who were not in receipt of planned treatment.
In England and Wales, homicides by patients with schizophrenia without substance misuse and in receipt of planned care are exceptionally rare. To prevent serious violence, mental health services should focus on drug and alcohol misuse, treatment adherence and maintaining contact with services.
一些被诊断为精神分裂症的人更容易实施严重暴力行为，尤其是在存在药物滥用或酒精滥用的情况下。杀人案件的罕见性意味着此前没有大规模对照研究对临床风险因素进行过考察。
确定被诊断为精神分裂症的男性实施杀人行为的风险因素。
对1997年1月1日至2012年12月31日期间所有此前已入院且被诊断为精神分裂症并因杀人罪被定罪的男性进行全国性巢式病例对照研究。采用单变量和多变量条件逻辑回归模型来确定该人群中杀人行为的预测因素。
在观察期内，160名有精神科住院史的男性精神分裂症患者因杀人罪被定罪，他们与542名未因杀人罪被定罪的男性对照患者进行匹配。实施杀人行为的患者更有可能有暴力史以及共患人格障碍或药物滥用。他们在犯罪前更有可能错过与服务机构的最后一次联系，并且未遵守治疗计划。几乎所有（94%）的杀人行为都是由有酒精或药物滥用史和/或未接受计划治疗的患者实施的。
在英格兰和威尔士，没有药物滥用且接受计划护理的精神分裂症患者实施杀人行为极为罕见。为预防严重暴力行为，精神卫生服务应关注药物和酒精滥用、治疗依从性以及与服务机构保持联系。
