Which of the following is true with regard to the association between schizophrenia and recorded crime rates?
E. Various types of studies have been hitherto employed to study the association between recorded crime and psychosis. One must remember that officially recorded crime may only be the tip of the proverbial iceberg in such studies. Various regional policies, jurisdictions, and practices affect the rate of recorded crime; in any case, these rates are not a true reflection of violence in the society. Many such studies have consistently found that a narrow diagnosis of schizophrenia or much broader psychosis have an increased risk of both non-violent and violent offending; this risk is greatest and most consistent for violent offenses.
All of the following factors are significantly associated with increased risk of violence among those with schizophrenia except:
E. The risk factors associated with violence in mental illness is a favourite topic in MRCPsych exams. It has been cogently shown that the magnitude of risk associated with a combination of factors such as male sex, young age, and lower socioeconomic status in a mentally ‘well’ person with no psychiatric history is higher than the risk of violence presented by mental disorders per se. Despite varied research, the causal pathway from mental illness to violence is still poorly sketched. The most consistently established risk factors that further increase the risk of violence among schizophrenia patients are:
Depression does not seem to be a major mediator of violence in schizophrenia patients.
Which of the following is true about the epidemiology of violence in schizophrenia?
E. Most schizophrenia patients do not offend in direct response to delusions or hallucinations, although homicide offenders may be over-represented in those who are actively psychotic at the time of the offense. In general, schizophrenia patients who offend tend to have long histories of substance misuse, conduct problems, and delinquency, with extensive nonviolent and violent offending prior to the onset of illness. Thus, the tendency to reoffend does not fall after a diagnosis of schizophrenia. The basic tenet one needs to remember regarding the epidemiology of violence in schizophrenia is that those risk factors for violence which operate in subjects without mental illness also operate in patients with schizophrenia.
The amount of societal violence rate that can be ascribed to psychiatric illness is:
B. Most research in forensic psychiatry has examined the relative risk of violence among the mentally ill compared with the general population. The population-attributable risk fraction (PAR%) refers to the percentage of violence in the population that can be ascribed to schizophrenia and thus could be eliminated if schizophrenia were eliminated from the population. Fazel and Grann (2006) reported that the population-attributable risk varied by gender and age in a given population. Overall, the PAR% of violence for psychiatric patients was 5.2%, suggesting that patients with severe mental illness commit 1 in 20 violent crimes. These data were obtained from analyzing Swedish health registers between 1988 and 2000. This value may vary between countries and across various generations of birth cohorts.
With respect to population-attributable risk of violence in those with schizophrenia, which of the following is true?
D. The population-attributable risk of violence in those with schizophrenia is a more important public health measure than relative risk as it indicates how much violence/crime could be eliminated if mental illness is ‘eliminated’. It provides an easier and more accurate reflection than relative risk for the general public. When the crime rates in a society increase, the population-attributable risk due to any mental illness reduces. The population-attributable risk fraction of violence for mental illness rate is estimated as 5% using Swedish registers; this suggests that most crimes in Europe are not related to mental illness.
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