Schizophrenia social impact

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2] Irfan Dotani

Social Impact and Misconceptions



  • The relationship between violent acts and schizophrenia is a contentious topic.
  • One survey found that 61% of Americans judged individuals with schizophrenia as likely to commit an act of interpersonal violence, while only 17% thought such an act likely to be committed by a person described as "troubled".[4]
  • Research on violence indicates that the percentage of people with schizophrenia who commit violent acts is several times higher than the percentage of people without any disorder, but lower than is found for disorders such as alcoholism, and the difference is reduced or not found in same-neighbourhood comparisons when related factors are taken into account, notably sociodemographic variables and substance misuse.[5][6][7][8][9]
  • Studies have indicated that 5 to 10% of those charged with murder in Western countries have a schizophrenia spectrum disorder.[10][11][12]
  • The occurrence of psychosis in schizophrenia has sometimes been linked to a higher risk of violent acts. Findings on the specific role of delusions or hallucinations have been inconsistent, but have focused on delusional jealousy, perception of threat and command hallucinations.
  • It has been proposed that a certain type of individual with schizophrenia may be most likely to offend, characterized by a history of educational difficulties, low IQ, conduct disorder, early-onset substance misuse and offending prior to diagnosis.[10]

Diagnostic Issues and Controversies

  • Schizophrenia as a diagnostic entity has been criticized as lacking in scientific validity or reliability, part of a larger criticism of the validity of psychiatric diagnoses in general.[19][20]
  • One alternative suggests that the issues with the diagnosis would be better addressed as individual dimensions along which everyone varies, such that there is a spectrum or continuum rather than a cut-off between normal and ill.
  • This approach appears consistent with research on schizotypy and of a relatively high prevalence of psychotic experiences[21][22] and often non-distressing delusional beliefs[23] amongst the general public.[24]
  • Another criticism is that the definitions used for criteria lack consistency; this is particularly relevant to the evaluation of delusions and thought disorder.[25]
  • More recently, it has been argued that psychotic symptoms are not a good basis for making a diagnosis of schizophrenia as "psychosis is the 'fever' of mental illness — a serious but nonspecific indicator".[26]


  1. American Psychiatric Association. Americans Still Cling to Myths About Mental Illness, Survey Finds. Psychiatric News. December 7, 2001 Volume 36 Number 23 Full text
  2. Gould, JE. (2006) Ethical Considerations in Medication-Free Research with Schizophrenia Patients: An Expert Interview with William T. Carpenter, Jr., M.D. Medscape Psychiatry & Mental Health 2006:11(2) Full text available
  3. Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S (1999). The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. American Journal of Public Health. Sep;89(9):1339–45. PMID 10474550
  4. Walsh E, Buchanan A, Fahy T (2002). Violence and schizophrenia: examining the evidence. British Journal of Psychiatry. 2002 Jun;180:490–5. PMID 12042226
  5. Stuart, H (2003). Violence and mental illness: an overview. World Psychiatry. June; 2(2): 121–124. PMID 16946914 Full text, Retrieved on 2007-05-17.
  6. Steadman HJ, Mulvey EP, Monahan J, et al (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry. May;55(5):393–401. PMID 9596041
  7. Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, et al (2006). A national study of violent behavior in persons with schizophrenia. Archives of General Psychiatry. May;63(5):490–9. PMID 16651506
  8. Swanson JW, Holzer CE, Ganju VK, Jono RT. (1990) Violence and Psychiatric Disorder in the Community: Evidence From the Epidemiologic Catchment Area Surveys Hosp Community Psychiatry 41:761-770, July 1990 PMID 2142118
  9. 10.0 10.1 Mullen PE (2006). Schizophrenia and violence: from correlations to preventive strategies. Advances in Psychiatric Treatment 12: 239–248. Full text available, Retrieved on 2007-05-17.
  10. Simpson AI, McKenna B, Moskowitz A, Skipworth J, Barry-Walsh J (2004). Homicide and mental illness in New Zealand, 1970–2000. British Journal of Psychiatry, 185, 394–8. PMID 15516547
  11. Fazel S, Grann M (2004). Psychiatric morbidity among homicide offenders: a Swedish population study. American Journal of Psychiatry, 161(11), 2129–31. PMID 15514419
  12. Brekke JS, Prindle C, Bae SW, Long JD (2001). Risks for individuals with schizophrenia who are living in the community. Psychiatric Services. Oct;52(10):1358–66. PMID 11585953
  13. Fitzgerald PB, de Castella AR, Filia KM, Filia SL, Benitez J, Kulkarni J (2005). Victimization of patients with schizophrenia and related disorders. Australia and New Zealand Journal of Psychiatry, 39(3), 169-74. (1), 187–9. PMID 15701066
  14. Walsh E, Gilvarry C, Samele C, et al (2004). Predicting violence in schizophrenia: a prospective study. Schizophrenia Research, 67(2–3), 247-52. PMID 14984884
  15. Solomon PL, Cavanaugh MM, Gelles RJ (2005). Family Violence among Adults with Severe Mental Illness. Trauma, Violence, & Abuse, Vol. 6, No. 1, 40–54. PMID 15574672Full text available.
  16. Chou KR, Lu RB, Chang M (2001). Assaultive behavior by psychiatric in-patients and its related factors. Journal of Nursing Research. Dec;9(5):139–51. PMID 11779087
  17. Logdberg B, Nilsson LL, Levander MT, Levander S (2004). Schizophrenia, neighbourhood, and crime. Acta Psychiatrica Scandinavica, 110(2) Page 92. PMID 15233709 Full text available, Retrieved on 2007-05-16
  18. Bentall RP (1992) Reconstructing Schizophrenia. London: Routledge. ISBN 0415075246
  19. Boyle M (2002) Schizophrenia: A Scientific Delusion?. London: Routledge. ISBN 0415227186
  20. Verdoux H, van Os J (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia Research, 54(1–2), 59–65. PMID 11853979
  21. LC, van Os J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21 (8),1125–41. PMID 11702510
  22. Peters ER, Day S, McKenna J, Orbach G(2005). Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). Schizophrenia Bulletin, 30, 1005–22. PMID 15954204
  23. Johns LC, van Os J (2001) The continuity of psychotic experiences in the general population. Clinical Psychology Review, 21 (8), 1125–41. PMID 11702510.
  24. David AS (1999) On the impossibility of defining delusions. Philosophy, Psychiatry and Psychology, 6 (1), 17–20
  25. Tsuang MT, Stone WS, Faraone SV (2000). Toward reformulating the diagnosis of schizophrenia. American Journal of Psychiatry, 157(7), 1041–1050. PMID 10873908
  26. Rosenhan D (1973). On being sane in insane places. Science, 179, 250-8. PMID 4683124Full text as PDF
  27. McGorry PD, Mihalopoulos C, Henry L, Dakis J, Jackson HJ, Flaum M, Harrigan S, McKenzie D, Kulkarni J, Karoly R (1995). Spurious precision: procedural validity of diagnostic assessment in psychotic disorders. American Journal of Psychiatry, 152 (2), 220–3. PMID 7840355
  28. Read J (2004) Does 'schizophrenia' exist? Reliability and validity. In Read J, Mosher LR, Bentall RP (eds) Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia. ISBN 1-58391-906-6
  29. Sato M (2004). Renaming schizophrenia: a Japanese perspective. World Psychiatry, 5(1), 53–5. PMID 16757998
  30. Schizophrenia term use 'invalid'. BBC News Online, (9 October 2006). Retrieved on 2007-05-16.
  31. Green MF (2001) Schizophrenia Revealed: From Neurons to Social Interactions. New York: W.W. Norton. ISBN 0393703347
  32. Wilkinson G (1986) Political dissent and "sluggish" schizophrenia in the Soviet Union. Br Med J (Clin Res Ed), 293(6548), 641-2. PMID 3092963
  33. Lyons D (2001). Soviet-style psychiatry is alive and well in the People's Republic. British Journal of Psychiatry, 178, 380–381. PMID 11282823

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