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Pharmacological treatment of violence in schizophrenia

Published online by Cambridge University Press:  25 July 2019

Martin T. Strassnig
Department of Psychiatry, University of Miami, Miami, FL, USA
Vanessa Nascimento
University of Miami, Miller School of Medicine, Miami, FL, USA
Elizabeth Deckler
University of Miami, Miller School of Medicine, Miami, FL, USA
Philip D. Harvey
Department of Psychiatry, University of Miami, Miami, FL, USA Bruce W. Carter VA Medical Center, Miami, FL, USA.
E-mail address:


Chronic aggression and violence in schizophrenia are rare, but receive disproportionate negative media coverage. This contributes to the stigma of mental illness and reduces accessibility to mental health services. Substance Use Disorders (SUD), antisocial behavior, non-adherence and recidivism are known risk factors for violence. Treatment with antipsychotic medication can reduce violence. Aside from clozapine, long-acting injectable antipsychotics (LAI) appear to be superior to oral antipsychotics for preventing violence, addressing adherence and recidivism. LAI also facilitate the implementation of functional skills training. For the high-risk recidivist target population with schizophrenia, better life skills have the potential to also reduce the risk for contact with the legal system, including an improved ability to live independently in supported environments and interact appropriately with others. High-risk patients who are resistant to treatment with other antipsychotics should receive treatment with clozapine due to its direct positive effects on impulsive violence, along with a reduction in comorbid risk factors such as SUDs.

© Cambridge University Press 2019

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