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The first step to addressing persistent aggression in patients with schizophrenia spectrum disorders is to categorize the nature of the aggression to help inform the approach to treatment strategies . There is evidence that understanding violence as a dimension of psychiatric illness, by identifying the underlying etiology, is an effective approach to treatment [2–4]. Based on studies within the New York and California State Hospital Systems [2, 3], three categories of aggression can be utilized to help focus treatment: psychotic, impulsive and predatory (also called organized or instrumental.)