Societal Costs of Non-Adherence in Schizophrenia: Homicide/Suicide

Reichhart T, Kissling W; Societal Costs of Non-Adherence in Schizophrenia: Homicide/Suicide. Mind & Brain, the Journal of Psychiatry, August  2010; 1(2):  29-32

REVIEW ARTICLE


Tatjana Reichhart and Werner Kissling

Affiliation : Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der lsar, Technische Universität München, Möhlstrasse 26, 81675 München, Germany

ABSTRACT

The long-term management of schizophrenia poses a major public health challenge. The case for integrating multiple therapeutic approaches and modalities is clear, especially with the issues faced by schizophrenia patients in terms of suicide, homicide, and violent behavior. This non-systematic review of published literature about this topic shows that schizophrenia and other psychoses are associated with violence and violent offending, particularly homicide. Most of the excess risk appears to be mediated by substance abuse comorbidity. The risk in these patients with comorbidity is similar to that for substance abuse without psychosis, and schizophrenia patients who adhere to prescribed medication are no more likely than the general population to commit violent crimes, unless drugs and alcohol are involved. Suicide is the leading cause of death in patients with schizophrenia—the rate of committed suicide in patients with schizophrenia is approximately 10%. Poor adherence to medication has been shown to be a risk factor for completed suicide in schizophrenia. Long-acting medications delivered using depot method may be one approach to improving adherence to medication and thus reducing the risk of suicide and violent behavior in patients with schizophrenia.

Keywords: schizophrenia, adherence, violence, homicide, suicide, long-acting medication
Correspondence: Werner Kissling, Leiter des Centrums für Disease Management, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Möhlstrasse 26, 81675 München, Germany. Tel: 0049/(0)89/4140-4207; Fax: 0049/(0)89/4140-4894; e-mail:W.Kissling@lrz.tu-muenchen.de