" Our lives begin to end when we remain silent about things that matter "
... Dr Martin Luther King
M ental I llness Concerns All carers


' wishful thinking is the enemy of truth '

Risk assessment.... using HCR 20


Jeffrey W. Swanson, Marvin S. Swartz, Richard A. Van Dorn, Jan Volavka, John Monahan, T. Scott Stroup, Joseph P. McEvoy, H. Ryan Wagner, Eric B. Elbogen, Jeffrey A. Lieberman the CATIE investigators Br J Psychiatry 2008 193: 37-43

To compare antipsychotic medications in reducing violence among patients with schizophrenia over 6 months, identify prospective predictors of violence and examine the impact of medication adherence on reduced violence.


Participants (n=1445) were randomly assigned to double-blinded treatment with one of five antipsychotic medications. Analyses are presented for the intention-to-treat sample and for patients completing 6 months on assigned medication.


.... Violence declined from 16% to 9% in the retained sample and from 19% to 14% in the intention-to-treat sample. No difference by medication group was found, except that perphenazine showed greater violence reduction than quetiapine in the retained sample. Medication adherence reduced violence, but not in patients with a history of childhood antisocial conduct.

Prospective predictors of violence included childhood conduct problems, substance use, victimisation, economic deprivation and living situation.

Negative psychotic symptoms predicted lower violence.


Newer antipsychotics did not reduce violence more than perphenazine. Effective antipsychotics are needed, but may not reduce violence that is unrelated to acute psychopathology.

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