More attention should be paid to schizophrenic patients with risk of violent offences


  • The manuscript is being submitted: general topics in psychiatry and related fields.

ASIGNIFICANT ASSOCIATION between schizophrenia and violent offences is suggested by some articles.1 Patients with schizophrenia are more likely to be violent than the general population.2 In particular, bizarre delusions are considered to be characteristic of schizophrenia related to aggressive behavior.3 This case confirms that bizarre delusions in a patient with chronic schizophrenia resulted in severe violence due to a lack of public attention. The patient and his legal guardians gave informed consent for publication.

The patient was a 57-year-old man who was arrested for abusing his prepubescent son and his psychiatric status was assessed in a forensic psychiatry institution. He had shown signs of abnormal behavior 12 years earlier. At that time, he threatened a neighbor with a knife during a bizarre delusion. His elder brother had considered sending him to a psychiatric hospital, but in the end the patient received no treatment due to economic reasons. From the time that he developed the disease, he began to drink a lot, and people imputed his abnormal actions to drunkenness. Nobody cared about his mental health condition until he cut off his son's penis on 1 January 2008. The loosening of his thoughts was obvious and his delusions were bizarre and well systemized when doctors met him. Results of physical, neurological, and laboratory investigations, including electroencephalography (EEG), were normal. Finally the patient was diagnosed as having schizophrenia according to the diagnostic criteria of the ICD-10 and he was sent to a high-security hospital.

At present, there are more than four million patients suffering schizophrenia in China. Although no epidemiological survey about the situation of crimes committed by these schizophrenic patients has been conducted, a survey carried out in our forensic psychiatric assessment institute, to some extent, revealed the serious situation. In the last ten years, we have met 1179 schizophrenic offenders. A total of 85.47% of them had committed violent offences at least once. These violent offences were often brutal, overt and of reduced selectiveness as to their target,4 and most of them were not diagnosed or treated in time. Also the assessment of these patients' aggression or violent offence risk was deficient. This condition is more serious in lower socio-economic groups. The Chinese populace's deficient knowledge about mental disorders, insufficient management of these dangerous patients, the heavy economic burden of mental disorders, and the fact that there is no Chinese Mental Health Law, are all possible reasons for this serious situation. It's time for Chinese scholars and the populace to pay more attention to schizophrenic patients who pose a risk of violent offences. Psychiatric services should be incorporated into primary health care; there should be increased investments in mental health; the Mental Health Law should be enacted speedily; and pilot studies estimating the risk factors for assault and predicting violence should be carried out.