A Comparison of General Adult and Forensic Patients with Schizophrenia Living in the Community

Schizophrenia is associated with an elevated risk for violence. The response has been to incarcerate people with schizophrenia and to increase the number of forensic beds. Most of these beds are filled by men with schizophrenic disorders with long histories of offending and of treatment in general psychiatry. Outcome from forensic, as compared to general psychiatric services, is unknown. The present study compared outcome defined as levels of positive and negative symptoms, readmission, and aggressive behavior for 248 men with schizophrenic disorders (150 discharged from forensic hospitals and 98 from general adult wards) during a two-year period after discharge from forensic and general psychiatric services. Patients were intensively assessed at discharge and four times during the subsequent two years. Illicit drug use was assessed both objectively and by self-report. More of the forensic than the general patients had failed to complete high school, had displayed a stable pattern of antisocial behavior since at least mid-adolescence, and had convictions for non-violent and violent offences. At discharge and throughout the follow-up period, general patients displayed higher levels of positive and negative symptoms than forensic patients, and more of them engaged in aggressive behavior towards others. Aggressive behavior was associated with positive symptoms and Antisocial Personality Disorder. Rates of readmission were similar for the two groups. The forensic approach that includes assessing and managing the risk of violence as well as treating symptoms of schizophrenia led to better outcome than that of general psychiatry.