Violence and substance abuse in psychotic patients: A forensic psychiatric perspective

In this chapter, a forensic psychiatric perspective on violent behaviour and substance abuse in psychotic patients will be described. First of all, the prevalence of substance abuse in schizophrenia and other psychotic disorders will be discussed. Next, some clinically important issues will be highlighted, such as the relationship between substance abuse and violence in psychotic disorders, and the impact of the type of substance on violent behaviour. Co-morbidity of substance abuse and a personality disorder in psychotic offenders will be discussed. Psychiatric services tend to separate mental illness and addiction services, despite evidence that more than half of the patients with a psychotic disorder have problems with alcohol and drug use and dependence. That is why substance abusing forensic patients need special attention. This could be achieved by joined-up working together between forensic and addiction services, and by further broadening forensic psychiatry training to include specialism in substance abuse, and vice versa. Finally we will summarize treatment possibilities. In conclusion, substance abuse has an aggravating effect on criminogenic behaviour, depending on the age at first conviction and the diagnosis.

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