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BMJ 2009; 338 doi: (Published 26 May 2009) Cite this as: BMJ 2009;338:b2124

Substance abuse explains much of the link between schizophrenia and violent crime

Although most violent crimes are committed by people without any history of mental illness, the fact remains that adults with schizophrenia are statistically more likely than other adults to commit violent crime. Some commentators blame this link for the enduring stigma surrounding schizophrenia. Research from Sweden now suggests that the association between schizophrenia and violent crime is largely confined to those patients who also have a history of substance misuse. The authors hope this finding will help target assessments, treatment, and prevention at high risk individuals and relieve the stigma for others.

Their analysis of 30 years of longitudinal data from three national registers found that adults with schizophrenia were twice as likely to have committed a violent crime compared with adults in the general population (13.2% v 5.3%; adjusted odds ratio 2.0, 95% CI 1.8 to 2.2). The association was much stronger among adults with schizophrenia and a history of substance misuse (4.4, 3.9 to 5.0) and was much weaker, even minimal, for adults with schizophrenia alone (1.2, 1.1 to 1.4).

The authors also compared patients who had schizophrenia with their unaffected siblings. The association of schizophrenia with violent crime was still significant but was weaker than before (1.8, 1.4 to 2.4), which suggests that a common familial factor (genetic or environmental) links schizophrenia, substance misuse, and violent crime.

Splint improves symptoms of osteoarthritis at the base of the thumb

A custom made neoprene splint can reduce pain and disability in adults with osteoarthritis at the base of thumb, according to a small French trial. The 112 patients in the trial were fitted with the rigid splint, worn at night, or treated with usual care at two specialist hospitals. Those wearing the splint showed no notable improvement after a month, but after a year they reported significantly greater reductions in pain scores than controls (mean change –22.2 v –7.9 on …

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