Psychiatric Bulletin (2006) 30: 254-256. doi: 10.1192/pb.30.7.254
© 2006 The Royal College of Psychiatrists
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Psychiatric Bulletin (2006) 30: 254-256
© 2006 The Royal College of Psychiatrists

Violence, stigma and psychiatric diagnosis: the effects of a history of violence on psychiatric diagnosis

Tom Clark, Consultant Forensic Psychiatrist and Honorary Senior Clinical Lecturer in Forensic Psychiatry

Reaside Clinic, Birmingham Great Park, Rubery, Birmingham B45 9BE, e-mail: thomas.clark{at}bsmht.nhs.uk

Renarta Rowe, Specialist Registrar in Forensic Psychiatry

Reaside Clinic, Birmingham

Declaration of interest

None.

AIMS AND METHOD

The aim of the study was to investigate whether psychiatrists consider that patients with schizophrenia present a greater risk of violence than patients with other forms of mental illness. Two pairs of clinical vignettes were devised. In each pair, one contained a history of violence and one did not. One vignette was mailed to each of 2000 consultant psychiatrists in the UK. Respondents were asked to give a preferred diagnosis. Rates of diagnosis of bipolar disorder, schizoaffective disorder and schizophrenia were compared within vignette pairs.

RESULTS

For each pair of vignettes, the rate of diagnosis of schizophrenia was higher (33 v. 21.5%, P=0.008 and 44.4 v. 32.1%, P=0.011), and the rate of diagnosis of bipolar disorder was lower (44.2 v. 62.6%, P<0.0005 and 34.9 v. 49.3%, P=0.004), among those who received the vignette containing a history of violence.

CLINICAL IMPLICATIONS

A history of violence may lead to an increased likelihood of receiving a diagnosis of schizophrenia as opposed to bipolar affective disorder. This bias in diagnostic decision-making may affect the treatment received by a patient and may perpetuate and exacerbate the stigma associated with a diagnosis of schizophrenia.




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Adv. Psychiatr. Treat., July 1, 2009; 15(4): 263 - 270.
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