The relationship between schizophrenia and violence Plea for a differentiated psychopathological approach in the era of evidence-based medicine

摘要

The relationship between schizophrenia and violence with its substantial implications for the care of the severely mentally ill is one major reason for the special position of psychiatry. Due to the unique complexity of the human brain psychiatry was able to catch up with all other medical disciplines as late as the second half of the twentieth century only by means of the progress in biological brain research and psychopharmacology. At the same time the position of psychopathology has substantially changed. Being one of the core research issues until the introduction of antipsychotic drugs, it is nowadays primarily understood as a mere auxiliary tool for communication, for the collection of administrative data and for the recruitment of patients for various research projects. After a short overview of the current knowledge concerning the association between schizophrenia and violence the authors demonstrate by means of two psychopathological models, the differentiated classification according to Leonhard and the concept of structural dynamics by Janzarik, that many of the findings of current brain research are compatible with these models, exclusively based on detailed psychopathological observations. Differentiated psychopathology plays an indispensable mediator role between biological brain research methods and the complex reality of human behaviour, which is of major importance especially in forensic psychiatric issues. By neglecting this fact psychiatry is in danger of abandoning the possibility to generate relevant questions and hypotheses for future research.