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In Reply: Dr Smith and colleagues raise concerns that our longitudinal analyses may have underestimated the risk of violent crime in schizophrenia. Specifically, they suggest that the rate of violent crime in patients without comorbid substance abuse should be compared with individuals in the general population who are not substance abusers. We believe that this is a different question. Because substance abuse is highly prevalent¹ and possibly treatable in schizophrenia,² our approach has potentially important implications for psychiatric services and public health.

Nevertheless, when analyzing the data as suggested by Smith et al, the adjusted odds ratio is 1.6 (95% confidence interval, 1.4-1.8) for patients with schizophrenia who are not substance abusers compared with population controls who are not substance abusers. However, the sensitivity of register-based data on substance abuse diagnoses in the general population is likely to be worse than for schizophrenia since inpatient admissions (which are very common . . . [Full Text of this Article]

Seena Fazel, MD
seena.fazel@psych.ox.ac.uk
Department of Psychiatry
University of Oxford
Oxford, United England

Niklas Långström, MD, PhD; Paul Lichtenstein, PhD
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet
Stockholm, Sweden

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