Violence Against Physicians by Patients With Schizophrenia: A Forensic Psychiatric Case Series

Violence toward healthcare professionals represents a critical challenge to clinical safety and the therapeutic alliance. 1lthough most individuals with schizophrenia are not violent, a small subgroup may commit severe acts when untreated psychosis and treatment non-adherence converge. 2We report five forensic cases involving male patients with schizophrenia who perpetrated homicide (n=2) or attempted homicide (n=3) against their treating physicians.These cases were reviewed as part of routinely collected clinical and legal records within the National Forensic Hospital; the Institutional Review Board approved this analysis and waived the requirement for written consent due to the retrospective design and the use of anonymized information (Approval No. 1-219577-AB-N-01-202503-BR-002-01).Across all cases, several shared clinical patterns were observed.The patients were single, unemployed, and had experienced long illness durations with repeated relapses.The most striking commonality was the presence of active persecutory delusions explicitly directed toward the physician or the treatment process.These delusions produced a total rupture of trust, transforming the physician-typically the core therapeutic figure-into a perceived persecutor.A second shared pattern was severe treatment non-adherence.Four of the five patients had discontinued medication or were receiving irregular treatment immediately before the offense.Despite the psychotic motivation, all cases showed elements of planning: acquiring a knife or blunt object in advance, choosing the timing of the attack, or waiting for a mo-