Recurrent violent behavior following medication discontinuation in chronic schizophrenia: A longitudinal forensic case report

Violence associated with schizophrenia is typically restricted to a small proportion of patients experiencing acute psychosis, impaired insight, or abrupt discontinuation of antipsychotic medication. Longitudinal forensic cases demonstrating recurrent severe violence across multiple decades are rarely documented. This report describes a 48-year-old man with chronic schizophrenia who committed two major violent acts-spousal homicide and attempted parricide-each following abrupt cessation of antipsychotic medication. Despite long-term legal supervision under Article 57 of the Turkish Penal Code and continuous follow-up via a Community Mental Health Center, medication nonadherence triggered rapid psychotic relapse and targeted interpersonal violence. This multi-decade trajectory offers rare insight into the chronic and fluctuating nature of violence risk in schizophrenia. The case highlights system-level challenges in community-based adherence monitoring and emphasizes the essential role of long-acting injectable antipsychotics, dynamic risk assessment, and structured relapse-prevention strategies in forensic psychiatric populations. It contributes new understanding to an underrepresented area of forensic science by identifying a predictable but underrecognized mechanism of recurrent violence, demonstrating that long-term remission does not eliminate risk among high-liability individuals.