The belief that people suffering from psychiatric disorders are more violent, in particular psychotic patients that do not have insight into their illness, is very common in the general population. Therefore, this review aimed to present a more accurate depiction of the link between lack of insight and violent behavior, by evaluating the existing scientific literature on the topic. For this purpose, a literature search on PubMed, Embase, and Google Scholar was conducted, selecting the relevant papers published during a 20-year period (2004–2024). The paper defined insight as a multi-dimensional concept and discussed its classification, explanatory models, and clinical implications, followed by a presentation of several insight-measuring scales. The meaning of violent behavior, its prevalence, underlying mechanisms, and different measuring scales were discussed, followed by the confounding factors that influence the relationship between insight and violent behavior, treatment options for violence in forensic psychiatry settings, and methods to improve medication adherence. Contrasting results were observed regarding the impact of each factor on leading to violent acts, which suggested that the relationship between insight and violence is more complex than previously thought. In conclusion, increased attention must be paid to the investigated dimensions of both the concepts and the confounding factors, with further research required on this topic.

There is an increased stigma in Romania regarding schizophrenia patients, who are thought to be violent and dangerous. However, there is little research on this topic that analyzes the exact risk of aggressive behavior, especially considering the high prevalence of alcohol and substance abuse, conditions also associated with a potential risk of violent behavior. The objectives of this study were to compare aggressivity levels between patients with schizophrenia admitted to an emergency hospital and healthy individuals and to find possible risk factors. This case-control study, matched for age and gender included 50 patients hospitalized for schizophrenia and 50 healthy participants from an emergency psychiatric facility in Romania. We collected demographic data and screened for major mental disorders using the Mini International Neuropsychiatric Interview (MINI). Aggressivity levels were measured with the Buss-Perry Aggression Questionnaire (BPAQ). The CAGE questionnaire and the Drug Abuse Screening Test (DAST-10) were used to screen for alcohol and substance use disorder. The results highlighted a 3.93 times increase in aggressivity in the schizophrenia group, with the involvement of specific violent domains. Younger men with alcohol abuse had a higher risk of violent acts. Schizophrenia patients appear to present an increased risk of violence, but this must be carefully assessed and confounders considered. Public health programs are needed to increase treatment compliance and decrease alcohol and other psychoactive substances consumption.