Introduction

Behaviors Associated with Schizophrenia

There are several types of behaviors that are highly associated with schizophrenia, including:

  • Suicide
  • Substance abuse
  • Smoking
  • Violence or aggression

Suicide

Schizophrenic patients, both male and female, have a higher rate of attempted and completed suicide than the general population. According to the National Institutes of Mental Health, approximately 10% of those who attempt suicide succeed. The risk of suicide is highest in the early years of schizophrenia but the elevated risk continues throughout the lifetime of the patient. Data from a study of suicide and schizophrenia showed that following the first psychotic episode, 11% of the subjects with schizophrenia attempted suicide. Approximately 50% of patients attempt suicide within 10 years of the first psychotic episode. The major risk factors for suicide in patients with schizophrenia include:

  • Severity of psychotic symptoms
  • Presence of persecutory delusions (someone is out to get them), auditory hallucinations (hearing voices), paranoia, or hallucinations
  • Prior suicidal attempts
  • Depressive symptoms or depression
  • Panic attacks or symptoms of anxiety
  • Poor compliance with treatment
  • High cognitive functioning before onset of schizophrenia
  • Substance abuse
  • Multiple brief hospitalizations
  • Significant stress
  • Poor support system (family, professionals)
  • Drug induced akathisia (inner restlessness that manifests itself as restlessness of the arms and legs)
  • Greater insight into the nature of schizophrenia and resulting difficulties

It is important to control psychosis and depression in order to reduce the risk of attempted suicide. Low self-esteem and the feeling of being a misfit are significant contributors to post-psychotic depression so that addressing these issues as early as possible helps reduce the risk of suicide.

Substance Abuse

People with schizophrenia abuse alcohol and drugs more than the general population, although the abuse itself is not known to cause schizophrenia. Substance abuse can interfere with drugs used to treat schizophrenia and the use of stimulants such as cocaine or amphetamines can actually exacerbate the condition. In addition, substance abuse reduces the probability of patient's following their treatment plan which, in turn, affects the severity of the symptoms. A history of substance abuse also elevates the risk of attempted suicide.

Smoking

According to the National Institutes of Mental Health, approximately 75-95% of schizophrenic patients smoke, a rate which is three times that of the general population. Patients with schizophrenia appear almost as if they are driven to smoke, leading some researchers to investigate whether there is a biological need for nicotine in schizophrenics. A major concern about this relationship of nicotine and schizophrenia is that in addition to the general health risks related to smoking, it also interferes with the effects of antipsychotic drugs. As a result, the dose of medication for effective treatment of schizophrenic symptoms in some patients may need to be raised.

The relationship between schizophrenia and smoking may be so complex that some investigators think that smoking cessation may be particularly difficult for people with schizophrenia and may actually cause a temporary exacerbation of psychotic symptoms. As a result, alternative strategies for smoking cessation must be implemented for patients with schizophrenia, such as nicotine replacement methods. Patients must be carefully monitored by their physicians for any changes in behavior or any indication of psychotic symptoms. For this reason, it is very important for the patient with schizophrenia to inform their doctor if they are beginning to smoke or if they are attempting to stop smoking.

Violence or Aggression

Studies have shown that if patients with schizophrenia were not violent before the onset of disease and were not substance abusers, they are unlikely to be violent after they develop schizophrenia. Schizophrenics are not typically violent and often prefer to be left alone. The most common violence is self-inflicted, resulting in suicide or attempted suicide. However, if a patient does become violent, the violence is most likely to be directed against a victim known to the patient and often takes place at home where it is directed towards a family member. The reason for this is not clear but may be due to the patient seeing the caregivers as enemies because they enforce rules and are perceived as authority figures.

Predictors of violence in schizophrenics include:

  • History of past violence
  • Drug/alcohol abuse
  • Male gender
  • Poverty
  • Unskilled
  • Uneducated
  • Unmarried
  • Failure to take medications
  • Paranoid schizophrenia with specific types of hallucinations where voices tell the patient what to do
  • Presence of depression - a study by the American Psychiatric Association showed that the risk of violence is 6-7 times higher among patients suffering from both depression and schizophrenia.