Complications

Schizophrenia has a devastating effect on all aspects of human thought, emotion, and expression. Only about 20% of patients reach full recovery after a first episode, but new drugs are offering significant hope for improving quality of life.

Medical Illnesses

Studies in 2002 reported that people with severe mental illnesses suffer more from serious health problems than those without mental disorders and they are less likely to receive medical help. Substance abuse is a significant factor in this higher risk. Research has suggested an increased risk of diabetes among people with schizophrenia. In addition, many new antipsychotic medications can elevate blood sugar levels. Patients taking atypical antipsychotics drugs such as clozapine, olanzapine, risperidone, aripiprazole, quetiapine fumarate, and ziprasidone should receive a baseline blood sugar level reading and be monitored for any increases in blood sugar levels. (See “Adverse Effects of Atypicals” in Medications section.)

Depression

Depression is common later in adulthood. Although such a mood disorder can certainly be a result of the negative social impact of schizophrenia, some experts believe that depression is part of the disease process itself.

Effect on Social Status

Studies indicate that after 20 - 30 years, half of patients are able to care for themselves, work, and participate socially. Support services and appropriate housing improve this outcome. Unsurprisingly, the decline in status, including the inability to earn a living, is less steep when there are more financial resources and fewer emotional disorders at the outset of symptoms. Also, on average, the later the onset of the disease, the milder the social impact. The long-term effects on work and relationships, however, are usually severe and difficult to repair, even if symptoms improve.

Effect on Intelligence

In one study, about half of patients experienced some decline in IQ (10 points or more), but intelligence scores remained the same in the other half. Experts believe that a decline in IQ reflects early nerve damage but that it is not an inevitable consequence of the disease process.

Suicide and Self-Destructive Behaviors

In spite of the sometimes frightening behavior, people with schizophrenia are no more likely to behave violently than are those in the general population. In fact, these patients are more apt to withdraw from others or to harm themselves.

Suicide. Between 20 - 50% of patients with schizophrenia attempt suicide, and an estimated 9 - 13% commit suicide.

• Within the first 5 years of onset of the disease
• During the first 6 months after hospitalization
• Following an acute psychotic episode

The widespread use of antipsychotic drugs over the past decade does not appear to have had much effect on suicide rates. In fact, evidence suggests that the use of these drugs as a way of reducing hospitalization time is increasing the incidence of suicide. Hopelessness, not delusions, appears to be the most important motive for suicide in these patients. In one study of patients who had attempted suicide, the most frequent reason given for an attempt was depression, and the second was the loss of an intimate partner. Cognitive impairment, which reduces the patient's ability to hold jobs and function normally, also seems to be a major factor in suicidal motivation.

Smoking and Other Addictions. Most people with schizophrenia abuse nicotine, alcohol, and other substances. Substance abuse, in addition to its other adverse effects, increases non-compliance with antipsychotic drugs in the schizophrenic patient and may exacerbate symptoms.

Smoking is of special interest. According to a 2000 study, up to 88% of schizophrenic patients are nicotine dependent. Biologic and genetic factors may be partially responsible for the addiction in this particular group. Nicotine helps reduce psychotic symptoms and impulsivity, perhaps by inhibiting the activity of a protein called monoamine oxidase B (MAO- B), which is linked to improved mood and possibly to nerve protection. Smoking for schizophrenics, then, may be a form of self-medication. Although attempts to help schizophrenic patients quit smoking usually fail, those taking atypical medications may have a better chance of quitting successfully than those taking typical medications. The use of bupropion and therapeutic administration of nicotine may also help.

Effect on Family Members

Family members suffer from grief, long-term guilt, and many emotional issues when faced with a schizophrenic loved one. If such patients commit suicide, which is not uncommon, the effects can be devastating.

Lack of Social and Government Support

In the 1970s, tens of thousands of patients were put on antipsychotic drugs and released from institutions into the community, a concept called deinstitutionalization. In spite of these attempts to reduce mental hospital costs, schizophrenia still accounts for 40% of all long-term hospitalization days. More than half of patients with schizophrenia require public assistance within a year of their reentry into the community.

Review Date: 12/21/2006
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

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