Schizophrenia Complications

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The major complications are to quality of life:

• An acute psychotic illness can be a terrifying experience - the hallucinations and delusions seem utterly real while they are being experienced.


• Social functions, such as being able to maintain personal relationships, ability to work and manage ones day-to-day life, are often seriously damaged.


• Suicide and self-harm are common in those with a diagnosis of schizophrenia: around 1 in 10 ultimately take their own life.


• Some of the drugs given to people with schizophrenia cause distressing side effects such as movement disorders, weight gain and sedation.

Complications of schizophrenia include:

• Inability to function independently


• Medication side effects:
  o Tardive dyskinesia


• Self-inflicted injury


• Suicide


• Violent behavior

Unemployment

Due to the complex nature of schizophrenia, many people with the condition have problems finding and keeping a job.

You may also be reluctant to re-enter the job market because you may fear that you would be unable to cope with the responsibility. However, most experts would recommend that you try to return to work as soon as possible because people with schizophrenia who continue to work tend to have a better quality of life compared with those who do not work.

If you feel ready and able to return to work you should ask to speak to an occupational therapist. An occupational therapist can help you to improve both your employment and social skills.

There are also a number of organisations that provide support, training and advice for people with schizophrenia who wish to continue working.

Your community mental health team is a good first point of contact to find out what services and support are available for you. Mental health charities such as Mind or Rethink are also an excellent source of information relating to training and employment.

SCHIZOPHRENIA COMPLICATIONS Abnormal fetal growth and development Obstetric Complications and Schizophrenia: Historical and Meta-Analytic Review Obstetric complications in women with schizophrenia Why Is It So Difficult to Study Obstetric Complications and Schizophrenia?

While you are looking for work, you may want to consider taking part in voluntary activities. Doing voluntary work is a good way of learning new skills and increasing your self-confidence.

Depression and suicide

Many people with schizophrenia experience periods of depression. You should not ignore these symptoms as, left untreated, depression can worsen and lead to suicidal thoughts.

Research has found that 30% of people with schizophrenia will attempt suicide at least once, and one in 10 people with schizophrenia will commit suicide.

If you find that you have been feeling particularly down over the last month and you no longer take pleasure in the things that you used to enjoy, you may be depressed. You should see your GP for advice and treatment.

You should immediately report any suicidal thoughts to your community mental health team.

The warning signs of suicide

The warning signs that can indicate that people with depression and schizophrenia are considering suicide are listed below.

* Making final arrangements - such as giving away possessions, making a will or saying goodbye to friends.
* Talking about death or suicide - this may be a direct statement such as, “I wish I was dead”. However, depressed people will often talk about the subject indirectly, using phrases such as “I think that dead people must be happier than us” or “wouldn’t it be nice to go to sleep and never wake up.”
* Self harm - such as cutting their arms or legs or burning themselves with cigarettes.
* A sudden lifting of mood - a sudden lift of mood could mean that a person has decided to commit suicide and feels better because of their decision.

Obstetric Complications in Schizophrenia

Although numerous studies have documented increased rates of obstetric complications in individuals who later became schizophrenic, the effect was small, many studies were methodologically weak, and meta-analyses showed bias against publication of negative findings. Two new studies that reexamined this issue in large cohorts report negative conclusions.

In the first study, researchers examined routinely recorded obstetric information about separate cohorts of 296 and 156 Scottish schizophrenics (birth years, 1971 to 1978) and matched controls; some schizophrenics had participated in an earlier study that had reported positive findings. However, in the present study, investigators found no evidence of higher rates for any pregnancy or delivery complication in schizophrenic participants, except for longer labor and increased cesarean sections.

In the second study, investigators compared labor and delivery records of 431 Irish schizophrenics diagnosed between 1972 and 1992 (representing 49 percent of the intended sample) with those of matched controls and found no overall differences in rate of labor and delivery complications. Schizophrenic males who sought psychiatric services before age 30 had more complications as well as higher rates of cesarean sections than did those who sought services after age 30.

Comment: In the first study, minor procedural differences and a longer follow-up reversed previous findings. However, the younger age (less than 27) in the first study (indicating that controls were not past the age of risk) and small enrollment in the second study are important limitations. The finding of increased cesarean sections in both studies is likely nonspecific because this procedure is determined by obstetricians’ judgment and only infrequently reflects serious complications. Two accompanying commentaries suggest that obstetric complications play no etiologic role in schizophrenia or that earlier positive findings were merely an effect of already maldeveloped fetuses and hence have limited significance. All authors recommend further meta-analyses of the better-designed studies to clarify this confusing issue.

— P Roy-Byrne

Published in Journal Watch Psychiatry July 18, 2000

Citation(s):
Kendell RE et al. Obstetric complications and schizophrenia: Two case-control studies based on structured obstetric records. Br J Psychiatry 2000 Jun 176 516-522.
Waddington JL. Commentary: Nature of obstetric complications in schizophrenia. Br J Psychiatry 2000 Jun 176 529-530.
Crow TJ. Commentary: Do obstetric complications really cause psychosis?. Why it matters. Br J Psychiatry 2000 Jun 176 527-529.
Byrne M et al. Labour and delivery complications and schizophrenia: Case-control study using contemporaneous labour ward records. Br J Psychiatry 2000 Jun 176 531-536.

RELATED STORIES:
Scientists propose new direction in the search for genetic causes of schizophrenia   Future directions: what type of research do we need?   The phenomena of schizophrenia   Antipsychotic treatment response and serum levels in men and women   Obstetric Complications and Schizophrenia: Historical and Meta-Analytic Review   Altered Brain Activity in Schizophrenia May Direct Focus on Self   Depression in the Course of Schizophrenia   Sociocultural Factors - Schizophrenia in African Americans   Pregnancy and prescribing antipsychotics   Schizophrenia-type illness linked to heart risk   Schizophrenia Epidemiology   The prevention of schizophrenia   Ethics of client-centered care in schizophrenia   Schizophrenia Neurobiological correlates   How do we determine if a treatment is working?

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