Associated Risks
Associated Risks
Introduction
There are a number of risks associated with schizophrenia and the medications that are used to treat this illness. People with schizophrenia experience an increased risk of experiencing the following:
Academic Performance and Achievement
People with schizophrenia tend to demonstrate poor academic performance which in turn, limits academic achievement.
AIDS and HIV
Sufferers of this disease have a 4-23% higher incidence of being HIV positive or of developing AIDS (Acquired Immunodeficiency Syndrome).1 This increases risk has been attributed to unsafe sex practices, the use of IV (intravenous) drugs and non-intravenous drug use. The latter is probably related to compromised immune system functioning in substance abusers.
Cancer
People with schizophrenia are more likely to develop cancer, but have a 50% lower chance of surviving. Women with schizophrenia experience an increased risk for breast cancer. Men experience a reduced risk for lung cancer.1
Cardiac Effects
Antipsychotic medications may produce prolonged QT and QRS intervals evident in ECG (electrocardiogram) tracings. Prolonged QT interval have been associated with Torsade de Pointes Syndrome, a potentially dangerous arrythmia.
Diabetes (Type II) and Insulin Resistance
Individuals diagnosed with this illness have an increased risk for Type II Diabetes simply due to having Schizophrenia; but also due to obesity and to an increased risk from some antipsychotic drugs that is independent of diagnosis and obesity.
Diet
They tend to have poor diets. This is complicated by poverty and impaired judgement regarding food choices.
Glaucoma
Heart Disease
People with schizophrenia have an increased risk for ischemic heart disease and myocardial infarction (heart attacks), as well as cardiac arrhythmias (irregular heart beats).
Hepatitis C
They are more likely to contract this type of hepatitis.
Hyperlipidemia
Increased serum lipids (fats).
Hyperthermia
Antipsychotic medications can cause hyperthermia by impairing heat regulation. Patients taking these drugs should avoid overexertion in hot or humid weather and should seek out cooler environments and consume plenty of fluids.
Life Expectancy
They tend to have shorter life spans, in part due to a higher rate of suicide and poor physical health, which is complicated by reduced exercise and poor medical care. Suicide accounts for less than one third of the total reduction.1
Metabolic Syndrome X
This is the constellation of obesity, insulin resistance, dyslipidemia (abnormal serum lipids), impaired glucose tolerance, and hypertension. It is more likely to occur in people with schizophrenia and appears to be related to antipsychotic medications, especially atypical antipsychotics.
Physical Illnesses
There is a high incidence of comorbidity (the coexistence of Schizophrenia with medical illnesses), but the detection rate is poor. Schizophrenia has been described as a “life-shortening disease”, and physical comorbidity accounts for 60% of premature deaths not related to suicide.
People with schizophrenia have a higher rate of preventable risk factors such as smoking, high alcohol consumption, poor diet, and lack of exercise (complicated by psychotropic medication side effects such as parkinsonism, sedation, and antipsychotic induced cognitive deficits.
Recognition and management of morbidity in people with mental illness are made more difficult by barriers related to the patient, the illness, the attitudes of medical practitioners, and the structure of healthcare delivery services. Improved detection and treatment of medical illness in people with schizophrenia will have significant benefits for their psychosocial functioning and overall quality of life.1
People with Schizophrenia have an increased incidence of irritable bowel syndrome when compared to the general population (19% vs 2.5%).1
Helicobacter pylori (an organism that has been associated with peptic ulcers and gastritis) infections are three times higher.1
Movement Disorders
These include TD (Tardive Dyskinesia), dystonias, and Parkinsonism. Dystonia are more likely to involve muscles of the neck (torticollis), face, tongue (opisthotonas) and other muscle groups of the mouth. They include oculogyric crisis.
Neuroleptic Malignant Syndrome
Neuroleptic Malignant Syndrome has been associated with the use of antipsychotic medications.
Obesity
40-60% people with schizophrenia are obese or overweight.1
Poverty
Prolactin Related Risks
Antipsychotics increase prolactin leading to galactorrhea, dysmenorrhea, amenorrhea, oligomenorrhea, gynecomastia, osteoporosis, and sexual dysfunction.
The increased osteoporosis risk is related to antipsychotic medications reducing estrogen and testosterone, reduced calcium due to smoking and alcoholism, and polydipsia (the excessive consumption of water).
Psychiatric Disorders
Depression, anxiety, and substance abuse disorders.
Respiratory Depression
Respiratory depression and hypoxia (excessively low levels of oxygen in the blood) and aspiration (inhalation) of gastric contents, which can lead to serious pneumonia, has been noted with the use of antipsychotics in children and in instances of mixed overdose (overdoses that include antipsychotic and other drugs).
Seizures
Antipsychotic medications can lower the seizure threshold (make it easier for seizures to occur).
Substance Abuse
This includes tobacco products, alcohol, and other drugs. Tobacco use leads to respiratory illnesses, ischemic heart disease, stroke, and reduces plasma levels of antipsychotic medications.
Suicide and Self Harm
Suicide accounts for less than 1/3 of premature deaths.1 Self harm includes overdoses, cutting, burning, and bruising.
Symptoms
They experience an increased risk for poor reality testing, intellectual impairment, diminished insight, poor judgement, institutional care, social isolation, apathy, delusions, hallucinations, disorganized or bizarre behavior, and impaired communication (both verbal and emotional). These are symptoms of the illness or consequences of symptoms.
Tumors
There seems to be a small risk for benign (non-cancerous) pituitary tumors associated with antipsychotics medications.2
Unemployment
Due to symptoms that are often quite disabling, people with Schizophrenia are likely to face unemployment continuously or at least periodically during the course of this illness.
1Timothy J R Lambert, Dennis Velakoulis and Christos Pantelis MJA (Medical Journal of Australia) 2003; 178 (9) Suppl May: S67-S70
2Szarfman A, Doraiswamy P, et al, Pharmacotherapy 2006; June 02
(Sources: The author’s knowledge base, unless otherwise noted.)
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