Risk issues associated with Schizophrenia - guide for carers and support coordinators

Schizophrenia is a complex condition that requires us to rethink “risk”: going beyond obvious and immediate issues such as self-harm, suicidality, and harm to others.

Physical health risks

Cardiovascular illnesses, cholesterol, obesity and obesity related cancers, and kidney failure due to a combination of antipsychotic medication, metabolic syndrome, increased sedentary living, poor nutrition and water intake (critical with the use of some antipsychotic medications) and high prevalence of smoking, contribute to the risk of physical health problems and reduced life expectancy in people with schizophrenia.

What symptoms of schizophrenia contribute to poor physical health outcomes?

Deficits in motivation, reduced goal-directed behaviours, apathy towards oneself and others, social withdrawal, and difficulties in daily problem solving and planning, affect one’s capacity to recognise physical health needs and plan routines to improve their health in a timely, consistent, and adequate manner.

Mental health risks

Mental illnesses often co-occur with schizophrenia either due to a genetic predisposition, early history of family dysfunction, trauma, or vulnerabilities associated with the onset of schizophrenia. These include anxiety disorders such as social anxiety, PTSD, generalised anxiety disorder, depression, OCD, substance abuse, and dementia.

Self-harm, suicidality, and harm to others or property

In people with schizophrenia, self-harm (non-suicidal intent) and suicidal ideation are more common than harm others or property destruction. Contributing factors include co-occurring depression, hopelessness, substance abuse, poor informal supports, inadequate treatment relative to symptom severity, history of self-harm or suicide attempts in the past, history of suicidality in family members, and poor emotion regulation skills.

What symptoms of schizophrenia contribute to declining mental health, self-injury and suicidality?

Distress caused by hallucinations and delusions, “commands” by voices to self-harm, deficits in emotional awareness and expression, and social withdrawal resulting in poor informal social supports and community engagement. Additionally, cognitive deficits in memory, attention, processing speed, processing others’ facial expressions and mental states, language processing, speech problems, and reduced judgement and insight result in functional decline and reduced capacity to seek and respond to supports.

Environmental risk and safety issues

Responding to emergency situations such as a fire alarm or property intrusion, noticing safety issues such as unlocked doors, steep stairs, pedestrian safety on the street, engaging in risky behaviours such as hazardous consumption of food or substances, wandering off at night, giving access to strangers, or not being aware of unsafe neighbourhoods are some common risk issues associated with schizophrenia.

Impaired attention to needs and support seeking

Responding to daily needs such as adequate stock of food, personal hygiene, nutrition and water intake, mobility, medication management, household cleaning, social interactions and community outings, seeking formal supports - such as seeing a psychologist, OT, physiotherapists, etc., may be impaired in people with schizophrenia, which can result in rapid functional decline, raise the frequency of severe psychotic episodes, raise the risk of harm from others (such as financial exploitation, harassment or assault), suicide risk, and lengthy hospitalisations.

What symptoms contribute to heightened environmental safety issues and impaired support seeking?

Significant apathy towards one’s needs, toward’s one’s surroundings, and diminished motivation and goal-directed behaviours are a key reasons for heightened environmental safety risks and impaired support seeking. Together with delusions of paranoia (if present), deficits in emotional awareness and expression, social withdrawal and isolation, as well as cognitive deficits noted earlier, difficulties recognising and articulating one’s needs and getting adequate support are commonly noted.

Managing risk factors thus requires regular monitoring, formal assessment, and instituting supports to prompt, plan, and execute risk management strategies.