Schizophrenia is associated with severe consequences

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"documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Psiquiatr Biol . 2023;30:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Review Article" "titulo" => "Respiratory depression caused by low dose of olanzapine: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Depresión respiratoria causada por dosis baja de Olanzapina: informe de un caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Masatoshi Inoue" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Masatoshi" "apellidos" => "Inoue" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134593423000210?idApp=UINPBA00004N" "url" => "/11345934/0000003000000002/v1_202310012033/S1134593423000210/v1_202310012033/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "Review Article" "titulo" => "Schizophrenia is associated with severe consequences" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Kalyani Rajalingham" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Kalyani" "apellidos" => "Rajalingham" "email" => array:1 [ 0 => "kalyani.rajalingham@mail.mcgill.ca" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cr0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "MSc Biology, GD Biotechnology and Genomics, GD Medicine Clinical Research, Concordia University, Department of Biology, 7141 Sherbrooke St W, Montreal, Quebec H4B 1R6, Canada" "identificador" => "af0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: 8518 Stuart Ave., Montreal H3N 2S5, Quebec, Canada." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asociación de la esquizofrenia con consecuencias graves" ] ] "textoCompleto" => "IntroductionSchizophrenia, one of the major causes of impairment, is a debilitating disease accompanied by a number of serious symptoms such as hallucinations, delusions, and disordered thinking. In fact, the lifetime prevalence of schizophrenia is approximately 1%—that's 1 in 100—and approximately 50% of individuals confined in hospitals for mental care have a diagnosis of schizophrenia.<a class="elsevierStyleCrossRef" href="#bb0005">1</a>,<a class="elsevierStyleCrossRef" href="#bb0010">2</a> The average age of onset for schizophrenia in males is late adolescence or early 20s while in females, the average age of onset is 20s or 30s.<a class="elsevierStyleCrossRef" href="#bb0015">3</a> Further, the prevalence rate of schizophrenia in males is higher than that of females.<a class="elsevierStyleCrossRef" href="#bb0015">3</a> Schizophrenia develops without regard to race, or ethnicity.<a class="elsevierStyleCrossRef" href="#bb0015">3</a> It's associated with a cost of $150 billion annually in the United States of America alone. It's an illness that is both incurable and permanent.Schizophrenia is associated with positive, negative, and cognitive symptoms. And this, we assume is the extent of the illness when it comes to symptoms and complications. However, it is not. What is notable is that schizophrenia individuals are significantly different from their healthy counterparts, and this from childhood onwards. For example, adult schizophrenia individuals tend to have a lower IQ in childhood when compared to their healthy counterparts.<a class="elsevierStyleCrossRef" href="#bb0020">4</a> The mere fact of having the disease implies certain “consequences” to the schizophrenia individual. In this paper, I will review that various severe consequences of having schizophrenia as they need to be addressed by healthcare professionals.Metabolic syndromeMost individuals who are diagnosed with schizophrenia are prescribed anti-psychotic drugs. The main side effect of said drugs is increased appetite and weight gain. Anti-psychotics have been shown to cause an average weight gain of 4.45 kg in clozapine, 4.15 kg in olanzapine, 2.92 kg in sertindole, and 2.10 kg in risperidone over a period of 10 weeks or 2.5 months.<a class="elsevierStyleCrossRef" href="#bb0025">5</a> In fact, almost every anti-psychotic is associated with weight gain over time; in anti-psychotic naive patients, this weight gain is more pronounced.<a class="elsevierStyleCrossRef" href="#bb0030">6</a>,<a class="elsevierStyleCrossRef" href="#bb0035">7</a> In the short-term (less than 12 weeks), anti-psychotics were found to cause a weight gain of approximately 3.22 kg (7.1 lbs) while in the long-term (more than 12 weeks), anti-psychotics were found to cause a weight gain of 5.30 kg (11.7 lbs) in individuals with first episode psychosis; olanzapine and clozapine were found to cause the highest weight gain.<a class="elsevierStyleCrossRef" href="#bb0040">8</a> Further, schizophrenia individuals tend to have unhealthy lifestyles—they eat a lot more fat and sugar, smoke, and lead a sedentary lifestyle which considerably increases the chances of gaining weight. Weight gain, in turn, substantially increases the chances of developing metabolic syndrome.Metabolic syndrome (MetS) is a combination of risk factors that substantially increases the probability of developing heart diseases, stroke, and type 2 diabetes. There are many ways of defining metabolic syndrome (WHO, EGIR, NCEP:ATPIII, AACE, and IDF). A diagnosis of metabolic syndrome is given if at least 3 of the following 5 criteria are present in an individual<a class="elsevierStyleCrossRef" href="#bb0045">9</a>:<ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="li0005">(i)Waist Circumference of >40 in. for men, >35 in. for women.</li><li class="elsevierStyleListItem" id="li0010">(ii)Triglycerides ≥150 mg/dl.</li><li class="elsevierStyleListItem" id="li0015">(iii)HDL-C: <40 mg/dl for men, <50 mg/dl for women.</li><li class="elsevierStyleListItem" id="li0020">(iv)Blood Pressure ≥ 130/85 mmHg.</li><li class="elsevierStyleListItem" id="li0025">(v)Fasting Plasma Glucose ≥110 mg/dl.</li></ul>The likelihood of developing metabolic syndrome however varies with the anti-psychotic used—anti-psychotics that cause weight gain also have a higher likelihood of causing metabolic syndrome.<a class="elsevierStyleCrossRef" href="#bb0030">6</a>,<a class="elsevierStyleCrossRef" href="#bb0050">10</a>,<a class="elsevierStyleCrossRef" href="#bb0055">11</a> For instance, it is known that clozapine and olanzapine cause very high/severe weight gain; chlorpromazine, quetiapine, risperidone, and paliperidone cause moderate weight gain; aripriprazole, amisulpride, asenapine, haloperidol, ziprasidone, and lurasidone cause low weight gain.<a class="elsevierStyleCrossRef" href="#bb0060">12</a> Further, in one study, it was shown that schizophrenia individuals who were administered risperidone or clozapine therapy had a greater chance of developing metabolic syndrome than schizophrenia individuals who were administered aripriprazole.<a class="elsevierStyleCrossRef" href="#bb0065">13</a> Thus, the likelihood of metabolic syndrome with aripriprazole is low but weight gain is also low while with clozapine this likelihood is high and weight gain is also high. The risk of developing metabolic syndrome is ranked as follows: quetiapine≥clozapine≥paliperidone≥olanzapine≥risperidone≥haloperidol≥aripiprazole.<a class="elsevierStyleCrossRef" href="#bb0050">10</a>A dose-dependent relationship between metabolic outcomes and serum concentrations of clozapine and olanzapine has also been noted.<a class="elsevierStyleCrossRef" href="#bb0070">14</a> In one study, it was concluded that there exists a positive linear relationship between olanzapine level (ng/ml) and weight (kg), and between olanzapine level (ng/ml) and BMI in drug-naive schizophrenia patients.<a class="elsevierStyleCrossRef" href="#bb0075">15</a> Further, schizophrenia individuals exhibit higher prevalence of metabolic syndrome than non-schizophrenia individuals. In fact, studies show that individuals with schizophrenia on anti-psychotics are 2–4 times more likely to develop metabolic syndrome.<a class="elsevierStyleCrossRef" href="#bb0080">16</a> Further, studies show that the prevalence of metabolic syndrome in drug-naive schizophrenia patients is between 3% and 26% while that in patients using anti-psychotics can be up to 69%.<a class="elsevierStyleCrossRef" href="#bb0085">17</a> In one particular study on Palestinian schizophrenia individuals, it was concluded that the overall prevalence of metabolic syndrome was found to be 43.6% with a prevalence of 39% in males and 55.9% prevalence in females.<a class="elsevierStyleCrossRef" href="#bb0090">18</a> The latter indicates that the likelihood of metabolic syndrome is higher in women as compared to men. Some ethnic groups are also more susceptible to metabolic syndrome than others.Other factors have been noted to influence metabolic syndrome such as duration of illness. In one study, 4 cohorts of schizophrenia patients (group 1: with a duration of illness (DOI) of less than 1.5 years; group 2: with a DOI between 11.5 and 10 years, group 3: with a DOI of between 10 and 20 years, and group 4: with a DOI of more than 20 years) were examined; it was noted that metabolic syndrome increased as the duration of illness (DOI) increased.<a class="elsevierStyleCrossRef" href="#bb0095">19</a> In fact, the prevalence of metabolic syndrome when the duration of illness is less than 1.5 years is 17%, while the prevalence in those with a duration of illness of 20 years or more is 49%.<a class="elsevierStyleCrossRef" href="#bb0095">19</a> Yet another study demonstrated that schizophrenia individuals with metabolic syndrome had the illness (schizophrenia) for a longer period of time and were administered treatment for a longer period of time.<a class="elsevierStyleCrossRef" href="#bb0100">20</a> Further, not every single individual treated with clozapine or olanzapine develops metabolic syndrome, and therefore, it is thought that metabolic syndrome could also be due to underlying genetic components. A recent systematic review shows that the rs1414334 C allele of the HTR2C gene is linked to metabolic syndrome in schizophrenia individuals using second generation anti-psychotics in a large number of studies.<a class="elsevierStyleCrossRef" href="#bb0105">21</a>Overall, metabolic syndrome seems to be least likely in young drug-naive schizophrenia patients and is more likely to be seen in schizophrenia patients who are on medications long-term. Thus, for schizophrenia individuals, it would be important to educate them about metabolic syndrome. Due to the severity of metabolic syndrome, it would be wise to occasionally assess schizophrenia individuals for metabolic syndrome. This assessment should be more frequently done on patients on certain medications like olanzapine, and for those who have been on medication long-term.Early death and suicideSchizophrenia individuals have mortality rates that are 2–3 times greater than that seen in non-schizophrenia individuals.<a class="elsevierStyleCrossRef" href="#bb0110">22</a> In fact, schizophrenia individuals die approximately 15–20 years earlier than non-schizophrenia individuals. In a Finnish study, the mortality gap was found to be 25 years in 1996, and 22.5 years in 2006.<a class="elsevierStyleCrossRef" href="#bb0115">23</a> In a Belgian study, it was noted that the mortality ratio for male patients was 5.05 times greater than for healthy Belgians while for women patients, this mortality ratio was 5.63 times greater.<a class="elsevierStyleCrossRef" href="#bb0120">24</a> Further, the mortality rates are only increasing with time (not decreasing). In fact, it has been noted that this death rate has increased 5-fold between the years 1960 and 2005.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Further, early death in schizophrenia can be attributed to suicides, accidents, diseases, unhealthy lifestyles, inadequate medical care, and homelessness.<a class="elsevierStyleCrossRef" href="#bb0125">25</a>Suicide and accidentsSchizophrenia individuals are at a higher risk of suicide and accidents. Unnatural deaths which includes suicides, homicides, and accidents are believed to account for 20–25% of the deaths.<a class="elsevierStyleCrossRef" href="#bb0130">26</a> In fact, the risk of suicide is approximately 13 times higher in schizophrenia individuals as opposed to non-schizophrenia individuals.<a class="elsevierStyleCrossRef" href="#bb0135">27</a> Suicide alone accounts for 10% of all deaths in schizophrenia patients.<a class="elsevierStyleCrossRef" href="#bb0140">28</a> However, others argue that this rate is between 4% and 5%.<a class="elsevierStyleCrossRef" href="#bb0145">29</a> And at least 50% of schizophrenia patients will attempt to suicide within their lifetime; most schizophrenia individuals will attempt suicide within the first 10 years after onset of illness.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Most schizophrenia individuals commit suicide because of depression.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> The following risk factors increase the probability of suicide in schizophrenia individuals: younger age, being male, being unmarried, living alone, being unemployed, being intelligent, being highly educated, proper premorbid functioning, having high expectations, believing that life's expectations won't be met with, life events within the past 3 months, poor work functioning, and having access to weapons.<a class="elsevierStyleCrossRef" href="#bb0150">30</a>Accidental deaths, in one study, was shown to cause twice as many deaths as compared to suicide in schizophrenia patients.<a class="elsevierStyleCrossRef" href="#bb0155">31</a> It is thought that substance abuse plays a role in accidents in schizophrenia individuals.<a class="elsevierStyleCrossRef" href="#bb0160">32</a>As such, health professionals should routinely check for suicidal thoughts in schizophrenia patients. In particular, healthcare professionals should check for signs of depression in schizophrenia individuals. Healthcare professionals should note that those with the highest risk of suicide are those who relapse easily, don't respond to medication very well, know they're sick, are socially isolated, are hopeless, and who show a big discrepancy in function before and after the illness.<a class="elsevierStyleCrossRef" href="#bb0125">25</a>DiseasesDiseases are normal in individuals with schizophrenia. Schizophrenia individuals tend to have a higher prevalence of HIV infections, hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, obesity, diabetes, dental problems, and polydipsia when compared to non-schizophrenia individuals.<a class="elsevierStyleCrossRef" href="#bb0165">33</a><ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="li0030">(a)Dental problems: Oral health in general is less likely to be in a good state in those with schizophrenia. Schizophrenia individuals have a higher incidence of dental plaques and stones, loss of dentition (edentulism), caries, gingivitis, and periodontitis.<a class="elsevierStyleCrossRefs" href="#bb0170">34–37</a></li><li class="elsevierStyleListItem" id="li0035">(b)Polydipsia: Polydipsia is observed in 18% of schizophrenia individuals.<a class="elsevierStyleCrossRef" href="#bb0190">38</a></li><li class="elsevierStyleListItem" id="li0040">(c)Cancer: Schizophrenia individuals have a lower probability (24%) of being diagnosed with cancer; however, if they are diagnosed, they have a higher mortality rate (64%) after diagnosis.<a class="elsevierStyleCrossRef" href="#bb0195">39</a> In particular, a recent study showed that individuals with schizophrenia are more likely to die from breast, colon, and lung cancer.<a class="elsevierStyleCrossRef" href="#bb0200">40</a></li><li class="elsevierStyleListItem" id="li0045">(d)HIV/AIDS/Hepatitis C: One study found that individuals with mental illnesses such as schizophrenia displayed a higher risk of blood-borne viral infections (HIV, hepatitis B virus, and hepatitis C virus); the prevalence of HIV in mentally ill individuals was approximately 6% in the United States (the prevalence in the general population was 0.6% in the USA).<a class="elsevierStyleCrossRef" href="#bb0205">41</a></li><li class="elsevierStyleListItem" id="li0050">(e)Osteoporosis: Bone mineral density (BMD) was found to decrease in schizophrenia individuals; in particular, individuals with chronic schizophrenia have a high prevalence of osteoporosis with a bone mass distribution that is different from the normal population.<a class="elsevierStyleCrossRef" href="#bb0210">42</a>,<a class="elsevierStyleCrossRef" href="#bb0215">43</a> In particular, hip and vertebral fractures were found to be higher in schizophrenia individuals as opposed to non-schizophrenia individuals.<a class="elsevierStyleCrossRef" href="#bb0220">44</a> Bone density can be low in young individuals with schizophrenia; it is thought that osteoporosis in schizophrenia individuals is associated with polydipsia, neuroleptics use, hyperprolactinemia, smoking, bad diet, drug/alcohol abuse, and no exercise.<a class="elsevierStyleCrossRef" href="#bb0215">43</a> According to Lambert et al., osteoporosis in schizophrenia individuals is due to a decrease in estrogen and testosterone as a result of anti-psychotic administration, due to lowered calcium as a result of smoking and alcoholism, as well as polydipsia.<a class="elsevierStyleCrossRef" href="#bb0225">45</a> However, a more recent study shows that there's no difference in the bone mineral density of schizophrenia individuals taking clozapine and healthy controls; however, the same study found that schizophrenia individuals who were administered non-clozapine anti-psychotics lost bone mineral density within 1–3 years.<a class="elsevierStyleCrossRef" href="#bb0230">46</a></li><li class="elsevierStyleListItem" id="li0055">(f)Hyperprolactinemia: Hyperprolactinemia is commonly thought to be a side effect of anti-psychotic medications.<a class="elsevierStyleCrossRef" href="#bb0235">47</a> However, high prolactin levels were found in first-episode drug-naive psychotic individuals.<a class="elsevierStyleCrossRef" href="#bb0240">48</a> In fact, 77.8% of first-episode psychosis patients and 74.2% of recurrent psychosis patients were found to have hyperprolactinemia; further, these 2 values were not found to be significantly different from each other.<a class="elsevierStyleCrossRef" href="#bb0245">49</a> Increase in prolactin levels is associated with lack of libido, erectile dysfunction, amenorrhea and galactorrhea, osteoporosis, obesity, and cancer.<a class="elsevierStyleCrossRef" href="#bb0250">50</a></li><li class="elsevierStyleListItem" id="li0060">(g)Other diseases: There are many other illnesses that are associated with schizophrenia individuals. For example, Lambert et al. states that schizophrenia individuals are 19% more likely to have irritable bowel syndrome and that the prevalence of Helicobacter pylori infection is much higher in schizophrenia individuals.<a class="elsevierStyleCrossRef" href="#bb0225">45</a></li></ul>However, most schizophrenia individuals aren't monitored for said diseases and not treated for them unless they are life-threatening. It would be wise to routinely have a checkup and tests for diseases in schizophrenia individuals.Unhealthy lifestylesSchizophrenia individuals tend to have a very unhealthy lifestyle (diet, smoking, alcohol, and little exercise). Schizophrenia individuals have been shown to eat a diet higher in fat and lower in fiber; schizophrenia individuals exercised very little, and smoked heavily.<a class="elsevierStyleCrossRef" href="#bb0255">51</a>,<a class="elsevierStyleCrossRef" href="#bb0260">52</a> The latter is associated with obesity and metabolic syndrome. A healthier choice in foods can not only be good for health but also in reducing the typical positive, negative, and cognitive symptoms of schizophrenia.<a class="elsevierStyleCrossRef" href="#bb0260">52</a> Schizophrenia patients should be taught to lead a healthier lifestyle and especially when it comes to eating habits.Inadequate medical careSchizophrenia individuals may not always be capable of explaining their illness to medical professionals which in turn will prevent the healthcare professionals from fully helping the schizophrenia individual.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Anti-psychotics drugs are also attached to other more serious side effects, and these side effects are at times lethal. For example, Mrs. S, a 44-year-old woman who has schizophrenia had been administered 160 mg/day of ziprasidone after admission into a Psych ward.<a class="elsevierStyleCrossRef" href="#bb0265">53</a> She began showing improvements and on the 5th day, after taking 10–15 steps, she collapsed onto the floor. Despite emergency resuscitative measures, she died on the spot. It is believed that the sudden death could have been due to the increase in the dose of ziprasidone which would have induced ventricular tachyarrhythmias. In another example, A 34-year-old woman was administered risperidone for schizophrenia.<a class="elsevierStyleCrossRef" href="#bb0270">54</a> On day 5, the patient had a cardiac arrest and despite all efforts, she died. In fact, all anti-psychotic drugs have the ability to cause some serious damage. Further, poly-pharmacy was also found to reduce survival.<a class="elsevierStyleCrossRef" href="#bb0275">55</a> Thus, some anti-psychotics require serious monitoring by medical professional. Healthcare professionals should always keep a sharp eye on patients taking anti-psychotics that requires monitoring.HomelessnessThe fate of individuals with schizophrenia is as follows: 6% are homeless, 6% in jail/prisons, 5–6% in hospitals, 10% in nursing homes, 25% with family, 28% live alone, and 20% in supervised homes.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Homelessness aggravates the situation by increasing the remaining factors especially suicide and accidents.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Millions of schizophrenia people are homeless, and the reason for the latter is the nature of the disease.In a recent study, it was found that the prevalence of schizophrenia specifically among the homeless is 10.29%; the prevalence of psychosis was 21.21%, schizophreniform disorder was 2.48%, schizoaffective disorder was 3.53%, and other psychotic disorders constituted 9% among the homeless people.<a class="elsevierStyleCrossRef" href="#bb0280">56</a> In a study on schizophrenia men who were homeless versus never-homeless, it was found that homeless subjects displayed higher positive symptoms than did the never-homeless (but no difference was found in the negative symptoms levels).<a class="elsevierStyleCrossRef" href="#bb0285">57</a> Further, in the same study, it was found that higher drug abuse, higher antisocial personality disorder, higher family disorganization, less adherence to medication, lack of a long-term therapist, and less adequate family support were more prominent in men who were homeless. In another study on schizophrenia women who were homeless versus never-homeless, it was found that homeless subjects displayed higher alcohol abuse, higher drug abuse, higher antisocial personality disorder, and had less family support.<a class="elsevierStyleCrossRef" href="#bb0290">58</a>Homeless individuals have a harder time accessing health care. Advice and help should be given to schizophrenia individuals to take them off the streets.Lowered pain perceptionSchizophrenic patients have been noted to have a lowered pain perception, a condition known as hypoalgesia. In fact, schizophrenic patients with a perforated appendix, or perforated gastrointestinal tract have been noted to not feel the pain associated with the condition.<a class="elsevierStyleCrossRef" href="#bb0295">59</a> Only 18% of schizophrenia individuals reported pain during a myocardial infarction (90% of normal patients suffer from pain during a myocardial infarction).<a class="elsevierStyleCrossRef" href="#bb0300">60</a> Pain was not present in 21.4% of psychotic patients with acute perforated peptic ulcer, in 36.8% of psychotic patients with acute appendicitis, and 41.3% of psychotic patients with femur fractures.<a class="elsevierStyleCrossRef" href="#bb0305">61</a> In fact, Zhou et al. showed that schizophrenia individuals don't respond to nociceptive stimuli which could be due to a dysfunction in the pain pathway.<a class="elsevierStyleCrossRef" href="#bb0310">62</a> In fact, in schizophrenia individuals, beta-endorphins have been noted to give out an analgesic type of effect following nociceptive stimuli.<a class="elsevierStyleCrossRef" href="#bb0315">63</a> A study showed that the β-endorphin concentration was approximately 20% higher in schizophrenia individuals (in a stable mental state) than their healthy counterparts; however, it is not known whether the increase can cause an analgesic effect.<a class="elsevierStyleCrossRef" href="#bb0320">64</a> Further, the authors state that most of noted hypoalgesia cases are of schizophrenia individuals in the acute phase of the episode.<a class="elsevierStyleCrossRef" href="#bb0320">64</a> However, hypersensitivity to pain has also been noted. A recent study compared hypoalgesia and pain hypersensitivity and noted that pain hypersensitivity occurs when there is a mechanical stimulus.<a class="elsevierStyleCrossRef" href="#bb0325">65</a> And though there is evidence for both hypoalgesia and pain hypersensitivity, most studies show that pain sensitivity is lower in schizophrenia individuals.<a class="elsevierStyleCrossRef" href="#bb0310">62</a> It is believed that it is possible that schizophrenia individuals show high sensitivity to acute pain (that lasts from minutes to up to 3–6 months) and low sensitivity to chronic pain (that lasts longer than 6 months).<a class="elsevierStyleCrossRef" href="#bb0315">63</a>Thus, lowered pain perception is frequently associated with schizophrenia. Whether schizophrenia patients display lowered pain perception or pain hypersensitivity should be noted by healthcare professionals. The latter is so because schizophrenia individuals are prone to other diseases and especially the side effects of anti-psychotics; they need to be able to communicate that there is something wrong when there is something wrong.Sexual dysfunctionSexual dysfunction is very common among those with schizophrenia, whether they are on medication or not; 45–80% of males and 30–80% of females are affected by sexual dysfunction.<a class="elsevierStyleCrossRef" href="#bb0330">66</a> However, sexual dysfunction can be present in schizophrenia patients using anti-psychotics as well; in fact, individuals on anti-psychotic medication are 2 times more likely to have sexual dysfunction.<a class="elsevierStyleCrossRef" href="#bb0335">67</a>,<a class="elsevierStyleCrossRef" href="#bb0340">68</a> Approximately, 1/3rd of chronically medicated schizophrenia males suffer from sexual dysfunction.<a class="elsevierStyleCrossRef" href="#bb0345">69</a> In particular, differences exist between anti-psychotics when it comes to sexual dysfunction. Quetiapine, ziprasidone, perphenazine, and aripriprazole are linked to a low rate (16%–27%) of sexual dysfunction; olanzapine, risperidone, haloperidol, clozapine, and thioridazine are linked to a high rate (40%–60%) of sexual dysfunction.<a class="elsevierStyleCrossRef" href="#bb0350">70</a> Sexual dysfunction is one of the primary reasons for medication non-adherence. It has been stated that sexual dysfunction as a result of anti-psychotics could be due to post-synaptic dopamine antagonism, prolactin elevation, and a1-receptor blockade.<a class="elsevierStyleCrossRef" href="#bb0355">71</a>Some anti-psychotics have been linked to an increase in prolactin levels (hyperprolactinemia); serum prolactin levels in normal individuals range between 5 and 10 μg/l. Increased prolactin levels have further been linked to sexual dysfunction.<a class="elsevierStyleCrossRef" href="#bb0360">72</a> In schizophrenia individuals who took a combination of first- and second-generation anti-psychotic, the serum prolactin level was highest (29.00±9.95 ng/ml); schizophrenia individuals who took first-generation anti-psychotics had medium levels of serum prolactin (13.54±10.34 ng/ml) while those who took second generation anti-psychotics had the lowest levels of serum prolactin (9.19±3.32 ng/ml).<a class="elsevierStyleCrossRef" href="#bb0360">72</a> The difference between groups were found to be statistically significant (P < .001).<a class="elsevierStyleCrossRef" href="#bb0360">72</a> In fact, one literature review argues that every single anti-psychotic is a dopamine antagonist and that the blocking of dopamine can elevate prolactin levels.<a class="elsevierStyleCrossRef" href="#bb0365">73</a> As a result of increased prolactin levels, there is typically a decrease in testosterone levels which further affects sexual performance. Clozapine, on the other hand, which causes very little prolactin elevation, has been thought to cause fewer and lower sexual dysfunction. However, anti-adrenergic and anti-cholinergic effects induced sexual dysfunction has been noted in clozapine.<a class="elsevierStyleCrossRef" href="#bb0330">66</a> Another study noted that quetiapine had the least effect on sexual function while olanzapine, risperidone, haloperidol, clozapine, and thioridazine were found to be highly linked to sexual dysfunction.<a class="elsevierStyleCrossRef" href="#bb0350">70</a> However, another study found that the serum prolactin is higher in drug-naive schizophrenia individuals as well.<a class="elsevierStyleCrossRef" href="#bb0370">74</a>Because schizophrenia individuals may stop taking anti-psychotics if they run into side effects, it would be important to prescribe an anti-psychotic that would minimize the side effects such as sexual dysfunction. Baggaley suggests the following order for severity of sexual dysfunction: risperidone>typical anti-psychotics (haloperidol)>olanzapine>clozapine>quetiapine>aripiprazole.<a class="elsevierStyleCrossRef" href="#bb0330">66</a> Baggaley, in particular, suggests that aripriprazole be prescribed for hyperprolactinemia and sexual dysfunction.<a class="elsevierStyleCrossRef" href="#bb0330">66</a> But if we take the more recent study by Alam et al., all second generation anti-psychotics would be preferable to first-generation anti-psychotics or combination therapy.<a class="elsevierStyleCrossRef" href="#bb0360">72</a> In this case, aripriprazole would still be the best option for sexual dysfunction.Aggressive behaviorUntil the 1980s, it was believed that schizophrenia individuals were not more violent than their healthy counterparts.<a class="elsevierStyleCrossRef" href="#bb0375">75</a> However, recent studies suggest that schizophrenia individuals are more likely to be violent than non-schizophrenia individuals.<a class="elsevierStyleCrossRef" href="#bb0380">76</a>,<a class="elsevierStyleCrossRef" href="#bb0385">77</a> In fact, schizophrenia individuals are 4–7 times more likely to carry out violent crimes; schizophrenia individuals are also 4–6 times more likely to be verbally and physically aggressive.<a class="elsevierStyleCrossRef" href="#bb0375">75</a> Genetics, substance abuse, alcohol abuse, neurological impairment, and social burdens have been shown to increase aggressive behavior. Comorbid substance abuse and acute psychotic symptoms have been linked to higher rates of aggression. In fact, Walsh, Buchanan, and Fahy have stated that aggression is lower in schizophrenia individuals who do not abuse comorbid substances.<a class="elsevierStyleCrossRef" href="#bb0375">75</a> Another study showed that 46% of psychotic offender's offenses were due to delusions.<a class="elsevierStyleCrossRef" href="#bb0390">78</a> Some anti-psychotic drugs—clozapine, risperidone, and olanzapine—have been shown to reduce the probability of violent behavior.<a class="elsevierStyleCrossRef" href="#bb0395">79</a> However, the total number of homicides carried out by schizophrenia individuals is considerably low (10% in the United States).<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Further, approximately 20% of jail inmates and 15% of state prison inmates have a mental illness.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> According to Torrey, these number mean that there are approximately 356 000 mentally ill jail inmates, which is 10 times the number of mentally ill individuals in state psychiatric hospitals.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Though it is true that most schizophrenia individuals are not all violent, those who are violent commit very high-profile violent crimes. Further, it has also been noted that schizophrenia individuals are 14 times more likely to be victims of violence than being the perpetrators.<a class="elsevierStyleCrossRef" href="#bb0400">80</a> Thus, healthcare professionals should also watch out for indicators of aggression or its opposite, victimization. Torrey explains that the 3 predictors of aggressive behavior is alcohol/drug abuse, failure to adhere to medications, and a history of violence.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Healthcare professionals should especially watch out for those 3 predictors as the 10% of schizophrenia individuals who do commit crimes will commit very violent high-profile crimes.StigmaSchizophrenia is typically accompanied by stigma in the common population. When asked, 32% of the participants stated that they would not be comfortable around schizophrenic individuals; 7% stated that schizophrenic individuals ought to be removed from society.<a class="elsevierStyleCrossRef" href="#bb0405">81</a> Previous surveys state that a large number of individuals believed that schizophrenia is due to sin and character weakness; these days, however, it is commonly accepted that it's a brain illness, however, stigma has also increased.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Torrey explains that in a 2006 survey, people reported that they didn't want a neighbor who had schizophrenia.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Torrey attributes this stigma to the high-profile violent crimes committed by a few schizophrenia individuals. The actions of a few cause stigma, trouble, and concern for all others who are mentally ill. Healthcare professionals should give them help to overcome the stigma that they might or might not face.Cognitive deficitCognitive deficit accompanies schizophrenia; this deficit may be mild to severe and affects attention, working memory, verbal learning, and executive functions.<a class="elsevierStyleCrossRef" href="#bb0410">82</a> Though the extent of the deficit varies across schizophrenia individuals, the majority still demonstrate a certain amount of deficit. It has been shown that a schizophrenia individual's cognitive performance would be approximately 2 standard deviations less than their healthy counterpart if measured many years after onset of illness but only 0.5 standard deviations lower if measured prior to diagnosis.<a class="elsevierStyleCrossRef" href="#bb0415">83</a>Three types of cognitive changes were observed in schizophrenia individuals in a recent study: normative, declining, and deteriorating. In schizophrenia individuals, cognitive decline begins quite early; however, cognitive decline is best described as a function of “time since onset of illness”.<a class="elsevierStyleCrossRef" href="#bb0420">84</a> From childhood to 14 years prior to onset of illness is the normative phase; from 14 years prior to onset of illness till 22 years thereafter is the declining phase; 22 years after onset of the illness begins the deteriorating phase. Thus, from childhood to 14 years before onset of illness, cognitive ability was found to be stable.<a class="elsevierStyleCrossRef" href="#bb0420">84</a> At approximately 13 years of age or approximately 14 years prior to onset of illness, a bifurcation is seen in individuals with schizophrenia as opposed to those with other psychotic illnesses. In particular, schizophrenia individuals showed a decline of 0.35 IQ points/year approximately 14 years before the onset of the illness; this decline becomes 0.59 IQ points/year at 22 years after onset of illness.<a class="elsevierStyleCrossRef" href="#bb0420">84</a>In fact, Torrey states that schizophrenia is an illness of the brain because there are abnormalities in the schizophrenia brain when compared to the healthy brain; both ventricular enlargement and a decrease in gray matter volume are seen in schizophrenia (this fact has been observed in more than a 100 studies).<a class="elsevierStyleCrossRef" href="#bb0125">25</a> Healthcare professionals should present schizophrenia individuals with opportunities to learn to overcome the deficits. Some of the suggested methods are cognitive remediation therapy (CRT), neuropsychological educational approach to rehabilitation (NEAR), cognitive adaptation training (CAT), and cognitive enhancement therapy (CET).<a class="elsevierStyleCrossRef" href="#bb0425">85</a>ConclusionSchizophrenia is a debilitating illness that is accompanied by 3 types of symptoms—positive, negative, and cognitive. Further, the mere fact of having schizophrenia implies other consequences or side effects. For example, metabolic syndrome, early death and suicide, diseases, sexual dysfunction, etc.… These consequences of schizophrenia accompany the owner of the illness alongside the previously mentioned symptoms. In this paper, I reviewed the various consequences of schizophrenia as they should be taken into account during treatment. The consequences of schizophrenia should be treated as well for a healthy and full life." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1979294" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "as0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1702230" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1979293" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "as0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1702231" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "s0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "s0010" "titulo" => "Metabolic syndrome" ] 6 => array:3 [ "identificador" => "s0015" "titulo" => "Early death and suicide" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "s0020" "titulo" => "Suicide and accidents" ] 1 => array:2 [ "identificador" => "s0025" "titulo" => "Diseases" ] 2 => array:2 [ "identificador" => "s0030" "titulo" => "Unhealthy lifestyles" ] 3 => array:2 [ "identificador" => "s0035" "titulo" => "Inadequate medical care" ] 4 => array:2 [ "identificador" => "s0040" "titulo" => "Homelessness" ] ] ] 7 => array:2 [ "identificador" => "s0045" "titulo" => "Lowered pain perception" ] 8 => array:2 [ "identificador" => "s0050" "titulo" => "Sexual dysfunction" ] 9 => array:2 [ "identificador" => "s0055" "titulo" => "Aggressive behavior" ] 10 => array:2 [ "identificador" => "s0060" "titulo" => "Stigma" ] 11 => array:2 [ "identificador" => "s0065" "titulo" => "Cognitive deficit" ] 12 => array:2 [ "identificador" => "s0070" "titulo" => "Conclusion" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-02-12" "fechaAceptado" => "2023-07-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1702230" "palabras" => array:9 [ 0 => "Schizophrenia" 1 => "Metabolic syndrome" 2 => "Death" 3 => "Suicide" 4 => "Disease" 5 => "Pain perception" 6 => "Sexual dysfunction" 7 => "Stigma" 8 => "Cognitive deficit" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1702231" "palabras" => array:9 [ 0 => "Esquizofrenia" 1 => "síndrome metabólico" 2 => "muerte" 3 => "suicidio" 4 => "enfermedad" 5 => "percepción del dolor" 6 => "disfunción sexual" 7 => "estigma" 8 => "déficit cognitivo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Schizophrenia is an illness that affects millions of individuals. It is typically accompanied by positive, negative and cognitive symptoms. These symptoms are typically associated with the onset and progression of schizophrenia. However, aside from these known symptoms, there are consequences of having schizophrenia. In particular, metabolic syndrome, early death and suicide, diseases, lowered pain perception, sexual dysfunction, aggressive behavior/victimization, stigma, and cognitive deficit are all consequences of having schizophrenia. In this paper, we review the various consequences of having schizophrenia. These consequences should be monitored for, much like the typical symptoms, but are usually omitted from treatment." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La esquizofrenia es una enfermedad que afecta a millones de individuos, y que normalmente se acompaña de síntomas positivos, negativos y cognitivos. Dichos síntomas están normalmente asociados al inicio y progresión de la esquizofrenia. Sin embargo, aparte de estos síntomas conocidos, existen consecuencias de padecer esquizofrenia. En particular, el síndrome metabólico, la muerte prematura y el suicidio, las enfermedades, la disminución de la percepción del dolor, la disfunción sexual, el comportamiento agresivo/victimización, el estigma, y el déficit cognitivo son consecuencias de padecer esquizofrenia. En este documento, revisamos las diversas consecuencias del padecimiento de esquizofrenia. Deberán supervisarse dichas consecuencias, al igual que los síntomas típicos, aunque normalmente se omiten del tratamiento de la enfermedad." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:85 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What it will take to make coordinated specialty care available to anyone experiencing early schizophrenia: getting over the hump" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Dixon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamapsychiatry.2016.2665" "Revista" => array:7 [ "tituloSerie" => "JAMA Psychiatry." 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Review Article

Schizophrenia is associated with severe consequences

Asociación de la esquizofrenia con consecuencias graves

Kalyani Rajalingham

Corresponding author

kalyani.rajalingham@mail.mcgill.ca

Corresponding author at: 8518 Stuart Ave., Montreal H3N 2S5, Quebec, Canada.

MSc Biology, GD Biotechnology and Genomics, GD Medicine Clinical Research, Concordia University, Department of Biology, 7141 Sherbrooke St W, Montreal, Quebec H4B 1R6, Canada

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Schizophrenia&#44; one of the major causes of impairment&#44; is a debilitating disease accompanied by a number of serious symptoms such as hallucinations&#44; delusions&#44; and disordered thinking&#46; In fact&#44; the lifetime prevalence of schizophrenia is approximately 1&#37;&#8212;that&#39;s 1 in 100&#8212;and approximately 50&#37; of individuals confined in hospitals for mental care have a diagnosis of schizophrenia&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> The average age of onset for schizophrenia in males is late adolescence or early 20s while in females&#44; the average age of onset is 20s or 30s&#46;<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> Further&#44; the prevalence rate of schizophrenia in males is higher than that of females&#46;<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> Schizophrenia develops without regard to race&#44; or ethnicity&#46;<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> It&#39;s associated with a cost of &#36;150 billion annually in the United States of America alone&#46; It&#39;s an illness that is both incurable and permanent&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">Schizophrenia is associated with positive&#44; negative&#44; and cognitive symptoms&#46; And this&#44; we assume is the extent of the illness when it comes to symptoms and complications&#46; However&#44; it is not&#46; What is notable is that schizophrenia individuals are significantly different from their healthy counterparts&#44; and this from childhood onwards&#46; For example&#44; adult schizophrenia individuals tend to have a lower IQ in childhood when compared to their healthy counterparts&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> The mere fact of having the disease implies certain &#8220;consequences&#8221; to the schizophrenia individual&#46; In this paper&#44; I will review that various severe consequences of having schizophrenia as they need to be addressed by healthcare professionals&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Metabolic syndrome</span><p id="p0015" class="elsevierStylePara elsevierViewall">Most individuals who are diagnosed with schizophrenia are prescribed anti-psychotic drugs&#46; The main side effect of said drugs is increased appetite and weight gain&#46; Anti-psychotics have been shown to cause an average weight gain of 4&#46;45&#8239;kg in clozapine&#44; 4&#46;15&#8239;kg in olanzapine&#44; 2&#46;92&#8239;kg in sertindole&#44; and 2&#46;10&#8239;kg in risperidone over a period of 10&#8239;weeks or 2&#46;5&#8239;months&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> In fact&#44; almost every anti-psychotic is associated with weight gain over time&#59; in anti-psychotic naive patients&#44; this weight gain is more pronounced&#46;<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a> In the short-term &#40;less than 12&#8239;weeks&#41;&#44; anti-psychotics were found to cause a weight gain of approximately 3&#46;22&#8239;kg &#40;7&#46;1&#8239;lbs&#41; while in the long-term &#40;more than 12&#8239;weeks&#41;&#44; anti-psychotics were found to cause a weight gain of 5&#46;30&#8239;kg &#40;11&#46;7&#8239;lbs&#41; in individuals with first episode psychosis&#59; olanzapine and clozapine were found to cause the highest weight gain&#46;<a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a> Further&#44; schizophrenia individuals tend to have unhealthy lifestyles&#8212;they eat a lot more fat and sugar&#44; smoke&#44; and lead a sedentary lifestyle which considerably increases the chances of gaining weight&#46; Weight gain&#44; in turn&#44; substantially increases the chances of developing metabolic syndrome&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">Metabolic syndrome &#40;MetS&#41; is a combination of risk factors that substantially increases the probability of developing heart diseases&#44; stroke&#44; and type 2 diabetes&#46; There are many ways of defining metabolic syndrome &#40;WHO&#44; EGIR&#44; NCEP&#58;ATPIII&#44; AACE&#44; and IDF&#41;&#46; A diagnosis of metabolic syndrome is given if at least 3 of the following 5 criteria are present in an individual<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a>&#58;<ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="li0005"><span class="elsevierStyleLabel">&#40;i&#41;</span><p id="p0025" class="elsevierStylePara elsevierViewall">Waist Circumference of &#62;<span class="elsevierStyleHsp" style=""></span>40&#8239;in&#46; for men&#44; &#62;<span class="elsevierStyleHsp" style=""></span>35&#8239;in&#46; for women&#46;</p></li><li class="elsevierStyleListItem" id="li0010"><span class="elsevierStyleLabel">&#40;ii&#41;</span><p id="p0030" class="elsevierStylePara elsevierViewall">Triglycerides &#8805;<span class="elsevierStyleHsp" style=""></span>150&#8239;mg&#47;dl&#46;</p></li><li class="elsevierStyleListItem" id="li0015"><span class="elsevierStyleLabel">&#40;iii&#41;</span><p id="p0035" class="elsevierStylePara elsevierViewall">HDL-C&#58; &#60;<span class="elsevierStyleHsp" style=""></span>40&#8239;mg&#47;dl for men&#44; &#60;<span class="elsevierStyleHsp" style=""></span>50&#8239;mg&#47;dl for women&#46;</p></li><li class="elsevierStyleListItem" id="li0020"><span class="elsevierStyleLabel">&#40;iv&#41;</span><p id="p0040" class="elsevierStylePara elsevierViewall">Blood Pressure&#8239;&#8805;&#8239;130&#47;85&#8239;mmHg&#46;</p></li><li class="elsevierStyleListItem" id="li0025"><span class="elsevierStyleLabel">&#40;v&#41;</span><p id="p0045" class="elsevierStylePara elsevierViewall">Fasting Plasma Glucose &#8805;<span class="elsevierStyleHsp" style=""></span>110&#8239;mg&#47;dl&#46;</p></li></ul></p><p id="p0050" class="elsevierStylePara elsevierViewall">The likelihood of developing metabolic syndrome however varies with the anti-psychotic used&#8212;anti-psychotics that cause weight gain also have a higher likelihood of causing metabolic syndrome&#46;<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a> For instance&#44; it is known that clozapine and olanzapine cause very high&#47;severe weight gain&#59; chlorpromazine&#44; quetiapine&#44; risperidone&#44; and paliperidone cause moderate weight gain&#59; aripriprazole&#44; amisulpride&#44; asenapine&#44; haloperidol&#44; ziprasidone&#44; and lurasidone cause low weight gain&#46;<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a> Further&#44; in one study&#44; it was shown that schizophrenia individuals who were administered risperidone or clozapine therapy had a greater chance of developing metabolic syndrome than schizophrenia individuals who were administered aripriprazole&#46;<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a> Thus&#44; the likelihood of metabolic syndrome with aripriprazole is low but weight gain is also low while with clozapine this likelihood is high and weight gain is also high&#46; The risk of developing metabolic syndrome is ranked as follows&#58; quetiapine<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>clozapine<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>paliperidone<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>olanzapine<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>risperidone<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>haloperidol<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>aripiprazole&#46;<a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a></p><p id="p0055" class="elsevierStylePara elsevierViewall">A dose-dependent relationship between metabolic outcomes and serum concentrations of clozapine and olanzapine has also been noted&#46;<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a> In one study&#44; it was concluded that there exists a positive linear relationship between olanzapine level &#40;ng&#47;ml&#41; and weight &#40;kg&#41;&#44; and between olanzapine level &#40;ng&#47;ml&#41; and BMI in drug-naive schizophrenia patients&#46;<a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> Further&#44; schizophrenia individuals exhibit higher prevalence of metabolic syndrome than non-schizophrenia individuals&#46; In fact&#44; studies show that individuals with schizophrenia on anti-psychotics are 2&#8211;4 times more likely to develop metabolic syndrome&#46;<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a> Further&#44; studies show that the prevalence of metabolic syndrome in drug-naive schizophrenia patients is between 3&#37; and 26&#37; while that in patients using anti-psychotics can be up to 69&#37;&#46;<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a> In one particular study on Palestinian schizophrenia individuals&#44; it was concluded that the overall prevalence of metabolic syndrome was found to be 43&#46;6&#37; with a prevalence of 39&#37; in males and 55&#46;9&#37; prevalence in females&#46;<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a> The latter indicates that the likelihood of metabolic syndrome is higher in women as compared to men&#46; Some ethnic groups are also more susceptible to metabolic syndrome than others&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">Other factors have been noted to influence metabolic syndrome such as duration of illness&#46; In one study&#44; 4 cohorts of schizophrenia patients &#40;group 1&#58; with a duration of illness &#40;DOI&#41; of less than 1&#46;5&#8239;years&#59; group 2&#58; with a DOI between 11&#46;5 and 10&#8239;years&#44; group 3&#58; with a DOI of between 10 and 20&#8239;years&#44; and group 4&#58; with a DOI of more than 20&#8239;years&#41; were examined&#59; it was noted that metabolic syndrome increased as the duration of illness &#40;DOI&#41; increased&#46;<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a> In fact&#44; the prevalence of metabolic syndrome when the duration of illness is less than 1&#46;5&#8239;years is 17&#37;&#44; while the prevalence in those with a duration of illness of 20&#8239;years or more is 49&#37;&#46;<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a> Yet another study demonstrated that schizophrenia individuals with metabolic syndrome had the illness &#40;schizophrenia&#41; for a longer period of time and were administered treatment for a longer period of time&#46;<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a> Further&#44; not every single individual treated with clozapine or olanzapine develops metabolic syndrome&#44; and therefore&#44; it is thought that metabolic syndrome could also be due to underlying genetic components&#46; A recent systematic review shows that the rs1414334 C allele of the HTR2C gene is linked to metabolic syndrome in schizophrenia individuals using second generation anti-psychotics in a large number of studies&#46;<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a></p><p id="p0065" class="elsevierStylePara elsevierViewall">Overall&#44; metabolic syndrome seems to be least likely in young drug-naive schizophrenia patients and is more likely to be seen in schizophrenia patients who are on medications long-term&#46; Thus&#44; for schizophrenia individuals&#44; it would be important to educate them about metabolic syndrome&#46; Due to the severity of metabolic syndrome&#44; it would be wise to occasionally assess schizophrenia individuals for metabolic syndrome&#46; This assessment should be more frequently done on patients on certain medications like olanzapine&#44; and for those who have been on medication long-term&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Early death and suicide</span><p id="p0070" class="elsevierStylePara elsevierViewall">Schizophrenia individuals have mortality rates that are 2&#8211;3 times greater than that seen in non-schizophrenia individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a> In fact&#44; schizophrenia individuals die approximately 15&#8211;20&#8239;years earlier than non-schizophrenia individuals&#46; In a Finnish study&#44; the mortality gap was found to be 25&#8239;years in 1996&#44; and 22&#46;5&#8239;years in 2006&#46;<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a> In a Belgian study&#44; it was noted that the mortality ratio for male patients was 5&#46;05 times greater than for healthy Belgians while for women patients&#44; this mortality ratio was 5&#46;63 times greater&#46;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> Further&#44; the mortality rates are only increasing with time &#40;not decreasing&#41;&#46; In fact&#44; it has been noted that this death rate has increased 5-fold between the years 1960 and 2005&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Further&#44; early death in schizophrenia can be attributed to suicides&#44; accidents&#44; diseases&#44; unhealthy lifestyles&#44; inadequate medical care&#44; and homelessness&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a></p><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Suicide and accidents</span><p id="p0075" class="elsevierStylePara elsevierViewall">Schizophrenia individuals are at a higher risk of suicide and accidents&#46; Unnatural deaths which includes suicides&#44; homicides&#44; and accidents are believed to account for 20&#8211;25&#37; of the deaths&#46;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> In fact&#44; the risk of suicide is approximately 13 times higher in schizophrenia individuals as opposed to non-schizophrenia individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a> Suicide alone accounts for 10&#37; of all deaths in schizophrenia patients&#46;<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> However&#44; others argue that this rate is between 4&#37; and 5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a> And at least 50&#37; of schizophrenia patients will attempt to suicide within their lifetime&#59; most schizophrenia individuals will attempt suicide within the first 10&#8239;years after onset of illness&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Most schizophrenia individuals commit suicide because of depression&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> The following risk factors increase the probability of suicide in schizophrenia individuals&#58; younger age&#44; being male&#44; being unmarried&#44; living alone&#44; being unemployed&#44; being intelligent&#44; being highly educated&#44; proper premorbid functioning&#44; having high expectations&#44; believing that life&#39;s expectations won&#39;t be met with&#44; life events within the past 3&#8239;months&#44; poor work functioning&#44; and having access to weapons&#46;<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a></p><p id="p0080" class="elsevierStylePara elsevierViewall">Accidental deaths&#44; in one study&#44; was shown to cause twice as many deaths as compared to suicide in schizophrenia patients&#46;<a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a> It is thought that substance abuse plays a role in accidents in schizophrenia individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a></p><p id="p0085" class="elsevierStylePara elsevierViewall">As such&#44; health professionals should routinely check for suicidal thoughts in schizophrenia patients&#46; In particular&#44; healthcare professionals should check for signs of depression in schizophrenia individuals&#46; Healthcare professionals should note that those with the highest risk of suicide are those who relapse easily&#44; don&#39;t respond to medication very well&#44; know they&#39;re sick&#44; are socially isolated&#44; are hopeless&#44; and who show a big discrepancy in function before and after the illness&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a></p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Diseases</span><p id="p0090" class="elsevierStylePara elsevierViewall">Diseases are normal in individuals with schizophrenia&#46; Schizophrenia individuals tend to have a higher prevalence of HIV infections&#44; hepatitis&#44; osteoporosis&#44; altered pain sensitivity&#44; sexual dysfunction&#44; obstetric complications&#44; cardiovascular diseases&#44; obesity&#44; diabetes&#44; dental problems&#44; and polydipsia when compared to non-schizophrenia individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a><ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="li0030"><span class="elsevierStyleLabel">&#40;a&#41;</span><p id="p0095" class="elsevierStylePara elsevierViewall">Dental problems&#58; Oral health in general is less likely to be in a good state in those with schizophrenia&#46; Schizophrenia individuals have a higher incidence of dental plaques and stones&#44; loss of dentition &#40;edentulism&#41;&#44; caries&#44; gingivitis&#44; and periodontitis&#46;<a class="elsevierStyleCrossRefs" href="#bb0170"><span class="elsevierStyleSup">34&#8211;37</span></a></p></li><li class="elsevierStyleListItem" id="li0035"><span class="elsevierStyleLabel">&#40;b&#41;</span><p id="p0100" class="elsevierStylePara elsevierViewall">Polydipsia&#58; Polydipsia is observed in 18&#37; of schizophrenia individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0190"><span class="elsevierStyleSup">38</span></a></p></li><li class="elsevierStyleListItem" id="li0040"><span class="elsevierStyleLabel">&#40;c&#41;</span><p id="p0105" class="elsevierStylePara elsevierViewall">Cancer&#58; Schizophrenia individuals have a lower probability &#40;24&#37;&#41; of being diagnosed with cancer&#59; however&#44; if they are diagnosed&#44; they have a higher mortality rate &#40;64&#37;&#41; after diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bb0195"><span class="elsevierStyleSup">39</span></a> In particular&#44; a recent study showed that individuals with schizophrenia are more likely to die from breast&#44; colon&#44; and lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a></p></li><li class="elsevierStyleListItem" id="li0045"><span class="elsevierStyleLabel">&#40;d&#41;</span><p id="p0110" class="elsevierStylePara elsevierViewall">HIV&#47;AIDS&#47;Hepatitis C&#58; One study found that individuals with mental illnesses such as schizophrenia displayed a higher risk of blood-borne viral infections &#40;HIV&#44; hepatitis B virus&#44; and hepatitis C virus&#41;&#59; the prevalence of HIV in mentally ill individuals was approximately 6&#37; in the United States &#40;the prevalence in the general population was 0&#46;6&#37; in the USA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a></p></li><li class="elsevierStyleListItem" id="li0050"><span class="elsevierStyleLabel">&#40;e&#41;</span><p id="p0115" class="elsevierStylePara elsevierViewall">Osteoporosis&#58; Bone mineral density &#40;BMD&#41; was found to decrease in schizophrenia individuals&#59; in particular&#44; individuals with chronic schizophrenia have a high prevalence of osteoporosis with a bone mass distribution that is different from the normal population&#46;<a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0215"><span class="elsevierStyleSup">43</span></a> In particular&#44; hip and vertebral fractures were found to be higher in schizophrenia individuals as opposed to non-schizophrenia individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a> Bone density can be low in young individuals with schizophrenia&#59; it is thought that osteoporosis in schizophrenia individuals is associated with polydipsia&#44; neuroleptics use&#44; hyperprolactinemia&#44; smoking&#44; bad diet&#44; drug&#47;alcohol abuse&#44; and no exercise&#46;<a class="elsevierStyleCrossRef" href="#bb0215"><span class="elsevierStyleSup">43</span></a> According to Lambert et al&#46;&#44; osteoporosis in schizophrenia individuals is due to a decrease in estrogen and testosterone as a result of anti-psychotic administration&#44; due to lowered calcium as a result of smoking and alcoholism&#44; as well as polydipsia&#46;<a class="elsevierStyleCrossRef" href="#bb0225"><span class="elsevierStyleSup">45</span></a> However&#44; a more recent study shows that there&#39;s no difference in the bone mineral density of schizophrenia individuals taking clozapine and healthy controls&#59; however&#44; the same study found that schizophrenia individuals who were administered non-clozapine anti-psychotics lost bone mineral density within 1&#8211;3&#8239;years&#46;<a class="elsevierStyleCrossRef" href="#bb0230"><span class="elsevierStyleSup">46</span></a></p></li><li class="elsevierStyleListItem" id="li0055"><span class="elsevierStyleLabel">&#40;f&#41;</span><p id="p0120" class="elsevierStylePara elsevierViewall">Hyperprolactinemia&#58; Hyperprolactinemia is commonly thought to be a side effect of anti-psychotic medications&#46;<a class="elsevierStyleCrossRef" href="#bb0235"><span class="elsevierStyleSup">47</span></a> However&#44; high prolactin levels were found in first-episode drug-naive psychotic individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0240"><span class="elsevierStyleSup">48</span></a> In fact&#44; 77&#46;8&#37; of first-episode psychosis patients and 74&#46;2&#37; of recurrent psychosis patients were found to have hyperprolactinemia&#59; further&#44; these 2 values were not found to be significantly different from each other&#46;<a class="elsevierStyleCrossRef" href="#bb0245"><span class="elsevierStyleSup">49</span></a> Increase in prolactin levels is associated with lack of libido&#44; erectile dysfunction&#44; amenorrhea and galactorrhea&#44; osteoporosis&#44; obesity&#44; and cancer&#46;<a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">50</span></a></p></li><li class="elsevierStyleListItem" id="li0060"><span class="elsevierStyleLabel">&#40;g&#41;</span><p id="p0125" class="elsevierStylePara elsevierViewall">Other diseases&#58; There are many other illnesses that are associated with schizophrenia individuals&#46; For example&#44; Lambert et al&#46; states that schizophrenia individuals are 19&#37; more likely to have irritable bowel syndrome and that the prevalence of <span class="elsevierStyleItalic">Helicobacter pylori</span> infection is much higher in schizophrenia individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0225"><span class="elsevierStyleSup">45</span></a></p></li></ul></p><p id="p0130" class="elsevierStylePara elsevierViewall">However&#44; most schizophrenia individuals aren&#39;t monitored for said diseases and not treated for them unless they are life-threatening&#46; It would be wise to routinely have a checkup and tests for diseases in schizophrenia individuals&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Unhealthy lifestyles</span><p id="p0135" class="elsevierStylePara elsevierViewall">Schizophrenia individuals tend to have a very unhealthy lifestyle &#40;diet&#44; smoking&#44; alcohol&#44; and little exercise&#41;&#46; Schizophrenia individuals have been shown to eat a diet higher in fat and lower in fiber&#59; schizophrenia individuals exercised very little&#44; and smoked heavily&#46;<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a> The latter is associated with obesity and metabolic syndrome&#46; A healthier choice in foods can not only be good for health but also in reducing the typical positive&#44; negative&#44; and cognitive symptoms of schizophrenia&#46;<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a> Schizophrenia patients should be taught to lead a healthier lifestyle and especially when it comes to eating habits&#46;</p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Inadequate medical care</span><p id="p0140" class="elsevierStylePara elsevierViewall">Schizophrenia individuals may not always be capable of explaining their illness to medical professionals which in turn will prevent the healthcare professionals from fully helping the schizophrenia individual&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Anti-psychotics drugs are also attached to other more serious side effects&#44; and these side effects are at times lethal&#46; For example&#44; Mrs&#46; S&#44; a 44-year-old woman who has schizophrenia had been administered 160&#8239;mg&#47;day of ziprasidone after admission into a Psych ward&#46;<a class="elsevierStyleCrossRef" href="#bb0265"><span class="elsevierStyleSup">53</span></a> She began showing improvements and on the 5th day&#44; after taking 10&#8211;15 steps&#44; she collapsed onto the floor&#46; Despite emergency resuscitative measures&#44; she died on the spot&#46; It is believed that the sudden death could have been due to the increase in the dose of ziprasidone which would have induced ventricular tachyarrhythmias&#46; In another example&#44; A 34-year-old woman was administered risperidone for schizophrenia&#46;<a class="elsevierStyleCrossRef" href="#bb0270"><span class="elsevierStyleSup">54</span></a> On day 5&#44; the patient had a cardiac arrest and despite all efforts&#44; she died&#46; In fact&#44; all anti-psychotic drugs have the ability to cause some serious damage&#46; Further&#44; poly-pharmacy was also found to reduce survival&#46;<a class="elsevierStyleCrossRef" href="#bb0275"><span class="elsevierStyleSup">55</span></a> Thus&#44; some anti-psychotics require serious monitoring by medical professional&#46; Healthcare professionals should always keep a sharp eye on patients taking anti-psychotics that requires monitoring&#46;</p></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Homelessness</span><p id="p0145" class="elsevierStylePara elsevierViewall">The fate of individuals with schizophrenia is as follows&#58; 6&#37; are homeless&#44; 6&#37; in jail&#47;prisons&#44; 5&#8211;6&#37; in hospitals&#44; 10&#37; in nursing homes&#44; 25&#37; with family&#44; 28&#37; live alone&#44; and 20&#37; in supervised homes&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Homelessness aggravates the situation by increasing the remaining factors especially suicide and accidents&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Millions of schizophrenia people are homeless&#44; and the reason for the latter is the nature of the disease&#46;</p><p id="p0150" class="elsevierStylePara elsevierViewall">In a recent study&#44; it was found that the prevalence of schizophrenia specifically among the homeless is 10&#46;29&#37;&#59; the prevalence of psychosis was 21&#46;21&#37;&#44; schizophreniform disorder was 2&#46;48&#37;&#44; schizoaffective disorder was 3&#46;53&#37;&#44; and other psychotic disorders constituted 9&#37; among the homeless people&#46;<a class="elsevierStyleCrossRef" href="#bb0280"><span class="elsevierStyleSup">56</span></a> In a study on schizophrenia men who were homeless versus never-homeless&#44; it was found that homeless subjects displayed higher positive symptoms than did the never-homeless &#40;but no difference was found in the negative symptoms levels&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0285"><span class="elsevierStyleSup">57</span></a> Further&#44; in the same study&#44; it was found that higher drug abuse&#44; higher antisocial personality disorder&#44; higher family disorganization&#44; less adherence to medication&#44; lack of a long-term therapist&#44; and less adequate family support were more prominent in men who were homeless&#46; In another study on schizophrenia women who were homeless versus never-homeless&#44; it was found that homeless subjects displayed higher alcohol abuse&#44; higher drug abuse&#44; higher antisocial personality disorder&#44; and had less family support&#46;<a class="elsevierStyleCrossRef" href="#bb0290"><span class="elsevierStyleSup">58</span></a></p><p id="p0155" class="elsevierStylePara elsevierViewall">Homeless individuals have a harder time accessing health care&#46; Advice and help should be given to schizophrenia individuals to take them off the streets&#46;</p></span></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Lowered pain perception</span><p id="p0160" class="elsevierStylePara elsevierViewall">Schizophrenic patients have been noted to have a lowered pain perception&#44; a condition known as hypoalgesia&#46; In fact&#44; schizophrenic patients with a perforated appendix&#44; or perforated gastrointestinal tract have been noted to not feel the pain associated with the condition&#46;<a class="elsevierStyleCrossRef" href="#bb0295"><span class="elsevierStyleSup">59</span></a> Only 18&#37; of schizophrenia individuals reported pain during a myocardial infarction &#40;90&#37; of normal patients suffer from pain during a myocardial infarction&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0300"><span class="elsevierStyleSup">60</span></a> Pain was not present in 21&#46;4&#37; of psychotic patients with acute perforated peptic ulcer&#44; in 36&#46;8&#37; of psychotic patients with acute appendicitis&#44; and 41&#46;3&#37; of psychotic patients with femur fractures&#46;<a class="elsevierStyleCrossRef" href="#bb0305"><span class="elsevierStyleSup">61</span></a> In fact&#44; Zhou et al&#46; showed that schizophrenia individuals don&#39;t respond to nociceptive stimuli which could be due to a dysfunction in the pain pathway&#46;<a class="elsevierStyleCrossRef" href="#bb0310"><span class="elsevierStyleSup">62</span></a> In fact&#44; in schizophrenia individuals&#44; beta-endorphins have been noted to give out an analgesic type of effect following nociceptive stimuli&#46;<a class="elsevierStyleCrossRef" href="#bb0315"><span class="elsevierStyleSup">63</span></a> A study showed that the &#946;-endorphin concentration was approximately 20&#37; higher in schizophrenia individuals &#40;in a stable mental state&#41; than their healthy counterparts&#59; however&#44; it is not known whether the increase can cause an analgesic effect&#46;<a class="elsevierStyleCrossRef" href="#bb0320"><span class="elsevierStyleSup">64</span></a> Further&#44; the authors state that most of noted hypoalgesia cases are of schizophrenia individuals in the acute phase of the episode&#46;<a class="elsevierStyleCrossRef" href="#bb0320"><span class="elsevierStyleSup">64</span></a> However&#44; hypersensitivity to pain has also been noted&#46; A recent study compared hypoalgesia and pain hypersensitivity and noted that pain hypersensitivity occurs when there is a mechanical stimulus&#46;<a class="elsevierStyleCrossRef" href="#bb0325"><span class="elsevierStyleSup">65</span></a> And though there is evidence for both hypoalgesia and pain hypersensitivity&#44; most studies show that pain sensitivity is lower in schizophrenia individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0310"><span class="elsevierStyleSup">62</span></a> It is believed that it is possible that schizophrenia individuals show high sensitivity to acute pain &#40;that lasts from minutes to up to 3&#8211;6&#8239;months&#41; and low sensitivity to chronic pain &#40;that lasts longer than 6&#8239;months&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0315"><span class="elsevierStyleSup">63</span></a></p><p id="p0165" class="elsevierStylePara elsevierViewall">Thus&#44; lowered pain perception is frequently associated with schizophrenia&#46; Whether schizophrenia patients display lowered pain perception or pain hypersensitivity should be noted by healthcare professionals&#46; The latter is so because schizophrenia individuals are prone to other diseases and especially the side effects of anti-psychotics&#59; they need to be able to communicate that there is something wrong when there is something wrong&#46;</p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Sexual dysfunction</span><p id="p0170" class="elsevierStylePara elsevierViewall">Sexual dysfunction is very common among those with schizophrenia&#44; whether they are on medication or not&#59; 45&#8211;80&#37; of males and 30&#8211;80&#37; of females are affected by sexual dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a> However&#44; sexual dysfunction can be present in schizophrenia patients using anti-psychotics as well&#59; in fact&#44; individuals on anti-psychotic medication are 2 times more likely to have sexual dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a> Approximately&#44; 1&#47;3rd of chronically medicated schizophrenia males suffer from sexual dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bb0345"><span class="elsevierStyleSup">69</span></a> In particular&#44; differences exist between anti-psychotics when it comes to sexual dysfunction&#46; Quetiapine&#44; ziprasidone&#44; perphenazine&#44; and aripriprazole are linked to a low rate &#40;16&#37;&#8211;27&#37;&#41; of sexual dysfunction&#59; olanzapine&#44; risperidone&#44; haloperidol&#44; clozapine&#44; and thioridazine are linked to a high rate &#40;40&#37;&#8211;60&#37;&#41; of sexual dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bb0350"><span class="elsevierStyleSup">70</span></a> Sexual dysfunction is one of the primary reasons for medication non-adherence&#46; It has been stated that sexual dysfunction as a result of anti-psychotics could be due to post-synaptic dopamine antagonism&#44; prolactin elevation&#44; and a<span class="elsevierStyleInf">1</span>-receptor blockade&#46;<a class="elsevierStyleCrossRef" href="#bb0355"><span class="elsevierStyleSup">71</span></a></p><p id="p0175" class="elsevierStylePara elsevierViewall">Some anti-psychotics have been linked to an increase in prolactin levels &#40;hyperprolactinemia&#41;&#59; serum prolactin levels in normal individuals range between 5 and 10&#8239;&#956;g&#47;l&#46; Increased prolactin levels have further been linked to sexual dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bb0360"><span class="elsevierStyleSup">72</span></a> In schizophrenia individuals who took a combination of first- and second-generation anti-psychotic&#44; the serum prolactin level was highest &#40;29&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;95&#8239;ng&#47;ml&#41;&#59; schizophrenia individuals who took first-generation anti-psychotics had medium levels of serum prolactin &#40;13&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;34&#8239;ng&#47;ml&#41; while those who took second generation anti-psychotics had the lowest levels of serum prolactin &#40;9&#46;19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;32&#8239;ng&#47;ml&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0360"><span class="elsevierStyleSup">72</span></a> The difference between groups were found to be statistically significant &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60; &#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0360"><span class="elsevierStyleSup">72</span></a> In fact&#44; one literature review argues that every single anti-psychotic is a dopamine antagonist and that the blocking of dopamine can elevate prolactin levels&#46;<a class="elsevierStyleCrossRef" href="#bb0365"><span class="elsevierStyleSup">73</span></a> As a result of increased prolactin levels&#44; there is typically a decrease in testosterone levels which further affects sexual performance&#46; Clozapine&#44; on the other hand&#44; which causes very little prolactin elevation&#44; has been thought to cause fewer and lower sexual dysfunction&#46; However&#44; anti-adrenergic and anti-cholinergic effects induced sexual dysfunction has been noted in clozapine&#46;<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a> Another study noted that quetiapine had the least effect on sexual function while olanzapine&#44; risperidone&#44; haloperidol&#44; clozapine&#44; and thioridazine were found to be highly linked to sexual dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bb0350"><span class="elsevierStyleSup">70</span></a> However&#44; another study found that the serum prolactin is higher in drug-naive schizophrenia individuals as well&#46;<a class="elsevierStyleCrossRef" href="#bb0370"><span class="elsevierStyleSup">74</span></a></p><p id="p0180" class="elsevierStylePara elsevierViewall">Because schizophrenia individuals may stop taking anti-psychotics if they run into side effects&#44; it would be important to prescribe an anti-psychotic that would minimize the side effects such as sexual dysfunction&#46; Baggaley suggests the following order for severity of sexual dysfunction&#58; risperidone<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>typical anti-psychotics &#40;haloperidol&#41;&#62;<span class="elsevierStyleHsp" style=""></span>olanzapine<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>clozapine<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>quetiapine<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>aripiprazole&#46;<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a> Baggaley&#44; in particular&#44; suggests that aripriprazole be prescribed for hyperprolactinemia and sexual dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a> But if we take the more recent study by Alam et al&#46;&#44; all second generation anti-psychotics would be preferable to first-generation anti-psychotics or combination therapy&#46;<a class="elsevierStyleCrossRef" href="#bb0360"><span class="elsevierStyleSup">72</span></a> In this case&#44; aripriprazole would still be the best option for sexual dysfunction&#46;</p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Aggressive behavior</span><p id="p0185" class="elsevierStylePara elsevierViewall">Until the 1980s&#44; it was believed that schizophrenia individuals were not more violent than their healthy counterparts&#46;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a> However&#44; recent studies suggest that schizophrenia individuals are more likely to be violent than non-schizophrenia individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0385"><span class="elsevierStyleSup">77</span></a> In fact&#44; schizophrenia individuals are 4&#8211;7 times more likely to carry out violent crimes&#59; schizophrenia individuals are also 4&#8211;6 times more likely to be verbally and physically aggressive&#46;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a> Genetics&#44; substance abuse&#44; alcohol abuse&#44; neurological impairment&#44; and social burdens have been shown to increase aggressive behavior&#46; Comorbid substance abuse and acute psychotic symptoms have been linked to higher rates of aggression&#46; In fact&#44; Walsh&#44; Buchanan&#44; and Fahy have stated that aggression is lower in schizophrenia individuals who do not abuse comorbid substances&#46;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a> Another study showed that 46&#37; of psychotic offender&#39;s offenses were due to delusions&#46;<a class="elsevierStyleCrossRef" href="#bb0390"><span class="elsevierStyleSup">78</span></a> Some anti-psychotic drugs&#8212;clozapine&#44; risperidone&#44; and olanzapine&#8212;have been shown to reduce the probability of violent behavior&#46;<a class="elsevierStyleCrossRef" href="#bb0395"><span class="elsevierStyleSup">79</span></a> However&#44; the total number of homicides carried out by schizophrenia individuals is considerably low &#40;10&#37; in the United States&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Further&#44; approximately 20&#37; of jail inmates and 15&#37; of state prison inmates have a mental illness&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> According to Torrey&#44; these number mean that there are approximately 356&#8239;000 mentally ill jail inmates&#44; which is 10 times the number of mentally ill individuals in state psychiatric hospitals&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Though it is true that most schizophrenia individuals are not all violent&#44; those who are violent commit very high-profile violent crimes&#46; Further&#44; it has also been noted that schizophrenia individuals are 14 times more likely to be victims of violence than being the perpetrators&#46;<a class="elsevierStyleCrossRef" href="#bb0400"><span class="elsevierStyleSup">80</span></a> Thus&#44; healthcare professionals should also watch out for indicators of aggression or its opposite&#44; victimization&#46; Torrey explains that the 3 predictors of aggressive behavior is alcohol&#47;drug abuse&#44; failure to adhere to medications&#44; and a history of violence&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Healthcare professionals should especially watch out for those 3 predictors as the 10&#37; of schizophrenia individuals who do commit crimes will commit very violent high-profile crimes&#46;</p></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Stigma</span><p id="p0190" class="elsevierStylePara elsevierViewall">Schizophrenia is typically accompanied by stigma in the common population&#46; When asked&#44; 32&#37; of the participants stated that they would not be comfortable around schizophrenic individuals&#59; 7&#37; stated that schizophrenic individuals ought to be removed from society&#46;<a class="elsevierStyleCrossRef" href="#bb0405"><span class="elsevierStyleSup">81</span></a> Previous surveys state that a large number of individuals believed that schizophrenia is due to sin and character weakness&#59; these days&#44; however&#44; it is commonly accepted that it&#39;s a brain illness&#44; however&#44; stigma has also increased&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Torrey explains that in a 2006 survey&#44; people reported that they didn&#39;t want a neighbor who had schizophrenia&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Torrey attributes this stigma to the high-profile violent crimes committed by a few schizophrenia individuals&#46; The actions of a few cause stigma&#44; trouble&#44; and concern for all others who are mentally ill&#46; Healthcare professionals should give them help to overcome the stigma that they might or might not face&#46;</p></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Cognitive deficit</span><p id="p0195" class="elsevierStylePara elsevierViewall">Cognitive deficit accompanies schizophrenia&#59; this deficit may be mild to severe and affects attention&#44; working memory&#44; verbal learning&#44; and executive functions&#46;<a class="elsevierStyleCrossRef" href="#bb0410"><span class="elsevierStyleSup">82</span></a> Though the extent of the deficit varies across schizophrenia individuals&#44; the majority still demonstrate a certain amount of deficit&#46; It has been shown that a schizophrenia individual&#39;s cognitive performance would be approximately 2 standard deviations less than their healthy counterpart if measured many years after onset of illness but only 0&#46;5 standard deviations lower if measured prior to diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bb0415"><span class="elsevierStyleSup">83</span></a></p><p id="p0200" class="elsevierStylePara elsevierViewall">Three types of cognitive changes were observed in schizophrenia individuals in a recent study&#58; normative&#44; declining&#44; and deteriorating&#46; In schizophrenia individuals&#44; cognitive decline begins quite early&#59; however&#44; cognitive decline is best described as a function of &#8220;time since onset of illness&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bb0420"><span class="elsevierStyleSup">84</span></a> From childhood to 14&#8239;years prior to onset of illness is the normative phase&#59; from 14&#8239;years prior to onset of illness till 22&#8239;years thereafter is the declining phase&#59; 22&#8239;years after onset of the illness begins the deteriorating phase&#46; Thus&#44; from childhood to 14&#8239;years before onset of illness&#44; cognitive ability was found to be stable&#46;<a class="elsevierStyleCrossRef" href="#bb0420"><span class="elsevierStyleSup">84</span></a> At approximately 13&#8239;years of age or approximately 14&#8239;years prior to onset of illness&#44; a bifurcation is seen in individuals with schizophrenia as opposed to those with other psychotic illnesses&#46; In particular&#44; schizophrenia individuals showed a decline of 0&#46;35 IQ points&#47;year approximately 14&#8239;years before the onset of the illness&#59; this decline becomes 0&#46;59 IQ points&#47;year at 22&#8239;years after onset of illness&#46;<a class="elsevierStyleCrossRef" href="#bb0420"><span class="elsevierStyleSup">84</span></a></p><p id="p0205" class="elsevierStylePara elsevierViewall">In fact&#44; Torrey states that schizophrenia is an illness of the brain because there are abnormalities in the schizophrenia brain when compared to the healthy brain&#59; both ventricular enlargement and a decrease in gray matter volume are seen in schizophrenia &#40;this fact has been observed in more than a 100 studies&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Healthcare professionals should present schizophrenia individuals with opportunities to learn to overcome the deficits&#46; Some of the suggested methods are cognitive remediation therapy &#40;CRT&#41;&#44; neuropsychological educational approach to rehabilitation &#40;NEAR&#41;&#44; cognitive adaptation training &#40;CAT&#41;&#44; and cognitive enhancement therapy &#40;CET&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0425"><span class="elsevierStyleSup">85</span></a></p></span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">Conclusion</span><p id="p0210" class="elsevierStylePara elsevierViewall">Schizophrenia is a debilitating illness that is accompanied by 3 types of symptoms&#8212;positive&#44; negative&#44; and cognitive&#46; Further&#44; the mere fact of having schizophrenia implies other consequences or side effects&#46; For example&#44; metabolic syndrome&#44; early death and suicide&#44; diseases&#44; sexual dysfunction&#44; etc&#46;&#8230; These consequences of schizophrenia accompany the owner of the illness alongside the previously mentioned symptoms&#46; In this paper&#44; I reviewed the various consequences of schizophrenia as they should be taken into account during treatment&#46; The consequences of schizophrenia should be treated as well for a healthy and full life&#46;</p></span></span>"
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          "identificador" => "xpalclavsec1702230"
          "titulo" => "Keywords"
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          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "s0005"
          "titulo" => "Introduction"
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        5 => array:2 [
          "identificador" => "s0010"
          "titulo" => "Metabolic syndrome"
        ]
        6 => array:3 [
          "identificador" => "s0015"
          "titulo" => "Early death and suicide"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "s0020"
              "titulo" => "Suicide and accidents"
            ]
            1 => array:2 [
              "identificador" => "s0025"
              "titulo" => "Diseases"
            ]
            2 => array:2 [
              "identificador" => "s0030"
              "titulo" => "Unhealthy lifestyles"
            ]
            3 => array:2 [
              "identificador" => "s0035"
              "titulo" => "Inadequate medical care"
            ]
            4 => array:2 [
              "identificador" => "s0040"
              "titulo" => "Homelessness"
            ]
          ]
        ]
        7 => array:2 [
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          "titulo" => "Lowered pain perception"
        ]
        8 => array:2 [
          "identificador" => "s0050"
          "titulo" => "Sexual dysfunction"
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        9 => array:2 [
          "identificador" => "s0055"
          "titulo" => "Aggressive behavior"
        ]
        10 => array:2 [
          "identificador" => "s0060"
          "titulo" => "Stigma"
        ]
        11 => array:2 [
          "identificador" => "s0065"
          "titulo" => "Cognitive deficit"
        ]
        12 => array:2 [
          "identificador" => "s0070"
          "titulo" => "Conclusion"
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        13 => array:1 [
          "titulo" => "References"
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    "fechaRecibido" => "2023-02-12"
    "fechaAceptado" => "2023-07-27"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1702230"
          "palabras" => array:9 [
            0 => "Schizophrenia"
            1 => "Metabolic syndrome"
            2 => "Death"
            3 => "Suicide"
            4 => "Disease"
            5 => "Pain perception"
            6 => "Sexual dysfunction"
            7 => "Stigma"
            8 => "Cognitive deficit"
          ]
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1702231"
          "palabras" => array:9 [
            0 => "Esquizofrenia"
            1 => "s&#237;ndrome metab&#243;lico"
            2 => "muerte"
            3 => "suicidio"
            4 => "enfermedad"
            5 => "percepci&#243;n del dolor"
            6 => "disfunci&#243;n sexual"
            7 => "estigma"
            8 => "d&#233;ficit cognitivo"
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        "titulo" => "Abstract"
        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Schizophrenia is an illness that affects millions of individuals&#46; It is typically accompanied by positive&#44; negative and cognitive symptoms&#46; These symptoms are typically associated with the onset and progression of schizophrenia&#46; However&#44; aside from these known symptoms&#44; there are consequences of having schizophrenia&#46; In particular&#44; metabolic syndrome&#44; early death and suicide&#44; diseases&#44; lowered pain perception&#44; sexual dysfunction&#44; aggressive behavior&#47;victimization&#44; stigma&#44; and cognitive deficit are all consequences of having schizophrenia&#46; In this paper&#44; we review the various consequences of having schizophrenia&#46; These consequences should be monitored for&#44; much like the typical symptoms&#44; but are usually omitted from treatment&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">La esquizofrenia es una enfermedad que afecta a millones de individuos&#44; y que normalmente se acompa&#241;a de s&#237;ntomas positivos&#44; negativos y cognitivos&#46; Dichos s&#237;ntomas est&#225;n normalmente asociados al inicio y progresi&#243;n de la esquizofrenia&#46; Sin embargo&#44; aparte de estos s&#237;ntomas conocidos&#44; existen consecuencias de padecer esquizofrenia&#46; En particular&#44; el s&#237;ndrome metab&#243;lico&#44; la muerte prematura y el suicidio&#44; las enfermedades&#44; la disminuci&#243;n de la percepci&#243;n del dolor&#44; la disfunci&#243;n sexual&#44; el comportamiento agresivo&#47;victimizaci&#243;n&#44; el estigma&#44; y el d&#233;ficit cognitivo son consecuencias de padecer esquizofrenia&#46; En este documento&#44; revisamos las diversas consecuencias del padecimiento de esquizofrenia&#46; Deber&#225;n supervisarse dichas consecuencias&#44; al igual que los s&#237;ntomas t&#237;picos&#44; aunque normalmente se omiten del tratamiento de la enfermedad&#46;</p></span>"
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Article information

ISSN: 11345934
Original language: English

DOI:10.1016/j.psiq.2023.100413

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