Addiction issues flag hostility risk in schizophrenia patients
medwireNews: Being an inpatient and abuse of alcohol or drugs are key predictors of hostility in patients with schizophrenia, a large study shows.
Researchers analyzed data from the European Schizophrenia Outpatient Health Outcomes (EU-SOHO) study, which included 10,189 patients. This included 6 months of retrospective pre-baseline data and 3 years of prospective observations.
Notably, variables associated with hostility differed in the baseline and prospective analyses, with demographic and social factors (being married, unemployed, and not living independently) associated only with hostility in the 6 months before study enrollment.
"It is possible that these variables are a consequence of previous hostility, rather than risk factors of future hostility," say Susana Ochoa (Parc Sanitari Sant Joan de Déu, Barcelona, Spain) and team.
In all, 27.9% of the patients had displayed hostility prior to enrollment. Other factors independently associated only with previous hostility were having more positive and fewer depressive symptoms, and being a survivor of violent crime.
Seven factors were associated with the risk for both hostility at baseline and new-onset hostility in patients who had not previously displayed this symptom (14% of 7344 patients). These were male gender, younger age, more severe cognitive impairment, alcohol abuse, extrapyramidal symptoms, noncompliance with medication, and inpatient admission.
In addition, substance abuse and the presence of tardive dyskinesia independently predicted hostility during follow up.
Alcohol abuse was one of the stronger predictors for both baseline and future hostility, raising the likelihood 1.62- and 2.02-fold, respectively, while substance abuse was a strong predictor of future hostility, raising the risk 1.77-fold.
"These findings indicate that special care might be appropriate in outpatients with schizophrenia who present with alcohol and substance abuse," write Ochoa et al in TheJournal of Nervous and Mental Disease.
Being an inpatient was also a strong predictor of both baseline and future hostility, being associated with respective 2.08- and 1.35-fold risk increases. However, the factor with the overall largest effect on hostility was having survived violent crime, which raised the likelihood for baseline hostility 3.49-fold.
"To avoid hostility, both external (reducing violent acts toward the patient) and disease-centered interventions (tailoring therapy for individual patients and optimizing compliance with antipsychotic medications) may be needed," concludes the team.
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By Eleanor McDermid, Senior medwireNews Reporter