Severe clinical events in 100 patients with schizophrenia: a retrospective clinical description using a system-specific psychopathological approach

Abstract

Catatonic states and numerous other severe clinical events can complicate the course of schizophrenia. Whether these severe courses are associated with particular system-specific symptom dimensions remain unclear. Aim is to assess the frequency of severe clinical events in a clinical population and to investigate the association of these events with sociodemographic data and system-specific psychopathology, combining qualitative and quantitative data. We performed a comprehensive retrospective description of a well-described and geographically stable sample of 100 patients with schizophrenia or schizoaffective disorder and linked severe clinical events with sociodemographic data at inclusion into the study (as indicators of social functioning) and symptoms at first admission, classified with the Bern Psychopathology Scale (BPS). We found 12 mentions of catatonic stupor or excitement, 45 of suicide attempts, 26 of suicidality, 18 of deliberate self-harm, 18 of self-threatening behaviour other than deliberate self-harm, 34 of violence against other persons, 18 of violence against objects and six of sexual harassment. Disinhibited language on first admission seemed to be a protective factor against suicidality and disinhibited motor behaviour seemed to predict self-threatening and violent behaviour. Catatonia and violence in particular seemed to be socially disabling. This exploratory study showed that the BPS is a promising instrument and might represent a system-specific approach in identifying patients at risk for severe sequelae of schizophrenia. This will have to be tested in future prospective studies.

Keywords:

• Catatonia
• suicide
• self-harm
• violence
• Bern psychopathology scale
• risk factors

Acknowledgements

The authors thank Jacquie Klesing, Board-certified Editor in the Life Sciences (ELS), for editing assistance with the manuscript.

Disclosure statement

M.E. Wigand, L. Reichhardt, T.G. Schulze, S. Walther and M. Jäger declare no conflict of interest. F.U. Lang has received remunerations and financial support for congresses from AstraZeneca, Janssen-Cilag and Lundbeck. T. Becker reports research funding to the department (Psychiatry II, Ulm University) from Astra Zeneca, GlaxoSmithKline and AFFECTIS Pharmaceuticals AG. The department has received funds and honoraria to a minor extent for seminars, invited speakers and hospitality from Astra Zeneca, Bristol-Myers Squibb, Eisai, GlaxoSmithKline, Janssen Cilag, Eli Lilly, Lundbeck, Novartis, Pfizer and Wyeth.

Additional information

Funding

This work was supported by the German Research Foundation (DFG) [grant number JA 1742/2-1]. TGS was supported by the German Research Foundation (DFG) within the framework of the Clinical Research Group 241 [www.kfo241.de, grant number SCHU1603/5-1]. The German Research Foundation (DFG) had no direct influence on the study design, the collection, analysis or interpretation of data, the writing of the report or the decision to submit the article for publication.