DIAGNOSTIC TESTSSchizophrenia

Impulsiveness, Violence, Suicide and Homicide

• IMSULSIVENESS– Agitated, little impulse

control– Decreased social

sensitivity– Suicide and homicide

attempts in response to hallucinations

Impulsiveness, Violence, Suicide and Homicide

• VIOLENCE. – Excluding homicide – Risk factors:

• Delusions of persecutory behavior

• Previous episodes of violence

• Neurologic deficits

Impulsiveness, Violence, Suicide and Homicide

• SUICIDE– 50% of all schizophrenia patients attempt suicide

(10-15% die by suicide)– Precipitants of suicide:• Misdiagnosed depression• Feelings of absolute emptiness• Need to escape from mental torture• Auditory hallucinations

Impulsiveness, Violence, Suicide and Homicide

• SUICIDE– Risk factors:

• Awareness of the illness, • Male sex, • College education,• Young age• A change in the course of the disease• Improvement after a relapse• Dependence on the hospital• Overly high ambitions• Previous suicide attempts early in the course of the disease• Living alone

Impulsiveness, Violence, Suicide and Homicide

• HOMICIDE– Same incidence as in general population– Unpredictable or bizarre reasons based

on hallucinations or delusions– Possible predictors:

• History of previous violence• Dangerous behavior while hospitalized• Hallucinations or delusions involving such

violence

SENSORIUM AND COGNITIONDiagnostic Tests

Orientation

• Usually oriented to person, time, and place• Some may give incorrect or bizarre answers– “I am Christ; this is heaven; and it is AD 35.”