Neuropsychiatric Syndromes

Most of the nongenetic risk factors of schizophrenia consist of problems during pregnancy and may have as a common thread the mother's stress response. It therefore shouldn't be surprising that the behavioral and anatomical effects of these problems (plus genetic vulnerability) are very widespread and include both neuropsychiatric syndromes other than psychosis and abnormalities outside of the brain.

The relationship between psychotic bipolar disorder and schizophrenia is unclear, but certainly within schizophrenia, full-fledged manic syndromes occur and serious depressive episodes are common. These can occur either during psychotic episodes or when psychotic symptoms are either absent or stable. The lifetime risk for major depression is very high, with perhaps a third to a half of patients experiencing at least one such episode. This problem contributes to the very high risk of suicide in schizophrenia; approximately 10 percent of patients may kill themselves.

Obsessive-compulsive symptoms such as excessive checking or excessive hand washing also appear to have an increased prevalence in schizophrenia (perhaps as much as 20 percent) and are sometimes difficult to distinguish from delusions.

Drug abuse is also much more common in schizophrenia than in the general population. Population-based estimates suggest that about a third of those with schizophrenia abuse alcohol at some point in their lives, while nearly half abuse alcohol or some other drug.

Other neuropsychiatric problems are also found in schizophrenia. With chronic use, the older antipsychotic drugs such as haloperidol and chlorpromazine cause abnormal, involuntary movements in some patients. These extra, purposeless movements are usually subtle but can be so frequent and severe that they are disfiguring and interfere with the patient's function. However, similar movements also occur in some patients with schizophrenia before they take such medications. Patients with deficit schizophrenia may exhibit these spontaneous movements more frequently than nond-eficit patients.

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