Attacks against strangers are extremely rare. When the attacker is female they will almost invariably attack their own children. Another kind of behaviour that can be considered dangerous is sexually disinhibited behaviour. We consider it here because, although it is usually quite superficial in nature, it can be extremely distressing to those on the receiving end of it and it is likely to lead to the person with schizophrenia coming into contact with the criminal justice system where, given the nature of the offence, they are unlikely to receive sympathetic treatment.

Sexually disinhibited behaviour is probably under-reported because it mainly occurs within the family context and families are often loathe to disclose it to professionals for fear that their loved one will be branded a sex offender and absorbed into the criminal system. It is not uncommon for young men with schizophrenia to develop a sexual attraction to their mother or sister or for people with schizophrenia to think that they have somehow become gay even though previously they were very happily heterosexual However conversations with other sufferers have led this author to conclude that bizarre thoughts and ideas of a sexual nature affect all sufferers of schizophrenia.

This is after all what we would expect. Schizophrenia affects the entire psyche including the sexuality and does not leave any part of it untouched. In conversation sufferers have described developing sexual attractions towards other family members, family pets and even inanimate objects such as household appliances! In this way, this aspect of schizophrenia illustrates superbly well the often extremely bizarre nature of psychotic thinking. Remember also that schizophrenia is principally a condition of young people three quarters of all diagnoses being made between ages 16 to 25 , the time of life when the libido is at its peak and when both men and women are usually very sexually active.

It is not therefore surprising for them to be troubled by bizarre sexual thoughts during psychotic episodes. Although cases of violence by people with schizophrenia and to a lesser extent suicide are well publicised by the media, dangerous behaviour may take a number of other forms. For instance a person with schizophrenia may become convinced that they can fly and will jump off a high building. They do not intend to kill themselves in doing so but their behaviour nonetheless will result in death or serious injury.

Or dangerous behaviour could be as simple as crossing the road without looking because they believe that they are invulnerable and are being protected by angels. The problem of dangerous behaviour in schizophrenia is all the more tragic when we accept that dangerous behaviour, both suicide and violence, by people suffering from schizophrenia is almost always predictable. There are three risk factors which, from years of study, we know will predict dangerous behaviour in schizophrenia. If you have attempted suicide before, then there is a good chance that it will happen again. Similarly, threats of suicide or violence should always be taken seriously by carers and practitioners.

The second risk factor is a history of drug or alcohol abuse. This is no great surprise. Being drunk or off your head on street drugs puts you at risk of dangerous behaviour whether you suffer from schizophrenia or not. The third risk factor is compliance with or as we prefer to say nowadays adherence to the medication regime. Time after time when we hear of some tragic death in the news we are told that the person deteriorated after they stopped taking their medication. These two risk factors tend to go hand in hand.

When a person stops taking their anti-psychotic medicine they will very often resort to alcohol or street drugs in its place. Carers and professionals must always be aware that whatever problems are experienced with taking antipsychotics they remain the first line of defence against dangerous behaviour for people living with schizophrenia.

Similarly some types of cognitive behavioural therapy have been found effective in reducing violent behaviour. It is vital that professionals caring for people with schizophrenia take all of the warning signs seriously and that carers are listened to when they try to get help for their loved ones. These tools have had varying amounts of success and the likelihood of predicting dangerous behaviour using these tools, without at the same time labelling as potentially dangerous many people who present no risk at all, remains low.

It's okay to refuse. Set limits and have structure. Everyone needs to know what the rules are.

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A few good rules keep things calmer. Let some things slide. Ignore what you can't change. Don't ignore violence! See that Dr's. Take medications as they are prescribed.

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Take only medication that is prescribed. Socialize and carry on business as usual. Reestablish family routines quickly as possible. Stay in touch with family and friends. Take vacations. Pick up on early signs of relapse. Note changes such as inappropriate fear, annoyance, etc. Solve problems step by step. Make changes gradually.

Helping Someone with Schizophrenia -

Work on one thing at a time. Lower expectations, temporarily. Use a personal yardstick.

Compare this month to last month rather than last year or next year. Provide a structured, supportive, tolerant, low stress environment. Set clear expectations of behavior and review them carefully. Give your relative clearly defined tasks, but keep expectations moderate. Learn to expect and tolerate some degree of deviant behavior. Have a set routine in the household with regular hours for meals, tasks, and other activities. Keep home atmosphere as calm as possible.

Each family member should speak for themselves and be allowed to finish what they are saying. Don't "mind-read" what another family member is thinking or feeling. Allow each family member to handle their own communication with another family member. Don't ask a brother to tell a sister. Do it yourself. Remind each other of that. Do not get emotionally overinvolved with your relative. Give them psychological and physical space ex.

Keep criticism and over enthusiastic praise to a minimum. Don't be overly intrusive of your ill relative's thoughts or feelings, like saying, "you wouldn't like that kind of work" or "you really don't like so and so". Expect that they may rest or pace a lot, and indulge in unusual but harmless behavior.

Allow this. Adopt an attitude of "Benign indifference" and a decreased focus on the details of the ill person's behavior. Put limits on hostile or bizarre behavior. Often deviant behavior or delusional verbalizations will decrease if he is told, in a non-emotional way, that it is not appropriate. If your relative has paranoid ideas like they feel people are out to hurt them don't argue them out of it. Just sympathize, saying it must be upsetting to feel like that. Be very clear but calm about the consequences of continuing with disruptive, hostile, or aggressive behavior.

Help in providing stimulation and treatment. Recognize changes in the person that signal they are ready for more indepence, or need more help if doing less well. Inform doctors, therapists, etc. Provide stimulation without stress. Visits, outings, etc.

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Questions and Answers

Discovering this is a trial and error procedure. Families can help explore available community programs. Become a knowledgeble aggressive advocate and your relative will get better care and do better. Take care of yourself. Families must take care of themselves. Share your frustrations with others.

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Enjoy outside interests, too. Increase your outside social contacts. Make sure all family members have their needs met, not just the sick person. Remember: The future is unpredictable and stay with the present. Reduce expectations for a rapid recovery. Reduce pressure on the patient for performance. Modify overall expectations and strike a reasonable balance between realism and hope. Effective communication with schizophrenic patients is particularly important because they are so easily overwhelmed by the external environment. Skillful communication can make an enormous difference in the ability of patients and families to resolve the problems of daily living.