Complications are problematic results of a health condition or its treatment. Complications can include drug side effects or behavior changes. They are different from comorbidities, or other health diagnoses that occur alongside schizophrenia.1,2
Several common complications of schizophrenia are described below. But this is not a full list of all potential issues. Talk with your doctor about what you might be at risk for. They can help you create a plan for avoiding or recognizing these as soon as they occur.
Increased substance use
People with schizophrenia tend to use recreational drugs, alcohol, and tobacco more often than the general public if they do not receive early treatment. Some people use these substances before their diagnosis. Others might begin after they are diagnosed. Substance use can increase to the point of developing a substance use disorder. Substance use disorder is a common comorbidity of schizophrenia.3-5
Experts do not know why people with schizophrenia have increased substance use. Schizophrenia and substance use may share an underlying genetic cause. They may also involve similar changes in the brain. In some cases, people use drugs and alcohol to cope with the frustrations of living with schizophrenia. More research is needed to better understand the connection between substance use and schizophrenia.3,4
Relationship issues
People with schizophrenia may struggle with strong interpersonal relationships. These may include friendships, family bonds, professional relationships, or romantic connections. One reason for this may be stigma around schizophrenia, such as the stigma that people with schizophrenia are always violent and unpredictable.6,7
Feeling stigmatized also can impact self-confidence and desire to connect. A person with schizophrenia may hesitate to reach out to others for fear of being rejected.6,7
The “negative” symptoms of schizophrenia also impact relationships. Negative symptoms are similar to the symptoms of depression. They include lack of motivation, lack of pleasure, and a lower desire to socialize. A person with negative symptoms may have a decreased interest in forming new relationships or maintaining old ones.3,5
Employment and financial challenges
The symptoms of schizophrenia can make it hard to work. People who are employed may no longer be able to carry out the functions of their job.8
Also, schizophrenia treatment can be expensive. If a person does not have health insurance or is not working, paying for it can be challenging. They may not be able to afford medicine, transportation, or even housing. Some experts estimate that nearly 1 in 5 people who are homeless may be experiencing a psychotic illness.8
Sexual dysfunction
A few drugs used to treat schizophrenia can directly affect sexual drive or performance, such as erectile dysfunction or achieving orgasm. Weight gain and other physical changes are common side effects, too. These can affect self-confidence and the desire to have sex. Negative symptoms can also make wanting to have sex and enjoying it difficult.9,10
Risky sexual behaviors
For those who do want to have sex, risky sexual behaviors can be a common complication. This includes having sex without a condom (unprotected sex). Having unprotected sex increases the risk of getting a sexually transmitted infection (STI). Examples of STIs include chlamydia, gonorrhea, HIV, and syphilis.5,11,12
Risky sexual behaviors may be related to substance use, impaired perception of reality during episodes of psychosis, homelessness, and more. These are people who may also be victimized more easily related to their illness, poor judgment, etc.5,11,12
Drug side effects
The main treatment for schizophrenia is with an antipsychotic medicines. These drugs can be very helpful in preventing psychosis and improving quality of life. However, they have side effects, or an effect that is in addition to what the medicine is designed to do. Side effects can vary depending on the specific drug. Some side effects are mild, but others can be dangerous or greatly impact daily life.4,6,13
Major side effects of schizophrenia drug treatment can include:4,6,13
- Agranulocytosis – This side effect increases the risk of severe infection. This occurs when the number of neutrophils in the body is low. Neutrophils are infection-fighting white blood cells. Some antipsychotic drugs like clozapine can cause agranulocytosis.
- Metabolic syndrome – Antipsychotic drugs can impact the way the body processes fats, sugars, and hormones. These changes can lead to weight gain in the abdomen (belly), diabetes, heart disease, high blood pressure (hypertension), and stroke.
- Extrapyramidal symptoms (EPS) – EPS are movement-related symptoms that can affect daily functioning. They include mild to severe restlessness, tremors, rigid muscles, and slow movements.
- Tardive dyskinesia – Tardive dyskinesia is the development of chronic involuntary muscle movements which the person may not be aware of. These movements can affect the face, neck, and trunk. These can be permanent and can greatly affect quality of life.
- Myocarditis and QT prolongation – Myocarditis is inflammation of the heart. QT prolongation involves changes in the way the heart beats. Both of these can be life-threatening.
These are not all the possible side effects of antipsychotic drugs. Talk to your doctor about what to expect when taking antipsychotics. You and your doctor will discuss potential risks and benefits of taking medicines. Your doctor will also talk with you about side effects to monitor for. You also should call your doctor if you have any changes that concern you when taking these drugs. Your doctor will monitor you for any treatment-related complications you are at risk for.
Suicide
About 2 out of every 3 people with schizophrenia have thoughts of killing themselves. This is called suicidal ideation. As many as 1 in every 10 to 20 people with schizophrenia will take their own life. The suicide rate is higher in those with schizophrenia than those without. This risk is highest in younger people, including older teenagers and young adults.4,6
Regular, consistent treatment with antipsychotic drugs can reduce the risk of suicidal ideation. The drug clozapine, used in treatment-resistant schizophrenia, may be especially helpful.4
If you are having thoughts of harming yourself or others, seek help right away. You can call the Suicide and Crisis Lifeline at 988, any time of the day or night. You can also send a text to 988 to chat with a counselor.14