Impulsive behavior and its correlates among patients with schizophrenia in a tertiary care psychiatry setting in Mansoura
Introduction
Impulsivity can be defined as ‘a predisposition toward rapid unplanned reactions to internal or external stimuli without regard to the negative consequences of these reactions to themselves or others’ (Moeller et al., 2001). Impulsive behavior in the mentally ill can lead to increased risk of violence, complications during admission for treatment and lengthened hospital stays (Hoptman et al., 2014). Impulsive behavior has been repeatedly identified as a major problem in schizophrenia. Many studies have shown its important role in the etiology of substance use, aggression, violence, and suicide in schizophrenia (Ouzir, 2013).
Patients with schizophrenia often display behavioral problems that suggest impaired impulse control (Nolan et al., 2011). They often engage in violent acts more frequently than general population (Hodgins, 2008, Sariaslan et al., 2015). This greater impulsivity may interfere with patient’s decision making process and in turn may be manifested by aggression towards self or others (Spivak et al., 2003).
To the best of our knowledge this is the first study addressing this issue in the developing countries. However, whether the degree of impulsive behavior is consistent across cultural boundaries has yet to be examined. The present study examines the possible demographical and clinical, correlates for impulsive behavior in those patients. We hypothesized that the participants with schizophrenia would have greater levels of impulsive behavior than the controls and would record different sets of predicting factors for impulsive behavior. The study also reports descriptive data on the frequency of impulsive behavior in patients with schizophrenia compared to a normal sample.
Section snippets
Subjects and methods
Fifty-eight schizophrenia patients were recruited from Mansoura Psychiatry Department during the last week of their hospitalization after considerable stabilization. They were recruited during the period from May 2014 to May 2015 after having an written consent. Thirteen patients refused to join the study; two of them were highly suspicious and uncooperative and the others were lacking the motivation and interest in participation.
Seventy-seven healthy controls were recruited from healthy
Measures
Sociodemographic data were collected including: age, marital status, education (below secondary, above secondary school), income where satisfactory income means sufficient enough to satisfy living needs of the family (e.g accommodation, food, transportation, clothes, costs of education & health care) (Amr et al., 2012), employment status well as the clinical characteristics of the patients, such as the duration of illness in years, type of schizophrenia, past history of substance abuse, and
Statistical analysis
All statistical tests were carried out using the Statistical Package for the Social Science (SPSS), version 17.0. Data analysis was conducted in three phases. Initially, comparisons of demographic characteristics and impulsive behavior assessment between the schizophrenia and control groups with illustration of the clinical variables of the patients were conducted using Mean ± Standard deviation (SD) and frequency (Number-percent). Additionally, two analytical approaches were applied in our
Results
We recruited Fifty-eight schizophrenia inpatients (42 males and 16 females) with mean age 30.36 ± SD 3.66, 65.5% were married, 67.2% were employed, 77.6%were educated above secondary school education and 89.7% were classified into the unsatisfactory group. No statistical significant difference was found between control and patients with regards to demographic characteristics (see Table 1).
63.8% of our patients reported history of abuse. Diagnosis with paranoid type of schizophrenia represented
Discussion
Impulsive behavior, defined as ‘multifactorial construct (Evenden, 1999), that involves a tendency to act on a whim, displaying behavior characterized by little or no forethought, reflection, or consideration of the consequences (VandenBos and APA, 2007).
Patients with schizophrenia often display behavioral problems that suggest impaired impulse control (Abed Dayem et al., 2011, Agoub, 2009, Amr and Volpe, 2013, Ford et al., 2004, Nolan et al., 2011, Ouzir, 2013, Roberts and Pennington, 1996).
Limitations
The limitation of the study was the small sized sample drawn from a single psychiatric facility and also the fact that the study was limited to schizophrenic inpatients and therefore not fully representative of all schizophrenic individuals. In addition, the data was obtained by self-administered questionnaires which need to be confirmed by an objective assessment.
Disclosure of interests
None to declare.
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