Aggressive behavior against self and others among first-admission patientswith schizophrenia

Objective: Aggressive behavior directed against self and others was examine d in a sample of patients with schizophrenia during their first hospitaliza tion and during any subsequent hospitalizations over the next two years. Me thods: The charts of 138 patients (77 men and 61 women) with a first episod e of schizophrenia or schizoaffective disorder admitted to a psychiatric ho spital in Weissenau, Germany, were reviewed to obtain information about fou r types of aggressive behavior (verbal aggression and aggression against ob jects, self, and others). Similar chart reviews were conducted for 83 patie nts (47 men and 36 women) who were rehospitalized during the next two years . The severity of the four types of behavior was rated using the Modified O vert Aggression Scale. Stepwise multiple regression was used to identify pr edictors of the number and duration of rehospitalizations. Results: Seventy -five percent of the men and 53 percent of the women in the sample exhibite d some type of aggressive behavior during the first or subsequent admission s. Seventeen percent of men and 26 percent of women attempted suicide. Amon g the predictors of rehospitalization that were examined, which did not inc lude medication compliance, only aggressive behavior against self and again st others were significant predictors during the two years after first admi ssion. Predictors of aggressive behavior against others were male sex, numb er of hospitalizations, and alcohol abuse (among men only). Self-directed a ggressive behavior was correlated with days of hospitalization but not with number of rehospitalizations. Conclusions: Aggressive behavior against sel f and others is a frequent symptom of schizophrenia in the first two years of illness and plays a major role in rehospitalization.