Aggressive behavior against self and others among first-admission patients with schizophrenia

Objective: Aggressive behavior directed against self and others was examined in a sample of patients with schizophrenia during their first hospitalization and during any subsequent hospitalizations over the next two years. Methods: The charts of 138 patients (77 men and 61 women) with a first episode of schizophrenia or schizoaffective disorder admitted to a psychiatric hospital in Weissenau, Germany, were reviewed to obtain information about four types of aggressive behavior (verbal aggression and aggression against objects, self, and others). Similar chart reviews were conducted for 83 patients (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 Overt Aggression Scale. Stepwise multiple regression was used to identify predictors of the number and duration of rehospitalizations. Results: Seventy-five percent of the men and 53 percent of the women in the sample exhibited some type of aggressive behavior during the first or subsequent admissions. Seventeen percent of men and 26 percent of women attempted suicide. Among the predictors of rehospitalization that were examined, which did not include medication compliance, only aggressive behavior against self and against others were significant predictors during the two years after first admission. Predictors of aggressive behavior against others were male sex, number of hospitalizations, and alcohol abuse (among men only). Self-directed aggressive behavior was correlated with days of hospitalization but not with number of rehospitalizations. Conclusions: Aggressive behavior against self and others is a frequent symptom of schizophrenia in the first two years of illness and plays a major role in rehospitalization.