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Cholesterol Flags Violence Risk in People with Schizophrenia

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Linked to a lower risk of heart attacks and strokes, low cholesterol may also be a sign that people with schizophrenia are at high risk of self-harm, suicide, and violence.

Medics measuring risk and treatment for people with psychosis might do well to check their patient’s cholesterol levels, new research shows.

The study was published in the Australian and New Zealand Journal of Psychiatry and shows low cholesterol levels might be a useful biomarker for aggression and suicidal tendencies in psychosis, including schizophrenia.

‘It is well known that high cholesterol, especially total cholesterol and high LDL (low-density lipoprotein) cholesterol, is bad for the heart,’ said Professor Veena Kumari. ‘But low levels of cholesterol can also come with their share of problems, like increase in impulsivity and effect on mood,’ warns the Brunel University London psychologist.

The team scoured medical databases for links between different lipids or body fats and aggression, self-harm, or suicide in people with schizophrenia. They also set out to see if the effects are similar in men and women. They focused on adults with a confirmed diagnosis of schizophrenia, schizoaffective disorder, or psychosis, rating patients’ verbal aggression and physical aggression against objects, other people, and themselves, including suicide.

About 70% of samples showed a link between low cholesterol and violence to others, and about half revealed a link with suicidal behaviour. Neuropharmacologists think low cholesterol may make brain cells less sensitive to the ‘happy hormone’ serotonin, which makes people depressed, more impulsive, and aggressive.

The link between lipid levels and violence was broadly similar for men and women, but slightly stronger for men, possibly because fewer women were studied. This is where more research is needed, the study notes, along with looking at more people diagnosed with schizophrenia and people with histories of violence, self-harm, and suicidal behaviour.

‘This is encouraging evidence of low cholesterol showing promise as a biomarker of risk in patients with schizophrenia,’ said Dr Piyal Sen, consultant forensic psychiatrist at King’s College London.

‘For doctors, the likely approach based on our findings is to be aware that if a patient has low cholesterol, that might increase their risk, either in the form of violence to others or self-harm and suicidality, and they should think of prescribing anti-psychotics and/or anti-depressants.’

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