Wandering Into Dangerous Situations

Hello everyone! Today in treatment team, we were working with a patient with schizophrenia that has a tendency to wander. The patient can’t identify why they wander, but they often will wander into dangerous areas/situations (when not hospitalized). I have scoured journal articles to see if medication or a different therapeutic approach is more successful in treating this behavior, but the literature doesn’t appear to be out there. Does anyone have any insight to offer? I don’t want to see them get injured. Thank you in advance :smile:

Does the patient live alone?

I used to meander around the residential care facility where I used to live, but I never wandered any place dangerous. I did it because I was restless, and different places and scenes kept me feeling content. Maybe if you stipulated different places where the patient can go that aren’t dangerous but that satisfy his need to wander it would help. Let him know where he can and can’t go. You might have to watch him until he gets the hang of it.

Wandering around aimlessly?

Sounds like disorganized.

Or just really psychotic and not aware of the danger their curiosity brings them. I’ve wandered before out of sheer disinhibition but I am not the average patient with scz. I was and am very fit and strong and have degrees in Krav Maga. I used to wander around with my friends just for the feeling of freedom and because I felt like exploring the world which always feels alien to me because of my schizophrenia.

It’s analogous to a sociologist wandering around a shopping mall observing people. I would wander around “the others” observing what they did. I thought of myself as different but didn’t know that I was Scz. I just thought I was special (and time has shown that I am! Yay! Special kind of pain!)


An equally adequate defense mechanism is looking homeless

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The patient lives in a pch (personal care home). However, they basically only offer room and board and don’t provide “monitoring”

He’s not homeless, and I don’t think he is seeking out dangerous places. It’s just the area where he is residing isn’t very safe. He’s on a limited income.

That was more of a joke, I spent a night or two wandering around Oakland, one night I had to sleep outside in oakland haha

He hasn’t been able to get stable on medication at all?

I liked your analogy of the sociologist roaming the mall :slight_smile: again, he doesn’t seek out dangerous areas, it’s just the area where he lives. He also doesn’t provide reasons as to why he wanders, and we’ve set him up with an act team (assertive community treatment), but unfortunately that doesn’t deter his wandering. He also doesn’t return. However, when asked, he says that he likes where he’s living just fine.

From what it sounds like, he needs to be hospitalized.

Maybe he is doing something he doesn’t want anyone to know, like street drugs or something? Sounds like he doesn’t care and that could be dangerous in itself.

He takes medication when he’s at his pch, and we have him on an LAI (long acting injectable), but he still is wandering. He was just inpatient a couple weeks ago and was doing really well before discharge and its hard to believe how much he’s decompensated in the past couple weeks. Also, I’d agree that he is very disorganized. Do you know meds to help this symptom of disorganization?

UDS is negative. Wondering what else he might want to explore. Good thought though.

The medications aren’t targeted for specific symptoms. They primarily operate on the dopamine and serotonin chemicals in the brain, to help balance these. That’s why what you see in medication studies is really just a look at general effectiveness.

He’s currently hospitalized. I work inpatient psychiatry. It’s just that we’re able to get him stable, but he has a tendency to wander and disappear. He doesn’t care for himself once he wanders. I’m going to research interventions used with patients that have dementia and have a propensity to wander. I’d just like him to retain some level of freedom and independence, and not have him placed in a nursing home type facility. I know he doesn’t want that either.

Agreed. I did find one study conducted in Japan that claims it (medication combination) was effective, but I can only read the abstract. I’ll give it to the psychiatrist tomorrow and see what he says, and see if he wants to pay the $36 to read it (and hopefully the article isn’t in Japanese as one copy I did find, the abstract is in English so I’m optimistic). Really appreciate all of your insight.

It could very well be what he needs. If he isn’t able to function on his own at the moment, then supervision could be very important. Each time he has to be re stabilized, it has been shown it impacts his brain and hurts his long term prognosis.

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I absolutely agree. I was reading one journal article the other day that claimed if a patient started receiving (and was compliant with) treatment (LAI in this case) it could “freeze” the progression of the illness if it was treated within the first year of onset. It also described the damage being done neurologically with each stint of psychosis.

Oh yes, definitely, there are groups here in the US devoted to early detection and prevention because of this.

I was reading one the other day that referenced brain scans of first episode schizophrenia patients before and after, the damage to the brain starts with the first episode.

Thank you for your feedback. I did read about “wandering gardens” for patients experiencing symptoms of mental illness, however there aren’t any around here that I know of. I think “wandering gardens” could be beneficial to everyone’s mental health. Do you mind if I ask if you ever stopped wandering? Did you return? If you did stop, what precipitated you stopping?