Fourteen-Year Prospective Follow-Up Study of Positive and Negative Symptoms in Chronic Schizophrenic Patients Dying from Suicide Compared to Other Causes of Death

Abstract

Background: Several trials have suggested that negative symptoms are inversely correlated with suicidal risk in schizophrenic patients. This fourteen-year follow-up study compared the positive and negative symptoms of schizophrenic patients who died from suicide to those of subjects dying from other causes. Sampling and Methods: From 1991 to 1995, 150 patients meeting the research diagnostic criteria for chronic schizophrenia were assessed. On inclusion, they completed the Physical Anhedonia Scale as well as the Beck Depression Inventory, and the positive and negative symptoms were rated by the Positive and Negative Syndrome Scale. Results: During the 14-year follow-up, 8 patients committed suicide, while 17 died from other causes. The suicide victims had a shorter duration of illness and a higher level of education compared to those who died from other causes. The proportion of ‘negative’ subjects, according to the composite index of the Positive and Negative Syndrome Scale, was lower among the suicide victims than among the participants who died from other causes. All these differences were significant. The rate of deficit syndrome (0%) among the suicides was lower than that (23.5%) of the other subjects. The scores on the Physical Anhedonia Scale and of the social withdrawal item of the Beck Depression Inventory were higher in the suicides than in the subjects who died from other causes. Conclusions: These findings suggest that negative symptoms and notably deficit-negative symptoms could be associated with a low risk of suicide. In this study, the link between anhedonia and high risk of suicide in schizophrenic patients indicates that this symptom could be more closely related to depression than to negative symptoms.

Inhibition of glutamine synthetase in the central nucleus of the amygdala induces anhedonic behavior and recurrent seizures in a rat model of mesial temporal lobe epilepsy

“…Anhedonia is an important behavior to study because, in humans, the presence of anhedonic symptoms in a setting of depression is predictive of suicidal thoughts and behaviors [26–30]. Our amygdala-dependent anhedonia model is, therefore, consistent with human studies, in which numerous gene and protein expression studies have demonstrated a relationship between the physiologic state of the amygdala and the occurrence of a successful suicide.…”

“…While depression is a complex disorder with multiple symptoms, we have chosen to focus on the anhedonic symptom of depression because it is a key symptom of depression that is highly predictive of suicidal thoughts and behaviors [26–30] and is common in patients with MTLE [31,32]. The model we are introducing is produced by inhibiting glutamine synthetase, an astrocytic enzyme that is critical for the metabolism of glutamate and ammonia to glutamine, in the central nucleus of the amygdala (CeA).…”

The Association between Anhedonia, Suicidal Ideation, and Suicide Attempts in a Large Student Sample

“…Previous research has identified a relationship between suicidal ideation and anhedonia; however, the extant literature has provided mixed results regarding the relationship between anhedonia and suicide. For instance, some research suggests that low levels of anhedonia may be characteristic of those dying by suicide (Loas, 2007;Watson & Kucala, 1978), whereas other research suggests high levels of anhedonia as one of several predictors of fatal suicide attempts (Fawcett, Clark, & Busch, 1993;Fawcett et al, 1990;Hall, Platt, & Hall, 1999;Loas, Azi, Noisette, Legrand, & Yon, 2009). In the current studies, we found that anhedonia was associated with suicidality but not related to previous suicide attempts.…”

Dysfunctional Attitudes and Expectancies in Deficit Syndrome Schizophrenia

“…3 Research has shown that deficit patients, as compared with nondeficit patients, have poorer premorbid functioning, 4 more severe neurocognitive impairment, 5 worse functional outcome, 6 and substantially lower rates of remission and recovery. 7 Yet, despite a worse prognosis, deficit patients experience less overall negative affect, 8 have a lower risk for suicide, 9 and abuse substances less than nondeficit patients. 10 Whereas neurobiological research has identified anomalies associated with the deficit syndrome in the areas of eye tracking, 11 olfaction, 12 event-related potentials, 13 and neuroanatomy, 14 these findings have not translated into improved treatments.…”