Suicide and schizophrenia

Abstract

Suicide and suicide attempts occur at a significantly greater rate in schizophrenia than in the general population. Common estimates are that 10% of people with schizophrenia will eventually have a completed suicide, and that attempts are made at two to five times that rate. Demographically associated with suicidality in schizophrenia are being young, being early in the course of the illness, being male, coming from a high socioeconomic family background, having high intelligence, having high expectations, not being married, lacking social supports, having awareness of symptoms, and being recently discharged from the hospital. Also associated are reduced self-esteem, stigma, recent loss or stress, hopelessness, isolation, treatment non-compliance and substance abuse. Clinically, the most common correlates of suicidality in schizophrenia are depressive symptoms and the depressive syndrome, although severe psychotic and panic-like symptoms may contribute as well. This review specifically explores the issue of depression in schizophrenia, in relation to suicide, by organizing the differential diagnosis of this state and highlighting their potentially treatable or correctable causes. This differential diagnosis includes both acute and chronic disappointment reactions, the prodrome of an acute psychotic episode, neuroleptic induced akinesia and akathisia, the possibility of direct neuroleptic-induced depression, negative symptoms of schizophrenia, and the possible co-occurrence of an independent depressive diathesis. The potential beneficial roles of 'atypical' antipsychotic agents, including both clozapine and more novel agents, and adjunctive treatment with other psychopharmacological medications are considered, and the important roles of psychosocial factors and interventions are recognized.

Differing correlates for suicide attempts among patients with schizophrenia or schizoaffective disorder in India and USA

“…Hopelessness, substance abuse, greater insight into illness, and higher cognitive function are associated with greater risk for suicidal behavior in chronic schizophrenia, with hopelessness being the principal predictor (Kim et al, 2003). A recent review also found that the most common correlates of suicidality in schizophrenia are depressive symptoms and the depressive syndrome, although severe psychotic and panic-like symptoms may contribute as well (Siris, 2001). …”

The burden of depressive symptoms in the long-term treatment of patients with schizophrenia

“…Although concurrent depressive symptoms were previously considered a good prognostic indicator (Stephens et al, 1966), research that is more recent has demonstrated that depressive symptoms serve as a poor prognostic indicator of recovery and reintegration into the community (Resnick et al, 2004). Depressive symptoms worsen quality of life (Reine et al, 2003) and increase the risk of suicide (Siris, 2001), psychotic relapse, and psychiatric hospitalization (Tollefson et al, 1999).…”

“…The prevalence of depressive symptoms among people with schizophrenia has been reported to range from 25% to 81% (Siris, 2001), depending on the treatment setting, phase of the illness, and the definition of depression. It is currently unclear what proportion of people with schizophrenia treated in usual practice settings experience at least a moderate level of depressive symptoms, whether the rates of depressive symptoms change over time, or which specific functional outcomes are more adversely affected by depressive symptoms during the course of the illness.…”

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

“…The results of this study raise the possibility that perceptions of defeat and entrapment could be used alongside better established indicators of suicide such as depression and hopelessness 200,230,[250][251][252][253] to identify patients diagnosed with schizophrenia who are at heightened risk of suicide. Further investigation of the utility of defeat and entrapment in predicting suicidal behaviour is therefore warranted.…”