Suicide in the Early Stage of Schizophrenia

Abstract

Suicide is a relevant leading cause of death among patients affected by schizophrenia. Even if suicidal ideation may be present in different stages of disease, some differences have been described between the risk of suicide in patients experiencing first episode of psychosis and those with long-term schizophrenia. It is particularly higher during the first year of illness and reaches a steady decline over the following years. Suicidal ideation and attempts may also be common among subjects with subthreshold psychotic experiences. Factors associated with the risk of suicide in the early phase of schizophrenia are previous suicidal attempts and social aspects: the lack of social support and stable relationships, social drift after the first episode, and social impairment. Also, several psychotic symptoms (suspiciousness, paranoid delusions, mental disintegration and agitation, negative symptoms, depression and hopelessness, and command hallucinations) and substance abuse are associated with higher risk of suicide. It has been described that perfectionism and good levels of insight among individuals who have recently developed psychotic symptoms are significantly associated with higher numbers of suicidal attempts. Moreover, recent evidences show that prefrontal cortex-based circuit dysfunction may be related to suicide in the early stage of schizophrenia. This narrative review summarizes available evidences on suicide in the early stage of schizophrenia and deals with issues to be further studied and discussed.

Suicide Ideation and Behavior as Risk Factors for Subsequent Suicide in Schizophrenia: A Nested Case–Control Study

“…However, a history of ever having attempted suicide was not significant, which may be explained by the fact that suicide attempts were common among both suicide cases and controls (58% vs. 44%). The proportion of patients with schizophrenia who ever attempt suicide has been estimated at between 10% and 50% (Pompili et al., ; Ventriglio et al., ). A Finnish psychological autopsy study of all suicides by patients diagnosed with schizophrenia during a one‐year period found that 71% had ever attempted suicide (Heila et al., ).…”

Suicidal ideation in individuals at ultra‐high risk for psychosis and its association with suspiciousness independent of depression

“…However, suspiciousness also seems to play an independent role beyond depression in the formation of suicidal ideation through various psychological processes including catastrophizing (Startup, Freeman, & Garety, 2007), threat beliefs (Freeman, Garety, Kuipers, Fowler, & Bebbington, 2002) and negative self-cognitions (Collett, Pugh, Waite, & Freeman, 2016). In UHR individuals, although their experiences of suspiciousness are attenuated in nature, the unfamiliarity and confusedness of newly emerging feelings of suspiciousness appear to further contribute to increasing psychological distress and suicidal ideation (Pyle et al, 2015;Ventriglio et al, 2016). Taken together, our current findings suggest that attenuated positive symptoms of UHR individuals, particularly suspiciousness, may represent a heightened risk for suicidal ideation.…”

Self-harm and suicide attempts in Schizophrenia

“…The risk of suicide is a continuum stretching from suicidal ideation (ideations, intent and plans) to attempted suicide to completed suicide (Ventriglio et al, 2016). Suicidal ideation is a strong predictor of suicide and the basis of suicide prevention in schizophrenia (Chung et al, 2014).…”