The correlation of suicide attempt and suicidal ideation with insight, depression and severity of illness in schizophrenic patients

Abstract

ÖZETŞizofreni hastalarında özkıyım girişimi ve özkıyım düşüncesinin, hastalık şiddeti, depresyon ve içgörü ile ilişkisi Amaç: Bu çalışmada şizofreni hastalarında özkıyım girişimi ve özkıyım düşüncesinin hastalık şiddeti, depresyon ve içgörü ile ilişkisi araştırılarak, şizofreni hastalarında özkıyım riskini yordayabilecek ölçütlerin gelişmesine katkı sağlanması amaçlanmıştır. Yöntem: Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi psikiyatri servislerinde DSM-IV-TR ölçütlerine göre şizofreni tanısı ile yatarak tedavi gören, 20-65 yaş arasındaki 104 hasta rastgele seçilmiş, hastalar hastaneye yattıktan sonraki 72 saat içinde değerlendirilmiştir. Olgular, İçgörünün Üç Bileşenini Değerlendirme Ölçeği (İÜBDÖ), Pozitif ve Negatif Sendrom Ölçeği (PANSS) ve Calgary Şizofrenide Depresyon Ölçeği (CŞDÖ) kullanılarak değerlendirilmiştir. Bulgular: Özkıyım girişimi öyküsü olan hastalarda depresyon puanları, özkıyım girişimi öyküsü olmayan hastalara göre daha yüksek bulunmuştur. Özkıyım düşüncesi olanların içgörü ve depresyon puanları, özkıyım düşüncesi olmayanlara göre daha yüksek bulunmuştur. Lojistik regresyon analizinde CŞDÖ özkıyım girişimi ve özkıyım düşüncesini, PANSS negatif toplam puanı özkıyım düşüncesini, kendine zarar veren davranış ise özkıyım girişimi öyküsünü belirleyen değişken olmuştur. Sonuç: Özkıyım girişimi ve özkıyım düşüncesini belirleyen ortak etken depresyon olduğundan, şizofreni hastalarında depresif belirtiler varlığında özkıyım düşüncesinin daha dikkatli ve ayrıntılı sorgulanması gerekmektedir. Kolaylıkla uygulanabilecek CŞDÖ'nün, şizofreni hastalarındaki depresyonu kolaylıkla saptayabileceğini, uygun tedavi yöntemleri ile depresyonun tedavisinin özkıyım riskini azaltabileceğini düşünmekteyiz. Anahtar kelimeler: Depresyon, içgörü, özkıyım, PANSS, şizofreni ABSTRACTThe correlation of suicide attempt and suicidal ideation with insight, depression and severity of illness in schizophrenic patients Objective: At this study, it is aimed to determine criteria to predict the suicidal risks of schizophrenic patients and to explore the correlation of suicide attempt and suicidal ideation with insight, depression and severity of illness as well. Method: Randomly selected 104 inpatients between 20 and 65 years of age, treated with a diagnosis of schizophrenia according to DSM-IV-TR criteria at Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery were included, and patients were examined at the period of first 72 hours of admission. The patients were evaluated with Schedule for Assessing the Three Components of Insight (SAI), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale for Schizophrenia (CDSS). Results: Depression scores were higher in the patients who had suicide attempt compared to those without suicide attempt. Depression and insight scores of the patients who had suicidal ideation were found to be higher compared to those without suicidal ideation. In the logistic regression analysis, CDSS was found t...

The interactive effects of negative symptoms and social role functioning on suicide ideation in individuals with schizophrenia

“…Unlike in previous studies (e.g., Tarrier et al, 2004; Umut et al, 2013; Yan et al, 2013), we did not find a significant relationship between negative symptoms and suicide ideation; however, we identified a significant interaction. Therefore, our findings fill a gap in the existing literature related to the interactive effects of negative symptoms, which may influence social functioning (e.g., Kring et al, 2013), and social role functioning in relation to suicide risk.…”

“…Therefore, individuals with prominent negative symptoms may not experience a thwarted need for belonging and, as such, may not be at elevated risk for suicide due to thwarted belongingness. Instead, suicide risk among individuals with elevated negative symptoms (e.g., Umut et al, 2013; Yan et al, 2013) may be due to other causes, such as demoralization (Drake et al, 1985). …”

“…Importantly, Kring et al (2013) found that individuals with experiential deficits in motivation and pleasure were less likely to endorse a desire for close relationships and social engagement. Moreover, multiple studies have identified a positive correlation between negative symptoms (assessed broadly through the negative symptoms subscale of the Positive and Negative Syndrome Scale [Kay et al, 1986]) and suicide ideation (Tarrier et al, 2004; Umut et al, 2013; Yan et al, 2013). Though there have been mixed findings regarding the role of negative symptoms and risk for suicide attempts or death by suicide (e.g., Luckhoff et al, 2014; McGirr et al, 2006; Umut et al, 2013; Yan et al, 2013), the extant literature consistently provides evidence that negative symptoms may be an important consideration in risk for suicide ideation among individuals with schizophrenia.…”

Personal Recovery as a Protective Factor Against Suicide Ideation in Individuals With Schizophrenia

“…Similarly, reviews have found inverse relationships between negative symptoms and suicide risk (Hor and Taylor, 2010) or no relationships between these variables (Hawton et al, 2005). Studies have also observed a positive relationship between suicide risk and negative symptoms (Tarrier et al, 2004; Umut et al, 2013; Yan et al, 2013). The inconsistent findings do not appear to be dependent on the suicide-related outcome of interest (e.g., ideation, attempts, death).…”

“…Jovanovic et al (2013) found that anxiety was associated increased suicide risk, defined as previous suicide attempts and/or current suicide ideation. Depressive symptoms have also been associated with suicide risk (Jovanovic et al, 2013), as well as previous suicide attempts (Umut et al, 2013) and suicide ideation (Umut et al, 2013; Yan et al, 2013) separately. Therefore, it is important to account for psychiatric symptoms such as depression and anxiety when examining predictors of suicide risk in individuals with schizophrenia.…”