Transcultural differences in suicide attempters: Analysis on a high-risk population of patients with schizophrenia or schizoaffective disorder

University of Milan, Milano, Lombardy, Italy
Schizophrenia Research (Impact Factor: 4.43). 01/2007; 89(1-3):140-6. DOI: 10.1016/j.schres.2006.08.023
Source: PubMed

ABSTRACT The aim of the study was to investigate transcultural differences between schizophrenia spectrum disorder patients who did or did not attempt suicide. DSM-IV schizophrenia (N=609) or schizoaffective disorder (N=371) patients who participated in the multicentre International Suicide Prevention Trial (InterSePT) were studied. Patients were sub-divided into 5 groups according to the different geographical regions of recruitment: North America (NA), Europe (EUR), East Europe (EEUR), South Africa (SAf), and South America (SA). The main lifetime clinical variables were compared, within each group, between attempters and non-attempters. The presence of comorbid substance abuse disorder and smoking was associated with suicide attempts in all the geographical groups considered (NA: chi(1)(2)=7.575, p<0.01 and chi(1)(2)=69.549, p<0.0001; EUR: chi(1)(2)=55.068, p<0.0001, and chi(1)(2)=48.431, p<0.0001; EEUR: chi(1)(2)=164.628, p<0.000, and chi(1)(2)=5.127, p<0.01; SA: chi(1)(2)=30.204, p<0.0001 and chi(1)(2)=11.710, p=0.001) except for SAf. For the other clinical variables various differences were found across the different groups. Variables related to suicide behavior were similar across the five groups investigated, with differences only in the age at the first suicide attempt (earlier in the NA sample) and the number of lifetime suicide attempts (higher in the NA sample). Results from this study show that, while some suicide-related clinical characteristics in schizophrenia patients are consistent worldwide suggesting the influence of stable biological traits, other variables may vary across different geographical areas suggesting environmental influences.

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    ABSTRACT: The primary objective of this review article is to provide a coherent, systematic synthesis of the literature on the management of suicidality in schizophrenia that is relevant to the front-line clinician. Literature searches were conducted on MEDLINE (1996 to 2007) and PubMed (1993 to 2007), using the key words "schizophrenia" and "suicide," as well as references from the resulting articles. I used my own clinical experience to create fictional case examples to illustrate the applicability of the literature discussed in this paper. Suicidality in schizophrenia is high, and early detection relies on the appreciation and evaluation of the clinical manifestations of depression, despair, and hopelessness, as well as on the nature and severity of the psychotic experience itself, particularly in recent-onset patients with higher cognitive function and educational background. Clinical management includes ensuring immediate safety, the use of psychosocial techniques to address depression and psychosocial stressors, targeted pharmacotherapy for depression and psychosis, and adequate discharge planning. Clozapine is the only antipsychotic with good evidence for efficacy in decreasing suicidal behaviour in schizophrenia. The optimal management of suicidality in schizophrenia involves the incorporation of traditional bedside clinical skills, selection of psychosocial modalities based on individual needs, and selective pharmacotherapy directed primarily at psychotic and depressive symptoms.
    Canadian journal of psychiatry. Revue canadienne de psychiatrie 07/2007; 52(6 Suppl 1):59S-70S.
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    ABSTRACT: Objectives: The relationship between suicidal attempt and opioid use disorder in patients with bipolar disorder (BD) is unknown. This study aimed at shedding some light on this issue. Method: 176 inpatients aged 18-65 with BD type I with or without opioid use disorders were interviewed face-to-face through the Persian Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), the Global Assessment of Functioning (GAF) scale, and a questionnaire including demographic characteristics and some clinical factors . Results: Gender was the only demographic factor with a statistically significant difference between suicidal and non-suicidal bipolar patients. In addition, comorbidity with anxiety disorders and the type of index and current mood episodes were significantly different between the two groups (p<0.05). However, after using a logistic regression analysis, the only statistically significant different factors (p<0.05) between the two groups were gender, comorbidity with anxiety disorders, and GAF . Conclusion: Opioid dependence comorbidity can not be considered as a risk factor for suicidal attempt in patients with BD. Mood disorder, especially bipolar disorder (BD) is the most important risk factor for attempted suicide (1), and substance use disorder (SUD) is placed as the second factor (2). Moreover, the SUD prevalence among people with BD has been reported to be 17 to 65 percent (3). Not only having BD or SUD is in association with attempted suicide (1, 2), but also specifically suffering from SUD has been considered as a risk factor for suicidal attempt among patients with BD (4-8). According to the review of the literature by Hawton et al. (9), substance abuse was one of the most consistent factors related to suicidal attempt in patients with BD. On this review, other factors related to suicidal attempt were "early onset of BD, family history of completed suicide, depression at index episode, comorbidity with axis II disorders, mixed affective states, rapid cycling, and anxiety disorders " . Nevertheless, such a relationship between substance abuse and attempted suicide in patients with BD has not been replicated in all studies (10). Although the effect of cultural differences on the relationship between substance abuse and suicidal attempt (at least in patients with schizophrenia) has not been confirmed (11), there would be some other factors that could be the reasons for the variety in the findings of the different studies. In this regard, we can point out to the factors such as not studying a homogenous sample of patients regarding the diagnosis; for example, entering the patients with BD-Not Otherwise Specified in the study of Oquendo et al. (10), the difference in sample selection (like the different sampling in the study of Dalton et al. (12) using advertisement at the newspaper), and the different features of prominent mood of the patients (13). Sometimes even the type of abused substance has identified the relationship between SUD and attempted suicide in patients with BD (12). Dalton et al. (12) reported that the substance use disorder (exception of alcohol) in contrast to the alcohol use disorder (AUD) was in association with attempted suicide in BD patients. Most of their patients with the substance use disorder (exception of alcohol) abused cannabis (74%), and after that hallucinogens (18%), sedatives (18%), and cocaine (18%). Furthermore, it has been drawn from several studies that three substances of alcohol, cocaine and cannabis are abused frequently by BD patients (18% to 75%) (14). Given that opioid abuse is less prevalent than the
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    ABSTRACT: Introduction Suicide is the leading cause of premature death in schizophrenia. Approximately 10 to 13% of deaths in schizophrenia are explained by suicide, despite widespread availability of generally effective antipsychotic treatments and suicide attempts have been reported among 20 to 50% of patients. This relatively low ratio of attempts/suicide is consistent with greater lethality of means – more violent – and intents – less ambivalence – in this population. Literature findings Many studies have focused on risk factors and clinical characteristics for completed and/or attempted suicide. Commonly, sociodemographic risk factors for suicide are male sex, younger age and, among women, being unmarried, divorced or widowed. Previous suicidal behaviour is a strong risk factor for suicide and contrary to the common view, schizophrenic patients often communicate their suicidal intents shortly before death. Moreover, family history of suicide is associated with a heightened risk of suicide and is independent of the diagnosis, according to the growing literature that shows that vulnerability to suicidal behaviour is independent of psychiatric diagnosis. Suicide can occur throughout the entire course of schizophrenia. This is particularly true in those high-risk periods: early phase of the disease, active illness phase, period of relapse or during a depressive episode. The role of insight and positive symptoms remains unclear and probably needs further studies. Although not specifically for people with schizophrenia, hopelessness is a major risk factor and tragic loss is often presented as a trigger for suicide. It has been suggested that treatment side-effects, such as akathisia are associated with suicidal behaviour. Conclusion A better knowledge of risk and protective factors is necessary to prevent suicide and suicidality.
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