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Suicidal Behavior in Patients With Schizophrenia and Other Psychotic Disorders
Abstract
Patients with schizophrenia are known to be at high risk for suicide attempts and dying by suicide. However, little research has been conducted to determine whether the risk for suicidal behavior is elevated among patients with psychosis in general.
This study evaluated 1-month and lifetime rates of suicidal behavior among 1,048 consecutively admitted psychiatric inpatients (ages 18 to 55 years) with DSM-III-R psychotic disorders. Demographic, clinical, and diagnostic correlates of suicidal behavior were examined.
A high rate of suicidal behavior was found in the group: 30.2% reported a lifetime history of suicide attempts, and 7.2% reported a suicide attempt in the month before admission. The highest 1-month and lifetime rates were found in patients with schizoaffective disorder and major depression with psychotic features. Ratings of the medical dangerousness of the most recent suicide attempt on the basis of the extent of physical injury were higher in patients with schizophrenia spectrum psychoses. Agreement was high between emergency room assessments and semistructured interview assessments of suicidal behavior.
Rates of suicidal behavior were high across a broad spectrum of patients with psychotic disorders; patients with a history of a current or past major depressive episode (as a part of major depressive disorder or schizoaffective disorder) were at a greater risk for suicide attempts, but patients with schizophrenia, on average, made more medically dangerous attempts. Risk factors for suicidal behavior in patients with psychosis appear to vary compared to those for the general population.
... For example, more than 50% of individuals who die by suicide experience symptoms of depression [20], and in Uganda, five (three with depression) out of 23 university students who died by suicide had a mental illness [6]. Various other risk factors for suicidal behavior have been documented among individuals with mental health conditions, including; a history of emotional and physical trauma or abuse, access to lethal means, male gender, young age, unemployment, family history of mental disorder, family history of suicide, and a lack of regular contact with a significant other [21][22][23][24][25]. In addition, individuals having a suicidal attempt are at higher risk of dying by suicide than those with other forms of suicidal behaviors [16]. ...
... Similar to other studies among patients with mental health conditions [21,25,29], the present study found that an increase in age was associated with a decreased likelihood of having suicidal behaviors. The protective effect of age may be due to several factors, including greater life experience and coping skills, stronger social support networks, and a greater sense of purpose and meaning in life [40]. ...
... This study found that having depressive disorders, when compared to bipolar affective disorders, was associated with an increased likelihood of having suicidal behaviors and suicidal attempts. This finding was congruent with that done by Radomski et al. (1999) at a university-based psychiatric treatment facility, which found that depression increases likelihood of all suicidal behavior compared to other psychiatric diagnoses [21]. In a study among Ugandan school going children and adolescents, the severity of depression increased the odds of having suicidal ideations [47]. ...
Background:
Suicidal behaviors are prevalent among inpatients with severe mental conditions and may result in many dying by suicide. Few studies have focused on the burden of suicidal behaviors among these inpatients in low-income settings, despite suicide being consistently higher in lower-income countries such as Uganda. This study, therefore, provides the prevalence and associated factors of suicidal behaviors and suicide attempts among inpatients with severe mental conditions in Uganda.
Method:
This was a retrospective chart review of all individuals admitted with severe mental conditions to a large psychiatry inpatient unit in Uganda for four years (2018-2021). Two separate logistic regressions were conducted to determine the factors associated with suicidal behaviors or suicidal attempts among the admitted individuals.
Results:
The prevalence of suicidal behavior and suicidal attempts among 3104 (mean age = 33, Standard deviation [SD] = 14.0; 56% were males) were 6.12% and 3.45%, respectively. Having a diagnosis of depression increased the likelihood of both suicidal behaviors (adjusted odds ratio [aOR]: 5.36; 95% confidence interval [CI]: 2.14-13.37; p =0.001) and attempts (aOR: 10.73; 95% CI: 3.44-33.50; p < 0.001). However, a diagnosis of substance-related disorder increased the likelihood of having attempted suicide (aOR: 4.14; 95% CI: 1.21-14.15; p = 0.023). The likelihood of having suicidal behavior decreased as one increased in age (aOR: 0.97; 95% CI: 0.94-0.99; p = 0.006) and increased among individuals reporting stress from financial constraints (aOR: 2.26; 95% CI: 1.05-4.86; p = 0.036).
Conclusion:
Suicidal behaviors are common among inpatients managed for severe mental health conditions in Uganda, especially those with substance use and depressive disorders. In addition, financial stressors are a main predictor in this low-income country. Therefore, regular screening for suicide behaviors is warranted, especially among individuals with depression, and substance use, among those who are young, and among those reporting financial constraints/stress.
... In schizophrenia and other psychotic disorders, the lifetime risk of suicide death is estimated to be 5.6% [1]. The prevalence of Suicidal behavior in schizophrenia varies from 20 to 55% [2][3][4]. Theoretically, there is a high proportion of young people who attempted suicide before their first psychiatric support. However, little is known about severe suicide attempt inauguring the first psychosis episode. ...
... The risk factors for suicide attempts in psychotic disorders are numerous. The most important are male 58%-62%, young age 12.7%, celibacy 73%-80%, the first psychotic episode [3,5], depressive disorders 57% [2,4], and impulsive behavior, such as self-harm and having a family history of severe mental disorder or substance use [6] Violent forms of suicide in schizophrenics account for 76% of suicidal behavior [4] and 10 to 15% of patients with schizophrenia die by suicide [2]. ...
... The risk factors for suicide attempts in psychotic disorders are numerous. The most important are male 58%-62%, young age 12.7%, celibacy 73%-80%, the first psychotic episode [3,5], depressive disorders 57% [2,4], and impulsive behavior, such as self-harm and having a family history of severe mental disorder or substance use [6] Violent forms of suicide in schizophrenics account for 76% of suicidal behavior [4] and 10 to 15% of patients with schizophrenia die by suicide [2]. ...
Acute Psychosis is a severe affection that predominantly affects young people. This disorder may be accompanied by severe behavioral disturbances, which may include self-harming acts. Suicidal behavior may inaugurate acute psychosis, and thus, be unexpected and misunderstood. The prevalence of Suicidal behavior in psychotic disorders is high, but little is known about suicide or severe suicide attempt as the first clinical signs of the disorder. We present here the case of a young man, without psychiatric history, who has committed a severe suicide attempt, preceded by delusional symptoms, requiring emergency evacuation and cardiovascular surgery before the psychiatric intervention.
... Individuals diagnosed with psychotic disorders are at an increased risk for suicide, as evidenced by a large body of research. [9][10][11][12][13][14] While earlier research largely focused on SB in patients living with schizophrenia, more recent studies have examined psychotic disorders across a broader continuum of diagnoses. Psychotic disorders, which include schizophrenia and schizotypal disorders, are primarily defined by the presence of hallucinations and delusions, thought disorder, and negative symptoms (eg, affective flattening, poverty of speech, avolition, and the inability to initiate and persist in goal-directed activities). ...
... 15 A lifetime prevalence of SAs has been found in anywhere from 18% to 55% of patients with a psychotic disorder diagnosis. 12,14 Estimated rates of completed suicide in people living with schizophrenia may range from 5.6% to 10%. 11,12,[16][17][18] Consistent with the dimensional nature of psychosis and the Research Domain Criteria (RDoC) approach to psychopathology, not all individuals who exhibit psychotic symptoms are diagnosed with a psychotic disorder. ...
... 12,14 Estimated rates of completed suicide in people living with schizophrenia may range from 5.6% to 10%. 11,12,[16][17][18] Consistent with the dimensional nature of psychosis and the Research Domain Criteria (RDoC) approach to psychopathology, not all individuals who exhibit psychotic symptoms are diagnosed with a psychotic disorder. Psychotic symptoms (most commonly delusions and/or hallucinations) have been shown to also be prevalent in other psychiatric disorders, as patients have reported experiencing attenuated symptoms falling below the threshold for the clinical diagnosis of a psychotic disorder. ...
Background:
Psychotic disorders, as well as psychotic symptoms, are associated with a greater lifetime risk of suicidal behavior (SB). It is not known, however, whether psychotic symptoms are independent predictors for short-term SB.
Methods:
Data were collected from 201 psychiatric inpatients at Mount Sinai Beth Israel Hospital. Self-reported psychotic symptoms were assessed using the Brief Symptom Inventory (BSI). Postdischarge SB defined as an aborted, interrupted, or actual suicide attempt was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS), during the 4 to 8 weeks following discharge from an inpatient psychiatric unit (n=127, 63% retention). Logistic regressions were performed to assess the relationships between psychotic symptoms and SB, controlling for primary psychiatric disorders.
Results:
Self-reported psychotic symptoms were associated with subsequent postdischarge SB. There was no significant difference between the SB versus no SB groups on the basis of primary psychiatric disorder. Self-reported psychotic symptoms remained an independent and significant predictor of postdischarge SB when the analysis controlled for primary psychiatric disorder.
Conclusions:
These results suggest that psychotic symptoms are a dimensional predictor of near-term postdischarge SB and are a necessary component of suicide risk assessment during inpatient hospitalization, independent of psychiatric diagnosis.
... The prevalence of SI and SB was 32%, comparable to other study findings from high-income countries examining patients with schizophrenia and other psychotic disorders (30%) (29). The frequency of suicidal attempts in persons with schizophrenia has been found to range between 18% and 55% (10) significantly higher compared to the general population. ...
... Unlike in other suicide risk studies, marital status was not associated with suicide risk in our study. Married status is considered a proxy measure for a social support network, of which the latter is a better metric (29). In African culture, social interaction and group-living is common, and may thus have extended benefits to unmarried patients with psychotic disorders. ...
Background
Psychotic disorders increase the risk for premature mortality with up to 40% of this mortality attributable to suicide. Although suicidal ideation (SI) and suicidal behavior (SB) are high in persons with psychotic disorders in sub-Saharan Africa, there is limited data on the risk of suicide and associated factors among persons with psychotic disorders.
Methods
We assessed SI and SB in persons with psychotic disorders, drawn from a large case-control study examining the genetics of psychotic disorders in a Kenyan population. Participants with psychotic disorders were identified using a clinical review of records, and the diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (MINI). We conducted bivariate and multivariate logistic (for binary suicide outcomes) or linear regression (for suicide risk score) analysis for each of the suicide variables, with demographic and clinical variables as determinants.
Results
Out of 619 participants, any current SI or lifetime suicidal attempts was reported by 203 (32.8%) with psychotic disorders, of which 181 (29.2%) had a lifetime suicidal attempt, 60 (9.7%) had SI in the past month, and 38 (20.9%) had both. Family history of suicidality was significantly associated with an increased risk of suicidality across all the following four outcomes: SI [OR = 2.56 (95% CI: 1.34–4.88)], suicidal attempts [OR = 2.01 (95% CI: 1.31–3.06)], SI and SB [OR = 2.00 (95% CI: 1.31–3.04)], and suicide risk score [beta coefficient = 7.04 (2.72; 11.36), p = 0.001]. Compared to persons aged <25 years, there were reduced odds for SI for persons aged ≥ 25 years [OR = 0.30 (95% CI: 0.14–0.62)] and ≥ 45 years [OR = 0.32 (95% CI: 0.12–0.89)]. The number of negative life events experienced increased the risk of SI and SB [OR = 2.91 (95% CI: 1.43–5.94)] for 4 or more life events. Higher negative symptoms were associated with more suicidal attempts [OR = 2.02 (95%CI: 1.15–3.54)]. Unemployment was also associated with an increased risk for suicidal attempts [OR = 1.58 (95%CI: 1.08–2.33)] and SI and SB [OR = 1.68 (95% CI: 1.15–2.46)].
Conclusion
Suicidal ideation and SB are common in persons with psychotic disorders in this African setting and are associated with sociodemographic factors, such as young age and unemployment, and clinical factors, such as family history of suicidality. Interventions targeted at the community (e.g., economic empowerment) or at increasing access to care and treatment for persons with psychotic disorders may reduce the risk of suicide in this vulnerable population group.
... People with psychotic disorders are at an increased risk of suicide compared to the general population (Osborn et al., 2008). 1 in 20 people with a psychotic disorder die by suicide (Hor and Taylor, 2010) and approximately 23-50% of people with psychotic disorders have attempted suicide in their lifetime (Aslan et al., 2020;Aydin et al., 2019;Radomsky et al., 1999). In addition, among people with schizophrenia, there may be a higher likelihood and more rapid rate of conversion from suicidal ideation (SI) to suicide behavior (Clapham et al., 2019), and means used for attempts may be more lethal (Lopez-Morinigo et al., 2016;Radomsky et al., 1999). ...
... People with psychotic disorders are at an increased risk of suicide compared to the general population (Osborn et al., 2008). 1 in 20 people with a psychotic disorder die by suicide (Hor and Taylor, 2010) and approximately 23-50% of people with psychotic disorders have attempted suicide in their lifetime (Aslan et al., 2020;Aydin et al., 2019;Radomsky et al., 1999). In addition, among people with schizophrenia, there may be a higher likelihood and more rapid rate of conversion from suicidal ideation (SI) to suicide behavior (Clapham et al., 2019), and means used for attempts may be more lethal (Lopez-Morinigo et al., 2016;Radomsky et al., 1999). Despite these striking statistics, the phenomenology of SI and behavior in psychotic disorders is poorly understood (Aleman and Denys, 2014;Donker et al., 2013;Villa et al., 2019). ...
Background
People with psychotic disorders are at an increased risk of suicide, but there is little understanding of suicidal ideation (SI) in this population. The Interpersonal Psychological Theory of Suicide posits that perceived burdensomeness (PB) and thwarted belonginess (TB) contribute to SI. To our knowledge there are no studies using ecological momentary assessment (EMA) to assess these interpersonal risk factors in a sample of individuals with psychotic disorders. This study investigated the validity and variability of PB and TB, and whether SI, EMA-measured psychotic symptoms, mood, and social context relate to PB and TB.
Method
Ninety-six participants with a psychotic disorder, including mood disorders with psychosis completed in-lab assessments of current SI, and then EMA surveys on a smartphone 3x/day for 10 days, answering questions about burdensomeness, belongingness, symptoms (i.e., hearing voices, experiencing suspiciousness), mood (i.e., happy, sad), and social context.
Results
Burdensomeness varied within-participants less than belongingness (t(95)=-3.74, p=< .001). Participants with SI had higher mean burdensomeness ratings (t(94) =-2.70, p<.01) and lower mean belongingness ratings (t(94) =3.68, p<.001) than did participants without SI. Being with others, greater psychotic experiences, less happiness, and greater sadness related to greater burdensomeness. SI status, being alone, greater psychotic experiences, less happiness, and greater sadness related to less belongingness.
Conclusions
This study examined the real-time influences of SI and psychotic symptoms on burdensomeness and belongingness. Hearing voices, suspiciousness, mood, and SI are related to interpersonal suicide-related risk factors. In this sample, social context had a differential effect on burdensomeness and belongingness.
... The mean age was 40.1 years and women accounted for 37.1% of the whole sample. Twenty-eight studies (11 756 patients) reported the lifetime prevalence, one study reported both the lifetime and 1-month prevalence (Radomsky et al., 1999), two studies reported the 1-year prevalence (Tang et al., 2007;Lee et al., 2012) and one study reported the 1-month prevalence of suicide attempts (Malandain et al., 2018), and two studies reported the prevalence of suicide attempts since illness onset (Prasad and Kellner, 1988;Assefa et al., 2012). One study from India (Shrivastava et al., 2016) and another from Greece (Andriopoulos et al., 2011) reported the 6-month prevalence and the prevalence of suicide attempts during the prodromal period, respectively. ...
... This may bias the validity of the pooled prevalence of suicide attempts across studies with different timeframes and sampling. Other than the confounding effects caused by potential recall bias and small number of studies, various factors such as more severe psychotic symptoms, impaired global functioning from onset and stigma could increase the risk of suicidal behaviours in individuals with schizophrenia (Kaplan and Harrow, 1996;Radomsky et al., 1999;Assefa et al., 2012;Jakhar et al., 2017). Patients with a younger age of illness onset had a higher risk of suicide attempts, which is consistent with Li Lu et al. some (Panariello et al., 2010;Vinokur et al., 2014;Niehaus et al., 2004), but not all studies (Popovic et al., 2014). ...
AimsSuicide attempt is an important indicator of suicide and potential future mortality. However, the prevalence of suicide attempts has been inconsistent across studies. This meta-analysis aimed to examine the prevalence of suicide attempts in individuals with schizophrenia and associated correlates.
Methods:
Relevant publications in Embase, PsycINFO, PubMed, Web of science and Cochrane were systematically searched. Data on the prevalence of suicide attempts in individuals with schizophrenia were pooled using a random-effects model.
Results:
Thirty-five studies with 16 747 individuals with schizophrenia were included. The pooled lifetime prevalence of suicide attempts was 26.8% (95% CI 22.1-31.9%; I2 = 97.0%), while the 1-year prevalence, 1-month prevalence and the prevalence of suicide attempts from illness onset were 3.0% (95% CI 2.3-3.7%; I2 = 95.6%), 2.7% (95% CI 2.1-3.4%; I2 = 78.5%) and 45.9% (95% CI 42.1-49.9%; I2 = 0), respectively. Earlier age of onset (Q = 4.38, p = 0.04), high-income countries (Q = 53.29, p < 0.001), North America and Europe and Central Asia (Q = 32.83, p < 0.001) were significantly associated with a higher prevalence of suicide attempts.
Conclusions:
Suicide attempts are common in individuals with schizophrenia, especially those with an early age of onset and living in high-income countries and regions. Regular screening and effective preventive measures should be implemented as part of the clinical care.
... For example, in psychotic disorders, suicidal ideation may be intertwined with hallucinations; ideation appears to be less transient [10] and more likely to be associated with suicide attempts than in people without psychosis [11]. Means used to attempt suicide are also different, and history of psychosis is overrepresented in those with severe attempts [12]. Moreover, social supports are frequently limited in SMI [13], and people with SMI may be less likely to self-initiate use of suicide prevention services like crisis lines [14]. ...
... Safety and Recovery Plan Recall (4,12,24 week only) ...
BACKGROUND
People with serious mental illnesses are at exceptionally high risk for lifetime suicidal ideation and behavior, with rates higher than that in the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific intervention for SMI. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific intervention cognitive behavioral intervention for SMI that is augmented with smartphone interactions.
OBJECTIVE
The primary objective of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention.
METHODS
Six-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia, or schizoaffective disorder and current active suicidal ideation were randomized to START or START + Mobile Augmentation. START consists of 4 weekly sessions addressing early warning signs/triggers, symptoms “drivers” of suicidal thinking, social relationships. And recovery planning and is followed by bi-weekly telephone coaching. START+Mobile Augmentation includes personalized automated CBT scripts that build from in-person content. Participants are evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching) and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial is change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcomes include the rate of outpatient engagement.
RESULTS
The trial is ongoing. Feasibility and acceptability across conditions will be assessed with t-tests/Mann Whitney tests or Chi-square. Reduction of SSI over time will be assessed with hierarchical linear models.
CONCLUSIONS
The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings.
CLINICALTRIAL
NCT03198364
... In patients with schizophrenia, the mortality rate by suicide is high, with a lifetime risk of about 5% (1). The rate of suicidal attempts is higher and varies between 20%-40% (2,3). Previous attempts are significant predictors of later attempts and completed suicide. ...
... In addition, between 15%-26% have made at least one suicide attempt by their first treatment contact and 2%-11% at least one more during their first year of treatment (7)(8)(9). The seriousness of suicide attempts is high for patients with schizophrenia spectrum psychoses (3,10). Treatment interventions can reduce suicide risk from the initiation of treatment onward but will not affect the high level of risk in undetected cases (11,12). ...
Objective: The suicide rate in schizophrenia is high, with the risk being highest early in the course. The rate of suicide attempts before treatment onset is also high and is often the event leading up to first treatment contact. A previous report showed that the duration of untreated psychosis can be reduced through an early detection program, and that the reduction was associated with lower symptom levels at treatment initiation. Treatment programs that bring first-episode patients into treatment at lower symptom levels can have the potential to reduce risk for suicide attempts. Method: The authors examined consecutive patients with nonorganic, nonaffective psychosis who sought initial treatment at psychiatric treatment units in four catchment areas: two that had an early detection program and two that did not. Results: The rate of severe suicidality (plans or attempts) was significantly higher in subjects from communities without the early detection program relative to those from early detection communities, even after adjustments for known predictors of suicidality. Conclusion: Early detection programs that bring patients into treatment at lower symptom levels may reduce suicidality risk at first treatment contact.
... 2,21 These are mainly depressive disorders, addictions, cluster B personality disorders, and schizophrenia. 24 Schizophrenia is associated with the highest elevated risk of suicide. About 40-50% of schizophrenia patients have suicidal thoughts at some point in life, and 4-13% commit suicide, making it a leading cause of premature death among patients. ...
... 23 In addition, the risk of a suicide attempt is increased by 30% in those patients suffering from schizophrenia who have symptoms of depression. 24 Depressive disorders and alcohol abuse are placed second and third, respectively. 1 Suicidal behaviors are also largely related to anxiety disorders. ...
There are 2 types of basic self-destructive behavior: suicide and non-suicidal self-injury (NSSI). Currently, more and more researchers point out significant disorders which are NSSI behavior. This phenomenon is not new; NSSI seemingly has always been present in society, and certainly in approx. 10% of the population worldwide in recent times. Despite the enormous scale of the phenomenon, so far it has been overlooked and marginalized. They were considered transient behavior, typical of adolescence, a part of youthful rebellion. Current research indicates that the disorder affects the adult population in almost equal measure. It is only in the latest diagnostic classification-Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5) by American Psychiatric Association-that has considered NSSI a separate class of behavior. Up to now, it was classified as a prelude to suicide or an element of personality disorders. NSSI is more commonly associated with disturbing behavior and suicide attempts.
... Although 50-80% of attempted suicides have no fatal outcomes, a history of attempted suicide is common among schizophrenics who die by suicide. Lifetime prevalence rates are estimated to be between 40% and 50% [12,13]. In addition, 10-15% re-offends and dies, while 11% die within the first year after diagnosis [13,14]. ...
... Lifetime prevalence rates are estimated to be between 40% and 50% [12,13]. In addition, 10-15% re-offends and dies, while 11% die within the first year after diagnosis [13,14]. ...
Background: There have been many studies on psychiatric disorders, but very little is known about the biology of suicide with schizophrenia. In the present study, we are looking for a possible connection between paraoxonase 1 (PON1) and suicidal behavior in schizophrenic Tunisian patients.
... In this study, we found that 23.5% of SZ patients had suicidal ideation, which is consistent with the results of previous studies [25,[36][37][38].Moreover, we found that young SZ patients had higher risk of suicidality than middle-aged and elderly SZ patients, which is consistent with the previous studies [2,39].Meanwhile, young age was a risk factor for suicidal ideation in middle-aged and elderly SZ patients. A positive effect of age on mental health-related quality of life (HRQOL) has been found in the previous study [40]. ...
Background
Schizophrenia patients have a high risk of suicide, and their cognition function is impaired with increasing age. The association between neurocognitive and suicidality in schizophrenia patients are heterogeneous. We aimed to explore the relationship between neurocognitive function and suicidal ideation in schizophrenia patients across age groups.
Methods
A total of 587 patients with schizophrenia were enrolled in this study. The schizophrenia patients were divided into young group (aged 18–44) and middle-aged and elderly group (aged 45–70). The schizophrenia patients were divided into suicidal ideation group and non-suicidal ideation group according to the evaluation results of the Beck Scale for Suicide Ideation. Insomnia symptoms were measured by the Insomnia Severity Index (ISI). Psychotic symptoms were measured by the Positive and Negative Syndrome Scale (PANSS), and cognitive function was measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).
Results
There was a negative correlation between the age and attention scores of RBANS (P = 0.018). The young schizophrenia patients had higher risk of suicidality than middle-aged and elderly schizophrenia patients (P = 0.001). In the logistic regression analysis, the scores of ISI and positive symptoms scores of PANSS were associated with suicidal ideation among young schizophrenia patients (All P < 0.05). Age, BMI, the scores of ISI, general symptoms scores of PANSS, visuospatial scores of RBANS and attention scores of RBANS were associated with suicidal ideation in middle-aged and elderly schizophrenia patients (All P < 0.05).
Conclusions
High visuospatial scores of RBANS and attention scores of RBANS were risk factors for suicidal ideation in middle-aged and elderly schizophrenia patients.
... The prevalence of class 1 did not differ between British and Chinese young men. We also found psychosis was associated with suicide attempts among both British and Chinese young men, which was consistent with previous evidence that psychosis is a key associated factor [32,33,[38][39][40]. These results indicate the importance of screening individuals attempting suicide for characteristics of class 1 due to their high risk and need for urgent psychiatric treatment, including consideration of need for hospitalisation in severe cases. ...
Background
Suicide attempts are critical predictors of suicide. Developing typologies of suicide attempt may indicate new prevention strategies, which have not been investigated by comparing developed and developing countries. Therefore, we aim to compare the relationship between suicide attempt and mental disorder and develop a typology of suicide attempts among Chinese and British young men.
Methods
Cross-national surveys of 2046 British and 4238 Chinese men aged 18 − 34 years old in households, 2011—2013. Hierarchical multinomial regression models were used to investigate associated factors. Latent class analysis (LCA) to identify homogeneous subgroups.
Results
Prevalence of suicide attempt was higher among Chinese (8.3%, 95% CI: 7.4%−9.2%) than British men (6.6%, 95% CI: 5.5%−7.7%) (OR: 1.27, 95% CI: 1.03–1.57, p = 0.025). Depression was not independently associated with suicide attempts among Chinese men, while anxiety played a vital role in both countries. Three latent classes identified a subgroup more prevalent among Chinese men featuring weakened social bonds in the absence of mental disorder, and another subgroup more prevalent among British men characterizing impulsivity, childhood maltreatment, substance misuse, and chaotic lifestyles.
Conclusions
Further research could test the clinical applicability of this typology in the assessment of men at risk of future suicide and choice of treatment and preventive interventions. Because Class 2 featured by weakened social bonds is more prevalent among Chinese men, research could stablish whether recent improvements in access to crisis services in China have been effective.
... A strong association has been reported between psychotic disorders and a high risk of suicide and/or suicide attempts. Lifetime risk of suicide death is around 2-8% and risk of suicide attempts is approximately 10-42.8% [12][13][14][15]. Previous studies reported that individuals with depression and psychological distress who experienced positive symptoms, such as auditory and visual hallucination and delusions, had a much higher risk of self-harm and suicide attempts after adjustment for confounders; and depression appeared to fully explain this association between delusions and self-harm and suicide attempts [6]. ...
Background:
Previous reports had linked depression to thyroid function. However, the relationship between thyroid function and clinical characteristics in major depressive disorder (MDD) patients with suicidal attempts (SA) is still unclear.
Aims:
This study aims to reveal the association between thyroid autoimmunity and clinical characteristics in depressed patients with SA.
Methods:
We divided 1718 first-episode and drug-naive MDD patients into groups with suicide attempt (MDD-SA) and without suicide attempt (MDD-NSA). Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and the positive subscale of the Positive and Negative Syndrome Scale (PANSS) were assessed; thyroid function and autoantibodies were detected.
Results:
The total scores of HAMD, HAMA and psychotic positive symptoms were significantly higher in patients with MDD-SA, accompanied by higher levels of TSH, TG-Ab and TPO-Ab, than in patients with MDD-NSA, without gender differences. Total scores of positive symptoms (TSPS) in MDD-SA patients with increased TSH or TG-Ab was significantly higher than in MDD-NSA patients and in MDD-SA patients with normal TSH and TG-Ab. The proportion of elevated-TSPS in MDD-SA patients was >4 times that in MDD-NSA patients. The proportion of MDD-SA patients with elevated-TSPS was >3 times that with not-elevated TSPS patients.
Conclusions:
Thyroid autoimmune abnormalities and psychotic positive symptoms may be the clinical features of MDD-SA patients. Psychiatrists should be more alert to the possibility of suicidal behaviors when they first encounter such a patient.
... Vulnerability to suicidal behaviour may be particularly significant among patients combining symptoms of mood and psychotic disorders (Bostwick and Pankratz, 2000). Suicidality is thus a primary concern for those with early affective psychoses (Miller and Black, 2020), including major depressive and bipolar disorder with psychotic features, and for patients with schizoaffective disorder, who show high rates of suicidal thoughts or behaviours (Berk et al., 2007;Bostwick and Pankratz, 2000;Gaudiano et al., 2008;Miller and Black, 2020;Radomsky et al., 1999). ...
Background:
Suicide prevention is a major challenge in the treatment of first-episode affective psychoses. The literature reports that combinations of manic, depressive and paranoid symptoms, which may interact, are associated with an increased risk of suicide. The present study investigated whether interactions between manic, depressive and paranoid symptoms affected suicidality in first-episode affective psychoses.
Methods:
We prospectively studied 380 first-episode psychosis patients enrolled in an early intervention programme and diagnosed with affective or non-affective psychoses. We compared intensity and presence of suicidal thoughts and occurrence of suicide attempts over a three-year follow-up period and investigated the impact of interactions between manic, depressive and paranoid symptoms on level of suicidality.
Results:
At 12 months follow-up, we observed a higher level of suicidal thoughts and higher occurrence of suicide attempts among the affective psychoses patients compared to non-affective psychoses patients. Combined presence of either depressive and paranoid symptoms, or manic and paranoid symptoms, was significantly associated with increased suicidal thoughts. However, the combination of depressive and manic symptoms showed a significant negative association with suicidal thoughts.
Conclusions:
This study suggests that paranoid symptoms combined with either manic or depressive symptoms are associated with an increased risk of suicide in first-episode affective psychoses. Detailed assessment of these dimensions is therefore warranted in first-episode affective patients and integrated treatment should be adapted to increased suicidal risk, even if patients do not display full-blown depressive or manic syndromes.
... A study based on psychotic disorders has reported an association of positive symptoms (such as command hallucinations for suicidality, and delusions) with an increased risk of suicide [75]. Studies have reported that around 30-40% of people with psychotic spectrum disorders (PSD), have suicidal ideations and 20-30% of PSD patients make a suicide attempt, while 5-10% die by committing suicide [76][77][78]. Similarly, a history of head injuries has also been reported to be linked to an increase in suicidality, as brain injuries are a long-term risk factor for the development of psychiatric and neurological disorders. ...
With an increasing incidence of psychiatric disorders worldwide, there is a need for a better understanding of the population-specific contributing risk factors that are associated with common psychiatric conditions. This study aimed to assess the correlation between socioeconomic, environmental and clinical features associated with major depression (MDD n = 479), bipolar disorder (BD n = 222) and schizophrenia (SHZ n = 146), in the Pakistani population. Multinomial logistic regression and Pearson’s correlation were applied to assess the association and correlation between demographic, socioeconomic, environmental, and clinical features of MDD, BD and SHZ. In the present study, MDD was found to be more prevalent than BD and SHZ. The average age at onset (AAO), was observed to be earlier in females with BD and SHZ, in addition, females with a positive family history of MDD, BD and SHZ also had an earlier AAO. The fitted multinomial logistic regression model indicated a significant association of; aggression, tobacco use, drugs abuse, history of head injuries and family history with BD as compared to MDD, while insomnia and suicidality were significantly associated with MDD. Strong positive correlations were observed mainly between age/AAO, AAO/tobacco use and aggression/insomnia in all three cohorts. In conclusion, the present study identifies possible contributing socio-demographic, biological and environmental factors that are correlated and associated with the psychiatric conditions in the Pakistani population.
Graphical abstract
... In a study 13.8% of 2000 patients treated in the psychiatry clinic have been reported to have a history of suicide attempt (9). In another study, 30.2% of 1048 patients hospitalized for the psychotic disorder was found to have a history of suicide attempt (10). This study aims to examine the general characteristics of patients who presented to the emergency department with a suicide attempt. ...
Introduction: Suicide is an important public health problem worldwide. This study aims to investigate the general characteristics of patients presenting to the emergency department with a suicide attempt. Material-method: Patients who presented to the emergency department with a suicide attempt between 01.12.2019 and 31.05.2020 were investigated prospectively. Age, gender, vital signs, method of suicide attempt, history, additional diseases, and regularly used medications were recorded. Results: The study included 247 patients. The median age of the patients was 32 (IQR 25-75: 25-41. 157 (63.6%) of the patients were female. While 222 (89.9%) of the patients attempted suicide by medication overuse, 78 (31.6%) were receiving psychiatric treatment. There was no statistically significant correlation between the suicide attempt method and the psychiatric treatment status of the patients (p>0.05). Similarly, no statistically significant correlation was found between the outcome status of the patients and receiving psychiatric treatment (p>0.05). Conclusion: The most frequent method in patients who presented to the emergency services with a suicide attempt is medication overuse. There is no relationship between the method of suicide attempt and the psychiatric treatment status of the patients.
... Models of suicide such as Baumeister's [4], which emphasizes the connection between hopelessness and suicide, provided further inspiration for the suicide trigger state. Additionally, research on the relationship between psychosis and suicidal attempts [68], combined with empirical findings on ruminative thoughts by Nock and Kazdin [55], and their somatic correlates provided support for the inclusion of a ruminative flooding and near-psychotic somatization, characterized by physical pain that derives as a direct consequence of a panic-like state, in the condition. ...
The Narrative Crisis Model of suicide (NCM) is a dynamic multi-stage model of suicide which incorporates well-documented long- and short-term risk factors for suicide. Very innovative, and yet in continuous dialogue with the other models of suicide in the extant literature, the NCM emerged out of the urgent need to better understand, assess, and treat imminent risk for suicide. The goal of this chapter is to provide a comprehensive presentation of the NCM and establish its contribution to the conceptualization and the assessment of imminent suicide risk. The first section of the chapter provides a comprehensive review of the underlying reasons for the creation of this model and the ways in which its components address common pitfalls in clinical conceptualizations of and assessment of imminent risk for suicide. The second section presents the different components of the model and the empirical evidence that supports each component as well as the model as a whole. The third and the last section of this chapter proposes a comparison of the NCM and the other leading models of suicide in the extant literature.
... BPD [30,39,40], SUD [30], DD [30,41,42] and SPD [30,43] are diagnostic groups known to be associated with elevated risk of suicidal behavior, thus we decided to include time dependent interaction effects between these groups and Covid-19 period in our Poisson regression models. Results from Poisson regression models are presented as rate ratios (RR) with 95% confidence intervals (95% CI) and are tested for significance using the Wald-Chi 2 test. ...
Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020–5/24/2020 “first-wave”) and second (9/15/2020–3/1/2021 “second-wave”) wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.
... Models of suicide such as Baumeister's [4], which emphasizes the connection between hopelessness and suicide, provided further inspiration for the suicide trigger state. Additionally, research on the relationship between psychosis and suicidal attempts [68], combined with empirical findings on ruminative thoughts by Nock and Kazdin [55], and their somatic correlates provided support for the inclusion of a ruminative flooding and near-psychotic somatization, characterized by physical pain that derives as a direct consequence of a panic-like state, in the condition. ...
The Narrative Crisis Model of suicide (NCM) is a dynamic multi-stage model of suicide which incorporates well-documented long- and short-term risk factors for suicide. Very innovative, and yet in continuous dialogue with the other models of suicide in the extant literature, the NCM emerged out of the urgent need to better understand, assess, and treat imminent risk for suicide. This raison d’etre will be presented in the first section of this chapter, followed by a description of the model’s components and their empirical support in the second section. Last, we will compare the NCM to other models of suicide in order to highlight their shared features as well as the NCM’s unique contribution to risk assessment and prevention.
... We conducted a large-scale systematic analysis of the comorbidities of schizophrenia using a nationwide health insurance database. Consistent with the literature [34][35][36][37][38][39], we demonstrated that conditions such as anxiety, posttraumatic stress disorder, as well as alcohol and substance abuse are significantly more common in schizophrenic patients prior to their schizophrenia diagnoses. Benign neoplasm of skin was noted to be more prevalent in non-schizophrenic control patients, suggesting a higher frequency of routine health checkups. ...
Schizophrenia affects >3.2 million people in the USA. However, its comorbidity patterns have not been systematically characterized in real-world populations. To address this gap, we conducted an observational study using a cohort of 86 million patients in a nationwide health insurance dataset. We identified participants with schizophrenia and those without schizophrenia matched by age, sex, and the first three digits of zip code. For each phenotype encoded in phecodes, we compared their prevalence in schizophrenia patients and the matched non-schizophrenic participants, and we performed subgroup analyses stratified by age and sex. Results show that anxiety, posttraumatic stress disorder, and substance abuse commonly occur in adolescents and young adults prior to schizophrenia diagnoses. Patients aged 60 and above are at higher risks of developing delirium, alcoholism, dementia, pelvic fracture, and osteomyelitis than their matched controls. Type 2 diabetes, sleep apnea, and eating disorders were more prevalent in women prior to schizophrenia diagnosis, whereas acute renal failure, rhabdomyolysis, and developmental delays were found at higher rates in men. Anxiety and obesity are more commonly seen in patients with schizoaffective disorders compared to patients with other types of schizophrenia. Leveraging a large-scale insurance claims dataset, this study identified less-known comorbidity patterns of schizophrenia and confirmed known ones. These comorbidity profiles can guide clinicians and researchers to take heed of early signs of co-occurring diseases.
... We were unable to accurately retrospectively explore the reasons for acute care referral in this group but relapse of illness with associated acute clinical risk is clearly most likely. Risk associated with mood disorder in schizoaffective disorder, such as suicidality, 22 may explain the greater need for acute care in this group. As expected, discontinuation of switched medication and acute care requirement were significantly correlated and discontinuation time was on average earlier than acute care, suggesting the former may lead to the latter. ...
Introduction
Pipotiazine palmitate depot injection (Piportil) was withdrawn from the UK marketplace in 2015. Few studies exist on the clinical impact of such market withdrawal. Purpose: We aimed to identify a cohort of patients switching from pipotiazine following this withdrawal and explore factors associated with effectiveness of the medication switched to and subsequent acute service use.
Methods
A naturalistic retrospective cohort study was conducted in Sussex, United Kingdom. Those discontinuing pipotiazine solely due to market withdrawal were identified from electronic patient database and manual searching. Multivariate logistic regression analyses and survival analyses were performed to explore associations between available baseline variables and dichotomous all-cause discontinuation of the next prescribed medication and admission to acute mental health services over the subsequent year.
Results
Of 205 patients identified as receiving pipotiazine in October 2014, 137 switched from this due to market withdrawal. Over the subsequent year, 31.5% discontinued the medication to which they were switched and 19% required acute care. Drug class switched to (typical depot vs atypical long acting injection (LAI) vs atypical oral) had no significant association with discontinuation. Switch to atypical LAI was significantly associated with acute care in comparison to typical depot. Those with a schizophrenia diagnosis were significantly less likely to discontinue switched medication or to receive acute care in comparison to those with schizoaffective disorder. Women were significantly more likely to discontinue switched medication than men. Of those requiring acute care, only 38% had required this in the previous 2 years.
Conclusions
Antipsychotic market withdrawal has demonstrable negative clinical implications and requires careful clinical management. Increased acute care rates in those receiving an atypical LAI versus a typical depot following pipotiazine suggests lower effectiveness or possible withdrawal effects. No significant difference between depots, LAIs and oral medications on discontinuation supports the importance of a collaborative, fully informed approach when deciding next treatment options.
... I 2 = 89.5%). The 3-month prevalence [37], 1-year prevalence [20], and prevalence of SI during more than 1 month period before admission [38] was 44.6%, 16.2%, and 19.6%, respectively. The lifetime prevalence of SP was 44.3% [25], and point prevalence of SP in two studies was 6.4% [26] and 13% [24], respectively. ...
Schizophrenia is a severe psychiatric disorder with high premature mortality rates. This is a meta-analysis and systematic review of the prevalence of suicidal ideation (SI) and suicide plan (SP) among people with schizophrenia. PubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 10, 2020. Data on prevalence of SI and/or SP were synthesized using the random effects model. Twenty-six studies covering 5079 people with schizophrenia were included for meta-analysis. The lifetime and point prevalence of SI were 34.5% (95% CI: 28.2−40.9%), and 29.9% (95% CI: 24.2−35.6%), respectively. The lifetime prevalence of SP was 44.3% and the point prevalence of SP ranged between 6.4 and 13%. Subgroup and meta-regression analyses revealed that source of patients, survey countries, and sample size were significantly associated with the point prevalence of SI, while male proportion and quality assessment scores were significantly associated with the lifetime and point prevalence of SI. Survey time and mean age were significantly associated with lifetime prevalence of SI. Both SI and SP are common in people living with schizophrenia, especially in males and inpatients. Routine screening and effective interventions for SI and SP should be implemented in this population.
... Longitudinal studies in schizophrenia patients showed a suicide rate of approximately five percent [1,2]. Suicidal attempts occur at a much higher rate, ranging from 30% to 49% in some studies [3][4][5][6]. Furthermore, suicidal ideation tends to rapidly progress, regardless of the mood status, to actual attempts and many studies confirmed a positive correlation between suicidal ideations and suicidal behaviors [2,7]. ...
Background: The aim of this study is to evaluate whether any specific antipsychotic regimen or dosage is effective in managing suicidal ideation in schizophrenia. Four comparisons were conducted between: (1) clozapine and other antipsychotics; (2) long-acting injectable and oral antipsychotics; (3) atypical and typical antipsychotics; (4) antipsychotics augmented with antidepressants and antipsychotic treatment without antidepressant augmentation. Methods: We recruited 103 participants diagnosed with schizophrenia spectrum disorders. Participants were followed for at least six months. The Beck Scale for Suicidal Ideation (BSS) was used to assess the severity of suicidal ideation at each visit. We performed a multiple linear regression model controlling for BSS score at study entry and other confounding variables to predict the change in the BSS scores between two visits. Results: Overall, there were 28 subjects treated with clozapine (27.2%), and 21 subjects with depot antipsychotics (20.4%). In our sample, 30 subjects experienced some suicidal ideation at study entry. When considering the entire sample, there was a statistically significant decrease in suicidal ideation severity in the follow-up visit compared to the study entry visit (p = 0.043). Conclusions: To conclude, our preliminary analysis implies that antipsychotics are effective in controlling suicidal ideation in schizophrenia patients, but no difference was found among alternative antipsychotics’ classes or dosages.
... Patients with schizophrenia die much earlier than expected [6], and up to 40% of these premature deaths can be due to suicide [7]. Studies estimated that nearly half (50%) of PWS attempt suicide [8], and around 10% completed suicide during their lifetime [9]. Epidemiological investigations indicated that PWS have about eight times increased risk of suicide than the general population [10] due to the complex and challenging nature of the symptoms of the disorder. ...
Background:
People with schizophrenia (PWS) are at greater risk of suicide. However, suicide behaviors that occur in PWS are often overlooked, inadequately characterized, and not consistently integrated into treatment. Despite this burden and consequences in Ethiopia, there is a dearth of studies concerning suicide behavior in PWS. Therefore, this study is aimed at assessing the magnitude of suicide behavior and its predictors among PWS in Ethiopia.
Methods:
An institution based cross-sectional study was employed. Data were collected using the structured interviewer-administered questionnaire from a sample of 300 PWS at Amanuel Mental Specialized Hospital (AMSH). The revised version of Suicide Behavior Questionnaire (SBQ-R) was used to assess suicide behavior in PWS. The data was collected from March 1 to 30, 2019. Binary logistic regression was performed to identify independent predictors of suicidal behavior at 95% confidence level. Statistical significance was declared at p value <0.05.
Result:
A total of 300 patients with schizophrenia participated in the study. More than two-thirds of 203 (67.7%) of the participants were males, and 116 (38.7%) participants were between the ages of 28 and 37 years. We found that the prevalence of suicide behavior among PWS was 30.3%. Being unemployed (AOR = 3.65, CI = 1.32, 10.05), family history of suicide (AOR = 3.16, CI = 1.38, 7.23), substance use (AOR = 2.51, CI = 1.13, 5.59), current positive psychotic symptoms (hallucination (AOR = 6.39, CI = 2.86, 14.29), and delusion (AOR = 4.15, CI = 1.95, 14.29) and presence of comorbid depression (AOR = 4.81, CI = 1.98, 11.68) were independent significant predictors with suicidal behavior in PWS.
Conclusion:
The prevalence of suicidal behavior among PWS was found to be high. Hence, designing strategies for early screening and intervention is the most critical prevention strategy of suicide in PWS.
... Los trastornos depresivos están asociados al suicidio [30,31] Sin embargo menos de un tercio de nuestros pacientes no tomaban ningún tratamiento antidepresivo previo al intento de suicidio, González-Rodríguez et al. [8] no encontró una tasa más alta de depresión en los pacientes que habían intentado suicidarse. Esto podría sugerir que el intento de suicidio pudiera producirse como reacción al pensamiento desordenado de la psicosis, o consecuencia del contenido temático del delirio o creencia delirante que afecta al paciente, lo cual también ha sido señalado por diversos autores [32,33,34]. ...
Introducción/antecedentes:
La conducta suicida en el trastorno delirante (TD) ha sido escasamente estudiada.
Objetivo:
Profundizar en el conocimiento de las características demográficas, ambientales, psicosociales y clínicas del suicido en un grupo de pacientes con TD con la finalidad de contribuir a generar y sugerir estrategias que contribuyan a realizar nuevos estudios de mayor nivel explicativo.
Método:
Estudio epidemiológico descriptivo retrospectivo de Registro de Casos en el Dispensario de Psiquiatría e Higiene Mental de Córdoba sobre pacientes con TD según criterios DSM-IV-TR. Aquellos pacientes que cumplieron con los criterios de inclusión definidos constituyeron nuestra muestra final de 261 casos, de ellos 26 casos presentaron evidencias de intento de suicidio. Las variables sobre las que se recogió información en base a protocolos, fueron agrupadas con el orden siguiente: I. Sociodemográficos y generales. II. Factores de riesgo del TD (familiares y personales). III. Cuadro Clínico y el Diagnóstico del TD (Presentación, Sintomatología, Funcionalidad y Discapacidad, utilización de los recursos sanitarios, tratamiento, problemas psicosociales, evolución y curso) y medios letales utilizados.
Resultados:
La edad media de los pacientes fue de 47 años y el 60% fueron hombres. Los datos sociodemográficos muestran que los pacientes con intento de suicidio residían en núcleos rurales (46,2%), no tenían estudios en un 15,4%, un 57,7% no trabajaba y un 26,9% recibía una pensión por enfermedad o jubilación laboral. El subtipo persecutorio con 8 casos, fue el más frecuente, seguido de los subtipos de grandiosidad (6 casos) y celotípico (6 casos), mixto (3 casos), erotomaniaco (2 casos) y somático (1 casos).
Discusión y Conclusión:
Son necesarios futuros estudios prospectivos para investigar los factores de protección, de riesgo y/o asociados al suicidio en el TD.
... For example, in psychotic disorders, suicidal ideation may be intertwined with hallucinations, suicidal ideation appears to be less transient [10], and suicidal ideation is more likely to be associated with suicide attempts than in people without psychosis [11]. The means used to attempt suicide are also different, and a history of psychosis is overrepresented in those with severe attempts [12]. Moreover, social support is frequently limited in SMIs [13], and people with SMIs may be less likely to self-initiate the use of suicide prevention services such as crisis lines [14]. ...
Background
People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions.
Objective
The primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention.
Methods
A 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement.
Results
The trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models.
Conclusions
The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings.
Trial Registration
ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364
International Registered Report Identifier (IRRID)
DERR1-10.2196/14378
... The findings of this narrative review concluded that the symptom domains of pessimism, low mood and suicidal ideation may be specific to depression, while alogia and blunted affect are specific to negative symptoms. Hopelessness is an important factor in terms of the relationship with suicidal intent and attempts; this has been shown to be present in both depression and psychosis, although hopelessness is more commonly seen in depression (Radomsky et al., 1999;Warman et al., 2004). The time is therefore ripe for a systematic meta-analysis of this field which aims to establish whether there is a quantitative relationship between negative and depressive symptoms in psychosis. ...
The negative symptoms of psychosis and depressive symptomatology share several features, e.g. low motivation, apathy and reduced activity. Understanding the associations between these two sets of symptoms will support improved assessment and the development of interventions targeting these difficulties in people with psychosis. This is the first large systematic review and meta-analysis to quantify the relationship between these two categories of symptoms , as measured in studies to date. PsycInfo, Embase and Medline were systematically searched to identify eligible studies. Inclusion criteria ensured the studies measured both depression and negative symptoms using validated measures in a sample of over 8000 participants with non-affective psychosis diagnoses. The search led to 2020 records being screened and 56 included in the meta-analysis and review. Both meta-analyses and meta-regressions were conducted to explore the main effect and potential moderating variables. A clear pattern emerges showing that higher ratings of negative symptoms are associated with higher levels of depressive symptoms, with a small effect [standardised effect size = 0.19, p < 0.05). This did not vary greatly with the measures used (SES = 0.19-0.26) and was not moderated by demographic variables or quality ratings. Interestingly, higher depressive symptoms predict a significant relationship with co-occurring negative symptoms. However, higher negative symptoms predict that it is less likely there will be a relationship with co-occurring depressive symptoms. Heterogeneity was high across these analyses. The findings support the adoption of a symptom-specific approach to understanding the interplay between negative and depressive symptoms in psychosis, to improve assessment and intervention.
... The associations of GTF2IRD1 with anxiety and social impairment in WS have been previously reported [53,55]. In addition, various copy number variations in 7q11.23 region have been strikingly implicated in the genetic etiology of schizophrenia and ASD [56,57], which are associated with high risk of youth suicide [58,59]. Focusing on this chromosomal region by more detailed genome sequencing is necessary to yield further insight into the genetic feature of suicide in young people. ...
Suicide is a significant public health problem worldwide, and several Asian countries including Japan have relatively high suicide rates on a world scale. Twin, family, and adoption studies have suggested high heritability for suicide, but genetics lags behind due to difficulty in obtaining samples from individuals who died by suicide, especially in non-European populations. In this study, we carried out genome-wide association studies combining two independent datasets totaling 746 suicides and 14,049 non-suicide controls in the Japanese population. Although we identified no genome-wide significant single-nucleotide polymorphisms (SNPs), we demonstrated significant SNP-based heritability (35–48%; P < 0.001) for completed suicide by genomic restricted maximum-likelihood analysis and a shared genetic risk between two datasets (Pbest = 2.7 × 10−13) by polygenic risk score analysis. This study is the first genome-wide association study for suicidal behavior in an East Asian population, and our results provided the evidence of polygenic architecture underlying completed suicide.
... De acuerdo con nuestros hallazgos, también existe una sólida evidencia que sugiere que los estresores psicosociales son muy comunes en pacientes con psicosis 20 . Varias investigaciones también han demostrado que las tasas de comportamiento suicida y de intentos de suicidio a lo largo de la vida son altas, en un amplio espectro de pacientes con TPs 21,22 . ...
Introducción: El manejo clínico de los pacientes con trastornos psicóticos (TPs) es particularmente complejo si se lleva a cabo en el contexto de los servicios de psiquiatría de enlace e interconsulta (PEI) de un hospital general. Sin embargo, disponemos de pocos estudios que hayan investigado de forma específica los procedimientos asistenciales de tratamiento agudo para estos pacientes en entornos PEI.
Objetivos: Examinar las características de una muestra de pacientes hospitalizados que presentan un TPs primario, que son remitidos a un servicio de PEI durante un período de 10 años y comparar las características clínicas de este subgrupo con respecto a los pacientes con otros diagnós-ticos (OD).
Material y métodos: Estudio observacional y descriptivo llevado a cabo durante un período de 10 años (2005-2014), evaluando prospectivamente pacientes adultos ingresados en unidades no psiquiátricas del Hospital Clínico Universitario de Barcelona, que fueron remitidos de forma consecutiva a nuestro servicio de PEI. Realizamos un análisis post-hoc para comparar las características clínicas entre el subgrupo de pacientes con TPs y el resto de pacientes que cumplían los criterios para OD.
Resultados: Se recibieron 393 interconsultas referentes a pacientes que presentaban un diagnóstico de TPs primario y 9.415 derivaciones de pacientes con OD. Nuestros resulta-dos mostraron que los pacientes con TPs eran más jóvenes que los pacientes con OD, tenían una mayor prevalencia de enfermedades somáticas relacionadas con un estilo de vida poco saludable (como enfermedades infecciosas, endocrinas o metabólicas), una menor frecuencia de cáncer y una necesidad de recibir asistencia psiquiátrica de forma más intensiva.
Conclusiones: Los pacientes hospitalizados con TPs que son remitidos a los servicios de PEI tienen diferentes características clínicas en comparación con aquellos que cumplen con los criterios para OD. Se trata de un grupo complejo, con necesidades específicas en cuanto a la atención psiquiátrica.
... Groups were defined as healthy controls, FEP, and two FEP subgroups: individuals with schizophrenia and schizoaffective disorders (S-FEP) and those with major depressive disorder and bipolar disorder with psychotic features (M-FEP). This was based on previous studies and two recent meta-analyses (Grossman et al., 1991;Maj, 1991;Pagel et al., 2013;Pini et al., 2001;Radomsky et al., 1999;Rink et al., 2016;Tsuang and Coryell, 1993) that found patients with schizoaffective disorders have illness characteristics similar to patients with schizophrenia, in comparison with patients with bipolar disorder or major depressive disorder with psychotic features (M-FEP). ...
... Los trastornos depresivos están asociados al suicidio 30,31 . Sin embargo, menos de un tercio de nuestros pacientes no tomaban ningún tratamiento antidepresivo previo al intento de suicidio, González-Rodríguez et al. 8 no encontró una tasa más alta de depresión en los pacientes que habían intentado suicidarse. ...
Introducción/antecedentes:
La conducta suicida en el trastorno delirante (TD) ha sido escasamente estudiada.
Objetivo:
Profundizar en el conocimiento de las características demográficas, ambientales, psicosociales y clínicas del suicido en un grupo de pacientes con TD con la finalidad de contribuir a generar y sugerir estrategias que contribuyan a realizar nuevos estudios de mayor nivel explicativo.
Método:
Estudio epidemiológico descriptivo retrospectivo de Registro de Casos en el Dispensario de Psiquiatría e Higiene Mental de Córdoba sobre pacientes con TD según criterios DSM-IV-TR. Aquellos pacientes que cumplieron con los criterios de inclusión definidos constituyeron nuestra muestra final de 261 casos, de ellos 26 casos presentaron evidencias de intento de suicidio. Las variables sobre las que se recogió información en base a protocolos, fueron agrupadas con el orden siguiente: I. Sociodemográficos y generales. II. Factores de riesgo del TD (familiares y personales). III. Cuadro Clínico y el Diagnóstico del TD (Presentación, Sintomatología, Funcionalidad y Discapacidad, utilización de los recursos sanitarios, tratamiento, problemas psicosociales, evolución y curso) y medios letales utilizados.
Resultados:
La edad media de los pacientes fue de 47 años y el 60% fueron hombres. Los datos sociodemográficos muestran que los pacientes con intento de suicidio residían en núcleos rurales (46,2%), no tenían estudios en un 15,4%, un 57,7% no trabajaba y un 26,9% recibía una pensión por enfermedad o jubilación laboral. El subtipo persecutorio con 8 casos, fue el más frecuente, seguido de los subtipos de grandiosidad (6 casos) y celotípico (6 casos), mixto (3 casos), erotomaniaco (2 casos) y somático (1 casos).
Discusión y conclusión:
Son necesarios futuros estudios prospectivos para investigar los factores de protección, de riesgo y/o asociados al suicidio en el TD.
... In studies with individuals with psychotic disorders suicide incidence rate was determined to be 8.5 to 39.2%. In one study, 30.2% of the 1048 in patents with psychotic disorder were stated to have a history of suicide attempt (Radomsky et al. 1999). In another study, it is stated that 34.5% of 264 people with psychotic disorders had a history of attempting suicide at least once (Suokas et al. 2010). ...
Özkıyım riski psikiyatrik sorunu olan hastalar arasında oldukça sık görülen ve acil müdahale edilmesi gereken bir durumdur. Özkıyım riskinin arttığını gösteren hastalıklara özgü bazı işaretler bulunmaktadır. Sağlık çalışanlarının önce bu erken uyarı işaretlerini tanımlamaları ve özkıyım riskini belirlemeleri önemlidir. Özkıyım riskini değerlendirdikten sonra yapılması gereken şey hastayla birlikte bir güvenlik planı oluşturmaktır. Güvenlik planı hastayı özkıyım girişiminden koruyan ve kriz yaşadığında neler yapacağı konusunda yol gösteren önemli bir girişimdir. Güvenlik planı güvende kalmak için hastanın kullanacağı stratejiler, erken uyarı işaretleri, baş etme stratejileri, sosyal destekleri, aile bireyleri veya arkadaşlarına ilişkin iletişim bilgileri ve kriz birimlerinin telefon numaraları gibi bilgileri içermektedir. Bu bilgiler ışığında hazırlanan güvenlik planının özellikle psikiyatri hemşireleri tarafından klinikte kullanılması önerilmektedir. Güvenlik planının oluşturulması, hastanın mümkün olduğunca özkıyım girişiminde bulunma riskini engelleyecek veya erteleyecektir.
... The incidence of suicidal ideation and behaviour (SIB) among individuals experiencing psychosis has been well documented (DeVylder, Lukens, Link, & Lieberman, 2015;Radomsky, Haas, Mann, & Sweeney, 1999). Evidence suggests that SIB is highly prevalent in samples with diagnosed psychotic disorders (Harkavy-Friedman, 2015;Palmer, Pankratz, & Bostwick, 2005) and in clinically high-risk (CHR) and ultrahigh-risk (UHR) populations (DeVylder, Oh & Ben-David et al. 2012;Hutton, Bowe, Parker & Forde, 2011). ...
Suicidal ideation/behaviour (SIB) and psychosis are highly associated phenomena. We propose that psychosis, for some, may be consequential to SIB. More specifically we hypothesise that psychosis may serve to externalise internally generated and self-directed threat among those experiencing SIB. Using prospective data from a Danish population cohort, we first sought to test the temporal occurrence of suicidal behaviour and psychotic disorder. Next, using cross-sectional epidemiological survey data (UK), we sought to demonstrate that psychotic experiences (PEs) were more commonly reported by those who experienced SIB and that the strength of the association varied according to (i) SIB recency and (ii) severity. Chi-square comparison tests on the Danish data revealed that suicidal behaviour was statistically more likely to precede (41.4%) rather than follow psychotic disorder (20.7%). Regression analyses of the UK data indicated that individuals who thought about suicide in their lifetime were up to eight times more likely to experience specific PEs while those who thought about and attempted suicide in their lifetime and in the year of assessment were up to 48 times more likely to experience PEs, compared to SIB free members of the population. The findings provide preliminary support for a novel suicidal drive hypothesis for psychosis.
... [12][13][14][15][16] Some studies suggest that treatment response to clozapine administration is particularly evident in patients who have increased suicidality, and that this response may extend to patients with bipolar disorders. [25][26][27][28] Although these data provide compelling evidence for an effect of clozapine use in reducing suicidality, the mechanism for this effect requires further study. Data from this study suggest that the effect of clozapine therapy may not relate to its superior efficacy for treatment-resistant psychotic symptoms. ...
Pedro Gargoloff is Principal Investigator in the InterSePT Study Group
... De plus, le sexe masculin, l'abus de substances, la dépression, un environnement social et familial défaillants représentent des facteurs de risque supplémentaires de suicide dans la schizophrénie. [70] D'autres auteurs y rajoutent le jeune âge [73,71] , et un meilleur niveau d'insight initial ; pour ces derniers, les femmes présenteraient davantage de risque de tentative de suicide. [73] Durant la phase précoce de la maladie, 15 à 26 % des patients auraient fait au moins une tentative de suicide. ...
Comme en témoigne l abondante littérature, les manifestations prémorbides et prodromiques de la schizophrénie connaissent un regain d intérêt depuis ces 15 dernières années. A partir de l' étude rétrospective d' une population de 50 sujets, nous avons recherché la présence de manifestations précoces de la maladie. Notre échantillon se constitue d adultes schizophrènes diagnostiqués selon la CIM-10, suivis au Centre Psychothérapique de Nancy (C.P.N) durant l' année 2008. Ils ont bénéficié d' un suivi antérieur dans un des secteurs de psychiatrie infanto-juvénile attenants au C.P.N avant leur 18ème année. La première partie de ce travail décrit les aspects cliniques, selon une perspective dimensionnelle, de l' enfance et l' adolescence de ces sujets ultérieurement diagnostiqués schizophrènes. Les stratégies de prises en charge médicamenteuses et institutionnelles, les facteurs environnementaux, les antécédents familiaux y sont également abordés. En second lieu, nous avons confronté les résultats de notre étude aux données récentes de la littérature se rapportant aux phases prémorbides et prodromiques de la schizophrénie. Dans une troisième partie abordant les interactions gènes-environnement, ces résultats ont pu être discutés à la lumière de l' hypothèse neurodéveloppementale de la schizophrénie.
... Those that have highlighted similar 10 or increased 11,12 risk of mortality compared with people with schizophrenia and increased mortality compared with people with bipolar disorder. [13][14][15] Further, research has found that in individuals with PMD there is an increase in suicide attempts compared with schizophrenia and bipolar disorder 16 as well as an increased risk of completed suicide compared with schizophrenia 17,18 and bipolar disorder. [13][14][15]18 A more recent study conducted over 10 years reported that people with PMD had better social and service use outcomes than people with schizophrenia, but were more likely to attempt suicide or self-harm. ...
Psychotic major depression is an under-researched and under-identified disorder. We highlight the major challenges both in clinical practice and in conducting research with people with this disorder. We also suggest which major issues need addressing to move treatment and knowledge of this disorder forward.
Declaration of interest
M.H. and A.H.Y. both report grants from the National Institute for Health Research (NIHR).
... [21]. Compared to schizophrenia, schizoaffective patients are more likely to attempt to take their lives if they have depressive symptoms [22]. Thus, identifying measures to improve depressive symptoms will improve the quality of life and reduce the premature death in patients with a diagnosis of schizoaffective disorder. ...
Ketamine use for patients with severe treatment-resistant depression continues to be an area of interest due to the relatively limited number of treatment options for those patients. Although its use as a treatment option for patients with schizophrenia and schizoaffective disorder may seem counterintuitive, in this case report, we explore the efficacy of ketamine for depressive episodes in schizoaffective disorder. This patient who carried a diagnosis of schizoaffective disorder was given 300 mg of intramuscular ketamine for agitation. However, over the course of four days of inpatient stay, her depression drastically improved. She met criteria for remission with the Hamilton Rating Scale for Depression (HAM-D) score of 4, down from an initial score of 21. We advocate for a better understanding of the pros and cons of using ketamine for depression in schizoaffective disorders considering the controversy over the diagnosis of schizoaffective disorder, especially in African American population. At the urging of reducing the risk of suicide among this group and improving their quality of life as well as reducing financial burden by shortening total duration of hospitalization, it may be worthwhile to explore the feasibility of ketamine as a treatment option for severe depression in these patients, possibly as a last resort.
Background and Hypothesis
People with serious mental illness (SMI; psychotic and affective disorders with psychosis) are at an increased risk of suicide, yet there is limited research on the correlates of suicide in SMI. Social cognitive impairments are common among people with SMI and several studies have examined social cognition and suicidal ideation (SI) and behavior. This systematic review aims to evaluate the links between various domains of social cognition, SI, and suicidal behavior in SMI.
Study Design
Electronic databases (PubMed and PsycInfo) were searched through June 2023. Records obtained through this search (N = 618) were screened by 2 independent reviewers according to inclusion criteria. Relevant data were extracted, and study quality was assessed.
Study Results
Studies (N = 16) from 12 independent samples were included in the systematic review (N = 2631, sample sizes ranged from N = 20 to N = 593). Assessments of social cognition and SI and behavior varied widely between studies. Broadly, effects were mixed. Better emotion recognition of negative affect was linked to SI and a history of suicide attempts, though there is little consistent evidence for the relationship of emotion recognition and SI or behavior. On the other hand, better theory of mind ability was linked to SI and a history of suicide attempts. Furthermore, negative attributional bias was linked to current SI, but not a history of SI or attempt.
Conclusions
This review suggests mixed associations between social cognition, SI, and behavior in SMI. Future research should evaluate additional mediators and moderators of social cognition and suicide, employing prospective designs.
The is the latest issue of Suicide Studies. Suicide Studies, 2024, 5(3).
Suicide is a common cause of death in all phases of schizophrenia spectrum disorder, particularly in the youngest patients. Clinical measures have demonstrated limited value in suicide prediction, spurring the search for potential biomarkers. The causes of suicidal behaviour are complex, but the immune system seems to be involved as it reflects or even causes mental suffering. We aimed to identify cytokines with associations to suicidality in a sample of patients with symptoms of active psychosis. Patients with schizophrenia spectrum disorder (N = 144) participating in a semi-randomized antipsychotic drug trial (the BeSt InTro study) were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS) at eight visits across 12 months. The Clinical Global Impression for Severity of Suicidality scale (CGI-SS) was used for assessing suicidality. Serum concentrations of tumour necrosis factor (TNF)-alpha, interferon (IFN)-gamma, interleukin (IL)-1beta, IL-2, IL-4, IL-6, and IL-10 were measured using immunoassays. A logistic regression model was used to investigate the association between cytokine levels and suicidality. To enhance clinical significance, the CGI-SS scores were dichotomized into two groups before analyses: low (=1) and high (≥2) risk for suicidality. Both uni- and multi-variate analyses revealed an inverse correlation between IL-2 and IL-10 serum levels and suicidality, where lower cytokine concentrations of IL-2 and IL-10 were associated with higher suicidality scores. The results were consistent when adjusted for depression and substance use. These results indicate that inflammatory processes are linked to the risk of suicidality in patients with schizophrenia spectrum disorders.
Drug omission in patients with schizophrenia is the main reason for frequent relapses, poor treatmentoutcome, reduced quality of life and significant increases in healthcare cost.Objectives: This study was conducted to assess the causes of drug omission in patients with schizophreniaand patients at there in Baghdad.Design A descriptive study was carried out in order to achieve the early stated objectives. The study wasinitiated from February 1st, 2017 through May 1st, 2017.Method: Descriptive study one hundred and twenty patients with schizophrenia receiving treatment in IbnRushd mental health hospital and Baghdad teaching hospital were randomly selected to participate in thestudy. Data were collected using a socio-demographic questionnaire, the translated version of the 8-itemMorisky medication adherence scale (MMAS-8). Logistic regression was used to determine significantvariables associated with suboptimal adherence to medication.Results: The prevalence of continuance drug omission by phenomenon schizophrenia patients outgrowand override 51.7%. The factors associated with that were weakness in treatment methods (OR 0.067,95%CI0.012-0.387, P-value 0.03) lack of supervised treatment (OR 0.117, 95%CI 0.038-0.352, P-value<0.001) and also previous experiences about side effects of treatment (OR 4.40, 95%CI= 1.358-14.313p-value 0.01).Conclusions: Medication adherence among patients with schizophrenia is low.Recommendations: The study recommends the need to develop a standard protocol for carrying outadherence counselling to all patients and their relatives
The majority of suicides worldwide are related to psychiatric disorders. Overall, suicide rates vary concerning the age, gender, and socioeconomic status of the individual and the method of suicide. The objectives of the study were to find the socio-demographic factors and suicidal behavior associated with suicidal attempts in patients with psychiatric disorders. A cross-sectional, hospital-based, descriptive study was conducted among the patients attending the psychiatry outpatient departments (OPD) of the National Institute of Mental Health, Dhaka, Bangladesh. A total of 98 consecutive cases were included those who were at and above18year, have a definite psychiatric disorder and history of suicidal attempt. The data were collected by face-to face interview using semi structured questionnaire. The study identified that most of the patients were in the age group 21-30 years (53.1%), mean age± SD was 27.02±8.42, more in female (66.2%), housewives (35.7%), 57.1% were from an urban background and 35.7% of them studied up to SSC. The vast majority (73.5%) came from a nuclear family. Suicidal behavior revealed that mean suicidal attempt was 2.63±2.84, Communication intent was 20.4%, Suicidal note was put by10.2%, at home (90.8%),59.2%, sample choose day time and common method were hanging (25.5%) and medicine (22.4%). Help nearby in 72.4%, precaution against rescue was 18.4%, intent to die was 65.3% and hospitalization needed for 34.7% cases. Suicides can be prevented by early identification, diagnosis and proper intervention of psychiatric disorder among risk groups. Restricting access to means of suicide, by training caregivers, provide adequate follow-up care may reduce impulsive suicidal attempts.
With the passage of time, the law also developed and the dictum of the Court emphasized that in a criminal case, the fate of proceedings cannot always be left entirely in the hands of the parties. Crime is a public wrong, in breach and violation of public rights and duties, which affects the community as a whole and is harmful to the society in general. If, there is clear callousness and irresponsibility on their part and deliberate attempt to misdirect the investigation to favour the alleged accused involved in medico-legal work. This results in shifting of avoidable burden and exercise of higher degree of caution and care on the courts. Dereliction of duty or carelessness is an abuse of discretion under a definite law and misconduct is a violation of indefinite law. Misconduct is a forbidden act whereas dereliction of duty is the forbidden quality of an act and is necessarily indefinite. One is a transgression of some established and definite rule of action, with least element of discretion, while the other is primarily an abuse of discretion. In a recent judgment of the Hon‟ble SC these aspects were discussed in detail in larger public interest. Brief Facts of the Case: That the fields of Gurumukh Singh and Dayal Singh were adjoining in the village Salwati within the limits of Police Station Sittarganj, District Udham Singh Nagar. These fields were separated by a mend (boundary mound). On 8th December, 1985, Gurumukh Singh, along with his father Pyara Singh, had gone to their fields. At about 12 noon, Smt. Balwant Kaur, wife of Pyara Singh came to the fields to give meals to Pyara Singh and their son Gurumukh Singh. At about 12.45 p.m., the accused persons, namely, Dayal Singh, Budh Singh & Resham Singh (both sons of Dayal Singh) and Pahalwan Singh came to the fields wielding lathis and started hurling abuses. They asked Pyara Singh and Gurumukh Singh as to why they were placing earth on their mend, upon which they answered that mend was a joint property belonging to both the parties. Without any provocation, all the accused persons started attacking Pyara Singh with lathis. Gurumukh Singh, at that time, was at a little distance from his father and Smt. Balwant Kaur, was nearby. On seeing the occurrence, they raised an alarm and went to rescue Pyara Singh. The accused, however, inflicted lathi injuries on both.
BACKGROUND: Congenital chloride diarrhea (CCD) is a rare inherited disorder of intestinal electrolyte transport that results in a large wastage of electrolytes and water. Advances in substitution therapy using sodium chloride (NaCl) and potassium chloride (KCl) have dramatically improved survival for patients with CCD. Slow-release KCl is widely prescribed as a potassium supplement; however, it has also occasionally been used in suicide attempts, as potassium poisoning can generate life-threatening hyperkalemia.
CASE SUMMARY: A 26-year-old female presented to the emergency department (ED) with self-poisoning, having taken 30 tablets of slow-release KCl (total: 240 mmol potassium) following an auditory hallucination. The patient had been undergoing substitution therapy with NaCl and KCl for CCD and been followed up in the pediatric department. One month prior, she developed insomnia and anxiety and had consulted a psychiatrist. At the ED, although her general condition was good, she appeared agitated. Her serum potassium level was 7.0 mmol/L, indicating hyperkalemia, and electrocardiographic changes showed tenting of the T-waves. She responded to the administration of calcium gluconate, sodium bicarbonate, and insulin with glucose, and the serum potassium level improved. Finally, she was diagnosed with schizophrenia.
CONCLUSION: In CCD management, physicians should pay careful attention to patients’ extraintestinal issues, including psychological disorders that may emerge in adulthood.
INTRODUCTION: In addition to being a global public health problem, suicide is a common issue in prisons and closed institutions. The main purpose of this study is to investigate the effects of medical, psychological and behavioural (clinical) characteristics of adult male inmates in the Kocaeli T-Type Closed Prison on suicide probabilities. METHODS: The study sample consisted of 508 adult male prisoners who were staying in the T-Type Closed Prison of Kocaeli No. 1 and who were willing to participate in the study. The data were collected with the 'Suicide Probability Scale and Personal Information Form developed by the researcher. Independent sample t-test and one-way analysis of variance (ANOVA) and Tukey test for multiple comparisons were used in the statistical evaluation of the study. According to the findings, the majority of the sample (n = 375; 74%) were convicts. RESULTS: Inmates who exhibited self-harm behaviour, who had tattooing, who used addictive substances, who had gone to a psychologist or a psychiatrist before imprisonment, who were diagnosed with a psychiatric disorder, have a chronic disease, previously attempted to commit suicide, were found to have higher probability rates for suicide.
Background:
A strong association has been shown to exist between schizophrenia and suicide; however, research examining suicidality in the prodromal phase of psychotic disorders is limited. This study aimed to meet this need by examining potential risk factors for lifetime suicide attempts in a population of individuals with attenuated psychosis syndrome (APS), as defined in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders as a condition for further study.
Methods:
A retrospective chart review was conducted to identify individuals with APS during a 5-year period across a large medical university's inpatient and outpatient settings. Sociodemographic and clinical factors were examined in relation to suicide attempts to identify risk factors for suicide attempts. χ analyses were used to analyze dichotomous variables, and t test analyses were used to compare means of continuous predictors among those with versus without suicide attempts. Final analyses consisted of fitting multivariate logistic regression models to control for sociodemographic factors.
Results:
In total, 26.3% of the APS population had at least 1 lifetime suicide attempt. Six covariates were found to be statistically significant predictors of suicide attempts: Axis II disorders (P=0.006); history of trauma as a whole (P=0.022); the subcategory of sexual trauma (P=0.005); tobacco use (P=0.039); family history of nonpsychotic Axis I disorders (P=0.042); and number of hospitalizations (P=0.001).
Conclusions:
Suicidality is a prominent feature of APS, and a number of risk factors increase the likelihood of suicide attempts in this population.
Les personnes présentant une maladie mentale sévère ont un risque augmenté de décès par maladie cardio-vasculaire par rapport à la population générale. Ce risque est surdéterminé par le tabagisme, la sédentarité, la prise de poids, le syndrome métabolique et le moindre recours aux thérapeutiques cardiaques. Les antipsychotiques et plus particulièrement les antipsychotiques atypiques dont la famille des dibenzodiazépines majorent le risque de survenue d’un syndrome métabolique chez les patients et des recommandations de monitoring de ce risque ont été formulées pour le prévenir. Cependant, ces recommandations apparaissent encore insuffisamment appliquées aux patients psychotiques. Notre objectif principal est d’évaluer si les recommandations vis-à-vis du syndrome métabolique sont suivies chez les patients schizophrènes sous antipsychotiques. Méthode : Nous avons mené une étude rétrospective dans 4 services de psychiatrie adulte du Centre Hospitalier Pierre Janet du Havre. Les patients éligibles étaient des patients souffrant de troubles psychotiques, hospitalisés dans un des services concernés. Au cours de leur hospitalisation, nous avons recensé les paramètres métaboliques enregistrés sur le dossier informatique des patients. Nous avons aussi recherché la présence d’un syndrome métabolqiue selon les critères NCEP-AT III chez ces patients. Résultats : Du 15.11.2014 au 30.11.2014, 116 patients ont été inclus. Les recommandations en termes de suivi et de prise en charge du syndrome métabolique n’étaient pas suivies. Sur ces 116 patients, 8 avaient des données suffisamment renseignés et positifs pour identifier un syndrome métabolique. Différents facteurs ont pu être mis en évidence pour expliquer le manque de surveillance des patients, comme le manque de moyens humains, la volonté des psychiatres de différencier le « psychique » du « somatique », une vision pessimiste des possibilités évolutives des patients, sous-tendue peut-être par un manque de connaissances sur les thérapeutiques disponibles pour enrailler l’apparition de ce syndrome métabolique. Discussion : Nos résultats sont en accord avec la littérature s’intéressant aux patients psychotiques en ce qui concerne le manque de monitoring et de prise charge du syndrome métabolique chez ces patients. Des hypothèses explicatives se dégagent pouvant expliquer ce phénomène. Conclusion : Nos résultats montrent que les patients sont encore insuffisamment dépistés et traités pour le syndrome métabolique, ce qui augmente leur risque de décès par maladie cardio-vasculaire. Des techniques visant à améliorer les pratiques existent et doivent être mises en place dans les services hospitaliers.
Praca mierzy się z zadaniem weryfikacji dość powszechnie panujących poglądów (w pracy wykorzystano wypowiedzi anonimowych użytkowników popularnych polskich portali internetowych w wątkach, dotyczących opinii o samobójstwie), że samobójstwo jest związane głównie z czterema rodzajami czynników sprawczych: choroby psychicznej, na jaką cierpi jednostka, próbująca sobie odebrać życie, określonego typu osobowości samobójczej (suicydalnej), uzależnienia od substancji psychoaktywnej (wśród których najważniejszy jest alkohol) bądź niekorzystnej przeszłości życiowej, jaką ma ona za sobą.
Metaanaliza, wykonana z użyciem niemal 100 pozycji o charakterze naukowym wykazała, iż poglądy te są w przeważającym stopniu uproszczeniami, niedopowiedzeniami i stereotypami. Wśród zaburzeń psychicznych najważniejsza okazały się nie psychozy, a depresja, zwłaszcza o długim przebiegu, a zwłaszcza poczucie beznadziejności, winy czy problemy z niską samooceną, a także nadmierna wrażliwość. Nie wykazano także istnienia modelu typowej osobowości suicydalnej, aczkolwiek takie cechy, jak wzmożona agresja, impulsywność, neurotyzm czy psychotyzm, lub cechy osobowości typu borderline wydają się być powiązane z tendencją do zachowań destrukcyjnych i autodestrukcyjnych. Także rola uzależnień nie jest do końca wyjaśniona w generowaniu zachowań suicydalnych, gdyż znaczenia alkoholu w podjęciu decyzji o odebraniu sobie życia jest bardzo trudna i zwykle nie jest jednoznaczna. Wśród wydarzeń życiowych, negatywnie rzutujących na przyszłość jednostki, wymienia się przede wszystkim doświadczenia abuzywne oraz utraty personalne.
Metaanaliza sugeruje, iż samobójstwo rozpatrywać więc należy indywidualnie jako złożony układ sprzężeń w sytuacji psychologicznej, gdzie występować może wiele czynników, działających w łańcuchach zależności przyczynowo-skutkowych o charakterze cyrkularnym.
[Work’s task is the verification of fairly generally thought (at work uses statements of anonymous users of the popular Polish Internet portals, in topics concerning opinions about suicide), that suicide is associated primarily with four types of factors: mental illness, a particular type of personality (suicidal personality profile), addiction of psychoactive substances (among which the most import_ant is alcohol) or negative past life, what is it behind.
A meta-analysis, made with almost 100 items of scientific showed that these views are largely simplifications, ambiguities and stereotypes. Among the most import_ant mental disorders was depression (not psychosis), especially the long run, especially hopelessness, feeling guilty and problems with low self-esteem. The result of analysis was, that there is no presented model of typical suicidal personality, although personality traits, like aggression, impulsiveness, neuroticism and psychoticism and excessive vulnerability or borderline personality seems to be connected with tendencies to destructive and autodestructive behavior. The role of addiction is not clearly explained in the generation of suicidal behavior, because its very difficult to it assess the import_ance and role of alcohol as a trigger of suicide. Among the events of life, the most significant were experience of abuse and personal loss in the childhood.
A meta-analysis suggests that suicide should be considered individually as a complex feedback system in psychological situation, where there can be many factors operating in the chains of circular feedbacks].
The authors studied 954 psychiatric patients with major affective disorders and found that nine clinical features were associated with suicide. Six of these--panic attacks, severe psychic anxiety, diminished concentration, global insomnia, moderate alcohol abuse, and severe loss of interest or pleasure (anhedonia)--were associated with suicide within 1 year, and three others--severe hopelessness, suicidal ideation, and history of previous suicide attempts--were associated with suicide occurring after 1 year. These findings draw attention to the importance of 1) standardized prospective data for studies of suicide, 2) assessment of short-term suicide risk factors, and 3) anxiety symptoms as modifiable suicide risk factors within a clinically relevant period.
This study examines risk factors for attempted suicide in the general community. Data from the five-site NIMH Epidemiologic Catchment Area (ECA) Study were used to estimate lifetime prevalence and identify risk factors for suicide attempts. Occurrence of suicide attempts and lifetime diagnosis of psychiatric disorder were ascertained, using the NIMH Diagnostic Interview Schedule (DIS). Of 18,571 adult respondents aged 18 and over, 2.9 percent reported that they had attempted suicide at some time in their lives. A weighted logistic regression model was constructed to ascertain significant (p less than .0028 with Bonferroni correction) risk factors for attempted suicide. Persons who had a lifetime diagnosis of a psychiatric disorder had the highest risk of attempted suicide (odds ratio [OR] = 8.4). Females (OR = 3.3), separated or divorced persons (OR = 2.5), Whites (OR = 1.7), persons in the two lowest socioeconomic quartiles (ORs = 2.2, 2.3), and respondents from the Los Angeles ECA (OR = 1.8) were also more likely to have attempted suicide. These findings contribute to an understanding of suicide and suicidal behavior in general populations, outside the clinical setting.
A group of 118 patients with a hospital diagnosis of schizophrenia was reviewed. The incidence of suicide attempts was significantly correlated with more frequent past psychiatric admissions, more frequent past diagnoses of schizophrenia, and poor work function. The apparent relationships could be spurious or based on a reversed causal sequence; for example, suicide attempts are likely to be followed by psychiatric admissions.
The purpose of this study was to investigate the prevalence and comorbidity of current mental disorders defined by DSM-III-R among a random sample of suicide victims from a nationwide suicide population.
Using a psychological autopsy method, the authors collected comprehensive data on all suicide victims in Finland during 1 year. Retrospective axis I-III consensus diagnoses were assigned to 229 (172 male, 57 female) victims.
One or more diagnoses on axis I were made for 93% of the victims. The most prevalent disorders were depressive disorders (59%) and alcohol dependence or abuse (43%). The prevalence of major depression was higher among females (46%) than among males (26%). Alcohol dependence was more common among the males (39% versus 18% for females). A diagnosis on axis II was made for 31% and at least one diagnosis on axis III for 46% of the cases. Only 12% of the victims received one axis I diagnosis without any comorbidity.
The majority of suicide victims suffered from comorbid mental disorders. Comorbidity needs to be taken into account when analyzing the relationship between suicide and mental disorders and in planning treatment strategies for suicide prevention in clinical practice.
Of 9156 patients admitted to psychiatric hospitals in Denmark between 1970 and 1987 and diagnosed for the first time as having schizophrenia, 508 committed suicide. The purpose of the study was to identify risk factors for suicide among patients with schizophrenia, particularly factors relating to hospitalisation.
From the cohort of all 9156 patients, the 508 who had committed suicide were individually matched to 10 controls from the same cohort, and data were analysed using conditional logistic regression.
Suicide risk was particularly high during the first 5 days after discharge, and increased risk was also associated with multiple admissions during the previous year, previous suicide attempts, previous diagnosis of depression, male gender, and previous admissions to general hospitals for physical disorders. After adjusting for these factors, no effect was found for age. There was some evidence of an excess of suicides during temporary leave from the psychiatric department.
The findings suggest that preventive measures could be focused on the first period after discharge, when closer monitoring and better social support may be needed. This may also apply to patients on temporary leave during a period of admission.
This article presents the epidemiology of suicide with a special focus on suicides among the elderly, and discusses the known risk factors for suicide within a framework designed to encourage a systematic approach to theory testing and prevention. Throughout the world, suicide rates are highest among the elderly. The risk factors for suicide can be classified as distal or proximal, and, within these broad categories, as sociodemographic, psychiatric, biological, familial, and situational. Mental and addictive disorders are the major risk factors for suicide in all age groups. Other risk factors include male gender, disrupted marital status, prior suicide attempt, reduced brain stem serotonergic activity, family history of psychiatric disorder or suicide, a firearm in the home, and a recent, severely stressful life event. Since risk factors for suicide rarely occur in isolation, prevention efforts are more likely to succeed if multiple risk factors are targeted.
Suicide is the chief cause of premature death among schizophrenic persons. The lifetime incidence of suicide for patients with schizophrenia is 10% to 13% compared to a general population estimate of about 1%, and is quite close to that observed among those with major affective disorder. The magnitude of increased risk for suicide among schizophrenics peaks before middle age and declines thereafter, although schizophrenic persons tend to be at increased risk throughout the life span. Among psychiatric patients, schizophrenics are overrepresented among suicides, and often schizophrenics constitute the majority of inpatient suicides. It is important in evaluating suicide risk among schizophrenic persons to assess depression and suicidal ideation especially during index admission and during acute phases of the illness. It is noteworthy that schizophrenic persons often commit suicide as the overall level of psychopathology decreases during a nonpsychotic phase. Research has yielded salient risk factors for suicide in schizophrenic persons and “types” of especially vulnerable patients, even though statistical prediction of individual suicides has not proven effective.
By reviewing causes of death among cohorts of various major disease entities or conditions, one may infer that a large majority of suicides are associated with a relatively small number of conditions. From the available follow-up studies, we might estimate that the following percentage of affected individuals will die by suicide: primary (endogenous) depression, 15 per cent; reactive (neurotic) depression, 15 per cent; alcoholism, 15 per cent; schizophrenia, 10 per cent; psychopathic personality, 5 per cent; opiate addiction, 10 per cent or more. Rough estimates of the number of suicides per year in the United States attributable to each condition might be as follows (using low incidence figures): depression, 12,900; alcoholism, 6,900; schizophrenia, 3,800; psychopathy, 2,000 (?); drug addiction, 900.
Previous studies of attempted suicide have cast doubt on the value of assessing psychological intent. By identifying a moderating variable, namely, the attempter's preconceptions about the lethality of his act, the authors were able to solve the puzzle of the low correlations between intent and lethality. Suicidal intent correlates highly with medical lethality when the attempter has sufficient knowledge to assess properly the probable outcome of his attempt. The authors conclude that suicidal intent and medical lethality are useful dimensions in classifying suicidal behavior.
The relationships between symptoms and both prior suicide attempts and current suicidal thinking were examined in a sample of schizophrenics at 2 points in time. Fifty subjects meeting DSM-III criteria for schizophrenia were assessed within 1 week of admission, and 41 were reassessed at a 6-month follow-up. On admission, prior suicide attempts were significantly associated with current depression, female sex, lower education and more frequent hospitalization. The association with depression remained significant at follow-up. In addition, current suicidal thinking was associated with depression at both times but also with negative symptoms at time 1 and delusions and hallucinations at time 2. These findings confirm and strengthen prior reports of an association between depression and attempted suicide.
Death rate and causes of death during a mean period of 5.8 years were investigated in 250 male inpatients with psychotic disorders (DSM-III). Fifty patients died during the observation period. Suicide was confirmed in 11 of these patients and could not be excluded in 7 cases, where the cause of death was reported as uncertain. Clinical and neurobiological characteristics (DST-non-suppression, CSF proteins, and monoamine metabolites) were compared in patients who committed suicide and non-suicide patients of the same age, with or without suicidal behaviour. A highly increased mortality rate was seen among the patients and the rate of suicide was more than 20 times higher than that expected in a normal population of the same age. The estimated annual incidence of suicide was 2.5%, 1.3%, 1.0% and 0.4% for patients with bipolar disorder, paranoid psychosis, major depression and schizophrenic disorder, respectively. The following factors were significantly positively correlated with completed suicide: depressive mood, elated mood, paranoid ideas, and paternal age. All suicides had previously shown suicidal behaviour and the suicide occurred during or shortly after a period of hospitalisation. No correlations were found with age at onset of illness, duration of illness, substance abuse or neurobiological parameters.
To determine the rate of suicide in young, early phase schizophrenics and other psychotic disorders, and to analyze risk factors for suicide, a large sample of patients was prospectively assessed at index hospitalization and then followed up systematically after discharge. Thirty-six patients committed suicide and these patients were compared with those who did not commit suicide for major diagnostic and prognostic factors. Results indicated the following: a) During early years, schizophrenics and other types of psychotic patients were more likely to commit suicide than nonpsychotic patients. b) Similarly, among depressives, psychotic depressed patients were more likely to commit suicide than nonpsychotic depressed patients. c) Schizophrenics and other psychotic patients were especially vulnerable to suicide within the first 6 years of their first hospitalization. d) Among the combined sample of psychotic patients (schizophrenic and other psychotic patients), those at greater risk for suicide were unmarried, white, high IQ, male patients with a more gradual onset of disorder and were of "chronic" Research Diagnostic Criteria subtypes.
Suicide rates among schizophrenic individuals are disturbingly high. At present, suicide is the number one cause of premature
death among schizophrenics, with 10 to 13 percent killing themselves. Recent studies place the risk of suicide for persons
with schizophrenia at a level comparable to that for persons with affective disorder. Depression, especially the symptom of
self-reported or perceived hopelessness, is an important comorbidity factor in assessing this risk. Young white schizophrenic
men with high levels of premorbid functioning and high expectations are at particularly high risk. Schizophrenic women, unlike
women in the general population, behave more like men when it comes to choosing suicide. This article reviews recent studies
reporting suicide rates and risk factors for suicide among schizophrenic patients. Current issues concerning the prediction,
prevention, and treatment of suicidality among persons with schizophrenia are also discussed.
The clinical and sociodemographic profile of suicidal and nonsuicidal schizophrenia patients was investigated in 801 patients with this diagnosis seen at a comprehensive psychiatric facility between 1983 and 1987. Suicidal patients tended to exhibit depression, aggressiveness, substance abuse and a severe and progressive impairment in adaptive functioning.
Depression and suicidal behavior are commonly found among schizophrenic patients and schizophrenia is associated with an increased risk of suicide; the reasons for this are reviewed.
In conclusion, suicide is prevalent in the schizophrenic population across all ages and diagnostic subtypes. A review of the literature leads to a profile of the schizophrenic patient who is most likely to commit suicide: this patient is young, male, and, although still within the first 10 years of the onset of illness, he has already experienced a severe chronic illness with multiple exacerbations and remissions. He is most likely, at the time of suicide, to have been recently discharged from a hospital, and to appear clinically depressed, hoepless, or negative toward his treatment. Rapid identification of such patients and prompt intervention with neuroleptics and antidepressants as clinically indicated would be appropriate treatment for these patients. Additional support and supervision should especially be given in periods of recompensation for psychotic episodes, when discharge is usually planned. At such times the patient is most likely to gain both insight into his illness and a recognition of the severity of his disability, which could lead to feelings of depression and suicide.
The authors report suicide risk among 1,593 patients with major depression or bipolar disorder, 443 (27.8%) of whom were psychotic (260 bipolar and 183 unipolar). The subjects were followed for 0-14 years, and their suicide experience was compared with that of the state population. Eight (19.5%) of the 41 suicide victims were from the psychotic group. The psychotic and nonpsychotic subjects in each diagnostic group had similar risks for suicide. A higher risk for suicide was not found in the bipolar subjects. The authors conclude that among patients with major affective disorder psychosis per se does not predispose to suicide.
A group of 25 hospitalised schizophrenics who had attempted suicide within the past year was compared with another group of 30 hospitalised schizophrenics who had not attempted suicide, using the PSE symptoms. The former had a significantly higher number of symptoms indicative of a depressive disorder. It is concluded that suicidal risk in schizophrenia is significantly raised when there are concomitant depressive symptoms.
Although suicidal behavior frequently complicates the treatment of schizophrenia, there are no clear criteria for evaluating suicide risk among schizophrenics. This review summarizes and integrates the available empirical studies. Studies that focus on schizophrenics and provide adequate comparison groups are emphasized. The literature suggests that young, male schizophrenics are the most vulnerable to self-destruction, particularly during the early years of illness. A clinical course characterized by many exacerbations and remissions increases risk. These patients experience severe functional deterioration yet retain a non-delusional awareness of the effects of chronic illness. Changes in clinical course precipitate suicide, and the period of clinical improvement following relapse is a particularly vulnerable time. Suicide occurs more frequently during periods of depression and hopelessness than during episodes of intense psychosis. Signs of severe agitation and excessive treatment dependence during hospitalization are dangerous. Previous suicidal behavior also increases the risk of completing suicide. Problems with the current research, controversies within the literature, and recommendations for further research are discussed.
A matched controlled study of 30 chronic schizophrenic suicides is presented. Eighty per cent were male and committed suicide at a mean age of 25.8 years after a mean duration of illness of 4.8 years. Significantly more of the suicides had a chronic relapsing schizophrenic illness; 23.3 per cent committed suicide while in-patients, and 50 per cent of the out-patients committed suicide within three months of discharge from in-patient care. Significantly more of the suicides had a past history of depression (56.6 per cent), were depressed in the last episode of contract (53.3 per cent), had their last admission for depression or suicidal ideation (55.2 per cent) and were unemployed (80 per cent).
Synopsis
Between 1968 and 1981 there were roughly equal numbers of male and female schizophrenic parasuicides in Edinburgh: males were significantly younger than females at parasuicide (33 v. 37 years), and had received a diagnosis of schizophrenia for a shorter time (3·4 v. 7·2 years). The clinical, epidemiological and social characteristics of such parasuicides are, by and large, those that might be expected from a knowledge of the epidemiology of schizophrenia.
Eight per cent of a sample of Edinburgh schizophrenic first-ever parasuicides subsequently committed suicide, when followed up for up to 14 years. This percentage is close to what would be expected for later suicide in non-schizophrenic parasuicides. When all the suicides were considered, similar numbers of male and female schizophrenics killed themselves; their mean ages at death were 42 and 43 years respectively; and the mean duration of the schizophrenic illness was 10 years in both cases, according to hospital records.
We found slight evidence that parasuicide is commoner in schizophrenic suicides than in schizophrenic controls but little evidence to support the contention that there may be a specific relationship between suicide (or parasuicide) and the presence of auditory hallucinations, recent discharge from in-patient care, the use of depot neuroleptic medication, or recent parasuicide.
From the point of view of the prevention of suicide and parasuicide in schizophrenics, it is noteworthy that we found few differences between the clinical characteristics and management of schizophrenic parasuicides and suicides, and schizophrenic controls.
A retrospective analysis of all the suicides at the New York State Psychiatric Institute over a 25-year period was carried out. The authors retrospectively assigned diagnoses according to Research Diagnostic Criteria and DSM-III and found that among the patients who committed suicide there were 14 with unipolar endogenous depression. Of those 14 patients, 10 were considered delusional or probably delusional. In comparison, a control group of similarly diagnosed depressed patients taken from the same institution over the same time period included far fewer delusional depressions. Thus, there was a significant association between delusions and suicide: A delusionally depressed patient was five times more likely to commit suicide than a nondelusional one.
In a consecutive series of 127 chronic schizophrenics admitted to hospital, 70 (55.1 per cent) had attempted suicide. When compared with the chronic schizophrenics who had not attempted suicide, significantly more of the attempters had had a major depressive episode (45.7 per cent) and had received antidepressant medication (65.7 per cent). They also had histories of significantly more psychiatric admissions (a mean of 5.4 compared with 3.6). These findings are discussed.
In a matched controlled study of 90 psychiatric patient suicides, I found that significantly more of the suicides suffered from chronic schizophrenia (33.3%) or recurrent affective disorder (18.8%) and had made a previous suicide attempt (46.6%). The suicides were young and significantly more were unmarried (84.5%), unemployed (66%), living alone, (55.5%) and depressed (65.5%), and 44.4% had a primary diagnosis of depressive disorder. Of the 75 outpatient suicides, 58% had seen a psychiatrist within the previous week, 61 of the 75 (81.3%) had been admitted in their last episode of contact, and 44% of these suicided within a month of discharge.
This paper presents the epidemiology of suicide and discusses the known risk factors for suicide within a framework designed to encourage a systematic approach to theory testing and prevention. Mental and addictive disorders are the most powerful of the multiple risk factors for suicide in all age groups. Since risk factors for suicide rarely occur in isolation, prevention efforts are more likely to succeed if multiple risk factors are targeted.
A retrospective analysis of the psychotrophic medication, illness history and recent mental symptoms of 28 schizophrenic or paranoid inpatients who had committed suicide and the same number of matched control subjects was carried out. The groups were first compared separately for every variable, and 6 statistically most significant variables in the paired comparisons were then entered into a stepwise linear logistic regression model. Four statistically significant differences between the groups were found with the paired comparisons. The suicide group had more often previous suicide attempts, lower neuroleptic doses, more depressive symptoms and less positive schizophrenic symptoms compared to their controls. The results of the regression analysis suggested that the lower neuroleptic doses in the suicide group were more probably a consequence of the differences in the symptom profile than in a direct causal relationship to the suicides per se.
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