Article

Schizophrenia - A predictor of suicide during the second half of life?

The Research Unit, Mental Health Centre Copenhagen, Bispebjerg Bakke 23, Bygn. 13A, DK-2400 Copenhagen NV, Denmark.
Schizophrenia Research (Impact Factor: 3.92). 02/2012; 134(2-3):111-7. DOI: 10.1016/j.schres.2011.09.032
Source: PubMed

ABSTRACT

Little is known about the suicide risk of older adults diagnosed with schizophrenia. The purpose of the study is to examine whether older adults diagnosed with schizophrenia have an elevated risk of dying by suicide, examine trends by age, and identify predictors of death by suicide.
Individual-level register data on all older adults aged 50+ living in Denmark during 1990-2006 (N=2,899,411) were assessed using survival analysis. The impact of predictors was adjusted for a series of socio-demographic and health-related covariates.
In all, 248 suicides were identified among older adults diagnosed with schizophrenia. The suicide rate ratios of men and women aged 50-69years with a diagnosis of schizophrenia was 7.0 [95%CI: 5.8-8.4] and 13.7 [95%CI: 11.3-16.6], respectively, when compared to those with no diagnosis. With increasing age a lower rate ratio was found; for men and women aged 70+ it was 2.1 [95%CI: 1.1-3.9] and 3.4 [95%CI: 2.0-5.8], respectively. Adjusted analyses revealed an elevated risk of suicide for diagnoses of schizophrenia, greater number of hospitalizations, recent admission (for men), recent discharge, previous suicide attempt, recent suicide attempt, comorbidity of mood disorders, personality disorders, and substance abuse (for women).
We found an elevated mortality risk of suicide for both men and women aged 50years and over diagnosed with schizophrenia. Health care staff should be aware of elevated risk, particularly in older women diagnosed with schizophrenia, in relation to chronic disease courses, recent discharge, and suicide attempt.

Download full-text

Full-text

Available from: Preben B Mortensen, Jun 09, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the present study, we examined whether there was an association between dopamine-β hydroxylase (DBH) promoter polymorphisms (a 5'-ins/del and a GTn repeats) and a history of suicide attempt in 223 chronic schizophrenia individuals using statistical and molecular analyses. Within the genetic association study design, we compared the statistical haplotype phase with the molecular phase produced by the amplicon size analysis. The two DBH polymorphisms were analysed using the Applied Biosystem 3130 and the statistical analyses were carried out using UNPHASED v.3.1.5 and PHASE v.2.1.1 to determine the haplotype frequencies and infer the phase in each patient. Then, DBH polymorphisms were incorporated into the Haploscore analysis to test the association with a history of suicide attempt. In our sample, 62 individuals had a history of suicide attempt. There was no association between DBH polymorphisms and a history of suicide attempt across the different analytical strategies applied. There was no significant difference between the haplotype frequencies produced by the amplicon size analysis and statistical analytical strategies. However, some of the haplotype pairs inferred in the PHASE analysis were inconsistent with the molecular haplotype size measured by the ABI 3130. The amplicon size analysis proved to be the most accurate method using the haplotype as a possible genetic marker for future testing. Although the results were not significant, further molecular analyses of the DBH gene and other candidate genes can clarify the utility of the molecular phase in psychiatric genetics and personalized medicine.
    No preview · Article · Apr 2014 · Psychiatric genetics
  • [Show abstract] [Hide abstract]
    ABSTRACT: Schizophrenia is a psychiatric disorder that causes severe cognitive, behavioral and social dysfunction, responsible for a shortening of the life expectancy of patients, with an increased risk of suicide, cardiovascular disease and cancer. The management of patient with schizophrenia is global and atypical antipsychotics, antagonizing dopamine pathway, are the first line pharmacological treatment. Clozapine, the first atypical antipsychotic discovered, is currently still the most effective molecule against schizophrenia, while causing less extrapyramidal side effects. Its particular pharmacological behavior towards serotonergic, muscarinic and NMDA receptors, seems essential to its action. However, clozapine is responsible for immunological and metabolic lethal adverse events, preventing its wider use. Clozapine is therefore reserved for resistant schizophrenia cases. Monitoring patients with different scales such as the Brief Psychiatric Rating Scale and the Positive And Negative Syndrome Scale showed that there were forms of ultra-resistant schizophrenia. The treatment in this case, must be customized to the patient's symptomatology, but the combination of clozapine with other pharmacological or non-pharmacological treatments, shows yet only small improvements.
    No preview · Article · May 2014 · Revue medicale de Bruxelles
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To identify risk factors associated with suicide of patients with schizophrenia and provide clinical recommendations, which integrate research findings into a consensus based on clinical experience and evidence. MethodA task force formed of experts and clinicians iteratively developed consensus through serial revisions using the Delphi method. Initial survey items were based on systematic literature review published up to June 2013. ResultsVarious risk factors were reported to be implicated in suicide in schizophrenia. Our findings indicate that suicide risk in schizophrenia is mainly related to affective symptoms, history of a suicide attempt and number of psychiatric admissions. Other risk factors identified are given by younger age, closeness to illness onset, older age at illness onset, male sex, substance abuse and period during or following psychiatric discharge. Integrating the evidence and the experience of the task force members, a consensus was reached on 14 clinical recommendations. Conclusion Identification of risk factors for suicide in individuals diagnosed with schizophrenia is imperative to improve clinical management and develop strategies to reduce the incidence of suicide in this population. This study provides the critical overview of available data and clinical recommendations on recognition and management of the above-mentioned risk factors.
    Full-text · Article · Sep 2014 · Acta Psychiatrica Scandinavica
Show more