Lifetime psychiatric symptoms in persons with schizophrenia who died by suicide compared to other means of death
Maryland Psychiatric Research Center, University of Maryland, Baltimore, MD 21228, USA. Journal of Psychiatric Research
(Impact Factor: 3.96).
09/2004; 38(5):531-6. DOI: 10.1016/j.jpsychires.2004.02.001
The focus of this report is to compare the psychiatric symptomatology of individuals with schizophrenia who have died by suicide to those who have died by other means of death. This study includes individuals with a diagnosis of schizophrenia whose families donated their brain tissue to the Maryland Brain Collection between September 1989 and August 1998. The psychological autopsy method was used to assess the deceased individual's demographic and clinical characteristics, psychiatric symptoms and history of suicidal thoughts and attempts. Ninety-seven individuals with schizophrenia were identified for this study. Fifteen had committed suicide, while the remaining 82 died from other causes. Thoughts of suicide and previous suicide attempts were more frequent among the group that died from suicide (93% compared to 26%) (p < 0.0001). Suicide victims had a higher rate of depressive symptoms and were twice as likely to have a depressed mood. The incidence of thoughts of dying was 60% compared to 20% in those who did not commit suicide (p = 0.002). Loss of interest was reported to occur in 20% in the suicide group compared to 4% in the group of individuals that died from other causes (p = 0.05). Victims of suicide also had higher rates of positive symptoms throughout their lifetime including thought control, flight of ideas, and loose associations. Suicide is one of the leading cause of premature death in individuals with schizophrenia and identification of risk factors is of great importance. Individuals who die by suicide experience higher rates of depressive symptoms, suicidal thoughts and positive symptoms during their life.
Available from: PubMed Central
- "Schizophrenia and psychotic disorders are also important risk factors for suicide. The main factors to be taken into account when assessing the risk of suicide in patients with schizophrenia are depressive syndromes, suicidal thoughts, and a history of suicide attempts [32-34]. It is recommended that modifiable factors, such as depression should be managed to reduce the suicidality of hospitalised patients with schizophrenia . "
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Because psychiatric disorders are risk factors for suicide, psychiatric consultation should be an essential element of suicide prevention among individuals with a high risk of suicide. The aim of the present study was to compare the characteristics of individuals who had or had not received psychiatric consultation before they attempted suicide in Japan.
Clinical records were used to identify 300 consecutive persons who were admitted to the hospital for attempting suicide between April 2006 and March 2013. We divided the patients into two groups. One group consisted of patients who consulted a psychiatrist before their suicidal behaviours (the consultation group), and the other group consisted of patients who had not consulted a psychiatrist before their suicidal behaviours (the non-consultation group). Group differences were analysed with respect to gender, age, method of suicide attempts, psychiatric diagnosis (ICD-10), and duration of hospitalisation in the emergency unit.
Females tended to be over-represented in the consultation group (73.0%), and males tended to be over-represented in the non-consultation group (59.8%). Poisoning by prescription drugs was used more frequently as a method of suicide in the consultation group than in the non-consultation group. Neuroticism and related disorders were higher in the non-consultation group (33.7%) than in the consultation group (18.9%). Mood disorders (32.6%) were nearly as common as neuroticism in the non-consultation group, and together they accounted for almost two-thirds of all diagnoses. Mood disorders were comparable between the consultation group (30.9%) and the non-consultation group (32.6%). Adult personality disorders (13.3%) and schizophrenia and related disorders (26.0%) were higher in the consultation group than in the non-consultation group.
Measures have to be taken to encourage people with these diverse characteristics to consult psychiatrists, and psychiatrists have to regularly evaluate patients for suicide risk. Furthermore, we need further research on the relationship between psychiatric consultation and poisoning by prescribed drugs.
Available from: Howard C Margolese
- "Some clinical characteristics, such as elevated levels of depressive symptoms or the presence of depressive disorders (Altamura et al., 2003; Fenton, 2000; Hawton et al., 2005; Heila et al., 1997; Hu et al., 1991; Kelly et al., 2004; Kreyenbuhl et al., 2002; Kuo et al., 2005; Plutchik et al., 1989; Potkin et al., 2003; Sinclair et al., 2004), have consistently been associated with suicide and suicidal behaviour among psychotic individuals, whereas others, such as alcohol and substance abuse (Baca-Garcia et al., 2005; Gut-Fayand et al., 2001; Kreyenbuhl et al., 2002; Kuo et al., 2005; Sinclair et al., 2004) have been associated with suicide attempts but not completed suicide. Mixed findings have emerged in studies of positive and negative symptoms (Fenton, 2000; Hu et al., 1991; Kelly et al., 2004; King et al., 2001; Sinclair et al., 2004). Though an increased frequency of an active illness phase among schizophrenic suicides has been reported (Heila et al., 1997), and these individuals are also more likely to have experienced psychotic symptoms in the month preceding their suicides (Hu et al., 1991), the association between the severity of current psychotic symptoms and completed suicide has, to our knowledge, not been examined in schizophrenia and other chronic psychotic disorders. "
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ABSTRACT: Despite an increased risk for suicide among individuals diagnosed with psychotic disorders, risk factors for completed suicide remain largely unexamined in this population. Using a case-control design, this study aimed to investigate clinical and behavioural risk factors for suicide completion in schizophrenia and other chronic psychotic disorders.
A total of 81 psychotic subjects were examined; of these, 45 died by suicide. Proxy-based interviews with, on average, 2 informants were conducted using the SCID I and II interviews and a series of personality trait assessments.
Psychotic individuals at risk for suicide are most readily identified by the presence of depressive disorders NOS, moderate to severe psychotic symptoms and a family history of suicidal behaviour. They also exhibited fewer negative symptoms, had more comorbid diagnoses and, contrary to findings in other populations, we found that cluster A and C personality trait symptoms seem to have protective effects against suicide in schizophrenics and other chronic psychotic suicides.
Our study suggests that behavioural mediators of suicide risk, such as impulsive-aggressive behaviours, do not play a role in schizophrenic and chronic psychotic suicide. This is contrary to findings in other diagnostic groups, thus implying heterogeneity in predisposing mechanisms involved in suicide.
Available from: yenisymposium.net
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ABSTRACT: ÖZET Amaç: fiizofrenide intihar davran›fl›na yol açan risk etmenlerinin bilinmesi bu konuda önleyici yak- lafl›mlar›n gelifltirilmesini salayabilir. Bu çal›flman›n amac› flizofrenlerde intihar düflüncesini yorda- y›c› faktörleri bâz› sosyodemografik ve klinik özellikler yönünden deerlendirmektir. Yöntem: Çal›flmaya Trabzon Ataköy Ruh ve Sinir Hastal›klar› Hastânesi'nde 2006 y›l›n›n Nisan ve Haziran aylar› aras›nda yatarak tedavi görmekte olan akut dönemdeki 60 flizofrenik hasta ve yine ayn› hastânenin polikliniine bu tarihler aras›nda kontrol için baflvuran stabil dönemdeki 60 flizof- renik hasta olmak üzere toplam 120 hasta al›nm›flt›r. SCID-I'e göre flizofreni tan›s› alan hastalara sosyodemografik veri toplama formu baflta sabit kalmak üzere ayn› s›rayla Beck Umutsuzluk Ölçe- ¤i (BUÖ), Calgary fiizofrenide Depresyon Ölçei (CfiDÖ) ve Pozitif ve Negatif Sendrom Ölçei (PANSS) uygulanm›flt›r. Bulgular: Çal›flmada deneklerin %31,66's›nda intihar düflüncesine, %18,3'ünde ise intihar giriflimi öyküsüne rastlanm›flt›r. Umutsuzluk ve depresyon intihar düflüncesi olan grupta olmayan gruba gö- re anlaml› düzeyde yüksek bulunmufltur. Pozitif belirtiler aç›s›ndan iki grup aras›nda farkl›l›k sap- tanmam›flt›r. ‹ntihar düflüncesi olan grupta negatif belirtiler istatistiksel olarak anlaml› düzeyde yüksek bulunmaktad›r. Tart›flma ve Sonuç: fiizofrenik hastalarda intihar giriflimi öyküsünün, depresyonun ve umutsuzluk düflüncelerinin deerlendirilmesinin flizofrenide intihar davran›fl›n› önlemede önemli olduu düflü- nülmektedir. Negatif belirtilerin intihar davran›fl› ile iliflkisinin ve flizofrenide intihar davran›fl›n›n çok yönlü doas›n›n aç›¤a ç›kar›lmas›nda yeni çal›flmalara ihtiyaç duyulmaktad›r. Anahtar Kelimeler: flizofreni, intihar düflüncesi, risk etmenleri, depresyon, umutsuzluk ABSTRACT Suicidal Ideation in Patients Who Are Being Treated in A Psychiatry Hospital: Relation Between Positive and Negative Symptoms, Depression, and Hapelessness Objective: Suicidal behavior, causing important psychological, social and economic problems for societies, is frequently seen in schizophrenia as in other psychological disorders. However, little research has been conducted to determine whether the risk for suicidal behavior is elevated among patients with psychosis in general. Being aware of risk factors causing suicidal behavior in schizophrenia can help to develop prevention strategies in this subject. The aim of this study is evaluate the factors on suicide idea at the patients with schizophrenia from the view of some socio-demographic and clinical properties. Method: The sample of the study consists of 120 patients with schizophrenia; from the patients' treated at Trabzon Ataköy Psychiatry Hospital between the dates of April-June 2006; 60 of them in the acute stage taking medical treatment while hospitalized and 60 of them in the stabile stage that applied to the hospital polyclinics for control treatment. Socio-demographic form being in the lead, Beck Hopelessness Scale (BHS), Calgary Depression Scale for Schizophrenia (CDSS) and Positive and Negative Syndromes Scale (PANSS) were applied in the same order were applied to samples being diagnosed as schizophrenia by SCID-I. Findings: In the study 31.66% of the sample has suicidal ideation and 18.3% of the sample has history of suicide attempts. In terms of hopelessness and depression, a significant difference was found out between groups. According to positive symptoms, no difference was present between groups. In the group with suicide ideation, negative symptoms are found out to be significantly higher. Discussion and Conclusion: Evaluating the history of suicide attempts, depression and hopelessness in patients with schizophrenia are thought to be important to prevent suicidal behavi-
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