Suicide in schizophrenia

Approximately 40% of patients with schizophrenia make a suicidal attempt during their lifetime, and in 10-20% it is successful.      

Even if it is possible to stop most of the symptoms of depression in patients with schizophrenia, this does not mean that the threat of suicide has passed. Suicidal thoughts in this disease go away relatively late.     

Among patients with schizophrenia, suicidal attempts are more common in young men, especially if they have tried to commit suicide in the past. Severe symptoms of depression, persistent disorders of perception, panic attacks, and frequent hospitalizations in a psychiatric hospital are considered harbingers of suicidal behavior .   

Suicide risk factors for schizophrenia

  • Young age;
  • Male;
  • History of suicidal attempts ; 
  • First psychotic episode;
  • Dominance of positive symptoms over negative;
  • Significant severity of symptoms of depression;
  • Persistent perception disorders (imperative auditory hallucinations);
  • Panic attacks;
  • Frequent relapses of the disease (frequent hospitalizations);
  • The first 3 months after discharge from the hospital;  
  • Resistant variants of the course of the disease;
  • Autoaggression manifestations;
  • Low level of compliance;
  • Severe side effects of therapy (akathisia);
  • Medicines suspected of increasing the risk of suicide (fluoxetine, duloxetine);
  • Inadequate drug therapy (low or high doses of drugs);
  • Substance abuse;
  • Insufficient social support;
  • Stigmatization of the disease;
  • Economic problems;
  • Relatively high level of intelligence in premorbid. 

The degree of suicide risk is influenced by the level of compliance and the adequacy of drug treatment. Neurological complications of therapy, especially akathisia, may be accompanied by suicidal thoughts .    

Poor social support, stigmatization of the disease, and economic hardship also increase suicidality.

The risk of suicide is higher in patients with a dual diagnosis, when, against the background of the course of schizophrenia, there is a dependence on psychoactive substances.    

Many psychiatrists have noted that suicide in schizophrenia is possible in the early stages of mental disorder, in patients with a relatively high premorbid level of intelligence and with deep feelings about the consequences of the mental disorder.      

The tendency to self-harm, auto-aggressive tendencies, imperative auditory pseudo-hallucinations should alert the doctor to possible suicide.  

In almost 20% of cases, suicidal attempts in schizophrenia occur with its resistant variants of the course (“refractory schizophrenia”) (Heila H. et al., 1999).    

According to psychiatrists, hospitalization partly increases the risk of suicide due to the fact that the patient’s forced isolation from society is perceived by him extremely negatively. At the same time, most psychiatrists consider hospitalization in the presence of suicidal thoughts mandatory, since in this case the patient can be monitored constantly, antidepressants can be prescribed, while providing him with the necessary psychological support (increasing the level of self-esteem, the degree of self-confidence , etc.).           

Suicidal thoughts in schizophrenia can be difficult to recognize, suicidal attempts are difficult to prevent, primarily because of their impulsiveness (Gut-Fayand A. et al., 2001). In addition, unlike other patients with mental disorders, patients with schizophrenia resort to methods of suicide, which practically exclude a failed attempt.         

Analysis of suicide cases in schizophrenia shows that in most cases, at least 3 months before suicide, patients or their relatives sought medical help. In particular, they underwent treatment in a psychiatric hospital, of which almost half of the cases were preceded by a visit to a psychiatrist a week before the suicide (Roy A., 1982). Quite often, the cause of suicide can be the wrong prescription of medications, the intake of inadequate doses of drugs that are either too low or too high.               

Medical personnel involved in the treatment of a person with schizophrenia must be constantly aware of the high risk of suicide in this disease. An open conversation with the patient, a sincere attitude to his experiences, attention to his plans often helps prevent a suicidal attempt.     

Clozapine is considered to be a drug that significantly reduces the likelihood of suicide in schizophrenia, which in this respect is superior not only to traditional antipsychotics, but also to modern atypical antipsychotics, such as olanzapine.    

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