Abstract
The risk for suicidal behavior in schizophrenia is high with 10–15% committing suicide and 20–40% making suicide attempts. Due to the chronicity and complexity of schizophrenia and the multi-determined nature of suicidal behavior, the clinician must utilize a biopsychosocial approach to assessment and intervention. Clinical factors such as psychosis, depression and substance abuse increase the risk for suicidal behavior in schizophrenia. Social factors such as social adjustment and social supports also play a critical role. Ongoing assessment and intervention of suicidal behavior, clinical symptomatology, social environment and treatment issues are essential. Prediction and prevention of suicidal behavior are not always possible however. Treatment focused on the reduction of symptomatology and maintenance of an effective social environment may attenuate the risk for suicidal behavior in schizophrenia.
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REFERENCES
Black DW, Warrack G, Winokur G. The Iowa record linkage study. Arch Gen Psychiatry 42:71–75, 1985.
Johns CE, Stanley M, Stanley B. Suicide in schizophrenia. Annals of The New York Academy of Sciences, 487:294–300, 1986.
Miles C. Conditions predisposing to suicide: A review. J Nerv Ment Dis 164:231–246, 1977.
Tsuang MT. Suicide in schizophrenics, manics, depressives and surgical controls. Arch Gen Psychiatry 35:153–155, 1978.
Winokur G, Tsuang M. The Iowa 500: Suicide in mania, depression and schizophrenia. Am J Psychiatry 132:650–651, 1975.
Landmark J, Cernovsky Z, Mersky H. Correlates of suicide attempts and ideation in schizophrenia. Br J Psychiatry 151:18–20, 1987.
Niskanen P, Lonnqvist J, Achte K, et al. Suicide in Helsinki psychiatric hospitals in 1964–1972. Psychiatr Fennica 275–280, 1974.
Planansky K, Johnston R. The occurrence and characteristics of suicidal preoccupation and acts in schizophrenia. Acta Psychiat Scand 47:473–483, 1971.
Roy A, Mazonson A, Pickar D. Attempted suicide in schizophrenia. Br J Psychiatry 144:303–306, 1984.
Wyatt RJ, Henter I, Lear MC, Taylor E. An economic evaluation of schizophrenia-1991. Soc Psychiatry Psychiatr Epidemiol 30:196–205, 1995.
Banen DM. Suicide by psychotics. J Nerv Ment Dis 120:349–357, 1954.
Cohen SCV, Farberow LNL, Shneidman ES. Tranquilizers and suicide in schizophrenic patients. Arch Gen Psychiatry 11:312–321, 1964.
Levy S, Southcombe RH. Suicide in a state hospital for the mentally ill. J Nerv Ment Dis 117: 504–514, 1953.
Virkkunen M. Suicide in schizophrenia and paranoid psychoses. Acta Psychiatr Scand (Suppl) 250:1–305, 1974.
Yarden P. Observations on suicide in chronic schizophrenia. Comp Psychiat 15:325–333, 1974.
Lindelius R, Kay DWK. Some changes in the pattern of mortality in schizophrenia in Sweden. Acta Psychiatr Scand 49:315–323, 1973.
Roy A. Suicide in chronic schizophrenia. Br J Psychiatry 141:171–177, 1982.
Warnes H. Suicide in schizophrenics. Dis Nerv Sys (Suppl) 29:35–40, 1968.
Wilkinson DG. The suicide rate in schizophrenia. Br J of Psychiatry 140:138–141, 1982.
Bleuler M. The schizophrenic disorders: Long-term patient and family studies (trans. SM Clemens). New Haven, CT: Yale University Press, 1978.
Ciompi L. Late suicide in former mental patients. Psych Clin 9:59–63, 1976.
Tsuang MT, Woolson RF. Excess mortality in schizophrenia and affective disorders: Do suicides and accidental deaths solely account for this excess? Acta Psychiat Scand 35: 1181–1185, 1978.
Mandel MR, Severe JB, Schooler NR, et al. Development and prediction of postpsychotic depression in neuroleptic treated schizophrenics. Arch Gen Psychiatry 39:197–203, 1982.
Siris SG, Harmon GK, Endicott J. Postpsychotic depressive symptoms in hospitalized schizophrenic patients. Arch Gen Psychiatry 38:1122–1123, 1981.
Caldwell BC, Gottesman, II. Schizophrenics kill themselves too: A review of the risk factors for suicide. Schiz Bull 16:571–589, 1990.
Copas JB, Freeman-Browne DL, Robin AA. Danger periods for suicide inpatients under treatment. Psychol Med 1:400–404, 1971.
Planasky K, Johnston R. Clinical setting and motivation in suicide attempts. Acta Psychiat Scand 49:680–690, 1973.
Sletten I, Brown M, Evenson R, et al. Suicide in mental hospital patients. Dis Nerv Sys 33:328–334, 1972.
Breier A, Astrachan BM. Characterization of schizophrenics who commit suicide. Am J Psychiatry 141:206–209, 1984.
Bromet EJ, Schwartz JE, Fennig S, Geller L, Jandorf L, Kovasznay B, Lavelle J, Miller A, Pato C, Ram R, Rich C. The epidemiology of psychosis: The Suffolk County Mental Health Project. Schiz Bull 18:243–255, 1992.
Inamdar S, Lewis D, Siomopolous G, et al. Violent and suicidal behavior in psychotic adolescents. Am J Psychiatry 139:932–935, 1982.
Wilkinson G, Bacon NA. A clinical and epidemiological survey of parasuicide and suicide in Edinburgh schizophrenics. Psychol Med 14:899–912, 1984.
Weissman M. The epidemiology of suicide attempts, 1960–1971. Arch Gen Psychiatry 30:737–746, 1974.
Shaffer JW, Perlin CW, Schmidt CW, et al. The prediction of suicide in schizophrenia. J Nerv Ment Dis 159:349–355, 1974.
Wilson GC. Suicide in psychiatric patients who have received hospital treatment. Am J Psychiatry 125:752–757, 1968.
Roy, A. Family history of suicide. Arch Gen Psychiatry 40:971–974, 1983.
Tsuang MT. Risk of suicide in relatives of schizophrenics, manics, depressives and controls. J Clin Psychiatry 44:396–400, 1983.
Drake RE, Gates C, Cotton, PG, Whitaker A, et al. Suicide among schizophrenics: Who is at risk?. J Nerv Ment Dis 172:613–618, 1984.
Goh SE, Salmons PH, Whittington RM. Hospital suicides: Are there preventable factors? Br J Psych 154:247–249, 1989.
Modestin J. Three different types of clinical suicide. European Archives of Psychiatry and Neurological Sciences 236:148–153, 1986.
Wolfersdorf M, Vogel R, Keller F, Hole G: The increase of suicides in psychiatric hospitals in southwestern Germany according to diagnostic subgroups. Crisis 12:34–47, 1991.
Drake RE, Bartels SJ, Torrey WC. Suicide in schizophrenia: Clinical approaches, in Depression in schizophrenics. Edited by Williams R and Dalby JT, New York: Plenum Press, 1989.
DeAlarcon R, Carney MW. Severe depressive mood changes following slow-release intramuscular fluphenazine injection. Br J Psychiatry 3:564–567, 1969.
Drake RE, Ehrlich J. Suicide attempts in association with akathisia. Am J Psychiatry 142:499–501, 1985.
Hogan TP, Awad AG. Pharmacotherapy and suicide risk in schizophrenia. Canadian Journal of Psychiatry 142:499–501, 1983.
Schultz JR. Homicide and suicide associated with akathisia and haloperidol. Am J Psychiatry 6:3–7, 1985.
Shear K., Frances A., Weider P. Suicide associated with akathisia and depot fluphenazine treatment. J Clin Psychopharm 3:235–236, 1986.
Guze SB, Robbins E. Suicide and primary affective disorders. Br J Psychiatr 117:437–438, 1970.
Fawcett J, Scheftner W., Clark D, Hedeker D, Gibbons R, Coryell W. Clinical predictors of suicide in patients with major affective disorders: A controlled prospective study. Am J Psychiatry 144:35–40, 1987.
Jones JS, Stein, DJ, Stanley B, Guido JR, Winchel R, Stanley M. Negative and depressive symptoms in suicidal schizophrenics. Acta Psychiat Scand 89: 81–87, 1994.
Pickar D, Roy A, Breier A, Doran A, Wolkowitz O, Colison J, Agren H. Suicide and aggression. Annals of the New York Academy of Sciences, 487:189–196, 1986.
Allebeck P., Varla, A., Kristjansson E., Wistedt B. Risk factors for suicide among patients with schizophrenia. Acta Psychiat Scand 76: 414–419, 1987.
Dassori AM, Mezzich JE, Keshavan M. Suicidal indicators in schizophrenia. Acta Psychiat Scand 81:409–413, 1990.
Drake RE, Gates C, Cotton PG. Suicides among schizophrenics: A comparison of attempters and completed suicides. Br J Psychiatry 149:784–787, 1986.
Drake RE, Gates C, Whitaker A, Cotton PG. Suicide among schizophrenics: A review. Comp Psychiatry 26: 990–100, 1985.
Lim, LCC, Tsoi, WF. Suicide and schizophrenia in Singapore: A fifteen year follow-up study. Annals of the Academy of Medicine, Singapore 20: 201–203, 1991.
Beck AT, Kovacs M, Weissman A. Hopelessness and suicidal behavior: An overview. JAMA 234:1146–1149, 1975.
Minkoff K, Bergman E, Beck AT, et al. Hopelessness and depression, and attempted suicide. Am J Psychiatry 130:455–459, 1973.
Virkkunen M. Attitude toward psychiatric treatment before suicide in schizophrenia and paranoid psychoses. Br J Psychiatry 128: 47–49, 1975.
American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition Washington, D.C.: American Psychiatric Association, 1994.
Oquendo M, Malone K, Ellis S Mann JJ. Do antidepressants change rates of suicide attempts in depression? Proceedings of the 35th annual meeting of the American College of Neuropsychopharmacology, San Juan, Puerto Rico, 1996.
Ghosh TB, Victor BS. Suicide, in The American Psychiatric Press Textbook of Psychiatry (2nd ed). Edited by R. E. Hales, S. C. Yudofsky, & J. A. Talbott, Washington, DC, American Psychiatric Press, 1994. p. 1251–1271.
Murphy GE, Wetzel RD. The lifetime risk of suicide in alcoholism. Arch Gen Psychiatry 47:383–392, 1990.
Roy, A. Psychiatric emergencies, in Comprehensive Textbook of Psychiatry (Vol. 2, 6th ed). Edited by Kaplan HI, Sadock BJ, Baltimore, MD, Williams & Wilkins, 1995, p1739–1752.
Soyka M, Albus M, Kathmann N, Finelli A, Hofstetter S, Holzbach R., Immler B, Sand P. Prevalence of alcohol and drug abuse in schizophrenic inpatients. European Archives of Psychiatry and Clinical Neuroscience 242:362–372, 1993.
Moscicki EK. Epidemiology of suicidal behavior. Suic Life-threat Beh 25:22–35, 1995.
Modestin J, Zarro I, Waldvogel D. A study of suicide in schizophrenic inpatients. Br J Psychiatry 160:398–401, 1992.
Farberow NL, Shneidman ES, Neuringer C. Case history and hospitalization factors in suicides of neuropsychiatric hospital patients. J Nerv Ment Dis 142:32–44, 1966.
Brown GL, Goodwin FK. Cerebrospinal fluid correlates of suicide attempts and aggression. Annals of the New York Academy of Sciences, 487:174–188, 1986
Cooper SJ, Kelly CB, King DJ. 5-hydroxy indoleacetic acid in cerebrospinal fluid and predication of suicidal behavior in schizophrenia. Lancet 340:940–941, 1992.
Lemus, C., Lieberman J, Johns CA, Pollack S, Bookstein P, Cooper T. CSF 5-hydroxy indoleacetic acid levels and suicide attempts in schizophrenia. Biol Psychiatry 27:923–926, 1990.
Garrison CZ, McKeown RE, Valois RF, Vincent ML. Aggression, substance use, and suicidal behavior in high school students. Am J Public Health 83: 179–184, 1993.
Grosz DE, Lipschitz DS, Eldar S, Finkelstein G, Blackwood N, Gerbino-Rosen G, Faedda G, Plutchik R. Correlates of violence risk in hospitalized adolescents. Comp Psych 35: 296–300, 1994.
Nielsen DA, Goldman D, Virkkunen M, Tokola R, Rawlings R, Linnoila M. Suicidality and 5-hydroxy indoleacetic acid concentration associated with a tryptophan hydroxylase polymorphism. Arch Gen Psychiatry 51: 34–38, 1994.
Virkkunen, M., DeJong, J., Bartko, J., Linnoila, M. Psychobiological concomitants of history of suicide attempts among violent offenders and impulsive fire-setters. Arch Gen Psychiatry 46: 604–606, 1989.
Bellack, AS. A comprehensive model for treatment of schizophrenia, in A clinical guide for the treatment of schizophrenia. Edited by Bellack AS, New York, NY, Plenum Press, 1989.
Linn, MW. Partial hospitalization, in A Clinical Guide for the Treatment of Schizophrenia. Edited by Bellack AS, New York, NY, Plenum Press, 1989.
Mosher LR. Community residential treatment: Alternative to hospitalization, in A Clinical Guide for the Treatment of Schizophrenia. Edited by Bellack AS, New York, NY, Plenum Press, 1989.
McGlashan TH, Dingman CW. Psychotherapy, in A Clinical Guide for the Treatment of Schizophrenia. Edited by Bellack AS, New York, NY: Plenum Press, 1989.
Weisman GK. Crisis intervention, in A Clinical Guide for the Treatment of Schizophrenia. Edited by Bellack AS, New York, NY, Plenum Press, 1989.
Cotton PG, Drake RE, Gates C. Critical treatment issues in suicide among schizophrenics. Hosp Comm Psychiatry 36: 534–536, 1985.
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Harkavy-Friedman, J.M., Nelson, E.A. Assessment and Intervention for the Suicidal Patient with Schizophrenia. Psychiatr Q 68, 361–375 (1997). https://doi.org/10.1023/A:1025447115067
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DOI: https://doi.org/10.1023/A:1025447115067