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Khutoryanskaya JV, Grechanyy SV. [Non-suicidal self-injurious behavior in conduct disorders and schizotypal disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:69-76. [PMID: 37942975 DOI: 10.17116/jnevro202312309269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To compare the methods and motives of non-suicidal self-injurious behavior (NSIB) in conduct disorders and schizotypal disorder. MATERIAL AND METHODS The main group consisted of 91 patients (77.8%), aged 13-24 years, with behavioral disorders and NSIB, who completed questionnaires using the self-harm statements questionnaire. The younger subgroup consisted of 54 patients under the age of 18 with a diagnosis of «Behavior Disorders» (ICD-10 F91), the older subgroup included 37 patients aged 18 years or more with a diagnosis of Emotionally Unstable Personality Disorder (F60.3). The comparison group consisted of 100 patients, aged 13-41 years with a diagnosis of schizotypal disorder (F21) and NSIB. We used clinical-psychopathological, standardized and statistical methods. RESULTS Significant differences were revealed in the sexual preference for NSIB (p=0.0001), a number of leading types of NSIB, and the absence of differences in the motives of self-injurious behavior in patients of the compared groups. In the comparison group, cuts and cauterization prevailed as the leading type of NSIB, in patients with behavioral disorders prevailed obstacles to wound healing, which is hypothetically associated with the influence of obsessive psychopathological mechanisms, since pathological excoriation has the same nature as obsessive-compulsive disorder and is included with it in the same DSM-5 category. The impulsive subtype of NSIB observed in this situation usually arises due to an increasing sense of tension and is associated with the motive of intrapersonal self-regulation. CONCLUSION The study showed that the difference between the compared nosological groups according to the methods and motives of self-harming actions is determined not so much by intergroup differences as by sex and age patterns within each of the compared groups. This allows us to talk about the proximity of the mechanisms of self-harm in various mental disorders, and the phenomenon of NSIB itself should be considered rather as a nosologically nonspecific psychopathological phenomenon.
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Affiliation(s)
- J V Khutoryanskaya
- Saint Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - S V Grechanyy
- Saint Petersburg State Pediatric Medical University, St. Petersburg, Russia
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Aydın M, Ilhan BC, Tekdemir R, Çokünlü Y, Erbasan V, Altınbaş K. Suicide attempts and related factors in schizophrenia patients. Saudi Med J 2019; 40:475-482. [PMID: 31056625 PMCID: PMC6535170 DOI: 10.15537/smj.2019.5.24153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives: To investigate the relationship between suicide attempts and demographic-clinical variables and to assess the methods used in suicide attempts by comparing schizophrenia patients with and without suicide attempts. Methods: A retrospective study with a total of 223 schizophrenia patients aged 18-65 years that were admitted to the Department of Psychiatry, Selcuk University and the Beyhekim Psychiatric Clinic Konya Training and Research Hospital, Konya, Turkey, between January 2014 and January 2018 The data collection forms created by researchers were completed using hospital medical records. Results: It was determined that 40.8% of schizophrenia patients attempted suicide at least once and that 39.6% of schizophrenia patients who attempted suicide had recurrent suicide attempts. Those with suicide attempts had a significantly longer mean duration of untreated psychosis and a higher total number of hospitalizations compared to those without suicide attempts. In addition, the use of depot antipsychotic drugs was significantly lower in those with suicide attempts. There was a statistically significant difference in the presence of traumatic life events between those with and without suicide attempts. Conclusion: Suicidal behavior is an important problem in schizophrenia. Identifying risk factors and high-risk individuals will guide us in the development of preventive interventions.
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Affiliation(s)
- Memduha Aydın
- Department of Psychiatry, Faculty of Medicine, Selçuk University, Konya, Turkey. E-mail.
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Singh H, Chandra PS, Reddi VSK. Clinical Correlates of Suicide in Suicidal Patients with Schizophrenia Spectrum Disorders and Affective Disorders. Indian J Psychol Med 2016; 38:517-523. [PMID: 28031586 PMCID: PMC5178034 DOI: 10.4103/0253-7176.194910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The most common psychiatric illnesses in the background of suicide are schizophrenia spectrum disorders (SSD) and affective disorders (AD). While depression and hopelessness are important factors for suicide in psychiatric patients, the role of psychotic symptoms is unclear. We examine the comparative differences in the clinical correlates of suicide in SSD and AD patients with suicidal risk. MATERIALS AND METHODS One hundred and twenty suicidal psychiatric patients (aged between 17-60 years) were evaluated for depression severity, hopelessness, past attempts, and reasons for wanting to commit suicide at the emergency psychiatry centre. Of these 29% had SSD, 65% AD, and 6% other disorders. RESULTS Lifetime history of suicide attempts and suicide attempts in previous month were higher in SSD patients. Mean Beck Depression scores, Hopelessness, and Suicide Intention scores were significantly lower in patients with SSD as compared to AD (P ≤ 0.05). More than 60% patients with SSD attributed psychotic symptoms as a reason for wanting to commit suicide, while more than 50% patients with AD attributed it to family and personal stressors (P ≤ 0.001). CONCLUSIONS Factors associated with suicidal ideations were significantly different between SSD and AD patients. Hence, suicide prevention strategies should be based on the specific risk factors for each group, SSD and AD.
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Affiliation(s)
- Hemendra Singh
- Department of Psychiatry, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - V Senthil Kumar Reddi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Rodriguez VJ, Cook RR, Peltzer K, Jones DL. Prevalence and psychosocial correlates of suicidal ideation among pregnant women living with HIV in Mpumalanga Province, South Africa. AIDS Care 2016; 29:593-597. [PMID: 27690544 DOI: 10.1080/09540121.2016.1238442] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pregnant women living with HIV (WLHIV) in South Africa (SA) report higher rates of suicidal ideation than those who are HIV uninfected, and antenatal suicidal ideation has been previously associated with adverse maternal and neonatal outcomes. Few studies have attempted to identify correlates and psychosocial predictors of suicidal ideation in this population. In this study, we sought to estimate the prevalence of and identify risk factors for suicidal ideation among pregnant WLHIV in rural SA (N = 673). Thirty-nine percent of women endorsed suicidal ideation (95% CI: 35.2% to 42.3%) and in multivariable logistic regression analysis, suicidal ideation was associated with intimate partner violence and stigma, which interacted to multiplicatively increase the odds of suicidal thoughts. Given the high rates of reported suicidal ideation identified in this sample, and the potential harm to mothers and neonates, suicide risk assessment and management protocols for pregnant WLHIV should be considered for inclusion in the standard of care in rural SA.
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Affiliation(s)
- Violeta J Rodriguez
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Ryan R Cook
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Karl Peltzer
- b HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.,c ASEAN Institute for Health Development , Mahidol University , Salaya , Thailand.,d Department of Psychology , University of Limpopo , Turfloop , South Africa
| | - Deborah L Jones
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
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Can Psychological, Social and Demographical Factors Predict Clinical Characteristics Symptomatology of Bipolar Affective Disorder and Schizophrenia? Psychiatr Q 2016; 87:501-13. [PMID: 26646576 PMCID: PMC4945684 DOI: 10.1007/s11126-015-9405-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Schizophrenia (SCH) is a complex, psychiatric disorder affecting 1 % of population. Its clinical phenotype is heterogeneous with delusions, hallucinations, depression, disorganized behaviour and negative symptoms. Bipolar affective disorder (BD) refers to periodic changes in mood and activity from depression to mania. It affects 0.5-1.5 % of population. Two types of disorder (type I and type II) are distinguished by severity of mania episodes. In our analysis, we aimed to check if clinical and demographical characteristics of the sample are predictors of symptom dimensions occurrence in BD and SCH cases. We included total sample of 443 bipolar and 439 schizophrenia patients. Diagnosis was based on DSM-IV criteria using Structured Clinical Interview for DSM-IV. We applied regression models to analyse associations between clinical and demographical traits from OPCRIT and symptom dimensions. We used previously computed dimensions of schizophrenia and bipolar affective disorder as quantitative traits for regression models. Male gender seemed protective factor for depression dimension in schizophrenia and bipolar disorder sample. Presence of definite psychosocial stressor prior disease seemed risk factor for depressive and suicidal domain in BD and SCH. OPCRIT items describing premorbid functioning seemed related with depression, positive and disorganised dimensions in schizophrenia and psychotic in BD. We proved clinical and demographical characteristics of the sample are predictors of symptom dimensions of schizophrenia and bipolar disorder. We also saw relation between clinical dimensions and course of disorder and impairment during disorder.
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Suicidal behaviour in first-episode non-affective psychosis: Specific risk periods and stage-related factors. Eur Neuropsychopharmacol 2015; 25:2278-88. [PMID: 26475577 DOI: 10.1016/j.euroneuro.2015.09.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 11/23/2022]
Abstract
Suicide is a major cause of premature death in psychosis. Earlier stages have been associated with higher risk. However, such risk periods have not been specifically determined and risk factors for suicidal behaviour may change over those periods, which may have crucial implications for suicide prevention. The aim of this study was to determine and characterize the highest risk period for suicide in a representative sample of first-episode psychosis (FEP) patients. Suicidal behaviour prior to first presentation of psychosis and during a 3-year follow-up was examined in a sample of 397 individuals. Risk factors for suicidal behaviour during specific time periods were investigated and compared. The greatest suicide risk was found during the month before and 2 months after first contact with psychiatric services (i.e., 'early' attempts). Severity of depressive symptoms and cannabis use emerged as predominant risk factors across time. 'Early' attempters were characterized as being male, living in urban areas, having poor premorbid adjustment, requiring hospitalization, scoring higher on anxiety measures and unusual thought content than non-attempters. Greater suspiciousness and more severe depressive symptoms distinguished the 'late' attempters. In conclusion, there is a specific high risk period for suicide in FEP around the time of the first presentation. Early intervention programmes targeting phase-specific risk factors, particularly psychotic symptoms management and secondary depression prevention strategies may be useful for suicide prevention in psychosis.
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Chang WC, Chen ESM, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prevalence and risk factors for suicidal behavior in young people presenting with first-episode psychosis in Hong Kong: a 3-year follow-up study. Soc Psychiatry Psychiatr Epidemiol 2015; 50:219-26. [PMID: 25116203 DOI: 10.1007/s00127-014-0946-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Individuals with first-episode psychosis (FEP) have markedly elevated risk for suicide. Previous research investigating risk factors of suicidal behavior in FEP mainly focused on western populations. This study aimed to examine the prevalence, and pretreatment and early illness predictors of suicidal behavior in Chinese FEP patients. METHOD Seven hundred participants aged 15-25 years consecutively enrolled in a territory-wide treatment program for FEP in Hong Kong from July 2001 to August 2003 were studied. Baseline and 3-year follow-up variables were collected via systematic medical file review. Suicidal behavior evaluated in this study comprised suicide attempt and completed suicide. RESULTS Seventy-four (10.6%) participants attempted suicide before treatment. Ten percent (n = 70) exhibited suicidal behavior and 1% (n = 7) committed suicide during 3-year follow-up. The majority of post-treatment suicidal behaviors (51.4%) occurred in the first year of follow-up. Jumping from a height was the most common method of committing suicide. Multivariate regression analysis indicated that previous suicide attempt, history of substance abuse and poorer baseline functioning were significantly associated with an increased risk for suicidal behavior after treatment initiation. CONCLUSION In a large representative cohort of Chinese young FEP patients, the rates of suicidal behavior before and after treatment and risk factors for post-treatment suicidal behavior were comparable to the findings of previous research on early psychosis conducted in western populations. Close monitoring of high-risk patients with history of attempted suicide or substance abuse, and enhancement of psychosocial functioning may help reduce suicide risk in the early stage of psychotic illness.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong,
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Pompili M, Lester D, Innamorati M, Tatarelli R, Girardi P. Assessment and treatment of suicide risk in schizophrenia. Expert Rev Neurother 2014; 8:51-74. [PMID: 18088201 DOI: 10.1586/14737175.8.1.51] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035, 00189 Roma, Italy.
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Bouhlel S, M'solly M, Benhawala S, Jones Y, El-Hechmi Z. [Factors related to suicide attempts in a Tunisian sample of patients with schizophrenia]. Encephale 2012; 39:6-12. [PMID: 23095582 DOI: 10.1016/j.encep.2012.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 03/06/2012] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The mortality rate in schizophrenia is 4.5 times higher than in the general population. Suicide is one of the main causes of premature death in this affection. Life time prevalence of this behavior ranges from 10 to 15%, which represents a risk 20 to 50 times higher than in the general population. In addition, 40 to 93% of patients who committed suicide had attempted suicide previously. Thus, assessment of correlated variables with suicide attempts is a fundamental issue for developing preventive and therapeutic strategies in suicidal behavior. To the best of our knowledge, no systematic study has yet investigated suicide attempts in an Arabic Muslim population with schizophrenia, although many authors have demonstrated cultural differences in socio-demographic and clinical variables related to suicide attempts within many geographic areas around the world. OBJECTIVES The objectives of this study were to assess the frequency and characteristics of lifetime suicide attempts in Tunisian schizophrenic outpatients and to determine the correlated socio-demographic, clinical and therapeutic variables. METHODS A total of 134 patients with a DSM-IV diagnosis of schizophrenia who attended the outpatient department of the university psychiatric hospital of Tunis were included. The main demographic and lifetime clinical variables considered were: gender, marital status, family history of psychiatric disorders and suicide attempts, age at time of recruitment, age at onset of illness, duration of untreated psychosis defined as the interval between the onset of the illness and the first antipsychotic treatment, the type and dose of current treatment, dose of antipsychotic drugs converted to chlorpromazine equivalents, extrapyramidal side effects assessed with the Simpson Angus rating scale, number of hospitalizations, comorbid substance abuse, cigarette smoking, severity of psychopathology measured with the Positive And Negative Syndrome Scale (PANSS), and history of at least one suicide attempt. A suicide attempt was defined as a self-destructive act carried out with at least some intent to end one's life. We also assessed the number, the used methods and the causes of suicide attempts. We subdivided the sample into two sub samples according to the presence or absence of suicidal attempts. We analyzed and compared the demographic, clinical and therapeutic variables. RESULTS Out of the 134 patients, 45 (32%) had attempted suicide at least once. Half of them (49%) had attempted suicide more than once. The number of suicide attempts varied from one to five with an average of 1.8. The most used methods were medication overdose (n=18, 23.4%), followed by organophosphate poisoning (n=11, 14.3%), defenestration (n=9, 11.7%) and hanging or using sharp objects (n=7, 9.1% for each of them). The main reported reasons of suicide attempts were depressive symptoms (n=46, 60%) including depressed mood and hopelessness, stressful life events (bereavement, divorce, separation) (n=35, 46%) and presence of delusions and/or auditory hallucinations (n=25, 32.5%). No differences were found between the two groups regarding the different socio-demographic variables. Significant differences were found with respect to a duration of untreated psychosis equal to or more than one year (P<0.001), smoking in men (P=0.03), positive symptoms score on the PANSS (P<0.001), scores of Simpson-Angus scale (P=0.029) and poor medication compliance (P=0.02). CONCLUSION Demographic variables as suggested by other studies are less valuable predictors of suicide attempts in patients with schizophrenia. Interventions for reducing such behavior should focus on clinical variables and integrate an early diagnosis of the disease, reduce positive psychotic symptoms and tobacco consumption, correct extrapyramidal signs and improve medication compliance.
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Mork E, Mehlum L, Barrett EA, Agartz I, Harkavy-Friedman JM, Lorentzen S, Melle I, Andreassen OA, Walby FA. Self-harm in patients with schizophrenia spectrum disorders. Arch Suicide Res 2012; 16:111-23. [PMID: 22551042 DOI: 10.1080/13811118.2012.667328] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study describes the prevalence, clinical characteristics, and gender profile of self-harm in a cross-sectional sample of 388 patients with schizophrenia spectrum disorders. All patients were interviewed and assessed with respect to lifetime self-harm and relevant clinical variables. An overall of 49% of the patients reported self-harm which was associated with female gender, having had a depressive episode, younger age at psychosis onset, alcohol abuse or dependence, current suicidality, awareness of illness, and low adherence to prescribed medication. Higher awareness of having a mental disorder was associated with self-harm in men only, while emotional dysregulation was associated with self-harm in women only. We conclude that while self-harm in patients with schizophrenia spectrum disorders is highly prevalent in both genders, risk factors in men and women differ in several important ways.
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Affiliation(s)
- Erlend Mork
- National Centre for SuicideResearch and Prevention, Institute ofClinical Medicine, University of Oslo, Oslo, Norway.
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Kim SW, Kim SJ, Mun JW, Bae KY, Kim JM, Kim SY, Yang SJ, Shin IS, Yoon JS. Psychosocial factors contributing to suicidal ideation in hospitalized schizophrenia patients in Korea. Psychiatry Investig 2010; 7:79-85. [PMID: 20577615 PMCID: PMC2890872 DOI: 10.4306/pi.2010.7.2.79] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/02/2010] [Accepted: 04/14/2010] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study aimed to comprehensively evaluate psychosocial risk factors associated with suicidality in patients with schizophrenia in Korea. METHODS The study sample consisted of 84 hospitalized patients with schizophrenia. Suicidal thoughts and a clear desire to be dead within 2 weeks were defined as a current suicidal ideation. Socio-demographic and clinical variables, including family history of completed suicides and psychiatric illnesses, were collected, and the Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Beck Depression Inventory (BDI), Simpson-Angus Scale (SAS), Scale to assess Unawareness of Mental Disorder (SUMD), and Alcohol Use Disorders Identification Test (AUDIT) were administered to identify factors associated with a current suicidal ideation. RESULTS Forty-three subjects (51.2%) reported clear suicidal ideation. Multivariate analysis revealed that later age of illness onset, previous suicide attempt, family history of completed suicide, depression, or substance abuse, fewer than one family visitation to the hospital per month, and score on the CDSS were independently related to current suicidal ideation in these subjects. Age, education level, and scores on the SUMD were not significantly associated with current suicidal ideation in the multivariate analysis, but were associated with suicidal ideation in a univariate analysis on the level of p<0.1. CONCLUSION The above clinical factors should be evaluated to predict and prevent suicidal risk in patients with schizophrenia. In particular, modifiable factors such as depression should be managed to reduce suicidality of hospitalized patients with schizophrenia.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Gwangju Buk-gu Mental Health Center, Gwangju, Korea
| | - Su-Jung Kim
- Department of Psychiatry, Naju National Hospital, Naju, Korea
- Rodem Clinic, Seoul, Korea
| | - Ji-Woong Mun
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
- Department of Psychiatry, Yeong Gwang Shin-ha Christian Hospital, Yeonggwang, Korea
| | - Kyung-Yeol Bae
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Seon-Young Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Su-Jin Yang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
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Is poor premorbid functioning a risk factor for suicide attempts in first-admission psychosis? Schizophr Res 2010; 116:210-6. [PMID: 19954930 PMCID: PMC2818578 DOI: 10.1016/j.schres.2009.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 11/10/2009] [Accepted: 11/12/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND While poor premorbid functioning is associated with poorer outcomes in psychotic illnesses, little is known about whether it is also a risk factor for suicide attempts. OBJECTIVE The current study examined the association of premorbid functioning and suicide attempts in a county-wide cohort of first-admission inpatients. METHOD Data were derived from participants of the Suffolk County Mental Health Project (n=444) over the course of 48-month follow-up. Premorbid functioning was estimated and categorized (good vs. poor/declining) using the Premorbid Adjustment Scale (PAS). RESULTS Poorer premorbid functioning was significantly associated with increased likelihood of a suicide attempt prior to first psychiatric hospital admission. Specifically, 33.0% of participants with poor/declining premorbid functioning had a history of suicide attempts compared to 23.5% with good premorbid functioning. Among participants with a prior attempt (n=126), poor premorbid functioning was significantly associated with an increased likelihood of additional attempts during the four years after first hospitalization. CONCLUSION Identifying those with poor premorbid functioning and prior histories of attempts could help clinicians target high-risk patients. Thus, greater attention to persons with both risk factors may form the basis for early interventions aimed towards reducing the risk for subsequent suicide attempts.
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Besnier N, Gavaudan G, Navez A, Adida M, Jollant F, Courtet P, Lançon C. Approche clinique du suicide au cours de la schizophrénie (I). Identification des facteurs de risque. Encephale 2009; 35:176-81. [DOI: 10.1016/j.encep.2008.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 02/25/2008] [Indexed: 11/28/2022]
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Kasckow J, Montross L, Golshan S, Mohamed S, Patterson T, Sollanzano E, Zisook S. Suicidality in middle aged and older patients with schizophrenia and depressive symptoms: relationship to functioning and Quality of Life. Int J Geriatr Psychiatry 2007; 22:1223-8. [PMID: 17506025 PMCID: PMC3118557 DOI: 10.1002/gps.1817] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Suicidality is a health concern in patients with schizophrenia. We examined the hypotheses: (1) Middle aged and older patients with schizophrenia, depressive symptoms and suicidality would exhibit worse quality of life and worse everyday functioning, social skills and medication management relative to those without suicidality; (2) higher levels of suicidality would be significantly associated with worse functioning, worse quality of life and older age. METHODS We examined 146 outpatients with schizophrenia and depression. Patients were at least 40 years old and were diagnosed with schizophrenia or schizoaffective disorder and had two or more depressive symptoms based on DSM-IV criteria for major depression. We assessed suicidality with the Intersept Suicide Scale (ISS) and functioning with the UCSD Performance-based Skills Assessment (UPSA), Social Skills Performance Assessment (SSPA), and Medication Management Ability Assessment (MMAA). Quality of life was assessed with the Heinrichs Quality of Life Scale (QLS). RESULTS The mean age of patients was 52.4+ 6.9 years. Subjects with suicidality (ISS scores > 0) had lower QLS scores compared to those without suicidality. However, there were no differences in UPSA, SSPA nor MMAA scores between the two groups. In addition, based on Spearman's rho correlational analysis, there were significant associations of QLS scores with ISS scores (r = - 0.236) and with MMAA "total errors" scores (r = 0.174). Logistic regression demonstrated that only QLS scores predicted suicidality. CONCLUSION Thirty-six percent of our sample had at least mild degrees of suicidality. Lower quality of life appears to be an important predictor of suicidality.
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Affiliation(s)
- J Kasckow
- VA Pittsburgh Health Care System, Pittsburgh, PA 15206, USA.
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Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, Montross LP, Bo Mortensen P, Munk-Jørgensen P, Nielsen J, Nordentoft M, Saarinen PI, Zisook S, Wilson ST, Tatarelli R. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry 2007; 6:10. [PMID: 17367524 PMCID: PMC1845151 DOI: 10.1186/1744-859x-6-10] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Accepted: 03/16/2007] [Indexed: 12/18/2022] Open
Abstract
Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5-13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the result of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophrenia patients.
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Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
- McLean Hospital – Harvard Medical School, USA
| | - Xavier F Amador
- Department of Psychiatry, Columbia University, New York, USA
| | - Paolo Girardi
- Department of Psychiatry, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
| | | | - Martin Harrow
- Department of Psychology, University of Illinois College of Medicine, Chicago, USA
| | - Kalman Kaplan
- Department of Psychology, University of Illinois College of Medicine, Chicago, USA
| | - Michael Krausz
- Psychiatric Clinic, University Hospital Eppendorf, Hamburg, Germany
| | | | - Herbert Y Meltzer
- Department of Psychiatry Vanderbilt University School of Medicine, USA
| | - Jiri Modestin
- Deptartment of Psychiatry (Burghölzli Hospital), University of Zurich, Switzerland
| | - Lori P Montross
- Department of Psychiatry, Division of Geriatric Psychiatry, University of California San Diego, USA
| | - Preben Bo Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Povl Munk-Jørgensen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Jimmi Nielsen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Merete Nordentoft
- Department of Psychiatry Copenhagen University, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Sidney Zisook
- Department of Psychiatry, Division of Geriatric Psychiatry, University of California San Diego, USA
| | - Scott T Wilson
- Department of Psychiatry, Columbia University, New York, USA
| | - Roberto Tatarelli
- Department of Psychiatry, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
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16
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Abstract
Huntington's disease is an autosomal-dominant, progressive neurodegenerative disorder with a distinct phenotype, including chorea and dystonia, incoordination, cognitive decline, and behavioural difficulties. Typically, onset of symptoms is in middle-age after affected individuals have had children, but the disorder can manifest at any time between infancy and senescence. The mutant protein in Huntington's disease--huntingtin--results from an expanded CAG repeat leading to a polyglutamine strand of variable length at the N-terminus. Evidence suggests that this tail confers a toxic gain of function. The precise pathophysiological mechanisms of Huntington's disease are poorly understood, but research in transgenic animal models of the disorder is providing insight into causative factors and potential treatments.
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Affiliation(s)
- Francis O Walker
- Department of Neurology, Wake Forest University, Medical Center Blvd, Winston Salem, NC 27157, USA.
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17
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McGirr A, Tousignant M, Routhier D, Pouliot L, Chawky N, Margolese HC, Turecki G. Risk factors for completed suicide in schizophrenia and other chronic psychotic disorders: a case-control study. Schizophr Res 2006; 84:132-43. [PMID: 16626940 DOI: 10.1016/j.schres.2006.02.025] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 02/20/2006] [Accepted: 02/28/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE 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. METHOD 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- A McGirr
- McGill Group for Suicide Studies, Douglas Hospital Research Centre, 6875 LaSalle blvd, Montreal QC, Canada H4H 1R3
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18
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Gavaudan G, Besnier N, Lançon C. Suicide et schizophrénie : évaluation du risque et prévention. ANNALES MEDICO-PSYCHOLOGIQUES 2006. [DOI: 10.1016/j.amp.2005.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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