Suicide attempts and related factors in schizophrenia patients

Association of empathy with clinical symptoms and cognitive function in chronic schizophrenia patients with and without suicide attempts

Cognitive impairment is recognized as a risk factor for suicide in schizophrenia (SZ) patients. Despite empathy being an important aspect of social cognition, the association between suicidal behavior and empathy has received little attention. We aimed to compare empathy and neurocognition in SZ patients with and without suicide attempts (SAs), and to explore the relationship between empathy, neurocognition, and clinical symptoms in SZ patients with and without SAs. Data on SAs and socio-demographic characteristics were collected from 628 chronic SZ patients. The patients' symptomatology was measured by the Positive and Negative Syndrome Scale (PANSS). Empathy and neurocognition were assessed with the Interpersonal Reactivity Index (IRI) and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), respectively. Patients with SAs performed better on all IRI domains (except for Perspective Taking) and total scores. Regression results showed that negative symptoms, positive symptoms, and duration of illness were independently associated with IRI total score in patients without SAs (adjusted R2 = 0.048). In patients without SAs, negative symptoms, general psychopathology, education, age, and sex were independently associated with RBANS total score (adjusted R2 = 0.265), while in patients with SAs, education, PANSS total score, and age at onset were independently associated with RBANS total score (adjusted R2 = 0.456). Our results show that SZ patients with SAs may have better empathic performance than patients without SAs. In chronic SZ patients, negative and positive symptoms may have different effects on cognition in the SAs and non-SAs groups.

Suicide Probability Among Patients With Schizophrenia and Bipolar Disorder

PURPOSE

To evaluate the possibility of suicide and related factors among individuals with schizophrenia and bipolar disorder (BD).

METHOD

Data were collected for 270 individuals registered in a community mental health center using the Suicide Probability Scale (SPS). Subsequently, t test and multiple linear regression analyses were conducted on independent samples.

RESULTS

There was no statistically significant difference found between mean SPS scores of participants with schizophrenia and BD. However, hostility subscale mean scores of participants with schizophrenia were higher than those of participants with BD, and the difference was statistically significant. Sex, family history of mental illness, need for help with medication, suicidal ideation in the past 10 days, and number of suicide attempts were important predictors of suicide probability.

CONCLUSION

Individuals with schizophrenia and BD and in remission should be evaluated periodically for the possibility of suicide. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 37-45.].

Associations between fearlessness about death and suicidal ideation in individuals with psychosis

BACKGROUND

Despite high rates of suicide among people with psychosis, relatively little is known about the mechanisms underlying the transition from suicidal ideation to behavior in this population. The Interpersonal Psychological Theory of Suicide (IPTS) proposes that fearlessness about death (FAD) may play a role in this relationship. The present study tested whether constructs of the IPTS [thwarted belongingness (TB), perceived burdensomeness (PB), and FAD] were associated with the severity of suicidal ideation in a sample of adults with histories of psychosis.

METHOD

261 adults with histories of psychosis completed measures of IPTS constructs, current severity of suicidal ideation, and history of suicidal attempts. We examined differences between those with past suicide attempts and those without and conducted regression analyses to evaluate the associations among TB, PB, FAD and severity of current suicidal ideation.

RESULTS

Contrary to expectations, a history of suicidal behavior was not uniquely associated with FAD. Regression analyses revealed TB × PB and FAD × PB interactions emerged as significant correlates of the severity of suicidal ideation, with the relationship between PB and suicidal ideation more pronounced at higher levels of FAD and TB. Interestingly, positive symptoms of psychosis were positively associated with PB.

IMPLICATIONS

This study provides support for broadening the investigation of FAD as a contributor to suicidal ideation in individuals with psychotic symptoms. Future research investigating the role of other contributors that may influence capability for suicide (e.g., impulsivity) may add additional understanding of suicide in this population.

Suicide attempts in schizophrenia - A large retrospective cohort study from a tertiary care psychiatry centre in India

The extent of variability in identified risk factors for suicide attempts (SA) in schizophrenia limits their generalization. This study aimed to identify the rates and associated correlates of SA in schizophrenia by reviewing a large cohort (n=500). Nearly one-fourth had a history of SA, which was independently associated with a family history of SA, more inpatient admissions, and better long-term treatment response. These findings highlight the complex interaction between biological factors influencing SA and illness determinants in schizophrenia. Furthermore, they reinforce the need for future research to unravel the association between suicide vulnerability and the pathophysiology of schizophrenia to attenuate morbidity and mortality associated with the same.

An ecological momentary cognitive assessment study of over-attribution of threat and suicide risk factors in people with serious mental illness

INTRODUCTION

People with serious mental illness (SMI; schizophrenia, schizoaffective disorder, bipolar disorder) are at increased risk of suicidal ideation (SI). Over-attribution of social threat, or attributing threatening emotions to neutral faces, may contribute to social isolation through increased social avoidance and decreased social approach motivation. These factors are related to suicide, as well as perceived burdensomeness (PB) and thwarted belongingness (TB). This study examined how over-attribution of threat relates to PB, TB, and social motivations.

METHOD

N = 273 participants with SMI were assessed for current SI and behavior, and were stratified into SI (N = 130) vs. non-SI (N = 143) groups. Participants completed smartphone surveys (via ecological momentary assessments [EMA]) 3×/day for 10 days. They also completed the Mobile Ecological Test of Emotion Recognition (METER) 1×/day. Linear mixed models and multi-level mediation tested the relationships between over-attribution of threat, METER performance, PB/TB, and social motivations.

RESULTS

Participants with and without SI did not significantly differ in over-attribution of threat or METER performance. In separate models, there was a relationship of over-attribution of threat with increased PB (B = 1.00, SE = 0.21, t = 4.72, p < .001), reduced social approach motivation (B = -0.74, SE = 0.22, t = -3.33, p < .001), and increased social avoidance (B = 0.90, SE = 0.24, t = 3.70, p < .001), all significant when adjusting for facial affect recognition ability. A model examining social motivations as a mediator between over-attribution of threat and PB/TB was not significant.

CONCLUSION

These results suggest that over-attribution of threat relates to interpersonal constructs related to SI irrespective of facial affect abilities. This study may inform understanding of social cognitive processes related to suicide in SMI.

Suicide Safety Plan Self-knowledge in Serious Mental Illness: Psychiatric Symptom Correlates and Effects of Brief Intervention

Psychiatric symptoms experienced by people with serious mental illness (SMI; schizophrenia, bipolar and other psychotic disorders) may impact suicide safety planning. This study examined safety plan self-knowledge, or an individual's own knowledge and awareness of their safety plan, in a sample of people with SMI. Participants (N = 53) with SMI at elevated risk of suicide completed a 4-session intervention that included safety plans, with one intervention group that included mobile augmentation. Self-knowledge was assessed from previous safety plans at 4-, 12- and 24-weeks. Fewer warning signs generated was correlated with greater psychiatric symptoms (r = - .306, p = .026) and suicidal ideation (r = - .298, p = .030). Fewer coping strategies generated was correlated with greater suicidal ideation (r = .- 323, p = .018). Preliminarily, there was greater self-knowledge of warning signs over time among participants in the mobile intervention. These preliminary findings highlight the relationship of safety plan self-knowledge to symptoms and suggest that mobile augmentation of safety planning may be beneficial. Trial Registration: NCT03198364.

Acceptability of a novel suicide prevention psychological therapy for people who experience non-affective psychosis

OBJECTIVES

Suicide is a leading cause of death worldwide. People experiencing psychosis are at increased risk of death by suicide. Talking therapies can alleviate suicidal thoughts, plans, and attempts. Therapies need to also be acceptable to recipients. The aim of this study was to investigate the views on psychological therapy for people experiencing psychosis and suicidality using the Theoretical Framework of Acceptability.

DESIGN

Qualitative interview study.

METHODS

Participants were recruited from a randomised controlled trial comparing suicide prevention psychological therapy with treatment as usual. Individuals had a diagnosis of non-affective psychosis and experience of suicidal thoughts, plans and/or attempts. To assess the acceptability of the therapy, semi-structured interviews were conducted with 20 participants randomised to receive therapy. Data were deductively analysed using an adaptation of the Theoretical Framework of Acceptability.

RESULTS

Interviews (Mean = 45 min) were conducted and audio recorded with 21 participants. Data were organised into six themes: 1. Affective attitude, 2. Burden, 3. Alliance, 4. Intervention coherence, 5. Perceived effectiveness, and 6. Self-efficacy. There was no evidence of issues relating to domains of ethicality and opportunity costs associated with receiving therapy.

CONCLUSIONS

Talking about suicide was difficult and, at times, distressing, but it was perceived to be useful for understanding experiences. To be acceptable, it is important for therapists to ensure that clients' understanding of therapy aligns with expectations of effectiveness and to invest in building strong therapeutic alliances. Future research will benefit from examining therapists' experiences of delivering therapy through different modes (e.g. online, telephone).

A cognitive-behavioral suicide prevention treatment for adults with schizophrenia spectrum disorders in community mental health: Preliminary findings of an open pilot study

Suicide is a leading cause of death among schizophrenia spectrum disorder populations. This open pilot study examined a modified cognitive-behavioral suicide prevention treatment for clients in community mental health. Providers (n=5) were trained to deliver the treatment and clients (n=5) received it in 10 individual therapy sessions. Clients experienced improvements in suicide ideation, depression, hopelessness, general symptoms of psychosis, entrapment, defeat, approaches to coping, psychological stress, impulsivity, and the number of treatment barriers from baseline to post-treatment. Qualitative findings reinforced quantitative results of client improvements and provided important suggestions to strengthen the intervention and its delivery in community mental health.

Depression, suicide intent, and plan among adults presenting in an emergency department after making a suicide attempt: Exploratory differences by psychosis symptom experience

Rates of suicide are significantly higher for individuals with schizophrenia spectrum disorders (SSDs) than those in the general population. With limited understandings of factors contributing to engaging in a suicide attempt among the psychosis population in the literature, the current study sought to preliminarily explore depression, suicide intent, and suicide plan among adults with and without psychosis symptom experiences who presented to an emergency department (ED) after making a suicide attempt. Electronic health record data were collected from the ED of an academic healthcare system in the Midwestern United States between 2011 and 2022. Patients included 1178 adults who arrived after making a suicide attempt. Trained research assistants conducted chart reviews and data were explored in SPSS28. A significantly smaller proportion of patients with psychosis had depressive symptoms and endorsed having suicide intent prior to their attempt in comparison to patients without psychosis. A smaller trending (p < .10) proportion of patients with psychosis endorsed having a suicide plan prior to their attempt than those with psychosis. Exploratory findings highlight the importance of EDs assessing for suicide risk beyond traditional approaches among patients with psychosis symptom experiences, including considerations for the potential of individuals not experiencing depression, suicide intent, or a suicide plan. Future research is particularly needed to examine psychosis symptomatology and the experience of distress as potential contributing factors to suicide behavior and death among patients with psychosis symptoms to better inform suicide risk assessment and intervention efforts.

Girl's and women's experiences of seeking mental health support for symptoms associated with psychosis. A narrative review

BACKGROUND

Women are more likely than men to experience symptoms associated with psychosis, such as voice hearing, and more likely to seek mental health support. However, little is known about the emotional experiences of girls and young women who seek help for symptoms of psychosis to inform gender sensitive services and access routes. The current review offers the first focused insights into barriers and facilitators relating to help seeking for girls and women experiencing symptoms of psychosis.

METHODS

OneSearch, PubMed, and PsychINFO databases were searched for suitable papers in relation to the research question between November 2021 and February 2022; 139 papers were found, of which eight met the inclusion criteria for review.

RESULTS

Across the eight papers reviewed, participants were aged 15- to 71-years-old. From the participant numbers available, data from a total of 54,907 participants from a range of demographic groups were included in the review. Results and findings sections from the eight papers were reviewed for themes, and four overarching themes emerged: (1) The emotional cost of seeking help, (2) voice hearing for girls and women, (3) side effects of treatment, and (4) facilitators to accessing support.

DISCUSSION

Engagement in talking therapies can be difficult when services minimize the experience of psychosis-related symptoms. Women may be more likely to have their symptom-related distress diagnosed as a mood disorder, rather than symptoms of psychosis being identified, preventing timely tailored intervention. Normalization, psychoeducation, social support, and validation were recommended as helpful interventions.

Mental health provider perspectives of the COVID-19 pandemic impact on service delivery: a focus on challenges in remote engagement, suicide risk assessment, and treatment of psychosis

Background

The COVID-19 pandemic has been impacting the need, utilization, and delivery of mental health services with greater challenges being faced by clients and providers. With many clients facing reduced access to services and social isolation, a focus on suicide risk assessment and prevention is critical. Concern is particularly increased for clients with schizophrenia spectrum disorders given data show suicide rates are disproportionately high for those with psychosis in comparison to the general population. Provider perspectives of challenges in service delivery are needed to inform efforts to improve access, feasibility, and quality of mental health care throughout the evolving pandemic. This study explored mental health provider perspectives of client challenges in service utilization and provider challenges in service delivery, including remote engagement, suicide risk assessment, and treatment of psychosis.

Methods

Data were collected from social work mental health providers (n = 12) in United States community mental health setting. Providers consented to participate and responded to questions about service delivery experiences in late 2020 and in relation to COVID-19. Demographic and practice-related provider data were explored descriptively using SPSS and qualitative data using open coding and grounded theory methods in Dedoose.

Results

Among the 9 providers who engaged in remote service delivery, 7 (77.8%) experienced challenges in remote engagement with clients and 8 (88.9%) experienced challenges in treatment of psychosis. Among the 7 providers who engaged in remote suicide assessment, 4(57%) experienced challenges. Qualitative themes emerged including logistic (e.g., technology access and use), engagement (e.g., virtual rapport-building and limited remote services), and clinical (e.g., difficulty assessing suicide risk, internal stimuli, abnormal involuntary movement, and affect) challenges in service delivery.

Conclusions

Provider perspectives are essential to inform efforts to build resources and problem-solve challenges and barriers that both providers and clients face throughout various shifts in mental health service delivery. Findings emphasize the need to troubleshoot client access to technology, bolster support for providers to prevent burnout, and greater provider training to improve skills in remote engagement, assessment, and treatment, particularly in relation to psychosis and suicide prevention. Study implications are not only critical for the evolving COVID-19 pandemic, but also in preparation for ongoing shifts in service delivery as technology evolves.

Suicidal Thinking and Behavior in First Episode Schizophrenia: Findings from the 24-Month Follow-Up of the "Parma Early Psychosis" Program

Although suicide risk is relevant in First Episode Schizophrenia (FES), little data are reported on suicidal ideation and its longitudinal stability. Aim of this study was: (1) to evaluate incidence rates of suicide attempts, completed suicide and suicidal thinking in FES patients at baseline and along a 24-month follow-up period, (2) to investigate any relevant association of baseline suicidal ideation with psychopathology, and (3) to longitudinally monitor suicidal thinking during the 2-years of follow-up. Participants (n = 149; age = 12-35 years) were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale. FES participants showed a 40.8% percentage of baseline suicidal ideation (i.e., BPRS item 4 cutoff score of ≥3) and a 2-year cumulative incidence rate of attempted suicide of 6.1%. One completed suicide (0.7%) was also found during the follow-up. Baseline suicidal ideation was positively correlated with depression and negatively correlated with younger age. These results support a routine monitoring of suicide risk in this young population at the point of entry into early intervention services.

Suicidality in patients with primary diagnosis of panic disorder: A single-rate meta-analysis and systematic review

BACKGROUND

This study investigated the lifetime suicide attempt and ideation rates among patients with panic disorder (PD).

METHODS

Online databases regarding lifetime suicide attempt and ideation rates in patients with PD were searched up to May 2021.

RESULTS

The suicide attempt and ideation rates were 0.17 (95% CI: 0.16, 0.18) and 0.23 (95% CI: 0.22, 0.25). The suicide attempt rates among female and male patients were 0.17 (95% CI: 0.14, 0.20) and 0.15 (95% CI: 0.12, 0.19). When PD was comorbid with anxiety, depression, substance abuse, and personality disorders, the suicide attempt rates increased to 0.23 (95% CI: 0.20, 0.26), 0.23 (95% CI: 0.18, 0.27), 0.25 (95% CI: 0.20, 0.31), and 0.25 (95% CI: 0.23, 0.28), respectively.

LIMITATIONS

The suicide attempt and ideation by age, suicide ideation by sex, and suicide ideation by comorbidity with other mental disorders were passed in our meta-analysis as sample size was small. Stratification analysis on ethnicity, marital status, education levels, resident location, and severity of PD should be considered in the future.

CONCLUSION

The lifetime suicide ideation and attempt rates in patients with PD were higher than general populations but lower than patients with bipolar or depression. The lifetime suicide attempt rate in female patients was slightly higher than male patients. When PD was comorbid with one other mental illness, the lifetime suicide attempt rate increased by about 50%.

Clinical insight and cognitive functioning as mediators in the relationships between symptoms of psychosis, depression, and suicide ideation in first-episode psychosis

First-episode psychosis (FEP) is a particularly high-risk period for suicide. Literature suggests poor cognitive functioning may serve as a protective factor, while investigations of clinical insight reveal a complex relationship with suicide outcomes. This study examined the mediating role of cognition and clinical insight in the relationships between positive and negative symptoms, depression, and subsequent suicide ideation among individuals in FEP. Data were obtained from the Recovery After an Initial Schizophrenia Episode project. Participants (n = 404) included adolescents and adults in FEP between the ages of 15 and 40. Measurement utilized the Calgary Depression Rating Scale, Positive and Negative Syndrome Scale, and Brief Assessment of Cognition in Schizophrenia. Structural equation modeling was used to examine the mediation model. The likelihood of experiencing suicide ideation was significantly decreased when working memory was stronger (b = -0.034, SE = 0.02, OR = 0.967, p < .05), and significantly increased when clinical insight was stronger (b = 0.191, SE = 0.08, OR = 1.21, p < .01), positive symptoms were greater (b = 0.422, SE = 0.20, OR = 1.52, p < .05) and depressive symptoms were greater (b = 0.545, SE = 0.15, OR = 1.70, p < .001). Clinical insight and working memory functioned as mediators in the relationships between depression, positive symptoms, negative symptoms, and suicide ideation. Findings suggest it is essential that clinicians have awareness of insight being a risk factor for suicide ideation and balance therapeutic efforts to strengthen clinical insight and cognition in psychosocial treatments with suicide risk assessment and prevention methods.

Predictors of High-Intensity Psychiatric Service Utilization by Veterans Health Administration Patients With Early Psychosis

OBJECTIVE

People with early episode psychosis (EEP) have more negative care outcomes than do people with later episode psychosis (LEP), including higher levels of high-intensity psychiatric service use. It is unclear whether these differences are best explained by clinical differences between these two groups or whether people with EEP have specific treatment needs. An assessment of the treatment needs of patients with EEP can help inform the implementation of national treatment programming designed to provide better care to this group.

METHODS

Administrative data were used to compare characteristics of Veterans Health Administration patients who had EEP (i.e., a psychotic diagnosis, diagnosis history of ≤4 years, and age ≤30 years; N=4,595) with those with LEP (i.e., a psychotic diagnosis, longer diagnosis history, and older age; N=108,713) who received care during a 1-year evaluation period. The authors generated logistic regressions to assess the potential impact of EEP status on the likelihood of receipt of emergency department (ED) and inpatient psychiatric admissions while controlling for other patient characteristics.

RESULTS

Patients with EEP had elevated psychiatric comorbidity and mental health severity yet received equivalent outpatient mental health services. Patients with EEP were more likely to have had an ED visit for the treatment of a mental health condition and inpatient psychiatric admissions; this pattern persisted in analyses that controlled for group differences.

CONCLUSIONS

Patients with EEP have unique mental health treatment needs. The development and implementation of EEP-specific treatments could help address these needs and reduce the number of patients using higher levels of psychiatric services within large health care systems.

Childhood maltreatment increases the suicidal risk in Chinese schizophrenia patients

OBJECTIVES

Childhood trauma might be a modifiable risk factor among adults with serious mental illness. However, the correlation of child trauma and suicide is unclear, which were cited most frequently as the biggest challenge to schizophrenia (SCZ) patients in China. We aim to study relationships between child trauma and suicide in SCZ patients of different disease stages.

METHODS

Ninety-one participants were included and divided into two groups, namely, first-episode group (n = 46), relapsed group (n = 45). The Positive and Negative Syndrome Scale was used to evaluate the severity of psychotic symptoms. The Beck's Suicide Intent Scale and The Nurses' Global Assessment of Suicide Risk were conducted by patient self-report to assess suicide symptom. The childhood trauma questionnaire was used to estimate severity of traumatic stress experienced during childhood.

RESULTS

Childhood trauma and different dimensions of suicide were significantly higher in the relapsed group than first-episode group (P < 0.01, respectively). BMI has a significant positive relationship with recent psychosocial stress (β = 0.473, t = 3.521, P < 0.001) in first-episode group. As in relapsed group, BMI has a positive effect between severe mental illness and suicide ideation (β = 0.672, t = 5.949, P < 0.001; β = 0.909, t = 2.463, P < 0.001), Furthermore, emotional neglect presented positively related to the suicide risk and proneness to suicidal behavior (β = 0.618, t = 5.518, P < 0.001; β = 0.809, t = 5.356, P < 0.001).

CONCLUSION

Relapsed group of patients had significantly more severe childhood trauma, recent psychosocial stress, suicidal risk and proneness to suicidal behavior. BMI and emotional neglect are unique predictors for different dimensions of suicide.

Mortality and non-use of antipsychotic drugs after acute admission in schizophrenia: A prospective total-cohort study

BACKGROUND

In society at large, it is debated whether use of antipsychotic drugs is associated with increased or decreased mortality among patients with schizophrenia. Large register studies have demonstrated an increased mortality risk associated with non-use of antipsychotic drugs, but prospective studies are missing.

AIMS

To investigate the association between mortality and non-use of antipsychotics in patients with schizophrenia.

METHOD

An open cohort study included and followed all patients with a discharge-diagnosis of schizophrenia consecutively admitted to a psychiatric acute unit at Haukeland University Hospital, Bergen, Norway during a 10 year period (n = 696). Cox multiple regression analyses were conducted with use of antipsychotic drugs as a time dependent variable, and periods of use and non-use were compared within individual patients. Adjustments were made for gender, age at index admission, number of acute psychiatric hospital admissions, excessive use of alcohol and illicit substances and use of benzodiazepines and antidepressants.

RESULTS

A total of 68 (9.8%) deaths were registered during follow-up. Of these, 40 (59%) had natural causes, whereas 26 (38%) had unnatural causes. Non-use of antipsychotics was associated with 2.15 (p = .01, CI: 1.24-3.72) times higher mortality risk compared to use of antipsychotics. The difference in mortality risk between use and non-use of antipsychotic drugs was age dependent, with the largest risk difference in young patients.

CONCLUSIONS

Non-use of antipsychotic drugs was associated with twofold increased mortality risk in patients with schizophrenia.

Ecological momentary assessment of interpersonal theory of suicide constructs in people experiencing psychotic symptoms

BACKGROUND

People with psychotic disorders are at an increased risk of suicide, but there is little understanding of suicidal ideation (SI) in this population. The Interpersonal Psychological Theory of Suicide posits that perceived burdensomeness (PB) and thwarted belonginess (TB) contribute to SI. To our knowledge there are no studies using ecological momentary assessment (EMA) to assess these interpersonal risk factors in a sample of individuals with psychotic disorders. This study investigated the validity and variability of PB and TB, and whether SI, EMA-measured psychotic symptoms, mood, and social context relate to PB and TB.

METHOD

Ninety-six participants with a psychotic disorder, including mood disorders with psychosis completed in-lab assessments of current SI, and then EMA surveys on a smartphone 3×/day for 10 days, answering questions about burdensomeness, belongingness, symptoms (i.e., hearing voices, experiencing suspiciousness), mood (i.e., happy, sad), and social context.

RESULTS

Burdensomeness varied within-participants less than belongingness (t (95) = -3.74, p=< .001). Participants with SI had higher mean burdensomeness ratings (t (94) = -2.70, p < .01) and lower mean belongingness ratings (t (94) = 3.68, p < .001) than did participants without SI. Being with others, greater psychotic experiences, less happiness, and greater sadness related to greater burdensomeness. SI status, being alone, greater psychotic experiences, less happiness, and greater sadness related to less belongingness.

CONCLUSIONS

This study examined the real-time influences of SI and psychotic symptoms on burdensomeness and belongingness. Hearing voices, suspiciousness, mood, and SI are related to interpersonal suicide-related risk factors. In this sample, social context had a differential effect on burdensomeness and belongingness.

Suicidal Behavior and Medication Adherence in Schizophrenic Patients

Suicide is one of the potential complications in the Schizophrenic patient population. This review article deals with the significance of antipsychotic medication compliance in decreasing suicidal behavior and hospitalizations in Schizophrenic patients. The medication adherence with second-generation antipsychotics (SGA) like clozapine and long-acting injectables (LAIs) like paliperidone is associated with decrease suicidal behavior and all-cause mortality in Schizophrenic patients. Concomitant treatment of depression and substance abuse disorder in this patient population is also associated with decreasing all-cause mortality and hospitalizations. On the other hand, long-term benzodiazepine use is associated with increase mortality in Schizophrenic patients. We also discuss some important physician intervention strategies to improve medication adherence in Schizophrenic patients like motivational interviewing (MI), behavioral tailoring (BT), and psychosocial interventions like cognitive behavior therapy (CBT).

Evaluation of long-acting injectable antipsychotics with the corresponding oral formulation in a cohort of patients with schizophrenia: a real-world study in Spain

To date, only a few studies compared some long-acting injectables (LAIs) antipsychotics showing similar symptom improvement, relapse rates and adherence to treatment. We evaluated the use of LAIs antipsychotics [aripiprazole-1-month (A1M); paliperidone-1-month and 3-month (PP1M and PP3M) and biweekly (2w)-LAIs] and their corresponding oral formulations through (1) the number of hospital re-admissions, (2) the number of documented suicidal behaviour/attempts and (3) the use of concomitant benzodiazepines, oral antipsychotics and biperiden. A total of 277 patients, ≥18 years old, were included if were treated with the corresponding oral or LAI antipsychotic during at least 12 months and were previously diagnosed with schizophrenia. Our results showed that LAIs associated significantly lower suicidal behaviour, reduced the number of hospital admissions, lower diazepam and haloperidol equivalents and mean daily dose of biperiden intake versus oral antipsychotics. Furthermore, significant differences were found between LAIs. Specifically, PP3M was associated to lower hospital admissions versus A1M; PP1M and PP3M lower doses of diazepam equivalents versus 2w-LAIs and finally, PP1M lower antipsychotic intake versus 2w-LAIs. In conclusion, LAIs improved clinical outcomes by reducing the need for concomitant treatments and hospital admissions over oral antipsychotics. PP1M and PP3M showed better outcomes versus A1M and biweekly LAIs.

Suicide and Schizophrenia: an Interplay of Factors

PURPOSE OF REVIEW

The main purpose of this review is to elucidate the interplay of various factors in the relationship between suicide and schizophrenia. Suicide and schizophrenia have been interlinked as a symptom, factor in recovery and prognosis, outcome measure and response to psychotic symptoms in patients with schizophrenia. Many biomarkers have been identified in relation to the two phenomena.

RECENT FINDINGS

The analysis of the papers of the last 5 years (2015-2019) and till date has revealed studies looking at outcomes in relation to suicide, biological markers to determine the protection from and occurrence of suicide in schizophrenia and demographic factors that play a role in the occurrence of suicide in patients with schizophrenia. Suicide is a common occurrence in patients with schizophrenia and must be studied further in diverse populations of the disorder to help determine exact relationships between these two variables that will aid in clinical recovery, better outcome and improve prognosis.