Suicidal Ideation in Patients with Schizophrenia

Article excerpt

Abstract: Objective: To evaluate the factors affecting suicidal ideas in patients with schizophrenia in terms of some socio-demographic and clinical properties. Method: The sample of the study consisted of 120 patients with schizophrenia selected from among patients receiving treatment at Trabzon Atakoy Psychiatry Hospital. All patients were evaluated using a Socio-demographic Data Collection Form, Reasons for Living Inventory (RLI), Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndromes Scale (PANSS), and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Results: Of the patients, 31.6% had suicide ideation. Negative symptoms are found to be significantly higher. The group with suicidal ideation had fewer reasons for living than the group without. Conclusion: Evaluations of the history of suicide attempts, depression and hopelessness in patients with schizophrenia are thought to be important in the prevention of suicidal behavior in these patients.

Introduction

The high incidence of suicidal behavior in schizophrenia is well documented. Suicide is the chief cause of premature death among individuals with schizophrenia. The Ufetime rate of completed suicide is estimated to be around 10% (1). Estimates of non-fatal suicide attempts range from 18% to 55% (2, 3). Further, 40% to 54% of individuals with schizophrenia either make an attempt or think about ending their Uves (4, 5). There is substantial evidence demonstrating a relationship between these different suicidal expressions. Completed suicide in psychosis has been linked to past suicide attempts, and to past and recent suicidal ideation (6-10). Suicidal ideation is also associated with increased risk of suicide attempts. While the absence of suicidal ideation should not be assumed to indicate the absence of risk, the presence of suicidal ideation is a potential early warning for more severe suicidal behavior. As reflected in existing suicide prevention strategy, it is an important phenomenon to identify in vulnerable individuals, and a potential target for intervention (11,12). Gaining a clear understanding of the causes of suicidal ideation in individuals with psychosis is an important step towards this therapeutic goal. One limitation to studying and understanding suicidal ideation is that it is only possible to assess stated ideation; individuals may not disclose their actual thoughts about suicide (13-17). Depression, hopelessness, and few reasons for Uving have been reliably identified as risk factors (18-24); however, there is a need for consideration of other affectrelated processes, such as self-esteem and schematic (core evaluative) beliefs. These have been identified as etiological and maintaining factors in studies of depression, and may play a similar role in depressed mood and suicidal thinking in schizophrenia. Suicidality might equally be driven by the positive symptoms of schizophrenia (2528). There are several reasons to expect haUucinations and delusions to be specific risk factors (29), including a tendency for irrational thinking and behavior when positive symptoms are pronounced, and intentional acts of suicide taken for psychotic reasons (e.g., to escape delusional persecution). Findings concerning the suicide risk associated with haUucinations and delusions have, however, been varied (30-34). This may in part be explained by evidence that individual positive symptom types relate differently to suicidal behavior, for example, paranoid delusions have been shown to be associated with an increased risk of suicide (35) but somatic delusions with a decreased risk (1). Further, the experience of psychotic symptoms can be seen as multidimensional, for instance, delusional experience differs in levels of beUef conviction, preoccupation, and distress. It may be that aspects such as delusional distress relate more closely to suicidal ideation; however, existing studies have not looked at suicidal ideation in relation to the multidimensional nature of psychosis. …