The International Handbook of Suicide Prevention: Research, Policy and Practice

By Rory C. O’Connor; Jane Pirkis | Go to book overview

5
Schizophrenia, Other Psychotic
Disorders, and Suicidal Behavior

Antoine Desîlets, Myriam Labossière,
Alexander McGirr, and Gustavo Turecki


Introduction

Schizophrenia is a severe disorder characterized by disturbances in perception, thought, language, social function, and volition. With the absence of pathognomonic features (i.e., features distinctively and characteristically associated with the disorder), a diagnosis of schizophrenia is considered after ruling out relevant medical conditions, as well as substance abuse or medication-induced symptoms (APA, 1994).

The signs and symptoms of schizophrenia are categorized as “positive” and “negative.” The distinction between positive and negative relates to what is normally observed in the general population. In other words, positive symptoms reflect aberrant thought processes in which behavioral and thought disturbances represent the appearance of active symptoms, and are classically thought of as delusions, hallucinations, and disorganized or unusual thinking. Conversely, negative symptoms reflect a deterioration of normal behavior that include phenomena such as anhedonia (the loss of pleasure), flat affect, decreased emotional expression, concentration difficulties, and a progressive withdrawal from social activities. There is some evidence to suggest that positive symptoms decrease in intensity with age, perhaps in association with the normal decrease in brain dopamine levels over the life course (APA, 2013). Yet, negative symptoms are more stable and are associated with poor response to pharmacological therapy as well as poorer long-term functional outcomes (Kirkpatrick & Tek, 2005).

In this chapter, we discuss recent progress in clinical research examining suicidal behavior in populations affected by chronic psychotic disorders, such as schizophrenia, and highlight the evidence that has influenced or could eventually influence suicide prevention in individuals with psychotic disorders, as well as key questions/challenges for the future. Clear definitions and a specific classification system are critical to studying the etiology of suicide. Standardized criteria, however, have been an obstacle despite the clear consensus on their importance. In this chapter, we use the term suicidality to refer to a spectrum of self-harming behaviors, cognitions, and aggregate variables of related concepts. We use the terms suicide or completed suicide in suicide studies, defining a phenotype characterized by (1) death as the result of some form of injury

The International Handbook of Suicide Prevention, Second Edition. Edited by Rory C. O’Connor and Jane Pirkis. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.

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