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 results 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 schizophenia patients.

This study investigated lifetime prevalence of criminal behavior in a population of male schizophrenia patients. A total of 282 schizophrenia patients was divided into three subgroups (representing schizophreniform disorder, acute schizophrenia, and chronic schizophrenia). The same number of control subjects was drawn from the general population and matched with the patients for sex, age, marital status, occupational level, and community size. The full account of conviction records in the criminal register was used as a measure of criminal behavior. Patients were 5 times more likely to have been convicted of violent crimes, 2 1/2 times more likely to have been convicted of crimes against property, and almost 3 times more likely to have violated drug laws. Criminality rates in schizophrenia depended, however, not only on the type of offense but also on the type or stage of the illness, which contributed to criminal behavior to some extent independently of sociodemographic factors.

A retrospective analysis of the clinical records of 53 schizophrenic in-patients who committed suicide, and the same number of matched control subjects, was carried out using a larger set of demographic, psychosocial and clinical variables. Univariate analysis of the data indicated an early disturbed psychosocial adjustment, more severe mental illness, unsatisfactory social situation, and more frequent suicidal behaviour in the suicide group. Suicide in schizophrenic in-patients thus appears to be closely connected with a particularly incapacitating form of the illness and its deleterious psychosocial consequences.

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The German version of the 20-item Toronto Alexithymia Scale (TAS-20) was studied in 277 medical students. The factor analysis yielded a two-factor solution, quite in agreement with the results of a recent analysis of the French version of the same scale. The first factor corresponds to the difficulties to identify and to describe feelings, where as the second factor corresponds to the externally oriented thinking. TAS-20 proved to be a reliable scale to measure alexithymia; the usage of the total scale score is recommended.