A biopsychosocial evaluation of the risk for suicide in schizophrenia

Hettige, Nuwan C.; Bani‐Fatemi, Ali; Sakinofsky, Isaac; Luca, Vincenzo De

doi:10.1017/s1092852917000128

Cited by 36 publications

(10 citation statements)

References 74 publications

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“…Comorbid depression and a history of suicidal behavior are important contributors to suicide risk in patients with schizophrenia [33,53,56]. One study showed that depressive symptoms, suicidal ideation and plans and a history of suicide attempts are amongst the most important forecasters of suicidal behavior in the early phases of schizophrenia [57].…”

Section: Risk Factors Related To Comorbid Disordersmentioning

confidence: 99%

Suicide in Schizophrenia: An Educational Overview

2019

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Suicide is an important public health problem. The most frequent psychiatric illnesses associated with suicide or severe suicide attempt are mood and psychotic disorders. The purpose of this paper is to provide an educational overview of suicidal behavior in individuals with schizophrenia. A lifetime suicide rate in individuals with schizophrenia is approximately 10%. Suicide is the largest contributor to the decreased life expectancy in individuals with schizophrenia. Demographic and psychosocial factors that increase a risk of suicide in individuals with schizophrenia include younger age, being male, being unmarried, living alone, being unemployed, being intelligent, being well-educated, good premorbid adjustment or functioning, having high personal expectations and hopes, having an understanding that life’s expectations and hopes are not likely to be met, having had recent (i.e., within past 3 months) life events, having poor work functioning, and having access to lethal means, such as firearms. Throughout the first decade of their disorder, patients with schizophrenia are at substantially elevated suicide risk, although they continue to be at elevated suicide risk during their lives with times of worsening or improvement. Having awareness of symptoms, especially, awareness of delusions, anhedonia, asociality, and blunted affect, having a negative feeling about, or non-adherence with, treatment are associated with greater suicide risk in patients with schizophrenia. Comorbid depression and a history of suicidal behavior are important contributors to suicide risk in patients with schizophrenia. The only reliable protective factor for suicide in patients with schizophrenia is provision of and compliance with comprehensive treatment. Prevention of suicidal behavior in schizophrenia should include recognizing patients at risk, delivering the best possible therapy for psychotic symptoms, and managing comorbid depression and substance misuse.

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Section: Risk Factors Related To Comorbid Disordersmentioning

confidence: 99%

Suicide in Schizophrenia: An Educational Overview

2019

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“…In schizophrenic patients, the risk of suicide is higher (Hettige et al 2018 ; Kasckow et al 2011 ), suicide deaths being common (Tousignant et al 2011 ). Thus, suicide is an important cause of death among patients with schizophrenia (Gómez-Durán et al 2012 ; Togay and Lippmann 2019 ).…”

Section: Discussionmentioning

confidence: 99%

The role of psychological autopsy in investigating a case of atypical suicide in schizophrenia: a case report with a brief review of literature

Crișan

Băcilă

Morar

2022

Egypt J Forensic Sci

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Background Self-harm typically is without lethal intent. Death can occur rarely, with suicide taking on an atypical form that raises the suspicion of hetero-aggression. Our study aimed to identify the link between self-harm and suicide intent and also to outline the positive diagnosis of an atypical suicide case which has raised the suspicion of hetero-aggression. For this purpose, the psychological autopsy method should be used regularly in suicide investigation because it not only allows a positive diagnosis of suicide but can also provide a detailed picture of mental degradation and associated suicide risk factors. Case presentation The case of a 26-year-old man from a rural area, found dead in the basement, at home, naked, barricaded inside, is described. Methods The on-site investigation and a complete forensic autopsy were performed. In addition, we apply the psychological autopsy method which gathered enough information to outline the positive diagnosis of suicide. We also made a brief literature review on the suicide risk factors and the behavioral changes that occurred during the COVID-19 pandemic in schizophrenic patients. Results The forensic autopsy revealed that he presented a complex craniofacial trauma as the cause of death (with scalp lacerations, frontal fracture, subarachnoid hemorrhage, and frontal cerebral contusions) associated with torso trauma (with self-inflicted stabbed wounds) with bruises and abrasions on the limbs. The injuries that caused death were self-inflicted and ensued repeatedly hitting his head against blunt objects. Using the psychological autopsy method, we found out that he presented multiple psychiatric hospitalizations for schizophrenia for almost 10 years, recently with reduced compliance to treatment. We also documented two previous suicide attempts and a gradual deterioration of his mental health. Conclusions We highlighted the role of the psychological autopsy (in addition to the judicial investigation and the forensic autopsy) for the diagnosis of committed suicide, for making a rigorous differential diagnosis between accident, hetero-aggression, and suicide, and also in pin-pointing the suicide risk factors.

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“…Antipsychotics are useful in the treatment of schizophrenia but not in catatonia and it may also worsen the case by inducing neuroleptic malignant syndrome. Benzodiazepines are effective in the treatment of both malignant catatonia and neuroleptic malignant syndrome [8].…”

Section: Discussionmentioning

confidence: 99%

Catatonia and Schizophrenia: A Case Report

2017

IJP

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This case is of a 47 year old African American female diagnosed with catatonic schizophrenia and paranoid schizophrenia which has deteriorated over the past two weeks. The patient recently attacked her father, has been mute and has also been throwing herself onto the floor expressing disorganized thoughts, poorly taking care of self and insomnia. The patient was first admitted for psychiatric care at the age of 20 and has a past history of DVT of lower extremities, hypertension, obesity and anemia. No signs of intoxication or drug withdrawal were observed. Patient had been on Haldol decanoate 300 mg IM. After admission in ward patient was continued on Haldol decanoate, Depakote and Lorazepam. Patient responded well to treatment and a certain level of independence wasachieved

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A biopsychosocial evaluation of the risk for suicide in schizophrenia

Cited by 36 publications

References 74 publications

Suicide in Schizophrenia: An Educational Overview

Suicide in Schizophrenia: An Educational Overview

The role of psychological autopsy in investigating a case of atypical suicide in schizophrenia: a case report with a brief review of literature

Catatonia and Schizophrenia: A Case Report

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