Suicide Prevention and Schizophrenia

Bilge Togay, MD; Steven Lippmann, MD

Prim Care Companion CNS Disord 2019;21(5):19l02433

Article Abstract

To the Editor: Suicide is a leading cause of death among people with schizophrenia. The risk is 12 times higher in those with schizophrenia compared with the general populatÄ±on.1 Between 40% and 50% of patients with schizophrenia experience thoughts about ending their lives.2 Their lifetime risk of death by suicide is approximately 5%.3

Prompt identification of patients at risk may prevent suicide attempts. Increased probability includes male sex, higher education level, having never married, inadequate social support, poor adherence to treatment, substance abuse, and previous suicide attempts.2 Actual prediction of attempts, however, remains inexact.

Prediction. Most suicides by people with schizophrenia occur within 1 decade of diagnoses.4 Following pharmacotherapy or hospitalization, some patients gain more self-awareness and can develop a postpsychotic depression with hopelessness; yet, the affective component of illness may not be easily recognized.5 Suicide attempts often occur with little verbal warning. Substance abuse increases impulsivity and escalates the chances for a negative outcome. Diminished social support and isolation add to this danger.

Prevention. When treating patients with schizophrenia, clinicians should always assess suicide risk factors. Suicide prevention requires sensitivity, active listening, and close clinical follow-up. Adequate therapy for coexisting depression or substance abuse is important. Antipsychotic drugs that may reduce suicide risk, such as clozapine or lithium, should be selected for high-risk patients.6 Psychosocial interventions and psychotherapy are helpful to address personal issues, diminish stress, and provide new coping skills.

Conclusion. Suicide is a public health problem. It is especially difficult to predict suicide in people with schizophrenia. Thus, a thorough evaluation, intense treatment, and close follow-up individualized to each patient are needed to diminish risk and improve prognosis.

References

1.Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007;64(10):1123-1131. PubMed CrossRef

2.Mauri MC, Paletta S, Maffini M, et al. Suicide attempts in schizophrenic patients: clinical variables. Asian J Psychiatr. 2013;6(5):421-427. PubMed CrossRef

3.Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol. 2010;24(suppl 4):81-90. PubMed CrossRef

4.Raymont V. Suicide in schizophrenia: how can research influence training and clinical practice? Psychol Bull. 2001;25:46-50.

5.Pompili M, Mancinelli I, Tatarelli R. Suicide and schizophrenia. Psychiatr Serv. 2003;54(5):747-748. PubMed CrossRef

6.Hennen J, Baldessarini RJ. Suicidal risk during treatment with clozapine: a meta-analysis. Schizophr Res. 2005;73(2-3):139-145. PubMed CrossRef

Bilge Togay, MDa

Steven Lippmann, MDa

[email protected]

aDepartment of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky

Potential conflicts of interest: None.

Funding support: None.

Published online: September 26, 2019.

Prim Care Companion CNS Disord 2019;21(5):19l02433

To cite: Togay B, Lippmann S. Suicide prevention and schizophrenia. 2019;21(5):19l02433.