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Psychotherapy with Suicidal Patients: The Integrative Psychodynamic Approach of the Boston Suicide Study Group
Open AccessFeature PaperReview

Suicide in Schizophrenia: An Educational Overview

1,2,* and 1,2
1
James J. Peters Veterans’ Administration Medical Center, Bronx, New York, NY 10468, USA
2
Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(7), 361; https://doi.org/10.3390/medicina55070361
Received: 16 June 2019 / Revised: 30 June 2019 / Accepted: 7 July 2019 / Published: 10 July 2019
(This article belongs to the Special Issue Preventing Suicide in Patients with Mental Disorders)
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PDF [345 KB, uploaded 11 July 2019]

Abstract

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. View Full-Text
Keywords: suicide; schizophrenia; antipsychotics; depression suicide; schizophrenia; antipsychotics; depression
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Sher, L.; Kahn, R.S. Suicide in Schizophrenia: An Educational Overview. Medicina 2019, 55, 361.

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