Suicide in Schizophrenia: An Educational Overview

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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The role of VEGF rs699947 polymorphism in End-Stage Renal Disease: A preliminary study

10.51271/kmj-0005 ◽

2021 ◽

pp. 19-23

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Protective Factor ◽

Public Health Problem ◽

Turkish Population ◽

Control Group ◽

Case Group ◽

Important Public Health Problem ◽

Stage Renal Disease ◽

End Stage

Aim: End-Stage Renal Disease (ESRD) is an important public health problem worldwide with an increasing incidence and prevalence. There are many environmental and genetic factors which contribute to the development of ESRD. Vascular endothelial growth factor (VEGF) has been suggested to play an important role in renal pathophysiology. The aim of this study was to determine the probable relation between ESRD and VEGF gene rs699947 polymorphism in Turkish population. Material and Method: Genotyping of rs699947 was carried out in 50 ESRD patients on dialysis treatment and 30 healthy controls, using a Kompetitive Allelic-Specific PCR (KASP) method following DNA isolation. Demographic and clinical characteristics of the patients were recorded. Results: The prevalance of rs699947 AA genotype was found to be higher in the control group, but it was not statistically significant (p>0.05) . Conclusion: Although statistically insignificant, the frequency of AA genotype was higher in the control group compared to the case group, therefore we concluded that AA genotype may be a protective factor for ESRD in Turkish population. However, this conclusion needs to be further verified by future studies performed in larger study groups.

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Pathological laughing and psychotic disorder: the medical evaluation of the Joker

Acta Neurologica Belgica ◽

10.1007/s13760-020-01332-3 ◽

2020 ◽

Vol 120 (6) ◽

pp. 1379-1382

Author(s):

Alexis Demas ◽

David Tillot

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Social Withdrawal ◽

Neuropsychiatric Symptoms ◽

Public Health Problem ◽

Psychotic Symptoms ◽

Left Frontal Lobe ◽

Physically Abused ◽

Medical Evaluation ◽

Origin Story

Abstract In the psychological thriller film Joker, released in 2019 and starring Joaquin Phoenix in the first role, another possible origin story for this iconic character is reported. Above all, it brings us medical elements for the understanding of the development of this complex character. Contrary to other interpretations, we discover a lonely, timid and uncharismatic man (Arthur Fleck). He seems to be suffering from psychobehavioral disorders and seems depressed. There is a strangeness in his behavior along with social withdrawal. He suffers from fits of laughter that occur at socially inappropriate times. He also suffers from psychotic symptoms with visual delusions. We learn through the film that he was a beaten child, psychologically and physically abused with severe traumatic brain injury (TBI). The uncontrollable outbursts of laughter, behavioral and psychotic disorders followed these elements. As a neurologist, I was intrigued by these symptoms. I have explored the neuropsychiatric symptoms complicating TBI from which he seems to suffer and which have been reported in the literature. We can assume that the Joker is suffering from neuropsychiatric sequelae related to childhood TBI involving the frontotemporal regions and, in particular, the lateral aspect of the left frontal lobe. The movie Joker has medical significance and covers social aspects of medicine and health care. First, it allows us to discuss whether psychotic disorder due to TBI should be considered a neurobiological syndrome. More broadly, albeit fictitious, it asks us about the management of patients with neuropsychiatric illness, which is a public health problem. It also reminds us that semiological descriptions of patients with neuropsychiatric disorders have served as inspiration for many authors.

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Assessing suicide risk with the Clinical Interview for Psychotic Disorders (CIPD): Preliminary reliability and validity of the Suicide Risk Scale for Psychosis (SRS-P)

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2113 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S188-S189

Author(s):

M.J. Martins ◽

P. Castilho ◽

C. Carvalho ◽

T. Pereira ◽

J. Gonçalves ◽

...

Keyword(s):

Convergent Validity ◽

Suicide Risk ◽

Psychotic Disorders ◽

Therapeutic Process ◽

Reliability And Validity ◽

Important Variable ◽

Psychotic Symptoms ◽

Good Reliability ◽

Illness Onset ◽

Self Compassion

BackgroundSuicide risk is an important variable to consider both in assessment and throughout the therapeutic process in psychotic disorders. The SRS-P is an 18-item scale computed from the patient and clinician-rated scores obtained in the CIPD. The scale comprises lifetime assessment of depressed mood, anhedonia and its current interference and severity, current and past feelings of hopelessness, suicidal ideation, ‘voices’ about suicide, and suicide-related behaviors.AimsTo assess reliability and convergent validity of the SRS-P in a sample of participants with psychosis.MethodsThe sample comprised 22 participants (68.2% male), single (72.7%), between 19 and 47 years old (M = 31.05; SD = 7.088), with 4–17 years of education (M = 11.77; SD = 3.176), employed (50%). The most prevalent diagnosis was schizophrenia (68.2%) and the participants had a mean of 1.90 hospitalizations (SD = 2.548). The mean age of illness onset was 23.57 years (SD = 5.555). The participants were assessed with the CIPD, Depression, Anxiety and Stress Scales-21, Forms of Self-Criticism and Reassurance Scale, Self-Compassion Scale, Other as Shamer Scale and the Empowerment with Psychotic Symptoms Scales.ResultsThe SRS-P has shown good reliability (α = .87) and validity in relation to depressive symptoms (r = .67; P = .001), anxiety (r = .74; P < .001), stress (r = .59; P = .004), inadequate self (r = .43; P = .046), hated self (r = .54; P = .009), reassured self (r = –.65; P = .001), self-compassion (r = –.63; P = .002), shame (r = .46; P = .033) and empowerment regarding positive symptoms (r = –.54; P = .015).ConclusionsThe SRS-P presented adequate reliability and convergent-divergent validity. Further studies are planned in order to test the factorial structure of the scale and confirm the presented results in a larger sample.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Comparative analysis of suicidality in two Bulgarian regions

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.476 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S403-S403

Author(s):

K. Stoychev ◽

V. Nakov ◽

D. Dekov ◽

M. Baltov ◽

R. Dinolova-Hodzhadzhikova ◽

...

Keyword(s):

Suicidal Behavior ◽

Suicide Risk ◽

Suicide Attempts ◽

Population Aging ◽

Psychotic Symptoms ◽

Prevention Interventions ◽

Health Related ◽

Competing Interest ◽

Methods Of Suicide ◽

Old Females

IntroductionSuicidality is still an understudied problem in Bulgaria especially on a subnational (regional) level.ObjectivesTo collect data on suicidality in two major regions of Bulgaria with a population over 250,000 each (Plovdiv and Pleven) for a six years period (2009–2015).AimsTo analyze demographic, health-related and other characteristics associated with suicidal behavior as well as motives and methods of suicide.MethodsData were extracted from relevant documentation (medical records, public health reports, etc.) and statistically processed upon collection.ResultsMajority of suicide victims were males between 45 and 64 years while most suicide attempts occurred among 18–29 years old females.Leading method of suicide was hanging, followed by jumping from high places and use of firearm.Prevailing suicidal motives were psychotic symptoms, serious somatic illnesses and family problems. Depression accounted for 25% of all suicide cases and in another 25% motivation could not be identified because of insufficient data.The proportion of unemployed among suicide committers was not significantly higher than that of employed and retired.ConclusionsSevere mental disorders are a major trigger of suicidal behavior.Personal relationships should be targeted by suicide prevention interventions.Somatic illnesses are increasingly important suicide risk factor driven by the ongoing process of population aging.Frontline healthcare professionals should be trained to explore underlying suicidal motives and actively probe for depression in each case of suicidal behavior.Unemployment related suicide risk is most likely mediated through an adaptation crisis mechanism induced by the abrupt change of social status.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Maternal Dissatisfaction During the Postpartum Recuperation Period is an Independent Risk Factor for Postpartum Depression after Caesarean Section in China – A Prospective Cohort Study

10.21203/rs.3.rs-792984/v1 ◽

2021 ◽

Author(s):

Liping Li ◽

Chaojin Chen ◽

Yiying You ◽

Mierzhati Muhetaer ◽

Fei Huang ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Caesarean Section ◽

Postpartum Depression ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Protective Factor ◽

Depression Scale ◽

Public Health Problem ◽

Important Public Health Problem

Abstract Background: Postpartum depression (PD) is a common disorder associated with severe adverse infant and maternal outcomes, which is becoming an important public health problem. However, studies on the clinical relevance of anesthesia and PD are very limited. This study aimed to examine risk factors for PD amongst Chinese parturients of caesarean section from the perspective of anesthesiology, especially during the standard Chinese postpartum recuperation period known as “doing the month”.Methods: Prospective cohort study of 125 women who received caesarean sections aged from 21 to 46 years. The Edinburgh Postnatal Depression Scale were evaluated at the day before caesarean section and 6 weeks postpartum. Demographic, clinical, and treatment, including postoperative prognostic data and conditions during “doing the month”, were recorded and compared between PD and non-PD groups. Univariable and multivariable logistic regression methods were used to explore the risk factors associated with the occurrence of PD. Results: 44 (34.9%) patients were diagnosed PD at 6 weeks postpartum. Occurrence of PD was associated with postoperative pain, pruritus, dissatisfaction with “doing the month”. Multivariate regression analysis showed that lumbago (OR 5.68, 95% CI 1.69-19.06; p=0.005), maternal total dissatisfaction during “doing the month”(OR 6.87, 95% CI 2.48-19.04; p=0.001), and dissatisfaction with mother in-law during “doing the month”(OR 3.22, 95% CI 1.43-16.16; p=0.020) were independent risk factors for PD, while mild activity pain was independent protective factor for PD 6 weeks postpartum (OR 0.018, 95% CI 0.01-0.25; p=0.003). Conclusions: PD was a commonly experienced psychological disorders for women undergoing caesarean section. Postpartum lumbago, maternal total dissatisfaction and dissatisfaction with mother in-law during “doing the month” and mild activity pain were main factors for PD at 6 weeks postpartum.

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Factors related to suicide among students: a narrative review of psychological literature

Mental Health Review Journal ◽

10.1108/mhrj-08-2020-0061 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Saba Javed ◽

Khadeeja Munawar

Keyword(s):

Mental Health ◽

Suicidal Ideation ◽

Suicidal Behavior ◽

Help Seeking ◽

Public Health Problem ◽

Life Stressors ◽

Health Issues ◽

Important Public Health Problem ◽

Content Type ◽

Mental Health Issues

Purpose The purpose of this paper is to provide an educational overview of suicidal behavior and the factors related to suicidality among students between the ages of 18 and 30 years. Design/methodology/approach The literature related to suicide among students were identified through various electronic database searches. The databases searched included: PsycINFO, PubMed, MEDLINE, ERIC/ProQuest, Embase, Scopus, Google Scholar and PMC using the following search terms and their derivatives: suicide/self-harm, suicide risk and students, mental health issues and suicide, substance use and suicide, childhood adversities and suicide, recent life stressors, help-seeking attitude and elevated suicidal risk, help-seeking behavior and suicide and subjective factors and suicide. Findings Suicide is an important public health problem. Several factors influence suicide (including suicidal ideation and taking life or dying by suicide) such as genetics, family functions, socioeconomic status, personality and psychiatric comorbidity. The main themes that were investigated included: mental health issues, childhood adversity and recent life stressors, barriers toward seeking professional help and subjective factors (psychache risk of suicidal behavior, impulsivity, aggression). Originality/value This review focuses on several modifiable psychological factors that have been shown to contribute toward suicidal ideation in youth, especially among university students.

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A biopsychosocial evaluation of the risk for suicide in schizophrenia

CNS Spectrums ◽

10.1017/s1092852917000128 ◽

2017 ◽

Vol 23 (4) ◽

pp. 253-263 ◽

Cited By ~ 5

Author(s):

Nuwan C. Hettige ◽

Ali Bani-Fatemi ◽

Isaac Sakinofsky ◽

Vincenzo De Luca

Keyword(s):

Risk Factors ◽

Suicidal Behavior ◽

Potential Risk ◽

Suicide Risk ◽

Psychotic Symptoms ◽

Multidimensional Approach ◽

Reciprocal Interaction ◽

Future Studies ◽

Potential Risk Factors ◽

History Of

The risk of suicide is greatly increased in individuals with schizophrenia. Previous research has identified several potential risk factors for suicidal behavior in schizophrenia, although their ability to independently predict suicide is limited. The objective of this review was to systematically analyze and identify the interaction between the proposed risk factors in the literature that may predict suicidal behavior in schizophrenia. Articles that explored suicidal behavior and suicide risk in schizophrenia that were published between 1980 and August of 2015, indexed in PubMed, MEDLINE, and Scopus were systematically reviewed. Many studies proposed a range of biopsychosocial risk factors that may independently lead to suicide in schizophrenia. These risk factors appear to be mainly related to stress, a history of suicidal behavior, and psychotic symptoms. It is clear, however, that many of these factors do not act independently and in fact require the reciprocal interaction of several of them to pose a risk for suicide in schizophrenia. Independently, the power of many risk factors to predict suicide is limited. Future studies should continue to adopt a multidimensional approach by considering the interaction of several factors in assessing the risk for suicide in schizophrenia.

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Suicidal Behavior in Four Ethnic Groups in The Hague, 2002–2004

Crisis ◽

10.1027/0227-5910.30.2.63 ◽

2009 ◽

Vol 30 (2) ◽

pp. 63-67 ◽

Cited By ~ 22

Author(s):

Irene Burger ◽

Albert M. van Hemert ◽

Willem J. Schudel ◽

Barend J.C. Middelkoop

Keyword(s):

Suicide Attempt ◽

Ethnic Groups ◽

Suicidal Behavior ◽

Emergency Service ◽

Attempted Suicide ◽

Public Health Problem ◽

Specific Rate ◽

Completed Suicide ◽

The Hague ◽

Psychiatric Department

Background: Suicidal behavior is a severe public health problem. Aims: To determine the rates of attempted and completed suicide among ethnic groups in The Hague, The Netherlands (2002–2004). Methods: By analyzing data on attempted and completed suicide (from the psychiatric department of general medical hospitals; the psychiatric emergency service and the municipal coroners). Results: Turkish and Surinamese females aged 15–24 years were at highest risk for attempted suicide (age-specific rate 545 / 100,000 and 421 / 100,000 person-years, respectively). Both rates were significantly higher than in the same age group of Dutch females (246 / 100,000 person-years). Turkish (2%) and Surinamese (7%) had lower repeat suicide-attempt rates than did Dutch (16%) females aged 15–24. Significantly lower suicide-attempt rates were found for Surinamese than for Dutch females aged 35–54 years. Differences were not explained by socioeconomic living conditions. The ratio fatal/nonfatal events was 4.5 times higher in males than in females and varied across age, gender, and ethnicity strata. Completed suicide was rare among migrant females. No completed suicides were observed in the Turkish and Surinamese females aged 15–24 years. Conclusions: The study demonstrates a high risk of attempted suicide and a low risk of completed suicide among young Turkish and Surinamese females.

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Perceptions of Adjunctive Mindfulness-Based Cognitive Therapy to Prevent Suicidal Behavior Among High Suicide-Risk Outpatient Participants

Crisis ◽

10.1027/0227-5910/a000519 ◽

2018 ◽

Vol 39 (6) ◽

pp. 451-460 ◽

Cited By ~ 2

Author(s):

Megan S. Chesin ◽

Beth S. Brodsky ◽

Brandon Beeler ◽

Christopher A. Benjamin-Phillips ◽

Ida Taghavi ◽

...

Keyword(s):

Cognitive Therapy ◽

Suicidal Behavior ◽

Group Treatment ◽

Suicide Risk ◽

Qualitative Data ◽

Descriptive Analysis ◽

Treatment Engagement ◽

Suicidal Thinking ◽

Prevention Interventions ◽

Risk Patients

Abstract. Background: Few investigations of patient perceptions of suicide prevention interventions exist, limiting our understanding of the processes and components of treatment that may be engaging and effective for high suicide-risk patients. Aims: Building on promising quantitative data that showed that adjunct mindfulness-based cognitive therapy to prevent suicidal behavior (MBCT-S) reduced suicidal thinking and depression among high suicide-risk patients, we subjected MBCT-S to qualitative inspection by patient participants. Method: Data were provided by 15 patients who completed MBCT-S during a focus group and/or via a survey. Qualitative data were coded using thematic analysis. Themes were summarized using descriptive analysis. Results: Most patients viewed the intervention as acceptable and feasible. Patients attributed MBCT-S treatment engagement and clinical improvement to improved emotion regulation. A minority of patients indicated that factors related to the group treatment modality were helpful. A small percentage of patients found that aspects of the treatment increased emotional distress and triggered suicidal thinking. These experiences, however, were described as fleeting and were not linked to suicidal behavior. Limitations: The sample size was small. Conclusion: Information gathered from this study may assist in refining MBCT-S and treatments to prevent suicidal behavior among high suicide-risk patients generally.

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Suicide on the Indian Subcontinent

Crisis ◽

10.1027//0227-5910.23.3.104 ◽

2002 ◽

Vol 23 (3) ◽

pp. 104-107 ◽

Cited By ~ 36

Author(s):

Murad M. Khan

Keyword(s):

Sri Lanka ◽

Mental Health Professionals ◽

Indian Subcontinent ◽

Interpersonal Relationship ◽

Public Health Problem ◽

Elderly Subjects ◽

Important Public Health Problem ◽

Policy Makers ◽

Formidable Challenge ◽

Causative Factors

Summary: The Indian subcontinent comprises eight countries (India, Pakistan, Bangladesh, Nepal, Sri Lanka, Afghanistan, Bhutan, and the Maldives) and a collective population of more than 1.3 billion people. 10% of the world's suicides (more than 100,000 people) take place in just three of these countries, viz. India, Sri Lanka, and Pakistan. There is very little information on suicides from the other four countries. Some differences from suicides in Western countries include the high use of organophosphate insecticides, larger numbers of married women, fewer elderly subjects, and interpersonal relationship problems and life events as important causative factors. There is need for more and better information regarding suicide in the countries of the Indian subcontinent. In particular, studies must address culture-specific risk factors associated with suicide in these countries. The prevention of this important public health problem in an area of the world with myriad socio-economic problems, meager resources, and stigmatization of mental illness poses a formidable challenge to mental health professionals, policy makers, and governments of these countries.

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