SYMPTOMS, SUBTYPE, AND SUICIDALITY IN PATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS

Objective: Suicide is the single largest cause of premature death amon g individuals with schizophrenia. This report examines the relationshi p between positive or negative symptoms, illness subtype, and suicidal behavior among patients with schizophrenia and schizophrenia spectrum disorders in a long-term follow-up cohort. Method: Based on index adm ission records, patients from the Chestnut Lodge Follow-Up Study with schizophrenia (N=187), schizoaffective disorder (N=87), schizophrenifo rm disorder (N=15), and schizotypal personality disorder (N=33) were r etrospectively assessed with the Positive and Negative Syndrome Scale, classical subtype criteria, and criteria for the deficit syndrome. Co mpleted suicide, suicide attempts, and suicidal ideation during the fo llow-up period (average=19 years) were ascertained by means of intervi ews with patients and/or surviving relatives. Results: Over the follow -up period, 40% of the patients reported suicidal ideation, 23% report ed suicide attempts, and 6.4% died from suicide. Patients dead from su icide had significantly lower negative symptom severity at index admis sion than patients without suicidal behaviors. Two positive symptoms ( suspiciousness and delusions), however, were more severe among success ful suicides. The paranoid schizophrenia subtype was associated with a n elevated risk (12%) and the deficit subtype was associated with a re duced risk (1.5%) of suicide. Conclusions: The impact of positive and negative symptoms on suicide risk has not been reported. These finding s suggest that prominent negative symptoms, such as diminished drive, blunted affect, and social and emotional withdrawal, counter the emerg ence of suicidality in patients with schizophrenia spectrum disorders and that the deficit syndrome defines a group at relatively, low risk for suicide. Prominent suspiciousness in the absence of negative sympt oms defines a relatively high-risk group.