Suicide and schizophrenia

Suicide and suicide attempts occur at a significantly greater rate in schiz ophrenia than in the general population. Common estimates are that 10% of p eople with schizophrenia will eventually have a completed suicide, and that attempts are made at two to five times that rate. Demographically associat ed with suicidality in schizophrenia are being young, being early in the co urse of the illness, being male, coming from a high socioeconomic family ba ckground, having high intelligence, having high expectations, not being mar ried, lacking social supports, having awareness of symptoms, and being rece ntly discharged from the hospital. Also associated are reduced self-esteem, stigma, recent loss or stress, hopelessness, isolation, treatment non-comp liance and substance abuse. Clinically, the most common correlates of suici dality in schizophrenia are depressive symptoms and the depressive syndrome , although severe psychotic and panic-like symptoms may contribute as well. This review specifically explores the issue of depression in schizophrenia , in relation to suicide, by organizing the differential diagnosis of this state and highlighting their potentially treatable or correctable causes. T his differential diagnosis includes both acute and chronic disappointment r eactions, the prodrome of an acute psychotic episode, neuroleptic induced a kinesia and akathisia, the possibility of direct neuroleptic-induced depres sion, negative symptoms of schizophrenia, and the possible co-occurrence of an independent depressive diathesis. The potential beneficial roles of 'at ypical' antipsychotic agents, including both clozapine and more novel agent s, and adjunctive treatment with other psychopharmacological medications ar e considered, and the important roles of psychosocial factors and intervent ions are recognized.