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Schizophrenia and Other Psychotic Disorders


Childhood-onset schizophrenia:

Paranoid type schizophrenia:

Schizophreniform disorder: 

Schizoaffective disorder:

Delusional disorder: http://www.webmd.com/schizophrenia/delusional-disorder

Psychotic disorder: http://www.webmd.com/schizophrenia/guide/mental-health-psychotic-disorders

Research articles:

Cohen, C. I., Abdallah, C. G., & Diwan, S. (2010). Suicide attempts and associated factors in older adults with schizophrenia. Schizophrenia Research, 119(1-3), 253-257. doi:10.1016/j.schres.2010.03.010

Abstract: Background: Although there have been numerous studies of suicidality in younger populations with schizophrenia, there have been no studies focused on community-dwelling older adults with schizophrenia. This study provides data on the prevalence of suicidality and factors associated with previous suicide attempts among a mixed racial sample of older persons with schizophrenia living in New York City. Methods: The schizophrenia group consisted of 198 persons aged ≥55years who developed schizophrenia before age 45. A community comparison group (n =113) was recruited using randomly selected block groups. Fifteen predictor variables of lifetime suicide attempts based on a risk model of suicide in schizophrenia were identified. Results: Persons in the schizophrenia group had a significantly higher prevalence of current and lifetime “suicidality” (i.e., wants to be dead, suicidal thoughts, or suicide attempts) when compared to the community group (current: 10% versus 2%; lifetime: 56% versus 7%) as well as past suicidal attempts (30% versus 4%). Within the schizophrenia group, in logistic regression analysis, 2 variables were significantly associated with lifetime suicidal attempts: current syndromal depression and higher scores on the Traumatic and Victimization Scale. Conclusions: The data confirmed that in later life, persons with schizophrenia continue to have a higher prevalence of suicidality than their age peers in the community. Our findings underscore the importance of monitoring for suicidality in this age group. The relative paucity of risk factors means that practitioners can more easily focus their therapeutic efforts on at-risk individuals. [Copyright &y& Elsevier]

Falcone, T., Mishra, L., Carlton, E., Lee, C., Butler, R., Janigro, D., & ... Franco, K. (2010). Suicidal behavior in adolescents with first-episode psychosis. Clinical Schizophrenia & Related Psychoses, 4(1), 34-40. Retrieved from EBSCOhost.

Background: Studies have reported an increased risk for suicide in adults with schizophrenia, but limited data on younger populations are available. Aims: We hypothesize that first-episode psychosis is associated with an increased risk of suicidal behavior in adolescents. Method: A retrospective study was conducted with patients (n=102) diagnosed with psychosis not otherwised specified (NOS), schizophreniform disorder, schizoaffective disorder or schizophrenia within six months prior to admission. A control group consisting of ninety-eight patients with other (nonpsychosis) psychiatric diagnoses admitted to the same unit was matched by age, gender and ethnicity. All patients and controls were administered the Brief Psychiatric Rating Scale-Children version to assess severity of psychiatric symptoms and suicidality, and medical records were used to assess suicidal behavior and possible risk factors. Results: When compared to controls, patients with psychosis had over twice as many suicide attempts overall (p<0.01). The 32% incidence of suicide attempts reported in this cohort is nearly double what is reported in adults with psychosis. Depressive symptoms were significantly correlated with increased suicide attempts (p<0.05). Conclusions: There was no significant difference between the number of pediatric psychosis inpatients versus nonpsychotic psychiatric inpatients who attempted suicide. There was, however, a significant difference between the total number of attempts between groups, illustrating that children and adolescents with psychosis are more likely than nonpsychotic psychiatric inpatients to have repeat, or multiple, suicide attempts. Longer duration of untreated psychosis, ADHD and depressive symptoms were found to be the strongest risk factors for patients with psychosis.

Fenton, W., McGlashan, T., Victor, B., & Blyler, C. (1997). Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. The American Journal Of Psychiatry, 154(2), 199-204. Retrieved from EBSCOhost.

Objective: Suicide is the single largest cause of premature death among individuals with schizophrenia. This report examines the relationship 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 admission records, patients from the Chestnut Lodge Follow-Up Study with schizophrenia (N = 187), schizoaffective disorder (N = 87), schizophreniform disorder (N = 15), and schizotypal personality disorder (N = 33) were retrospectively assessed with the Positive and Negative Syndrome Scale, classical subtype criteria, and criteria for the deficit syndrome. Completed suicide, suicide attempts, and suicidal ideation during the follow-up period (average = 19 years) were ascertained by means of interviews with patients and/or surviving relatives. Results: Over the follow-up period, 40% of the patients reported suicidal ideation, 23% reported suicide attempts, and 6.4% died from suicide. Patients dead from suicide had significantly lower negative symptom severity at index admission than patients without suicidal behaviors. Two positive symptoms (suspiciousness and delusions), however, were more severe among successful suicides. The paranoid schizophrenia subtype was associated with an elevated risk (12%) and the deficit subtype was associated with a reduced risk (1.5%) of suicide. Conclusions: The impact of positive and negative symptoms on suicide risk has not been reported. These findings suggest that prominent negative symptoms, such as diminished drive, blunted affect, and social and emotional withdrawal, counter the emergence 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 symptoms defines a relatively high-risk group.

Joiner, T. R., Gencoz, F., Gencoz, T., Metalsky, G. I., & Rudd, M. (2001). The relation of self-hatred and sucidality in people with schizophrenia-spectrum symptoms. Journal of Psychopathology and Behavioral Assessment, 23(2), 107-115. doi:10.1023/A:1010915709011

It is well known that depressive symptoms represent a risk for suicidality in general. It is less clear, however, that general depressive symptoms comprise a definite suicide risk factor for people with schizophrenia. Based on this, as well as on the early writings of E. Bleuler (1911/1987), it was hypothesized that there may be a particular aspect of depressive symptoms that combines with schizophrenia to encourage suicidality. Specifically, schizophrenia may impart to self-concept a quality of self-hatred that encourages suicidality in schizophrenic people. If so, then an index of self-hatred should be more correlated with suicidality among people with schizophrenia-spectrum symptoms than among people with fewer such symptoms. Two studies evaluated this possibility. In Study 1 on 243 suicidal outpatients (aged 18–31 yrs) affiliated with the military, self-hate and suicidality were more correlated among people with schizotypal symptoms than among other patients. In Study 2 on 113 VA psychiatric inpatients (aged 21–72 yrs), self-hate and suicidality were more correlated among people with a diagnosis of schizophrenia than among patients with a diagnosis of major depression. It was suggested that self-hatred be a focus of suicide risk assessment in schizophrenic people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Reutfors, J., Bahmanyar, S., Jönsson, E. G., Ekbom, A., Nordström, P., Brandt, L., & Ösby, U. (2010). Diagnostic profile and suicide risk in schizophrenia spectrum disorder. Schizophrenia Research, 123(2/3), 251-256. doi:10.1016/j.schres.2010.07.014

Abstract: Background: Earlier studies of patients with schizophrenia have investigated suicide risk in relation to specific psychiatric symptoms, but it remains to be better understood how suicide risk relates to the diagnostic profile in these patients. Methods: We identified all patients with a first clinical ICD-diagnosis of schizophrenia, schizophreniform or schizoaffective disorder in Stockholm County between 1984 and 2000. Patients who died by suicide within five years from diagnosis were defined as cases (n=84) and were individually matched with a similar number of living controls from the same population. Sociodemographic and clinical variables were retrieved from hospital records through a blind process. DSM-IV lifetime diagnoses for cases and controls were derived using the OPCRIT algorithm. Results: A schizophrenia spectrum diagnosis (i.e. schizophrenia, schizophreniform or schizoaffective disorder) was assigned by OPCRIT to 50% of the suicide cases and 62% of the controls. Criteria for schizophrenia were met by 41% of the cases and 51% of the controls; for schizoaffective disorder by 8% of the cases and 10% of the controls; for other psychosis by 23% of the cases and 25% of the controls; and for mood disorder by 26% of the cases and 12% of the controls. Using the schizophrenia diagnosis as a reference, suicide risk was significantly higher in patients meeting criteria for a mood disorder diagnosis with an adjusted odds ratio of 3.3 (95% CI 1.2–9.0). Conclusion: In patients with a clinical schizophrenia spectrum diagnosis, a DSM-IV mood disorder diagnosis increases the suicide risk more than three-fold. [Copyright &y& Elsevier]

Reutfors, J., Brandt, L., Jönsson, E. G., Ekbom, A., Sparén, P., & Ösby, U. (2009). Risk factors for suicide in schizophrenia: Findings from a Swedish population-based case-control study. Schizophrenia Research, 108(1-3), 231-237. doi:10.1016/j.schres.2008.12.023

Abstract: Previous reports regarding risk factors for suicide in schizophrenia have been inconclusive. We performed a matched case-control study of in-patient-treated schizophrenia patients in order to assess the suicide risk associated with socioeconomic, demographic, and psychiatric factors. The cases were 84 patients who died by suicide within five years after diagnosis in a cohort of all patients discharged for the first time from psychiatric hospitals in Stockholm County, Sweden, with a diagnosis of schizophrenia, schizophreniform disorder or schizoaffective disorder between the years 1984 and 2000. One control was individually and randomly matched with each case from the same cohort by date (±1 year) and age (±5 years) at index diagnosis. Data were retrieved from clinical records of the case-control pairs in a blind fashion. Of the suicides, 54% were men and 46% were women. In multivariate analyses, higher educational attainment (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.03–8.0), age ≥30 years at onset of symptoms (OR 4.8, CI 1.1–21.2), and a history of a suicide attempt requiring non-psychiatric medical treatment (OR 5.0, CI 1.6–15.4) were found to be significantly associated with an increased suicide risk. Gender did not significantly affect the suicide risk, nor did a history of self-discharge, compulsory in-patient treatment, substance-use disorder or a family history of mental disorders or suicide. In schizophrenia, certain suicide risk factors may differ from those in the general population. Clinical suicide risk assessment for schizophrenia patients should be performed taking this into account. [Copyright &y& Elsevier]

Shrivastava, A., Johnston, M., Shah, N., Innamorati, M., Stitt, L., Thakar, M., & ... Pompili, M. (2010). Persistent suicide risk in clinically improved schizophrenia patients: Challenge of the suicidal dimension. Neuropsychiatric Disease And Treatment, 6, 633-638. Retrieved from EBSCOhost.

Background: Suicide is a major problem in schizophrenia, estimated to affect 9%-13% of patients. About 25% of schizophrenic patients make at least one suicide attempt in their lifetime. Current outcome measures do not address this problem, even though it affects quality of life and patient safety. The aim of this study was to assess suicidality in long-term clinically improved schizophrenia patients who were treated in a nongovernmental psychiatric treatment centre in Mumbai, India. Method: Participants were 61 patients out of 200 consecutive hospitalized first-episode patients with schizophrenia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders who were much improved on the Clinical Global Impression Scale-Improvement (CGI-I) scale at the endpoint of a 10-year follow-up. Clinical assessment tools included the Positive and Negative Syndrome Scale for Schizophrenia, CGI-I, Global Assessment of Functioning, and suicidality. Results: Many of the patients, although clinically improved, experienced emerging suicidality during the 10-year follow-up period. All of the patients reported significant suicidality (ie, suicide attempts, suicidal crises, or suicidal ideation) at the end of the study, whereas only 83% had reported previous significant suicidality at baseline. No sociodemographic and clinical variables at baseline were predictive of suicidal status at the end of the 10-year follow-up. Conclusion: Schizophrenia is a complex neurobehavioral disorder that appears to be closely associated with suicidal behavior. Adequate assessment and management of suicidality needs to be a continual process, even in patients who respond well to treatment.

Suokas, J. T., Perälä, J., Suominen, K., Saarni, S., Lönnqvist, J., & Suvisaari, J. M. (2010). Epidemiology of suicide attempts among persons with psychotic disorder in the general population. Schizophrenia Research, 124(1-3), 22-28. doi:10.1016/j.schres.2010.09.009

Abstract: Objective: To establish the epidemiology of suicide attempts in persons with psychotic disorder identified from the general population and to investigate the associations of suicidal behavior with other clinical characteristics and with physical violence against other people. Method: A random sample of 9922 Finnish persons aged 18years or over was screened for psychotic disorder using multiple sources of information. All screen positives and random sample of screen negatives were invited to an SCID interview. Diagnostic assessment, lifetime history of suicide attempts and violence against others were based on all available systematically evaluated information from the questionnaire, interview and/or case records. Results: Of persons with a lifetime history of any primary or substance-induced psychotic disorder (n =264), 34.5% (women: 34.1%, men: 34.9%) had a history of at least one suicide attempt. There were no suicide attempts among persons with delusional disorder, while the rate of suicide attempts was higher among persons with substance-induced psychotic disorders (48.8%) than in persons with other psychotic disorders 41.8%) (χ 2 =4.4, d.f.=1, P =0.036). Suicide attempts were associated with younger age, comorbid substance use disorders, depressive symptoms, and physical violence against other people. Conclusion: Suicide attempts are common in all psychotic disorders except for delusional disorder. They are particularly common in substance-induced psychotic disorder and in persons with comorbid substance use disorders. They are associated with severe depressive symptoms but not with the severity of psychotic symptoms. Suicidal behavior correlates with physical violence against other people. [Copyright &y& Elsevier]


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