It may often be very difficult to determine the risk for suicide in schizophrenia. Across a variety of studies that were conducted, it was found that suicide ideation, suicide attempts and the chances of successful suicide are higher in schizophrenia. Risk factors may be present, but often the exact role each risk factor would be playing in suicide may be difficult to understand.
As most of the patients involved in the studies were schizophrenic patients who were suffering from the disease, patients without a suicidal risk or patients surviving out of unsuccessful bids, the exact risk for suicide still cannot be assessed (as the risk in the successful suicide attmepts are not known) (Bandolier Journal, 2007).
However, the studies tried to identify the most important risk factors for suicide ideation and suicide which included male gender, Caucasian, depression, hopelessness, worthlessness, aggressiveness, earlier suicidal attempts, significant losses in the family, substance abuse, hallucinations, fear of deterioration of the mental state due to illness, loss of reality, poor treatment compliance and adherence, poor family ties, etc (through studies Fenton, 2003, Addington, 2006 & Bandolier Journal, 2007).
Through Tikkanen et al (2009) and to some extent Fenton 2003, it appears that good performance at school and higher IQ levels also were important risk factors in the development of suicidal ideation and suicide in schizophrenia. This was because the mental functioning was better intact in such circumstances. There were fewer problems with the metnal functioning, which created greater fear and awareness in the idivdiaul. As successes and ambitions are a threat due to disease, there would be greater chances to suffer from suicidal attemtps and suicidal ideation in schizophrenia.
These findings are vital in the diagnosis and strategic management as critically the risk factors once identified can help reudce the chances of successful sucide actions. The use of the findings of risk factors for suicidal ideation and suicidal attempts in schizophrenia should be critically appraised before being implemented in clinical practice. More often should the practitioner determine the risk factors that are present, rather than the nature of the disorder (to manage suicide ideation and suicide).
Greater vigilance of such patients would help to prevent any life-taking steps (Bandolier Journal, 2007). The current reporting of attempted suicides is very low, and more often the physician would be playing not a significant role (would only have to provide a legal statement). However, the responsibility of the physician and other healthcare providers should be even greater as the risk factors (or identification factors) for suicide in schizophrenia have well been identified.
The first and foremost thing in managing such patients would be suicide prevention and risk reduction. The physician should have a closer relationship with the patients in understanding their problems that could pose a threat to suicidal risk. Several other strategies may be employed to lower the suicidal risk in schizophrenic patients such as education, counseling, providing education to the family members and friends, drug therapy, psychotherapy, etc (Addington, 2006).
A questionnaire tool also needs to be prepared which can effectively help assess the suicidal risk in patients. Some of the areas in which the patient can be probed include the presence of suicidal thoughts, events that precipitate such thoughts, frequency of suicidal thoughts, relieving factors, ability to control such thoughts, access to a gun or lethal device, drug abuse risk, risk of others persuading the individual into committing suicide, etc.
Accordingly the physician would have to implement protective measures (Gliatto, 1999). As suicidal ideation carries a very high risk in schizophrenia, the individual needs to be hospitalized based on the assessment (to ensure that a safe environment for recovery is provided). Critical to the prevention and management of suicidal ideation and suicidal risks is the overall the treatment of schizophrenia, which is based on administration of medication for short duration along with psychotherapy (Christos Ballas, 2008).
Frequently, schizophrenia requires treatment on a lifelong basis (to also keep the risk for suicide and suicidal ideation under control). Coordination between various professionals including the physician, nurse, psychiatrist, psychologist, social worker, family doctor, etc is required as a key to a good outcome in schizophrenia. The main stream of drugs that are administered in the treatment of schizophrenia is antipsychotics. These drugs basically control the level of several neurotransmitters in the brain including dopamine and serotonin.
The conventional antipsychotics include haloperidol and thioridazine. Newer generation atypical antipsychotics are more effective and cause lesser number of side-effects. They include clozapine, risperidone, and quetiapine. Risperidone is frequently utilized to treat schizophrenia in young children. Long-term psychotherapy helps in effectively ensuring that the patient’s behavior, feelings and emotions are altered positively (Mayo Clinic, 2008).
Works Cited
Addington, D. (2006). The Management of Suicide Risk in Schizophrenia. Medscape , http://www.sprc.org/