In schizophrenia, the mental functioning of the individual is seriously disabled. One of the greatest threats that can develop is the premature death of the patient from suicidal ideation and subsequent successful suicidal actions. The NIMH has conducted a house-to-house epidemiological study and has found that about 1. 5 % of the people in the US are affected with schizophrenia. People with schizophrenia had a very high chance of meeting with a major depressive episode.
Depression can develop during the early and the later stages of schizophrenia and can even occur during or after the resolution of an acute attack of psychosis that is so common amongst schizophrenics (Fenton, 2003). Suicidal ideation or suicidal attempts may be present in about half the number of patients suffering from schizophrenia. Studies conducted in the past, effectively demonstrate that suicidal ideation may be more lethal and violent in schizophrenics compared to normal populations and also tends to occur in a haphazard manner.
Nieto et al (1992) demonstrated that in the psychiatric outpatient wards, the chances that the patient uses violent means of ending life were more common. Studies have also shown that patients suffering from schizophrenia did not communicate their feelings to the physician. In most cases, the patients were rather surprised and shocked when they learnt that their patients suffering from schizophrenia had successful suicides. Studies have also demonstrated that suicide in schizophrenia occurs due to acute exacerbations (Fenton, 2003).
Suicide can reduce the life expectancy of the schizophrenic patients on an average by about 10 years (Kontaxakis, 2004). About 30 % of the patients who suffer from schizophrenia make suicide attempts, and about 10 % of the total patients suffering from schizophrenia have successful suicide bids (Kontaxakis, 2004). However, although this data may suggest high suicidal risks, the problem may even be more serious with the chances of unreported suicides and doubtful cases. Addington et al (2006) suggested that the risk for suicide in schizophrenia may not be as high as 10 %, but may be around 4 %, and schizophrenic populations were 8.
5 times more likely to suicide compared to the normal populations (Addington, 2006). A Swedish study effectively demonstrated that the suicidal rates in the schizophrenic populations were double of that of the normal populations (Addington, 2006). The entire stepwise pattern of successful suicide attempts in schizophrenic patients has not understood clearly. It may begin with suicidal ideation, followed by planning, attempts and successful actions (Kontaxakis, 2004). Even under psychiatric are the risk of suicide is high.
the risk of suicide is highest during initial hospitalization (as the patient may be admitted due to an acute exacerbation) or after the patient is discharge (as surveillance of the patient would be less). The young adults and middle-aged individuals suffering from schizophrenia are at the highest risk of dying from suicide (Conwell, 1998). Considering that the risk for suicidal ideation, suicidal attempts ad successes at suicide were high in schizophrenic populations, the risk for suicide and their adequate management needs to be studied more closely. Objectives
It is important to determine the risk factors for suicide and suicidal ideation in schizophrenic patients. It is important to determine both the general risk factors and the disease-specific risk factors. The risk factors needs to be studied during the hospitalization period and after discharge as studies effectively demonstrated high suicidal rates during these periods (Fenton, 2003). To study the suicidal risk several components need to be assessed including the mental disorder, history, psychological state, and the individual risk factors and strengths.
Based on these components, the risk for suicidal ideation and suicide need to be assessed and an effective management plan chalked out (Addington, 2006). Usually, in the past, information regarding suicidal ideation and suicide are obtained through interview sessions and charts about the patient. Studies in the past have clearly demonstrated that the risk for suicide and the amount of violence involved in such suicides were certainly less in any other disorder compared to schizophrenia (Addington, 2006).
Once the suicidal risk factor has effectively been identified, the strength of the risk factor, the link it has to the disorder and the ways in which the risk factor can be altered needs to be determined (Conwell, 1998). Literature Review Across various studies, the risk for suicidal ideation was assessed and the various risks for suicide, suicidal ideation and attempted suicide were charted keeping in mind the data recorded. Fenton (2003) had studied 322 patients between the years 1955 to 1975 (over a long-term basis). He found that 40 % of the patients had suicidal ideation, 23 % had attempted suicide 43 % had a successful suicide attempt.
However, Fenton et al also cautioned that when the recovery of schizophrenia was on, the chances of suicide was the greatest. Fenton especially cautioned that good IQ levels, better prognostic factors, disease beginning at a later age, lesser number of negative features, etc, placed the patients at a higher risk for suicide. This was because such patients had thinking functions intact, and were at the risk for abstract thinking. They were able to identify losses associated with the disease and hence were at the risk to commit suicide.
On the other hand, if the patient was seriously disabled with the disease, risk of suicide was less. Fenton tabled the general risk factors for suicide included male gender, Caucasian race, depression, hopelessness, suicide, earlier suicide attempts, poor functioning, social isolation, losses in life, poor health, substance abuse, etc. On the other hand, the disease-specific risk factors included longer terms duration of the illness, being ill at the time of discharge, constant fear developed from the illness, hopelessness, mood dysfunction, greater positive symptoms, loss of faith over treatment, etc (Fenton, 2003).