Risk factors for suicidal ideation in patients with schizophrenia and their management Abstract The risk for suicidal ideation, suicide and suicidal attempts are high in schizophrenia. In schizophrenia episodes of depression along with mental problems would seriously affect the mental functioning. During periods of acute exacerbations the risk of suicides are high. Studies have shown that suicide in schizophrenics is the highest initially during hospitalization and following discharge.
Frequently the individual may have to be hospitalized to ensure greater vigilance, enforcement of protective measures and better treatment strategies. Fenton, Addington and Bandolier have demonstrated several risk factors for suicide and suicidal ideation including 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 Tikkonen 2009 and some extent Fenton 2003, good performance at school and higher IQ levels are understood as risk factors for suicide. The physician and other healthcare professionals need to be more attentive to determine if any of these risk factors are present in the patients suffering from schizophrenia. Besides, the use of a questionnaire tool is required to probe the presence of risk factors. Introduction Schizophrenia is a group of psychiatric disorders in which the individual’s perception of reality is seriously affected.
The individual develops serious mental problems such as hallucinations, delusions, irrational thinking, withdrawal from activities, etc. Psychosis develops as a serious internal problem. Schizophrenia should not be considered as a disorder in which the individual would develop a split-personality. There is serious disruption of the cognitive functions and emotions. An individual who develop schizophrenia would be suffering from a chronic disorder (it is likely to be lifelong) with periods of acute exacerbations (Mayo Clinic, 2008).
The ability to function normally in a social environment is seriously affected (Christos Ballas, 2008). The condition usually begins by the age of 45 years and each episode of schizophrenia lasts for a duration of 6 months or greater. About 1 % of the individuals throughout the world are affected with schizophrenia. It occurs equally in both males and females, but in women the conditions begins at a later age compared to men. In men, schizophrenia usually begins during the early adulthood stage, whereas in females it begins above the age of 45 years.
Schizophrenia can also occur in children, but occurs very rarely, except in the case the child is suffering from a serious developmental disorder such as autism (Christos Ballas, 2008). Schizophrenia is of five types namely, catatonic schizophrenia, disorganized schizophrenia, paranoid schizophrenia, residual schizophrenia, and undifferentiated schizophrenia. The exact cause for the development of schizophrenia is not understood clearly, but both genetic and environmental factors play an important role in the development of the disorder.
Studies have shown that people who have a family history of the disorder are more likely to develop it. Insult, nutritional deficiency and damage during the development stages of the womb can also result in schizophrenia (Christos Ballas, 2008). An individual suffering from Schizophrenia typically has an imbalance in various chemicals and neurotransmitters that are present in the brain. Studies conducted using images of the brain may demonstrate an abnormality in structure. A person can develop schizophrenia due to problems associated with social functioning and psychological activity.
People who have an affected relation or family member suffering from the disorder, the chances of developing it are higher. Individual who have been affected with other mental disorders and those taking certain drugs are also at a higher risk for developing schizophrenia (Mayo Clinic, 2008). An individual affected with schizophrenia would have a range of symptoms including general symptoms, positive symptoms, negative symptoms, cognitive symptoms and other symptoms. The symptoms can range from mild, moderate to severe.
The condition develops gradually, but in some individuals the symptoms worsen quickly. Some of the common general symptoms that are present in schizophrenia include delusions (beliefs not based on reality), visual or audio hallucinations (hearing or seeing objects that don’t exist), difference in voice, clumsy behavior, coordination problems, getting worried that others are watching them, catatonic behavior (reaction to the environmental needs are altered), inappropriate emotions, anxiety, depression, anger, neglect of meeting personal needs, etc.
The individual would find it very difficult to function normally at home, workplace or in social settings. Negative symptoms are those that are characterized by a drop in emotional functioning. It includes loss in the ability to perform daily functions, poor emotional abilities, neglect of personal hygiene needs, withdrawal from all social and family activities, and poor ability to motivate oneself. Positive symptoms are those that involve the development of certain thoughts and feelings arising from the loss of one’s reality.
Some of the common positive symptoms that are experienced in schizophrenia include hallucinations (especially hearing voices that threaten or harm the individual), delusions (forces that direct others to harm the individual), difficulty in speaking and organizing thoughts, in coordination, repetitive movements, etc. The individual would also develop symptoms suggesting problems in functioning of cognition. Memory, intelligence, attention, thinking and judgment are all affected. Often cognition is the most affected in schizophrenia.
Some of the common cognitive symptoms include memory problems, difficult to comprehending or understanding, difficulty in concentration, jumping to conclusions, etc (Mayo Clinic, 2008). The individual’s mood tends to show no effect. Besides, the individual also suffers from depression, suicidal ideation, suicide attempts and distress (Christos Ballas, 2008). The diagnosis of schizophrenia is made based on the history, symptoms, signs, physical examination, psychiatric examination, laboratory tests, etc.
The history may be positive for a family history or a personal history of schizophrenia. A thorough physical examination is conducted to determine whether any physical disorder is leading to the development of the psychiatric and physical symptoms which can be considered to be a part of schizophrenia. Laboratory tests include blood and urine tests (to determine if any drug is responsible for the development of the symptoms) or CT and MRI scans to study the brain.
During the psychiatric examination, the patient would be asked questions about feeling such as delusions, hallucinations, behavior, suicidal ideation, etc. Several assessments questionnaires and tools form a part of the examination including questionnaires or tools to determine the risk for suicide. The diagnosis of Schizophrenia is established using the guidelines lay down under DSM-IV-TR. The symptoms of schizophrenia should be present for at least six months and should cause significant functional distress (Mayo Clinic, 2008).