South African Journal of Psychiatry

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Suicide risk in schizophrenia – a follow-up study after 20 years

G Lippi, DJ Smit, JC Jordaan, JL Roos


Objective. This study followed up, after a period of 20 years, a group of patients with schizophrenia who were considered to be at high risk for suicide. In Part 1 we reported on outcome and associated social factors, and in this paper we discuss re-evaluated suicide risk in these patients and investigate symptomatology and pharmacotherapy over the past two decades.
Method. The subjects were interviewed and a questionnaire evaluating suicide risk was completed. The Beck Hopelessness Scale (BHS) was administered and ratings were compared with those from the original study. The Calgary Depression Scale for Schizophrenia (CDSS) was also administered. Crosstabulations were then performed to identify factors associated with increased suicide risk. For those subjects who had committed suicide since the original study, a psychological
autopsy was performed.

Results. Fourteen of the original 33 high-suicide-risk schizophrenia patients were traced. Three subjects had committed suicide during the 20-year period. Among the living subjects, risks for suicide were found to be lower than those 20 years ago. Hopelessness and depressive symptoms correlated with independently evaluated suicide risk. Social withdrawal, blunting of affect and delusions were also associated with elevated risk. Good insight into illness and a history of previous suicide attempts coincided with high suicide risk. Cannabis abuse and poor or periodic adherence to treatment, as well as weight gain, akathisia and parkinsonian adverse effects, were also associated with an increase in risk of suicide. Formal thought disorder, avolition and cognitive impairment were associated with a lower risk of suicide.
Conclusion. Hopelessness, depression, certain positive symptoms and adverse effects of medication found to be associated with suicide risk in patients with schizophrenia in this study are in accord with those reported in the literature. Despite current knowledge about this subject, suicide remains notoriously and ominously unpredictable in patients with schizophrenia.

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