Suicide in schizophrenia.
It is known that 9-13% of individuals with a diagnosis of schizophrenia commits suicide. In addition, patients with schizophrenia have approximately a 50% lifetime risk for attempting suicide. The authors review the identified risk factors for suicide in schizophrenia. The most significant risk factors include the age of the patient, male gender, depression, presence of positive symptoms and substance abuse. There is evidence that implicates the serotonin system in the suicide of individuals with schizophrenia. Overactivity of the hypothalamo-pituitary-adrenal axis has also been reported in individuals who went on to attempt suicide. The authors review the molecular biology of suicide in schizophrenia. With regard to prevention of suicide, pharmacological intervention with typical antipsychotics and antidepressants may be helpful. It is suggested that atypical anti-psychotics, in particular clozapine may provide additional benefit in reducing the rate of suicide attempts. The authors emphasise the importance of early treatment of individuals with a diagnosis of schizophrenia, the role of maintenance therapy and the importance of a collaborative approach between in- and outpatient services.
Perenyi
Andras
A
Southern Community Mental Health Services, Southern Health Care Network, Melbourne, Victoria, Australia. apereny1@bigpond.net.au
Forlano
Rosaria
R
D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D003863:Depression / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D009478:Neuropeptide Y / Q000235:genetics / Q000378:metabolism*; D011110:Polymorphism, Genetic; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism*; D012565:Schizophrenic Psychology; D050486:Serotonin Plasma Membrane Transport Proteins / Q000235:genetics / Q000378:metabolism*; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000150:complications; D013405:Suicide / Q000523:psychology*; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D009478:Neuropeptide Y; C493230:SLC6A4 protein, human; D050486:Serotonin Plasma Membrane Transport Proteins; D003024:Clozapine