title: Command hallucinations and clinical characteristics of suicidality in patients with psychotic spectrum disorders.
abstract: BACKGROUND
  Suicide is a leading cause of death among patients with psychotic illnesses. Several researchers have suggested that specific illness symptoms may better predict suicide risk. An ability to identify high-risk patients would aid clinicians in instituting risk-reduction measures to decrease suicidal behavior in this population.
  
  
  METHODS
  We examined the association between psychotic symptoms and suicidal behavior among 148 inpatients with psychosis using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the Scale for the Assessment of Positive Symptoms, and the Positive and Negative Syndrome Scale. Measures of suicidality were obtained from risk assessment clinical data routinely collected during intake.
  
  
  RESULTS
  For individuals with a DSM-IV diagnosed psychotic spectrum disorder, 40% (n=57) endorsed suicidal ideation on admission and 23% (n=33) endorsed a recent suicide attempt. The presence of command auditory hallucinations was significantly associated with active suicidal ideation across diagnostic categories. Similarly, a greater percentage of patients endorsed a recent suicide attempt in the presence of command hallucinations. These correlations with CAH are noteworthy, as we found no significant difference in the prevalence of SI among those with and without general auditory hallucinations (42.5% and 37.7%).
  
  
  CONCLUSIONS
  The presence of command auditory hallucinations, in particular, but not auditory hallucinations, in general, was associated with suicidal behavior. These results indicate that command auditory hallucinations may identify or even place psychotic individuals at greater risk for acute, suicidal behavior--these symptoms should be the target of immediate and aggressive characterization and treatment.
authors: Alpert Medical School, Brown University, Providence, RI 02912, USA. zerlina.wong@med.brown.edu
authors: Zerlina
authors: Z
authors: Wong
authors: Dost
authors: D
authors: Öngür
authors: Bruce
authors: B
authors: Cohen
authors: Caitlin
authors: C
authors: Ravichandran
authors: Gil
authors: G
authors: Noam
authors: Beth
authors: B
authors: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006212:Hallucinations / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D012307:Risk Factors; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology*