title: Differences between subjective experiences and observed behaviors in near-fatal suicide attempters with untreated schizophrenia: a qualitative pilot study.
abstract: BACKGROUND
  In cases of untreated schizophrenia, the patients' entourage often does not recognize the psychotic symptoms of the patient and the possibility that the patient may attempt suicide. The aim of this study was to investigate the discrepancies between the subjective experiences and observed behaviors in near-fatal suicide attempters with untreated schizophrenia.
  
  
  METHODS
  A semi-structured interview was carried out with seven near-fatal suicide attempters with untreated schizophrenia to examine the subjective experiences at the time of the suicide attempt. The families of the patients were also interviewed to determine their recognition of the patients' psychotic symptoms and the suicidal ideation. The interview data were analyzed qualitatively.
  
  
  RESULTS
  Six subjects were undergoing exacerbation of the psychotic symptoms at the time of exhibiting the suicide-related ideation. One subject had been in a prolonged depressive state before attempting suicide. Although all the patients experienced severe distress due to psychotic symptoms and depressive mood, they all exhibited only low level or no help-seeking behavior, and six of seven families had not recognized the change in the patient's mental condition.
  
  
  CONCLUSIONS
  Appropriate information about schizophrenia should be provided to the general public so that any help-seeking by the patients with this disease is not overlooked. In addition, accessible early intervention services for psychosis should be established.
authors.affiliation: Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan.
authors.forename: Taiju
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 1878553 Japan.
authors.forename: Chiyo
authors.initials: C
authors.lastname: Fujii
authors.affiliation: Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nemoto
authors.affiliation: Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Tsujino
authors.affiliation: Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan.
authors.forename: Kiyoaki
authors.initials: K
authors.lastname: Takeshi
authors.affiliation: Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Mizuno
keywords: Family; Help-seeking; Psychoeducation; Suicide; Untreated schizophrenia