title: Suicide in the Early Stage of Schizophrenia.
abstract: Suicide is a relevant leading cause of death among patients affected by schizophrenia. Even if suicidal ideation may be present in different stages of disease, some differences have been described between the risk of suicide in patients experiencing first episode of psychosis and those with long-term schizophrenia. It is particularly higher during the first year of illness and reaches a steady decline over the following years. Suicidal ideation and attempts may also be common among subjects with subthreshold psychotic experiences. Factors associated with the risk of suicide in the early phase of schizophrenia are previous suicidal attempts and social aspects: the lack of social support and stable relationships, social drift after the first episode, and social impairment. Also, several psychotic symptoms (suspiciousness, paranoid delusions, mental disintegration and agitation, negative symptoms, depression and hopelessness, and command hallucinations) and substance abuse are associated with higher risk of suicide. It has been described that perfectionism and good levels of insight among individuals who have recently developed psychotic symptoms are significantly associated with higher numbers of suicidal attempts. Moreover, recent evidences show that prefrontal cortex-based circuit dysfunction may be related to suicide in the early stage of schizophrenia. This narrative review summarizes available evidences on suicide in the early stage of schizophrenia and deals with issues to be further studied and discussed.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Department of Mental Health, Regione Marche, ASUR, Area Vasta 2, Jesi, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ventriglio
authors.affiliation: Department of Mental Health, Regione Veneto, ULSS 13 , Mirano , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gentile
authors.affiliation: Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy.
authors.forename: Iris
authors.initials: I
authors.lastname: Bonfitto
authors.affiliation: Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Stella
authors.affiliation: Department of Mental Health, Regione Marche, ASUR, Area Vasta 2 , Jesi , Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Mari
authors.affiliation: Department of Psychiatry, University of Naples SUN , Naples , Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Steardo
authors.affiliation: Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Bellomo
keywords: first episode of psychosis; schizophrenia; suicidal attempts; suicide