Suicide Attempts in Schizophrenia: The Role of Command Auditory Hallucinations for Suicide
Jill M. Harkavy-Friedman, PhD; David Kimhy, MA; Elizabeth A. Nelson, PhD; David F. Venarde, PsyD; Dolores Malaspina, MD; and J. John Mann, MD
J Clin Psychiatry 2003;64(8):871-874
© Copyright 2019 Physicians Postgraduate Press, Inc.
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Background: We examined the presence of command
auditory hallucinations for suicide (CAHS) in a sample of
individuals with schizophrenia or schizoaffective disorder. We
examined the relationship between CAHS and demographic and
clinical variables. We also investigated the relationship between
CAHS and suicide attempts.
Method: 100 individuals with DSM-IV
schizophrenia or schizoaffective disorder hospitalized on an
inpatient research unit participated. Information was gathered
using the Diagnostic Interview for Genetic Studies and the
Harkavy Asnis Suicide Scale. Data were gathered from 1995 to
2001.
Results: CAHS were frequent in this sample
(22%), as were suicide attempts (33%). Eight percent of the
entire sample (36% of those who experienced CAHS) made at least 1
suicide attempt in response to the hallucinations. The presence
of CAHS was not related to demographic or clinical measures
assessed. The frequency of CAHS was not statistically different
for suicide attempters (30%) and nonattempters (18%). However,
80% (8/10) of attempters with CAHS reported at least 1 attempt in
response to CAHS. Three of 6 repeat attempters who made at least
1 suicide attempt in response to CAHS also made other attempts
that were not in response to CAHS. The presence of CAHS was not
associated with a history of depression or substance
abuse/dependence.
Conclusion: The presence of CAHS does not
directly predict suicide attempts. However, individuals who are
already at risk for suicidal behavior (e.g., past attempters) may
be at increased risk for a suicide attempt when experiencing
CAHS.