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<p class="ltrs-br-ltr-br-title"><span class="bold">Suicide Prevention and Schizophrenia</span></p>
<p class="ltrs-br-ltr-br-body-text"><span class="semibold">To the Editor:</span> Suicide is a leading cause of death among people with schizophrenia. The risk is 12 times higher in those with schizophrenia compared with the general populatıon.<span class="htm-cite"><a href="#ref1">1</a></span> Between 40% and 50% of patients with schizophrenia experience thoughts about ending their lives.<span class="htm-cite"><a href="#ref2">2</a></span> Their lifetime risk of death by suicide is approximately 5%.<span class="htm-cite"><a href="#ref3">3</a></span></p>
<p class="ltrs-br-ltr-br-body-text">Prompt identification of patients at risk may prevent suicide attempts. Increased probability includes male sex, higher education level, having never married, inadequate social support, poor adherence to treatment, substance abuse, and previous suicide attempts.<span class="htm-cite"><a href="#ref2">2</a></span> Actual prediction of attempts, however, remains inexact.</p>
<p class="ltrs-br-ltr-br-body-text">&nbsp;</p>
<p class="ltrs-br-ltr-br-body-text"><span class="semibold-ital">Prediction.</span> Most suicides by people with schizophrenia occur within 1 decade of diagnoses.<span class="htm-cite"><a href="#ref4">4</a></span> Following pharmacotherapy or hospitalization, some patients gain more self-awareness and can develop a postpsychotic depression with hopelessness; yet, the affective component of illness may not be easily recognized.<span class="htm-cite"><a href="#ref5">5</a></span> Suicide attempts often occur with little verbal warning. Substance abuse increases impulsivity and escalates the chances for a negative outcome. Diminished social support and isolation add to this danger.</p>
<p class="ltrs-br-ltr-br-body-text">&nbsp;</p>
<p class="ltrs-br-ltr-br-body-text"><span class="semibold-ital">Prevention.</span> When treating patients with schizophrenia, clinicians should always assess suicide risk factors. Suicide prevention requires sensitivity, active listening, and close clinical follow-up. Adequate therapy for coexisting depression or substance abuse is important. Antipsychotic drugs that may reduce suicide risk, such as clozapine or lithium, should be selected for high-risk patients.<span class="htm-cite"><a href="#ref6">6</a></span> Psychosocial interventions and psychotherapy are helpful to address personal issues, diminish stress, and provide new coping skills.</p>
<p class="ltrs-br-ltr-br-body-text">&nbsp;</p>
<p class="ltrs-br-ltr-br-body-text"><span class="semibold-ital">Conclusion.</span> Suicide is a public health problem. It is especially difficult to predict suicide in people with schizophrenia. Thus, a thorough evaluation, intense treatment, and close follow-up individualized to each patient are needed to diminish risk and improve prognosis.</p>
<p class="references_references-heading"><span class="bold">References</span></p>
<p class="references-references-text-1-9"><a name="ref1"></a><span class="htm-ref"> 1. </span>Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? <span class="italic">Arch Gen Psychiatry</span>. 2007;64(10):1123–1131. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17909124&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1001/archpsyc.64.10.1123" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref2"></a><span class="htm-ref"> 2. </span>Mauri MC, Paletta S, Maffini M, et al. Suicide attempts in schizophrenic patients: clinical variables. <span class="italic">Asian J Psychiatr</span>. 2013;6(5):421–427. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=24011691&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1016/j.ajp.2013.07.001" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref3"></a><span class="htm-ref"> 3. </span>Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. <span class="italic">J Psychopharmacol</span>. 2010;24(suppl 4):81–90. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=20923923&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1177/1359786810385490" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref4"></a><span class="htm-ref"> 4. </span>Raymont V. Suicide in schizophrenia: how can research influence training and clinical practice? <span class="italic">Psychol Bull</span>. 2001;25:46–50.</p>
<p class="references-references-text-1-9"><a name="ref5"></a><span class="htm-ref"> 5. </span>Pompili M, Mancinelli I, Tatarelli R. Suicide and schizophrenia. <span class="italic">Psychiatr Serv</span>. 2003;54(5):747–748. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12719514&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1176/appi.ps.54.5.747" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="references-references-text-1-9"><a name="ref6"></a><span class="htm-ref"> 6. </span>Hennen J, Baldessarini RJ. Suicidal risk during treatment with clozapine: a meta-analysis. <span class="italic">Schizophr Res</span>. 2005;73(2-3):139–145. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15653256&dopt=Abstract" target="_blank"><span class="pubmed-crossref">PubMed</span></a> <a href="https://doi.org/10.1016/j.schres.2004.05.015" target="_blank"><span class="pubmed-crossref">CrossRef</span></a></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Bilge Togay, MD</span><span class="superscript">a</span></p>
<p class="ltrs-br-ltr-br-author"><span class="bold">Steven Lippmann, MD</span><span class="superscript">a</span></p>
<p class="ltrs-br-ltr-br-author"><a href="mailto:steven.lippmann@louisville.edu">steven.lippmann@louisville.edu</a></p>
<p class="end-matter"><span class="superscript">a</span>Department of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky</p>
<p class="end-matter"><span class="bold-italic">Potential conflicts of interest: </span>None.</p>
<p class="end-matter"><span class="bold-italic">Funding support:</span> None.</p>
<p class="end-matter"><span class="bold-italic">Published online:</span> September 26, 2019.</p>
<p class="end-matter"><span class="italic">Prim Care Companion CNS Disord 2019;21(5):19l02433</span></p>
<p class="front-matter-rule"><span class="bold-italic">To cite:</span> Togay B, Lippmann S. Suicide prevention and schizophrenia. 2019;21(5):19l02433.</p>
<p class="doi-line"><span class="bold-italic">To share:</span> https://doi.org/<span class="doi">10.4088/PCC.19l02433</span></p>
<p class="end-matter"><span class="italic">© Copyright 2019 Physicians Postgraduate Press, Inc.</span></p>
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