Definition of suicide risk in patients with schizophrenia (literature review)

Definition of suicide risk in patients with schizophrenia (literature review)

 

Authors

 

A.O. Munin

State Budgetary Healthcare Institution “Psychiatric Clinical Hospital No. 4 named after P.B. Gannushkin Department of Health of the City of Moscow”, Moscow, Russian Federation; Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

S.A. Golubev

State Budgetary Healthcare Institution “Psychiatric Clinical Hospital No. 4 named after P.B. Gannushkin Department of Health of the City of Moscow”, Moscow, Russian Federation; Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

 

https://doi.org/10.26617/1810-3111-2024-2(123)-65-74

 

Journal: Siberian Herald of Psychiatry and Addiction Psychiatry. 2024; 2 (123):  65-74.

 

Abstract

Background.Currently, there is no generally accepted reliable method for determining (including comparison, measurement) suicide risk. Many authors point out a large number of false results when assessing suicide risk using simple generally accepted methods. In this review, we propose considering the assessment of suicide risk using the example of the definition (formulation) of suicide risk. The formulation of suicide risk is a comprehensive assessment of many factors using a person-centered approach. When formulating the suicide risk, four groups of parameters are assessed. The first group, suicide risk status, includes an assessment of general risk factors typical for patients with schizophrenia. The second group – the state of risk of suicidal behavior (suicide risk state), assesses the risk for a person in comparison with his/her condition before the disease or without an exacerbation of the disease. The third group allows us to identify the availability of resources that exist for a given patient and which he/she could use to prevent suicidal behavior. The fourth group includes predictable events that could increase the risk of suicidal behavior. Numerous data indicate individual, clinical, social and psychological risk factors for suicide in patients with schizophrenia. In schizophrenia, the model for formulating suicide risk allows the clinician to assess the patient’s current condition and choose a personalized treatment strategy for a particular patient with an emphasis on activities aimed at preventing suicidal behavior. Materials and Methods. An analysis of modern Russian and foreign scientific publications devoted to suicidal behavior in schizophrenia has been carried out. The search for scientific publications has been carried out using keywords: suicide in patients with schizophrenia, formulation of suicide risk, assessment of suicide risk in schizophrenia. To search for literary sources, scientometric information databases (PubMed, Google Scholar data-bases, eLibrary) have been used.

 

Keywords: schizophrenia, suicidal behavior, formulation of suicide risk.

 

Article (pdf)

 

Contacts

 

This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Materials  

For citation: Munin A.O., Golubev S.A. Definition of suicide risk in patients with schizophrenia (literature review). Siberian Herald of Psychiatry and Addiction Psychiatry.2024; 2 (123): 65-74. https://doi.org/10.26617/1810-3111-2024-2(123)-65-74

 

REFERENCES

  1. Polozhy BS. Suicidal behavior (clinical, epidemiological and ethnocultural aspects). Moscow: Publication of the State Scientific Center for Social Forensic Psychiatry, 2010:229 (in Russian).
  2. Bilsen J. Suicide and youth: risk factors. Front Psychiatry. 2018 Oct 30;9:540. doi: 10.3389/fpsyt.2018.00540. PMID: 30425663; PMCID: PMC6218408.
  3. Brådvik L. Suicide risk and mental disorders. Int J Environ Res Public Health. 2018 Sep 17;15(9):2028. doi: 10.3390/ijerph15092028. PMID: 30227658; PMCID: PMC6165520.
  4. Bryan CJ. The 90% Statistic, rethinking suicide: why prevention fails, and how we can do better. New York, 2021; online edn Oxford Academic, 1 June 2021. https://doi.org/10.1093/med-psych/ 9780190050634.003.0003, accessed 4 Feb. 2024.
  5. Sher L, Kahn RS. Suicide in schizophrenia: an educational overview. Medicina (Kaunas). 2019 Jul 10;55(7):361. doi: 10.3390/medicina55070361. PMID: 31295938; PMCID: PMC6681260.
  6. Bertolote JM, Fleischmann A. Suicide and psychiatric diagnosis: a worldwide perspective. World Psychiatry. 2002 Oct;1(3):181-5. PMID: 16946849; PMCID: PMC1489848.
  7. Vishnevskaya OA, Petrova NN. Suicidal behavior of patients in remission of schizophrenia. Suicidology. 2014;5(1,14):35-41 (in Russian).
  8. Ventriglio A, Gentile A, Bonfitto I, Stella E, Mari M, Steardo L, Bellomo A. Suicide in the early stage of schizophrenia. Front Psychiatry. 2016 Jun 27;7:116. doi: 10.3389/fpsyt.2016.00116. PMID: 27445872; PMCID: PMC4921745.
  9. Berardelli I, Rogante E, Sarubbi S, Erbuto D, Lester D, Pompili M. The importance of suicide risk formulation in schizophrenia. Front Psychiatry. 2021 Dec 16;12:779684. doi: 10.3389/fpsyt.2021.779684. PMID: 34975579; PMCID: PMC8716825.
  10. Zotov PB, Bokhan NA, Khokhlov MS, Spaderova NN. The proportion of drug addicts among completed suicides. Siberian Herald of Psychiatry and Addiction Psychiatry. 2019;3(104):49-54. https://doi.org/10.26617/1810-3111-2019-3(104)-49-54 (in Russian).
  11. Polozhy BS. Conceptual model of suicidal behavior. Suicidology. 2015;6(1,18):3-7 (in Russian).
  12. PolozhyBS. Integrative model of suicidal behavior. Russian Journal of Psychiatry. 2010;4(55-62) (in Russian).
  13. Pisani AR, Murrie DC, Silverman MM. Reformulating Suicide Risk Formulation: From Prediction to Prevention. Acad Psychiatry. 2016 Aug; 40(4):623-9. doi: 10.1007/s40596-015-0434-6. Epub 2015 Dec 14. PMID: 26667005; PMCID: PMC4937078.
  14. Silverman MM. Suicide risk assessment and suicide risk formulation: essential components of the therapeutic risk management model. J Psychiatr Pract. 2014 Sep;20(5):373-8. doi: 10.1097/01. pra.0000454784.90353.bf. PMID: 25226200.
  15. Canetto SS, Sakinofsky I. The gender paradox in suicide. Suicide Life Threat Behav. 1998 Spring;28(1):1-23. PMID: 9560163.
  16. Fleischhacker WW, Kane JM, Geier J, Karayal O, Kolluri S, Eng SM, Reynolds RF, Strom BL. Completed and attempted suicides among 18,154 subjects with schizophrenia included in a large simple trial. J Clin Psychiatry. 2014 Mar;75(3):e184-90. doi: 10.4088/JCP.13m08563. PMID: 24717389.
  17. Zhang XY, Al Jurdi RK, Zoghbi AW, Chen DC, Xiu MH, Tan YL, Yang FD, Kosten TR. Prevalence, demographic and clinical correlates of suicide attempts in Chinese medicated chronic inpatients with schizophrenia. J Psychiatr Res. 2013 Oct; 47(10):1370-5. doi: 10.1016/j.jpsychires. 2013.05.024. Epub 2013 Jun 20. PMID: 23791457.
  18. Carlborg A, Winnerbäck K, Jönsson EG, Jokinen J, Nordström P. Suicide in schizophrenia. Expert Rev Neurother. 2010 Jul;10(7):1153-64. doi: 10.1586/ern.10.82. PMID: 20586695.
  19. Pompili M, Serafini G, Innamorati M, Lester D, Shrivastava A, Girardi P, Nordentoft M. Suicide risk in first episode psychosis: a selective review of the current literature. Schizophr Res. 2011 Jun;129(1):1-11. doi: 10.1016/j.schres.2011.03.008. Epub 2011 May 6. PMID: 21530179.
  20. Schenkel LS, Spaulding WD, DiLillo D, Silverstein SM. Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits. Schizophr Res. 2005 Jul 15;76(2-3):273-86. doi: 10.1016/j.schres.2005.03.003. PMID: 15949659.
  21. Misiak B, Frydecka D. A history of childhood trauma and response to treatment with antipsychotics in first-episode schizophrenia patients: preliminary results. J Nerv Ment Dis. 2016 Oct;204(10):787-792. doi: 10.1097/NMD.0000000000000567. PMID: 27441460.
  22. Uçok A, Bikmaz S. The effects of childhood trauma in patients with first-episode schizophrenia. Acta Psychiatr Scand. 2007 Nov;116(5):371-7. doi: 10.1111/j.1600-0447.2007.01079.x. PMID: 17919156.
  23. Larkin W, Read J. Childhood trauma and psychosis: evidence, pathways, and implications. J Postgrad Med. 2008 Oct-Dec;54(4):287-93. doi: 10.4103/0022-3859.41437. PMID: 18953148.
  24. Immonen J, Jääskeläinen E, Korpela H, Miettunen J. Age at onset and the outcomes of schizophrenia: A systematic review and meta-analysis. Early Interv Psychiatry. 2017 Dec;11(6):453-460. doi: 10.1111/eip.12412. Epub 2017 Apr 27. PMID: 28449199; PMCID: PMC5724698.
  25. Grover S, Sahoo S, Nehra R. A comparative study of childhood/adolescent and adult onset schizophrenia: does the neurocognitive and psychosocial outcome differ? Asian J Psychiatr. 2019 Jun;43:160-169. doi: 10.1016/j.ajp.2019.05.031. Epub 2019 May 20. PMID: 31176081.
  26. Bornheimer LA, Wojtalik JA, Li J, Cobia D, Smith MJ. Suicidal ideation in first-episode psychosis: Considerations for depression, positive symptoms, clinical insight, and cognition. Schizophr Res. 2021 Feb;228:298-304. doi: 10.1016/j.schres.2020.12.025. Epub 2021 Jan 23. PMID: 33493778; PMCID: PMC7987901.
  27. Kasckow J, Felmet K, Zisook S. Managing suicide risk in patients with schizophrenia. CNS Drugs. 2011 Feb;25(2):129-43. doi: 10.2165/11586450-000000000-00000. PMID: 21254789; PMCID: PMC3056073.
  28. Dutta R, Murray RM, Hotopf M, Allardyce J, Jones PB, Boydell J. Reassessing the long-term risk of suicide after a first episode of psychosis. Arch Gen Psychiatry. 2010 Dec;67(12):1230-7. doi: 10.1001/archgenpsychiatry.2010.157. PMID: 21135323.
  29. Kornetova EG, Gerasimova VI, Kornetov AN, Yazykov KG, Goncharova AA, Mednova IA, Semke AV, Ivanova SA, Bokhan NA. The influence of cognitive functions on the level of suicide risk in patients with schizophrenia. Suicidology. 2020;11(4,41):13-25. doi:10.32878/suiciderus.20-11-04(41)-13-25(in Russian).
  30. Gerasimova VI, Kornetova EG, Goncharova AA, Mednova IA, Kornetov AN, Semke AV. Relationship between self-assessment of social adaptation and suicidal risk in patients with schizophrenia. Psychiatry. 2021;19(3,91):34-40. https://doi. org/10.30629/2618-6667-2021-19-3-34-40 (in Russian).
  31. Grover LE, Jones R, Bass NJ, McQuillin A. The differential associations of positive and negative symptoms with suicidality. Schizophr Res. 2022 Oct; 248:42-49. doi: 10.1016/j.schres.2022.07.016. Epub 2022 Aug 4. PMID: 35933743.
  32. Lyubov EB. Risk factors for suicidal behavior in patients with schizophrenia. Russian Journal of Psychiatry. 2018;4:24-30 (in Russian).
  33. Fenton WS, McGlashan TH, Victor BJ, Blyler CR. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. Am J Psychiatry. 1997 Feb;154(2):199-204. doi: 10.1176/ajp.154.2.199. PMID: 9016268.
  34. Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, Montross LP, Mortensen PB, Munk-Jørgensen P, Nielsen J, Nordentoft M, Saarinen PI, Zisook S, Wilson ST, Tatarelli R. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry. 2007 Mar 16; 6:10. doi: 10.1186/1744-859X-6-10. PMID: 17367524; PMCID: PMC1845151.
  35. De Hert M, McKenzie K, Peuskens J. Risk factors for suicide in young people suffering from schizophrenia: a long-term follow-up study. Schizophr Res. 2001 Mar 1;47(2-3):127-34. doi: 10.1016/s0920-9964(00)00003-7. PMID: 11278129.
  36. Montross LP, Zisook S, Kasckow J. Command hallucinations and suicide risk / In: R. Tatarelli, M. Pompili, P. Girardi (Eds.). Suicide in schizophrenia. Nova Biomedical Books, 2007:113-132.
  37. Kornetova EG, Galkin SA, Kornetov AN, Mednova IA, Kozlova SM, Bokhan NA. Cross-sectional psychometric study of patients with paranoid schizophrenia with or without a history of suicide attempts. Suicidology. 2024;15(1,54):170-182. doi: 10.32878/suiciderus.24-15-01(54)-170-182 (in Russian).
  38. Wong Z, Öngür D, Cohen B, Ravichandran C, Noam G, Murphy B. Command hallucinations and clinical characteristics of suicidality in patients with psychotic spectrum disorders. Compr Psychiatry. 2013 Aug;54(6):611-7. doi: 10.1016/j.comppsych.2012.12.022. Epub 2013 Jan 31. PMID: 23375263.
  39. Buchanan A, Sint K, Stefanovics E, Rosenheck R. An 18-month longitudinal study of suicidality in patients diagnosed with schizophrenia. Schizophr Res. 2020 Oct; 224:102-107. doi: 10.1016/j.schres.2020.09.019. Epub 2020 Oct 9. PMID: 33046335.
  40. Olfson M, Wall M, Wang S, Crystal S, Liu SM, Gerhard T, Blanco C. Short-term suicide risk after psychiatric hospital discharge. JAMA Psychiatry. 2016 Nov 1;73(11):1119-1126. doi: 10.1001/jamapsychiatry.2016.2035. PMID: 27654151; PMCID: PMC8259698.
  41. Krause TJ, Lederer A, Sauer M, Schneider J, Sauer C, Jabs B, Etzersdorfer E, Genz A, Bauer M, Richter S, Rujescu D, Lewitzka U. Suicide risk after psychiatric discharge: study protocol of a naturalistic, long-term, prospective observational study. Pilot Feasibility Stud. 2020 Sep 30;6:145. doi: 10.1186/s40814-020-00685-z. PMID: 33005433; PMCID: PMC7526195.
  42. Balhara YP, Verma R. Schizophrenia and suicide. East Asian Arch Psychiatry. 2012 Sep;22(3):126-33. PMID: 23019287.
  43. Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol. 2010 Nov;24(4 Suppl):81-90. doi: 10.1177/1359786810385490. PMID: 20923923; PMCID: PMC2951591.
  44. Braga RJ, Reynolds GP, Siris SG. Anxiety comorbidity in schizophrenia. Psychiatry Res. 2013 Nov 30;210(1):1-7. doi: 10.1016/j.psychres.2013.07.030. Epub 2013 Aug 7. PMID: 23932838.
  45. Shenoy S, Praharaj SK. Risk factors associated with suicide attempts in patients with schizophrenia: an observational study from South India. Middle East Curr Psychiatry. 2023;30(48). https://doi.org/10.1186/s43045-023-00319-z
  46. Xie M, Zou X, Xie Y, Hu L, Tang Y, Cai J, Kuang Y, Zhu L, Zou M, Wang Q. Childhood trauma and suicide risk in hospitalized patients with schizophrenia: the sequential mediating roles of pandemic related post-traumatic stress symptoms, sleep quality, and psychological distress. Front Psychiatry. 2023 Sep 21;14:1221529. doi: 10.3389/fpsyt.2023.1221529. PMID: 37810605; PMCID: PMC10551446.
  47. Khokhar JY, Dwiel LL, Henricks AM, Doucette WT, Green AI. The link between schizophrenia and substance use disorder: A unifying hypothesis. Schizophr Res. 2018 Apr;194:78-85. doi: 10.1016/j.schres.2017.04.016. Epub 2017 Apr 14. PMID: 28416205; PMCID: PMC6094954.
  48. Moggi F. Epidemiologie, Ätiologie und Behandlung von Patienten mit Psychosen und komorbider Suchterkrankung [Epidemiology, etiology and treatment of patients with psychosis and co-morbid substance use disorder]. Ther Umsch. 2018 Jun;75(1):37-43. German. doi: 10.1024/0040-5930/a000964. PMID: 29909760.
  49. Kavanagh DJ, McGrath J, Saunders JB, Dore G, Clark D. Substance misuse in patients with schizophrenia: epidemiology and management. Drugs. 2002;62(5):743-55. doi: 10.2165/00003495-200262050-00003. PMID: 11929329.
  50. Pompili M, Tatarelli C, Kotzalidis GD, Tatarelli R. Suicide risk in substance abusers with schizophrenia / In: R. Tatarelli, M. Pompili, P. Girardi (Eds.) Suicide in schizophrenia. Nova Biomedical Books, 2007:157-174.
  51. King SA. Opioids, suicide, mental disorders, and pain. Psychiatry Times 2018;35, 11. Available online: https://www.psychiatrictimes.com/psychopharmacology/opioids-suicide-mental-disorders-and-pain (accessed on 24 April 2019).
  52. Coughlin SS, Sher L. Suicidal behavior and neurological illnesses. J Depress Anxiety. 2013 Apr 18;Suppl 9(1):12443. doi: 10.4172/2167-1044.S9-001. PMID: 24501694; PMCID: PMC3910083.
  53. Cassidy RM, Yang F, Kapczinski F, Passos IC. Risk factors for suicidality in patients with schizophrenia: A systematic review, meta-analysis, and meta-regression of 96 studies. Schizophr Bull. 2018 Jun 6;44(4):787-797. doi: 10.1093/schbul/sbx131. PMID: 29036388; PMCID: PMC6007264.
  54. Seemüller F, Schennach R, Mayr A, Musil R, Jäger M, Maier W, Klingenberg S, Heuser I, Klosterkötter J, Gastpar M, Schmitt A, Schlösser R, Schneider F, Ohmann C, Lewitzka U, Gaebel W, Möller HJ, Riedel M; German Study Group on First-Episode Schizophrenia. Akathisia and suicidal ideation in first-episode schizophrenia. J Clin Psychopharmacol. 2012 Oct;32(5):694-8. doi: 10.1097/JCP.0b013e3182677958. PMID: 22926606.
  55. Seemüller F, Lewitzka U, Bauer M, Meyer S, Musil R, Schennach R, Riedel M, Doucette S, Möller HJ. The relationship of Akathisia with treatment emergent suicidality among patients with first-episode schizophrenia treated with haloperidol or risperidone. Pharmacopsychiatry. 2012 Nov;45(7):292-6. doi: 10.1055/s-0032-1309004. Epub 2012 May 21. PMID: 22614116.
  56. Kornetova EG, Dmitrieva EG, Dubrovskaya VV, Mednova IA, Goncharova AA, Kornetov AN, Semke AV Ivanova SA, Bokhan NA. Suicidal behavior in patients with schizophrenia and metabolic syndrome. Suicidology. 2019;10(2,35):92-98. doi: 10.32878/suiciderus.19-10-02(35)-92-98 (in Russian).
  57. Kornetova EG, Goncharova AA, Kornetov AN, Davydov AA, Dubrovskaya VV, Semke AV, Bokhan NA. The relationship between suicidal behavior and hopelessness and akathisia in patients with schizophrenia. Suicidology;2018;9(3,32):63-70. doi: 10.32878/suiciderus.18-09-03(32)-63-70 (in Russian).
  58. Ran MS, Wong YI, Yang SY, Ho PS, Mao WJ, Li J, Chan CL. Marriage and outcomes of people with schizophrenia in rural China: 14-year follow-up study. Schizophr Res. 2017 Apr;182:49-54. doi: 10.1016/j.schres.2016.10.034. Epub 2016 Oct 28. PMID: 28029516.
  59. Bornheimer LA, Li J, Im V, Taylor M, Himle JA. The role of social isolation in the relationships between psychosis and suicidal ideation. Clin Soc Work J. 2020;48(1):54-62. doi: 10.1007/s10615-019-00735-x
  60. Lyubov EB, Tsuprun VE. Suicidal behavior and schizophrenia: A biopsychosocial approach to diagnosis, treatment and prevention. Suicidology. 2013;4(3,12):3-16 (in Russian).
  61. Moutier CY, Pisani AR, Stahl SM. Suicide prevention / In: Stahl SM, editor. Stahl's Essential Psychopharmacology Handbooks. Cambridge: Cambridge University Press, 2021:95.