Abstract
Purpose of Review
The main purpose of this review is to elucidate the interplay of various factors in the relationship between suicide and schizophrenia. Suicide and schizophrenia have been interlinked as a symptom, factor in recovery and prognosis, outcome measure and response to psychotic symptoms in patients with schizophrenia. Many biomarkers have been identified in relation to the two phenomena.
Recent Findings
The analysis of the papers of the last 5 years (2015–2019) and till date has revealed studies looking at outcomes in relation to suicide, biological markers to determine the protection from and occurrence of suicide in schizophrenia and demographic factors that play a role in the occurrence of suicide in patients with schizophrenia.
Summary
Suicide is a common occurrence in patients with schizophrenia and must be studied further in diverse populations of the disorder to help determine exact relationships between these two variables that will aid in clinical recovery, better outcome and improve prognosis.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Chong HY, Teoh SL, Wu DB, Kotirum S, Chiou CF, Chaiyakunapruk N. Global economic burden of schizophrenia: a systematic review. Neuropsychiatr Dis Treat. 2016;12:357.
Aydın M, Ilhan BC, Tekdemir R, Çokünlü Y, Erbasan V, Altınbaş K. Suicide attempts and related factors in schizophrenia patients. Saudi Med J. 2019;40:475–82.
• Ventriglio A, Gentile A, Bonfitto I, Stella E, Mari M, Steardo L, et al. Suicide in the early stage of schizophrenia. Front Psychiatry. 2016;7:116 a good review of suicide in the early stages of schizophrenia.
Sher L, Kahn RS. Suicide in schizophrenia: an educational overview. Medicina. 2019;55:361.
• Sher L, Kahn RS. Family interventions and prevention of suicide in first-episode schizophrenia. Acta Psychiatr Scand. 2019;139:484–93 a good overview of family based interventions in schizophrenia.
•• Taylor PJ, Hutton P, Wood L. Are people at risk of psychosis also at risk of suicide and self-harm? A systematic review and meta-analysis. Psychol Med. 2015;45:911–26 a large systematic review on self harm and suicide in patients with schizophrenia where various factors have been considered.
Fusar-Poli P, Yung AR, McGorry P, Van Os J. Lessons learned from the psychosis high-risk state: towards a general staging model of prodromal intervention. Psychol Med. 2014;44:17–24.
Coentre R, Talina MC, Góis C, Figueira ML. Depressive symptoms and suicidal behavior after first-episode psychosis: a comprehensive systematic review. Psychiatry Res. 2017;253:240–8.
Jakhar K, Beniwal RP, Bhatia T, Deshpande SN. Self-harm and suicide attempts in schizophrenia. Asian J Psychiatry. 2017;30:102–6.
Shrivastava A, Johnston M, Campbell R, De Sousa A, Shah N. Serum cholesterol and suicide in first episode psychosis: a preliminary study. Indian J Psychiatry. 2017;59:478–82.
Shrivastava A, Jadhav V, Karia S, Shah N, De Sousa A. Serum thyroid stimulating hormone levels and suicidal tendency in patients with first-episode schizophrenia: an exploratory study. Thyroid Res Pract. 2016;13:63–6.
Praharaj SK. Thyroid abnormalities and suicidality in patients with first-episode schizophrenia. Thyroid Res Pract. 2016;13:147.
• Notaras M, Hill R, Van den Buuse M. A role for the BDNF gene Val66Met polymorphism in schizophrenia? A comprehensive review. Neurosci Biobehav Rev. 2015;51:15–30 good review on the genetic relationship of the BDNF gene and schizophrenia.
Rao J, Chiappelli J, Kochunov P, Regenold WT, Rapoport SI, Hong LE. Is schizophrenia a neurodegenerative disease? Evidence from age-related decline of brain-derived neurotrophic factor in the brains of schizophrenia patients and matched nonpsychiatric controls. Neurodegener Dis. 2015;15:38–44.
• Shrivastava A, Avinash De Sousa G. Brain-derived neurotrophic factor and suicide in schizophrenia: critical role of neuroprotective mechanisms as an emerging hypothesis. Indian j Psychol Med. 2016;38(6):499–504 good review on the various mechanisms by which BDNF plays a role in schizophrenia.
Jacomb I, Stanton C, Vasudevan R, Powell H, O'Donnell M, Lenroot R, et al. C-reactive protein: higher during acute psychotic episodes and related to cortical thickness in schizophrenia and healthy controls. Front Immunol. 2018;9:2230.
Sisek-Šprem M, Gradiški IP, Žaja N, Herceg M. The longitudinal course of schizophrenia: testosterone and progression of the negative symptoms. Nordic J Psychiatry. 2020;74(2):147–54.
• Lodha P, Karia S. Testosterone and schizophrenia: a clinical review. Ann Indian Psychiatry. 2019;3:92–6 good review on various aspects of schizophrenia and its relationship to serum testosterone levels.
Hettige NC, Bani-Fatemi A, Sakinofsky I, De Luca V. A biopsychosocial evaluation of the risk for suicide in schizophrenia. CNS Spectr. 2018;23(4):253–63.
Tanskanen A, Tiihonen J, Taipale H. Mortality in schizophrenia: 30-year nationwide follow-up study. Acta Psychiatr Scand. 2018;138(6):492–9.
Volk DW, Lewis DA. Early developmental disturbances of cortical inhibitory neurons: contribution to cognitive deficits in schizophrenia. Schizophr Bull. 2014;40:952–7.
Ran MS, Wong YL, Yang SY, Ho PS, Mao WJ, Li J, et al. Marriage and outcomes of people with schizophrenia in rural China: 14-year follow-up study. Schizophr Res. 2017;182:49–54.
•• Upthegrove R, Marwaha S, Birchwood M. Depression and schizophrenia: cause, consequence, or trans-diagnostic issue? Schizophr Bull. 2017;43:240–4 excellent paper on the relationship between depression and schizophrenia.
Kline ER, Seidman LJ, Cornblatt BA, Woodberry KA, Bryant C, Bearden CE, et al. Depression and clinical high-risk states: baseline presentation of depressed vs. non-depressed participants in the NAPLS-2 cohort. Schizophr Res. 2018;192:357–63.
Marchetti I. Hopelessness: a network analysis. Cogn Ther Res. 2019;43:611–9.
• Penttilä M, Jääskeläinen E, Hirvonen N, Isohanni M, Miettunen J. Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. Br J Psychiatry. 2014;205:88–94 good paper on the relation of the duration of untreated psychosis and outcome in schizophrenia.
Barzilay S, Assounga K, Kim HJ, Rudner E, Yaseen Z, Galynker I. Psychotic symptoms predict suicidal behavior postdischarge in high risk psychiatric inpatients. J Psychiatr Pract. 2019;25:418–26.
Kjelby E, Sinkeviciute I, Gjestad R, Kroken RA, Løberg EM, Jørgensen HA, et al. Suicidality in schizophrenia spectrum disorders: the relationship to hallucinations and persecutory delusions. Eur Psychiatry. 2015;30:830–6.
Krynicki CR, Upthegrove R, Deakin JF, Barnes TR. The relationship between negative symptoms and depression in schizophrenia: a systematic review. Acta Psychiatr Scand. 2018;137:380–90.
Verma D, Srivastava MK, Singh SK, Bhatia T, Deshpande SN. Lifetime suicide intent, executive function and insight in schizophrenia and schizoaffective disorders. Schizophr Res. 2016;178:12–6.
Hassan AN, Stuart EA, De Luca V. Childhood maltreatment increases the risk of suicide attempt in schizophrenia. Schizophr Res. 2016;176:572–7.
Szmulewicz AG, Smith JM, Valerio MP. Suicidality in clozapine-treated patients with schizophrenia: role of obsessive-compulsive symptoms. Psychiatry Res. 2015;230:50–5.
• Nakajima S, Takeuchi H, Fervaha G, Plitman E, Chung JK, Caravaggio F, et al. Comparative efficacy between clozapine and other atypical antipsychotics on depressive symptoms in patients with schizophrenia: analysis of the CATIE phase 2E data. Schizophr Res. 2015;161:429–33 good paper on the effect of medical treatments on depressive symptoms and suicidality in schizophrenia.
Zaheer J, Jacob B, de Oliveira C, Rudoler D, Juda A, Kurdyak P. Service utilization and suicide among people with schizophrenia spectrum disorders. Schizophr Res. 2018;202:347–53.
Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. 2016;3:646–59.
Tarrier N, Kelly J, Maqsood S, Snelson N, Maxwell J, Law H, et al. The cognitive behavioural prevention of suicide in psychosis: a clinical trial. Schizophr Res. 2014;156:204–10.
Linehan MM, Wilks CR. The course and evolution of dialectical behavior therapy. Am J Psychother. 2015;69:97–110.
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De Sousa, A., Shah, B. & Shrivastava, A. Suicide and Schizophrenia: an Interplay of Factors. Curr Psychiatry Rep 22, 65 (2020). https://doi.org/10.1007/s11920-020-01188-7
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DOI: https://doi.org/10.1007/s11920-020-01188-7