Suizidalität bei schizophrenen Psychosen: eine aktuelle Übersicht

Suicidality in schizophrenic psychosis: a current overview

Zusammenfassung

Hintergrund

Suizidalität bei schizophrenen Psychosen ist ein wichtiges, jedoch im klinischen Alltag in seiner Rezeption aus Sicht der Autoren hinter die Suizidalität bei affektiven Erkrankungen aktuell zurücktretendes Thema. Schizophrene Psychosen sind als eigenständige Risikofaktoren für Suizidversuche und vollendete Suizide anerkannt, wobei sie aufgrund ihrer häufigen Unvorhersehbarkeit, Abruptheit und Brutalität der verwendeten Methoden den klinisch Tätigen vor besondere Herausforderungen stellen und oftmals das Umfeld verstört zurücklassen.

Ziele der Arbeit

Es soll ein Überblick über die vorhandene relevante Literatur zum Thema Suizidalität bei Psychosen gegeben werden. Ausführungen zur Psychodynamik, Hinweise zu Pharmako- und Psychotherapie und Überlegungen zur Prävention runden die Arbeit ab und bieten insbesondere dem klinisch Tätigen einen aktuellen Überblick zu diesem Thema.

Material und Methoden

Es erfolgten PubMed- und Google-scholar-Suchen mit den Begriffen „suicide“, „suicidality“, „schizophrenia“, „suicide AND schizophrenia“, „suicide AND psychosis“, „suicidality AND schizophrenia“, „suicidality AND psychosis“, „suicidality AND psychosis AND prevention“, „suicide AND psychosis AND prevention“, „suicidality AND schizophrenia AND prevention“, „suicide AND schizophrenia AND prevention“.

Diskussion

Die Kenntnis der spezifischen Risikofaktoren für Suizidalität bei psychotischen Patienten, die Besonderheiten der Suizidalität hinsichtlich ihrer Ausgestaltung und ihrem zeitlichen Zusammenhang mit einer Behandlung muss klinisch Tätigen bekannt sein. Die Exploration und Einschätzung der Suizidalität ist bei psychotischen Patienten oftmals schwieriger als bei affektiv Erkrankten oder an einer Persönlichkeitsstörung leidenden Patienten, da es sich häufig um impulsive Suizidversuche handelt, die sich aus (plötzlich auftretenden) psychotischen Symptomen ableiten lassen und somit nur schwer bis gar nicht vorhersehbar sind.

Abstract

Background

Suicidality in schizophrenic psychosis is an important topic but stands in clinical everyday work behind the perception of suicide especially in affective disorders. Schizophrenic psychosis is recognized as an independent risk factor for suicide attempts and suicides, whereas it poses particular challenges to the clinical professional due to the frequent unpredictability, abruptness and brutality of the methods used. For this reason, the suicide of a psychotic patient often leaves the professional and non-professional environment disturbed.

Aims

An overview of the existing relevant literature on suicide in psychosis is given. Explanations on the psychodynamics, indications on pharmacotherapy and psychotherapy and considerations on prevention round off this article and provide an up to date overview of this topic for clinicians.

Material and methods

A search was carried out in PubMed and Google scholar using the terms “suicide”, “suicidality”, “schizophrenia”, “suicide AND schizophrenia”, “suicide AND psychosis”, “suicidality AND schizophrenia”, “suicidality AND psychosis”, “suicidality AND psychosis AND prevention”, “suicide AND psychosis AND prevention”, “suicidality AND schizophrenia AND prevention”, “suicide AND schizophrenia AND prevention”.

Conclusion

Clinicians must have knowledge of the specific risk factors for suicide in psychotic patients, the characteristics of suicide in terms of design and temporal connection with treatment. The exploration and assessment of suicidality is often more difficult in psychotic patients than in affective or personality disorder patients, as there are often impulsive suicide attempts that can be explained by (suddenly occurring) psychotic symptoms and are therefore difficult or even impossible to foresee.

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Notes

  1. 1.

    Grad B bedeutet eine Empfehlung mit der Syntax „soll/sollte“ und korreliert mit einer mittleren Evidenzstärke. Quelle: https://www.awmf.org/leitlinien/awmf-regelwerk/ll-entwicklung/awmf-regelwerk-03-leitlinienentwicklung/ll-entwicklung-graduierung-der-empfehlungen.html. Abgerufen am 01.04.2020.

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Correspondence to Dr. med. Roman Knorr.

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Knorr, R., Hoffmann, K. Suizidalität bei schizophrenen Psychosen: eine aktuelle Übersicht. Nervenarzt (2020). https://doi.org/10.1007/s00115-020-01028-2

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Schlüsselwörter

  • Suizidalität
  • Suizidversuch
  • Suizid
  • Psychose
  • Schizophrenie

Keywords

  • Suicidality
  • Suicide attempt
  • Suicide
  • Psychosis
  • Schizophrenia