Abstract
Suicide is a relevant leading cause of death among patients affected by schizophrenia. Even if suicidal ideation may be present in different stages of disease, some differences have been described between the risk of suicide in patients experiencing first episode of psychosis and those with long-term schizophrenia. It is particularly higher during the first year of illness and reaches a steady decline over the following years. Suicidal ideation and attempts may also be common among subjects with subthreshold psychotic experiences. Factors associated with the risk of suicide in the early phase of schizophrenia are previous suicidal attempts and social aspects: the lack of social support and stable relationships, social drift after the first episode, and social impairment. Also, several psychotic symptoms (suspiciousness, paranoid delusions, mental disintegration and agitation, negative symptoms, depression and hopelessness, and command hallucinations) and substance abuse are associated with higher risk of suicide. It has been described that perfectionism and good levels of insight among individuals who have recently developed psychotic symptoms are significantly associated with higher numbers of suicidal attempts. Moreover, recent evidences show that prefrontal cortex-based circuit dysfunction may be related to suicide in the early stage of schizophrenia. This narrative review summarizes available evidences on suicide in the early stage of schizophrenia and deals with issues to be further studied and discussed.
Highlights
The risk of suicide can be valued in a multistage continuum, which includes suicidal ideation, as a critical initial step, attempted, and completed suicide
The long-term suicide risk in subjects without mental disorders is 0.3%, whereas the risk measured among mentally ill patients ranges from 3.4% for people affected by one mental disorder to 6.2% for people reporting more than one psychiatric disorder: each additional psychiatric diagnosis seems to contribute significantly to increase risk of suicide [1]
Suicide is a relevant leading cause of death among patients affected by schizophrenia spectrum disorders, and the rate of attempted suicide in psychotic patients ranges from 10 to 50% [3, 4]
Summary
The risk of suicide can be valued in a multistage continuum, which includes suicidal ideation (ideation, intent, and plans), as a critical initial step, attempted, and completed suicide. Suicide is a relevant leading cause of death among patients affected by schizophrenia spectrum disorders, and the rate of attempted suicide in psychotic patients ranges from 10 to 50% [3, 4]. Suicide in the Early Stage of Schizophrenia than those reported for patients affected by other psychiatric conditions: 0.24 and 0.74 per 100 person years, respectively [9]. The delay in accessing the mental health-care system and starting treatment (called DUP) may greatly contribute to increase suicide risk among schizophrenia patients at FEP [12]. During the acute phase of schizophrenia, psychotic experiences (distressing delusions, command hallucinations, or passivity phenomena) and feelings, such as fear, stigma, and loss (in patients with some degree of insight), are relevant factors for suicide. Risk of suicide during the following phase of post-psychotic recovery may be related to the loss of role and function mostly due to neurocognitive sequelae [13]
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