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Abstract
<p><strong>Objective:</strong> This study prospectively followed up, after a period of 20 years, a group of patients with schizophrenia who were considered to be at high risk for suicide. In Part 1, we reported on outcome and associated social factors, and in this paper we discuss re-evaluated suicide risk in these patients and investigated symptomology and pharmacotherapy over the last 2 decades.</p><p><strong> Method:</strong> The subjects were interviewed, and a questionnaire evaluating suicide risk was completed. The Beck Hopelessness Scale (BHS) was administered and ratings were compared to those from the original study. The Calgary Depression Scale for Schizophrenia (CDSS) was also administered. Cross tabulations were then performed to identify factors associated with increased suicide risk. For those subjects who committed suicide since the original study, a psychological autopsy was performed.</p><p><strong>Results:</strong> Fourteen of the original 33 high suicide risk schizophrenia patients were found. Three subjects committed suicide during the 20 year period. Among the living subjects, risks for suicide were found to be lower than 20 years ago. Hopelessness and depressive symptoms correlated with independently evaluated suicide risk. Social withdrawal, blunting of affect and delusions were also associated with elevated risk. Good insight into illness and a history of previous suicide attempts correlate with high suicide risk. Cannabis abuse, poor or periodic adherence to treatment, as well as weight gain, akathisia and parkinsonian adverse effects were also associated with an increase in risk for suicide. Formal thought disorder, avolition and cognitive impairment were associated with lower risk of suicide.</p><p><strong>Conclusion:</strong> Hopelessness, depression, certain positive symptoms and adverse effects of medication, found in this study to be congruent with suicide risk in patients with schizophrenia, coincide with those mentioned in the literature. Despite current knowledge about this subject, suicide remains notoriously and ominously unpredictable in patients with schizophrenia.</p>
Highlights
Demographic factors and those related to illness course found to be associated with suicide risk in patients with schizophrenia in this study are in accord with those reported in the literature
Recent research consistently indicates the incidence in people suffering from schizophrenia to be at least 20 times higher.[1,3,4]
In this article – the first of two – we report on the current suicide risk in the cohort and its association with the following factors: Volume 15 No 3 October 2009 - SAJP
Summary
Subjects were contacted and interviewed face to face using a questionnaire devised for this purpose. The Beck Hopelessness Scale (BHS) was administered and ratings were compared with those from the original study. A psychological autopsy was performed for those subjects who had committed suicide since the original study. In 1992 Roos et al.[15] published the retrospective empirical study, entitled ‘Suicide among patients with schizophrenia’ (translated). Thirty-three Caucasian subjects who had committed suicide and suffered from schizophrenia were compared with a control group of high-risk subjects with schizophrenia of the same ethnic background treated at Weskoppies Hospital, Pretoria. Contact details from patient records were utilised, as well as information from local clinics. In many cases these details were outdated and insufficient, since a significant number of subjects had disengaged from services provided at Weskoppies Hospital many years earlier. The frequent socio-economic difficulties and high mobility of this patient population further hindered our ability to find many of the subjects
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