Suicidality and Outcome in Schizophrenia Patients

Abstract

Almost half of all patients suffering from schizophrenia attempt suicide during their life emphasizing the dramatic impact of suicidality in schizophrenia illness. Today, several theoretical and biological models have been proposed to enhance the understanding of suicidality in schizophrenia patients in order to develop specific treatment strategies. A serotonergic dysfunction seems to be the underlying pathophysiological condition, imaging studies further suggest a gray matter density reduction in the temporal lobe of suicidal schizophrenia patients. This book chapter describes risk factors of suicidal action schizophrenia patients with focus on the relationship between suicidality and outcome in this patient population. Among the most prominent risk factors of suicidality in schizophrenia are a younger age, male gender, depressive symptoms, insight into illness, non-adherence to treatment and the development of side effects. Today it is still unclear if suicidality affects response to treatment, for recently published studies were not able to detect a significant association between suicidality and predefined outcome criteria. However, suicidal patients seem to be significantly impaired through depressive symptoms, with a reduced functioning level and a greater vulnerability to side effects suggesting an association between suicidality and the course of the illness and its outcome. Different measuring instruments are introduced and clinical implications are discussed. Current treatment recommendations to reduce the risk of suicidality are furthermore reviewed in order to provide a better knowledge basis for clinicians and care providers.