Suicide and schizophrenia: data from a prospective community treatment study

Article Abstract:

Suicide is the leading cause of death among schizophrenics. It is estimated that in the first 10 years of the illness, 1 in 10 schizophrenics commit suicide, and there is a lifetime incidence of 15 percent. Therefore, it is important to identify characteristics among schizophrenics that may put them at increased risk for suicide. To further examine this, eight schizophrenic young adults who ultimately committed suicide, and who were a part of a longitudinal long-term study on schizophrenics which is still in progress, were examined. This study was based on a large amount of data gathered between 1978 and 1986, and included interviewer-rated symptoms and a number of standardized tests. The original 122 subjects consisted of 82 men and 40 women who had been treated and monitored for at least four years. Out of the ten deaths that occurred during the study period, eight were determined to be suicides. These cases were reviewed for treatment condition, gender, demographic and history variables, and clinical characteristics, over the course of the study. Of the eight who committed suicide, all were male and all were Caucasian. Based on the evaluation of the data, it was concluded that young men with an early onset of schizophrenia or other related psychiatric disorders were at highest risk for suicide. The data that were most predictive of future suicide were self-reports of distress and dissatisfaction with life, more so than the assessments of the patients that were made by interviewers. Patients who eventually committed suicide showed higher rates of distress and dissatisfaction upon admission to this study than the other patients. One of the more difficult symptoms to treat, which was recognized as being associated with higher risk for suicide, was hopelessness. Oftentimes, hopelessness, as a characteristic of a schizophrenic, is seen as a realistic response by the patient to his condition, and is therefore not given enough attention. Also, bizarre behavior and psychotic symptoms, which these patients may often exhibit, may serve to distract attention from subtle but serious underlying feelings of distress, loneliness, and hopelessness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Testing, Complications and side effects, Schizophrenia, Schizophrenics

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Defense mechanisms in risk of suicide and risk of violence

Article Abstract:

Mechanisms of ego defense refer to psychological processes that are created in attempts to resolve conflicts. Relatively little empirical evidence concerning defense mechanisms is available because there are currently no reliable techniques to measure the various defenses that are utilized by individuals. A vectorial model consisting of two stages has been introduced for the understanding of suicidal and violent behavior. According to this model, an aggressive drive is initially activated and a number of biological, psychological and psychosocial variables either reduce or increase this drive. A new set of variables then directs this drive outward or inward. Violence or suicidal behavior can be explained by this model as a vectorial result of a competing set of forces. With this model in mind, 60 psychiatric inpatients were clinically observed and assessed for eight components of defense mechanisms. Out of the eight variables, a correlation between certain defense mechanisms and specific behaviors was observed. Regression was found to be significantly higher in suicidal patients than in non-suicidal patients. Violent patients utilized displacement more than nonviolent patients. It was also observed that projection and denial turned aggression outward, while repression tended to be accompanied by inwardly directed aggression. Denial was the mechanism that had the strongest negative correlation with risk of suicide but the strongest positive correlation with the risk of violence. One implication may be that the individual with a realistic view of life's stresses is more inclined to depression and suicidal tendencies than the individual who denies reality, whose mechanism encourages manifestation of aggressive drives. In general, it was surmised that defense mechanisms that function differently and specifically are an important part of the sequence of events involved in violent behavior and suicide.

Case studies, Violence, Defense mechanisms (Psychology)

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Psychodynamics of suicide, with particular reference to the young

Article Abstract:

Certain groups of patients are at increased risk for suicide, including schizophrenics, alcoholics, and depressives; more recently, those with panic disorders have also been included in this group. While patients with these disorders may be at increased risk for suicide, the majority do not commit suicide, and those who are suicidal do not necessarily cease to be suicidal when their conditions are treated. This suggests that a high risk for suicidal behavior is not in itself an explanation of suicide. In response to this argument, there has been a move to differentiate factors within high risk groups that distinguish patients who are suicidal from those who are not. Of particular concern has been the high rate of youth suicide, which has been on the rise since 1958. The literature suggests that there are two main components to suicide - an affective component and a cognitive component. The affective component of suicide refers to the rage, helplessness, despair, and guilt felt by those who commit suicide. The cognitive component refers to the meaning that is given to death by suicidal patients. For some, suicide is fantasized as a way to join a loved one who has died. For others, death is rebirth. For others still, death by suicide can be a retaliatory abandonment, revenge, self-punishment, or atonement. By evaluating the psychodynamics, or affective and cognitive states, of patients at high risk for suicide, we may be able to distinguish those who are the most likely to complete the act. This would provide an added measure of evaluation, rather than categorizing patients by risk group alone. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Prevention, Suicide prevention, Suicide victims

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