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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An act of suicide is understood as a sort of decompensation inside a schizophrenia, a cyclic psychosis as described by Leonhard, or a reactive depression, but is in particular the expression of a depressive reaction and the end result of a depressive neurotic development. 107 patients (55 men and 52 women) were under constant treatment because of suicide attempts: 37 cases of depressive neurosis, 23 cases of depressive reaction, 7 cases of reactive depression, 10 cases of hysterical reaction, 8 alcoholics, and 22 endogenous psychotics. In 1974 there were still 50 patients under examination. 22 patients were no longer alive, 15 of which had committed suicide. Check-ups showed that the depressive neurotics and reactive depressives had an emotive personality stress, whilst the cases of depressive reaction appeared mostly beyond help.
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PMID:[Catamnestic studies of 107 patients receiving inpatient treatment 1966-1969 because of attempted suicide]. 12 54

This paper discusses the magnitude of the effect of life events in the causation of psychiatric illness. It is argued that an established epidemiological concept, relative risk, provides a useful measure of association which can be approximately adapted for retrospective controlled studies. Examination of studies employing general population controls consistently indicates effects of some importance, with risks of illness increased by factors of between 2 and 7 in the 6 months after an event. Risks are greater for the more stressful types of events, greater for depression and neuroses than schizophrenia, and even greater for suicide attempts. However, similar events occur commonly and a large proportion of event occurrences are not followed by illness. Events must interact with a wide variety of background factors, and the appropriate model is one of multifactorial causation.
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PMID:Contribution of life events to causation of psychiatric illness. 65 98

To characterize siucidal behavior among hospitalized medical and surgical patients, all suicide attempts in the Peter Bent Brigham Hospital were surveyed for seven years. Seventeen attempts occurred, non of them fatal. Only four patients were seriously ill, two with neoplasia. All the attempts were impulsive and were associated with stress and disturbances of impulse control. Anger, not depression, was the effect most often seen before the attempts. In all cases the precipitating stress was loss of emotional support. However, patient vulnerability to suicide seemed to be the key determinant. Fifteen patients had mental disorders, including eight with personality disorders, three with schizophrenia, three with organic brain syndromes, and one with manic depressive psychosis. Seven were psychotic, and six had made prior suicide attempts. These findings suggest that the characteristics of impulsive suicide should be considered when a suicide prevention program is being developed for a general hospital.
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PMID:Suicide attempts by hospitalized medical and surgical patients. 124 68

Low concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in cerebrospinal fluid (CSF) are associated with suicidal behaviour in patients with depressive illness, but studies of the relation between CSF 5-HIAA and suicide in schizophrenia have been inconclusive and have not included long-term follow-up. In a prospective study, we measured 5-HIAA in CSF taken from 30 schizophrenic patients in a drug-free state, and followed these patients for 11 years. 10 patients made suicide attempts during follow-up. Suicide attempters had significantly lower concentrations of CSF 5-HIAA at initial evaluation than non-attempters (mean [SE] 6.7 [2.2] vs 23.6 [5.6] ng/ml, p < 0.05). Our findings provide further evidence of the relation between serotoninergic dysfunction and suicide, and suggest a role for drugs with serotoninergic effects in schizophrenia.
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PMID:5-Hydroxyindoleacetic acid in cerebrospinal fluid and prediction of suicidal behaviour in schizophrenia. 138 59

Suicide has been associated traditionally with major depression, alcoholism, and schizophrenia and in the past several years with alcoholism and comorbid depression. More recently, however, panic disorder has been linked with suicide attempts, and the importance of severe anxiety symptoms (panic attacks, psychic anxiety, and agitation) as possible predictors of suicide risk in patients with major affective disorder has been studied. The author discusses data sets from three such studies: (1) the Clinical Studies of the National Institute of Mental Health Collaborative Program on the Psychobiology of Depression, (2) a study on 17-hydroxycorticosteroid concentrations in inpatients with major affective disorder, and (3) a study on inpatient suicides. The author concludes by suggesting that anxiety, which is readily treatable, may in fact be one of the most clinically important symptoms in depressive disorders.
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PMID:Suicide risk factors in depressive disorders and in panic disorder. 154 56

117 subjects admitted to the Department of Emergency and Critical Care Medicine at Sapporo City General Hospital due to suicide attempts between June 1983 and August 1986 were studied. Various aspects of attempted suicide and successful suicide in patients with schizophrenia were compared with those same aspects in patients with other psychiatric conditions. Similarly, 30 patients with schizophrenia who attempted suicide between January 1975 and December 1989 while inpatients or discharged outpatients in the Department of Neuro-Psychiatry at Sapporo City General Hospital were also examined. 1) In both the transverse study in the Department of Emergency and Critical Care Medicine and the longitudinal study in the Department of Neuro-Psychiatry at Sapporo City General Hospital, suicidal behavior in patients with schizophrenia increased significantly over a 5 year period after the onset of the disease. 2) Schizophrenic patients used more lethal methods for suicide (such as a direct and violent injury to the body) than did other psychiatric patients. With regards to body injury method, there was no difference between schizophrenics and other psychiatric patients between the ages of 20 and 30, though significantly more schizophrenics between the ages of 30 and 50 chose a violent body injury method. 3) Schizophrenics attempted suicide more often at any other place out of their houses than did other psychiatric patients (depressives, neurotics, etc.) and normal subjects. The difference between schizophrenics and other psychiatric patients was particularly distinct between the ages of 30 and 50. 4) Most schizophrenic patients who attempted suicide were in an exacerbated period of the illness. Interviews immediately after suicide attempts revealed that most patients attempted suicide against their will, moved by delusional and hallucinatory experiences. It is therefore presumed that most suicide in schizophrenics, even though seemingly unexpected or impulsive, is actually provoked by rapid fluctuation of the psychosis. 5) Positive symptoms reported at the time of attempted suicide included delusion of persecution, imperious auditory hallucinations, hypochondriacal delusions, and delusion of guilt. The abnormal experience which induced suicide attempts generally consisted of delusional perceptions regarding an inability to recover health, hallucinatory commands, and acute self-disruption generated by experiences such as sudden delusional ideas. These drove the patients toward suicide. 6) Most suicide attempts were within several days or several hours of abrupt symptom exacerbation. It is noteworthy that these attempts were clustered within limited periods of time. Overt suicidal tendencies continued for several months, suggesting that there is a period in which suicide may be easily induced.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A clinical study of suicidal behavior in schizophrenic patients]. 157 Mar 64

The relationships between symptoms and both prior suicide attempts and current suicidal thinking were examined in a sample of schizophrenics at 2 points in time. Fifty subjects meeting DSM-III criteria for schizophrenia were assessed within 1 week of admission, and 41 were reassessed at a 6-month follow-up. On admission, prior suicide attempts were significantly associated with current depression, female sex, lower education and more frequent hospitalization. The association with depression remained significant at follow-up. In addition, current suicidal thinking was associated with depression at both times but also with negative symptoms at time 1 and delusions and hallucinations at time 2. These findings confirm and strengthen prior reports of an association between depression and attempted suicide.
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PMID:Attempted suicide and depression in schizophrenia. 159 63

Heart transplant programs were surveyed regarding psychosocial evaluation process, criteria, and outcomes. There was considerable disagreement among programs when a patient is rejected on psychosocial grounds with regard to the use of second opinions and how often patients are informed of the reasons. Wide discrepancies in criteria used and rates of patients refused on psychosocial grounds were discovered. More than 70% of all programs excluded patients for transplantation on the grounds of dementia, active schizophrenia, current suicidal ideation, history of multiple suicide attempts, severe mental retardation, current heavy alcohol use, and current use of addictive drugs. Lack of consensus was found for some exclusion criteria (cigarette smoking, obesity, noncompliance, recent alcohol or drug abuse, criminality, personality disorder, mild mental retardation, controlled schizophrenia, and affective disorder). The proportion of patients rejected for transplantation on psychosocial grounds ranged from 0% to 37%, with an average rate of 5.6% in the United States and 2.5% in non-U.S. programs. This survey thus supports the need for research on the validity and reliability of psychosocial selection criteria.
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PMID:Psychosocial evaluation of heart transplant candidates: an international survey of process, criteria, and outcomes. 175 61

This article reports on the evidence for the validity of psychotic major depression as a distinct subtype based on cross-sectional and 1-year prospective data from the Epidemiologic Catchment Area study. Consistent with findings from previous clinical studies, only about 14% of major depressions were accompanied by psychotic features. Psychotic as compared with nonpsychotic depression had a more severe course, as reflected in increased risk of relapse, persistence over 1 year, suicide attempts, hospitalization, comorbidity, and financial dependency. These differences could not be explained by differences in demographic characteristics or by symptom severity, as assessed by symptom profile or number of symptoms. The boundary problem with schizophrenia and bipolar affective disorder that is seen in clinical studies was also found in this sample. To our knowledge, this is the first study to examine the validity of psychotic depression in a community sample; the findings are consistent with those from clinical samples. They support the clinical significance of psychotic depression and the continuation of its inclusion as a distinct subtype in DSM-IV.
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PMID:The validity of major depression with psychotic features based on a community study. 184 25

Depressed patients and suicidal patients are common Emergency Department patrons with the potential for serious morbidity or death. Dysphoric mood, vegetative symptoms, and negative perceptions of oneself, the environment, and the future are characteristic of depression. Often, the patient is unaware of the depression and presents with a variety of somatic complaints, chronic fatigue, or pain syndromes. In these instances, the physician must consider the diagnosis of depression and ask the patient about any history of depressive symptoms. In all depressed patients, a careful history and physical examination are needed to identify any drugs or concurrent medical illnesses which might cause or exacerbate the depression. If depression is suspected or if the patient presents after a suicide attempt, then a thorough evaluation of suicide potential is mandatory. Several risk factors for completed suicide exist. Male sex, age under 19 or over 45, few social supports, and a history of previous suicide attempts are all factors associated with increased suicide rates. Concurrent chronic or severe medical illnesses and certain psychiatric illnesses, notably depression, schizophrenia, and substance abuse, also increase an individual's risk for suicide. The method of suicide attempt and the chance for rescue must also be considered when determining risk as well as the presence of an organized plan. Acute psychosis in the suicidal patient is an ominous finding and these patients should be admitted to the hospital. The physician must adopt an empathetic and nonjudgmental attitude when caring for potentially suicidal patients. Disposition can be determined after careful evaluation of risk factors, circumstances surrounding the attempt, and the patient's current feelings. Consultation with a psychiatrist or another mental health professional is desirable for any potentially suicidal patient. Many such patients can be safely treated as outpatients with proper referral; certain high-risk individuals will need to be admitted to the hospital. The decision to either hospitalize or discharge can be difficult and the emergency physician should admit the patient if doubt exists.
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PMID:Depression and suicide assessment. 200 61


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