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Suicide Risk in Schizophrenia

To the Editor: We read with great interest the excellent article by Hannele Heilä, M.D., and colleagues (1) on the clinical characteristics of suicide victims with schizophrenia in the general population of Finland. One important finding of this study is that suicide may occur at any point during the course of the illness, since three-fourths of the suicides were committed during an active phase. Previous reports, focusing especially on attempted suicide, had led to the general conclusion that active psychotic features were less important than depression and hopelessness in the assessment of suicide risk in schizophrenic patients (2, 3). When we studied the more severe forms of attempted suicide, however, 81% of the schizophrenic subjects presented positive psychotic symptoms at the time of attempting suicide (4). Our study also stressed the importance of previous attempts and the fact that more than one-quarter of the schizophrenic subjects were receiving psychiatric inpatient care when they attempted suicide, a finding similar to those of Heilä et al. (1). Therefore, we believe that clinicians should keep in mind that not only demoralization or depressive symptoms are important in the assessment of suicide risk in schizophrenia, but positive psychotic symptoms are even more significantly related to the risk of a serious attempt or suicide.

REFERENCES

1. Heilä H, Isometsä ET, Henriksson MM, Heikkinen ME, Marttunen MJ, Lönnqvist JK: Suicide and schizophrenia: a nationwide psychological autopsy study on age- and sex-specific clinical characteristics of 92 suicide victims with schizophrenia. Am J Psychiatry 1997; 154:1235–1242[Abstract]
2. Roy A, Mazonson A, Pickar D: Attempted suicide in chronic schizophrenia. Br J Psychiatry 1984; 144:303–306[Abstract/Free Full Text]
3. Drake R, Gates CH, Cotton P: Suicide among schizophrenics: a comparison of attempters and complete suicide. Br J Psychiatry 1986; 149:784–787[Abstract/Free Full Text]
4. Nieto E, Vieta E, Gastó C, Vallejo J, Gastó C: Suicide attempts of high medical seriousness in schizophrenic patients. Compr Psychiatry 1992; 33: 384–387

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