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Suicidality and Outcome in Schizophrenia Patients

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Handbook of Schizophrenia Spectrum Disorders, Volume III

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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 in 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.

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Abbreviations

EPS:

Extrapyramidal side effects

GAF:

Global assessment of functioning scale

HAMD:

Hamilton depression rating scale

PANSS:

Positive and negative syndrome scale

SOFAS:

Social and occupational functioning scale

UKU:

Udvalg for Klinske Undersogelser side effect rating scale

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Acknowledgments

The authors thank Michael Obermeier for computing the presented figures. The naturalistic study the figures refer to was performed within the framework of the German Research network on Schizophrenia, which is funded by the German Federal Ministry for Education and Research BMBF (grant 01 GI 0233).

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, München, Germany

    Rebecca Schennach-Wolff, Florian Seemüller, Ilja Spellmann, Hans-Jürgen Möller & Michael Riedel

  2. Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, 80336, München, Germany

    Richard Musil

  3. Psychiatric Clinic, Vinzenz-von-Paul-Hospital, Rottweil, Germany

    Michael Riedel

Authors
  1. Rebecca Schennach-Wolff
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  2. Florian Seemüller
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  3. Richard Musil
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  4. Ilja Spellmann
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  5. Hans-Jürgen Möller
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  6. Michael Riedel
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Corresponding author

Correspondence to Rebecca Schennach-Wolff .

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Editors and Affiliations

  1. , Rappaport Faculty of Medicine, Technion - Israel Institute of Technolog, Haifa, Israel

    Michael S. Ritsner

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Schennach-Wolff, R., Seemüller, F., Musil, R., Spellmann, I., Möller, HJ., Riedel, M. (2011). Suicidality and Outcome in Schizophrenia Patients. In: Ritsner, M. (eds) Handbook of Schizophrenia Spectrum Disorders, Volume III. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0834-1_16

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