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Suicide and suicidal behaviour are major problems in schizophrenia. Our aim was to review the recent literature on risk factors for suicide in schizophrenia from genes to clinical characteristics to identify different pathways leading to suicide and present a life-span developmental model for suicide in schizophrenia.
We performed a database search in four databases (Medline, PubMed, PsycInfo and Web of Science) with the keywords suicide AND schizophrenia. A comprehensive hand search was also performed.
There seem to be five main pathways for schizophrenia patients leading to suicide: First is comorbid depression that leads to suicide. Second, there is a group of patients with a difficult, chronic course of illness and many relapses and exacerbations. They lose their hope progressively over time. Third group comprises patients (mostly young males) with impulsiveness, dysphoric affect and substance abuse. Fourth is a relatively small but theoretically interesting and clinically important group of mainly young patients with high premorbid functioning and above average intellectual capacity. Fifth pathway, failure in treatment, comprises patients lacking social support whose treatment has failed. We also propose a life span model showing these five different pathways to suicide in schizophrenia.
There are different pathways leading to suicide in schizophrenia. These suicidal trajectories could be useful in clinical work when evaluating patients’ possible suicide risk and treating them. They might also provoke some further research ideas and hypotheses.
Alcohol and other substance use problems are common among individuals with schizophrenia. Many of the previous studies have focused on clinical comorbidity, not on longitudinal studies aiming to look for possible causal associations. We aimed to investigate if premorbid or early substance use predicts long-term clinical and social course in schizophrenia.
A systematic review to identify potentially relevant studies was conducted. Only studies with a follow-up period of at least two years were included. We studied following outcomes: negative, positive and total symptoms, clinical remission, hospitalizations, social functioning, employment, and global outcome.
The search identified 9343 unique potentially relevant articles of which 20 studies presenting results from 24 samples met our inclusion criteria. The meta-analysis included 5 to 13 studies in each outcome category. The studied in outcome groups were mainly moderate to high heterogeneous. In meta-analysis, substance use associated modestly with outcome, all the associations (Spearman's r) were non-significant and between −0.05 and 0.10. Non-significant findings are explained by the fact that the original studies found often opposite results, indicating both worse and better long-term outcome for early substance users.
Although comorbid substance use associates with poorer outcome in schizophrenia, the early substance use has only a modest effect as a predictor of long-term outcome. This difference between these two designs may be explained for instance with poorer treatment adherence of dual diagnosed patients.
Neurocognitive impairments are a core feature of schizophrenia. The medial temporal lobe (MTL) is a brain region associated with declarative memory important in conscious acquisition and recollection of facts and events. The basal ganglia (BG) instead are linked to non-declarative memory functions such as gradual learning of skills and habits.
Acquired equivalence (AE) is a phenomenon in which prior training to treat two stimuli as an equivalent increases generalization between them. Our objective was to study this phenomenon in birth cohort setting.
To investigate whether the recall of previously learned associations and memory generalization are declined in schizophrenia, other psychoses and siblings compared to healthy controls.
The Northern Finland Birth Cohort 1966 is based upon 12, 068 women and their 12, 058 live-born children. The modified Rutger's AE-task was performed for 35 schizophrenia patients, 26 patients suffering from other psychosis, 18 siblings of psychotic subjects and 174 controls.
The behavioral data showed statistically significant impairment in both recall of learned associations and generalization in schizophrenia and other psychosis groups compared to control subjects. Siblings did not differ significantly from controls in recall of learned associations but they showed impairments in generalization.
Impairment in recall of learned associations and memory generalization seem to be present also in other psychotic disorders, not only in schizophrenia. Since decline in generalization was seen in addition in siblings the hypothesis that declarative memory could be one of endophenotypes of schizophrenia is supported by this study.
The Temperament and Character Inventory (TCI) is used to measure novelty seeking (NS), harm avoidance (HA), reward dependence RD), and persistence (P).
We will study temperament in individuals with psychosis and healthy controls.
We aim to study the stability of temperament in individuals with psychotic disorders (with onset of illness before and after first follow-up) and in healthy controls.
As part of the 31-year follow-up survey of the prospective population based Northern Finland 1966 Birth Cohort, the TCI was filled by a large sample of individuals. A subsample of psychotic individuals, with the onset of illness before (n=16) or after (n=15) the 31-year follow-up, and healthy controls (n=117) filled in these scales again at the age of 43. We studied also the association between psychotic symptoms and premorbid temperament.
The 31-year and 43-year temperament scores correlated strongly among controls (Pearson's r: NS 0.68, HA 0.60, RD 0.56, P 0.54), whereas correlations among psychotic individuals with the onset of psychosis before first follow-up were weaker (NS 0.38, HA 0.50, RD 0.17, P 0.53). High HA before the onset of illness (at age of 31 years) associated significantly with a lower likelihood of remission and with more negative, disorganization and total symptoms in the PANSS. High NS before illness associated with a higher likelihood of remission according to the PANSS.
Temperament was stable among controls, and more unstable in individuals with psychoses. Premorbid harm avoidance and novelty seeking predicts the clinical outcome in schizophrenia.
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