Suicides schizophrenia

Schizophrenia is a chronic, complex psychiatric disorder affecting approximately 1% of the population worldwide. The chronic nature of the illness, in addition to the early age of onset, results in direct and indirect health care expenditures in the U.S., which amount to approximately 30 to 64 billion dollars per year [4]. It is perhaps the most devastating of psychiatric disorders, with approximately 10% of patients committing suicide. The dopamine hypothesis of schizophrenia postulates that overactivity at dopaminergic synapses in the central nervous system (CNS), particularly the mesolimbic system, causes the psychotic symptoms (hallucinations and delusions) of schizophrenia. Roth and Meltzer [5] have provided a review of the literature and have concluded a role for serotonin as well in the pathophysiology and treatment of schizophrenia. The basic premise of their work stems from the known interaction between the serotonergic and dopaminergic systems. 

Psychoactive. Substances that have mood- or reality-altering properties. Referral. A process of sending your client to another professional for care. Schizophrenia. A debilitating class of mental disorders that involve psychosis. Suicidal ideations. Thoughts about self-harm or suicide. 

There are data to confirm and reject the association of the Cys23Ser S-HT and the Gly22Ser 5-HTj receptor variants, characterized in vitro by reduced agonist potency, with phenotypes such as intractable suicidal ideation (98), ADHD (100), alcohol dependence, and schizophrenia (98,99,109-116). While the -1348 A/G polymorphism of the S-HT receptor has been associated with the negative symptoms of schizophrenia, other studies of eating disorders appear to be equivocal. A body of evidence is available, however, that S-HT variants may be associated with psychotic symptoms in Alzheimer s patients (94,100,117,118). 

There are two general classes of clinical characteristics of schizophrenia. First, there are the positive symptoms that include auditory hallucinations (voices) and delusions, often paranoid. Second, there are the negative symptoms these include disorganization, loss of will, inability to pay attention, social withdrawal, and flattening of affect. The relative roles of positive and negative symptoms for a particular victim vary over time. The positive symptoms may predominate for a period to be followed by one in which the negative symptoms are more prominent. About 10% of people with schizophrenia commit suicide. 

Other Symptoms. Although they are not reflected in the DSM-IV criteria, it now appears that mood and cognitive symptoms also hinder the patient with schizophrenia. Depressed mood, often short of the duration or severity needed to diagnose major depression or schizoaffective disorder, is an all too common problem. Because the negative symptoms of the illness and certain antipsychotic side effects resemble depression, this was long overlooked. Indeed, depressed mood may in part explain the extremely high rates of attempted and successful suicides by those with schizophrenia. 

The goals of treatment during the acute phase of illness are to reduce the positive symptoms of schizophrenia and to plan for extended treatment during the maintenance phase. Reducing the positive symptoms quickly is important for at least two reasons. First, the erratic behavior of an acutely psychotic patient can take a tremendous toll, risking arrest, loss of job, suicide, and the alienation of friends and family. Second, there is some evidence that psychosis itself is harmful to the brain. In other words, it may be that the longer the patient is actively psychotic, the worse the prognosis becomes. 

Recurrent suicidal behavior (except orally disintegrating tablets) - For reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at chronic risk for reexperiencing suicidal behavior, based on history and recent clinical state. Continue clozapine treatment to reduce the risk of suicidal behavior for at least 2 years. 

These are usually treated with sedative neuroleptics (as for schizophrenia, above). Treatment must also aim to support the patient socially including for instance advising on legal protection from the financial or other consequences of mania. One of the risks of treatment is the sudden mood swing at the end of the manic episode, with acute depression possibly triggered by the neuroleptics. Because of the concern for the manic episode and symptoms, return to normal is viewed with relief, and the downswing may go un-noticed, with the concomitant suicidal risk. 

Although genetic influences on the dynamics of drug response have been studied in a wide range of disorders, most of the studies have been carried out in only the past few years. Disorders and behaviors studied include Alzheimer s disease, schizophrenia, depression, suicide, anxiety, obsessive-compulsive disorder (OCD), substance abuse, smoking, and alcoholism. Across these disorders, however, there has been a focus on only a handful of neuroeffector systems. These include apolipoprotein and the cholinergic system (in Alzhei-... 

Many eminent persons have had children with serious mental problems and have had at least one child take his or her life. Robert Frost s daughter was committed to the state mental hospital and another daughter had a nervous breakdown. One of Albert Einstein s children was diagnosed as schizophrenic. Ambrose Bierce s oldest son committed suicide, and his other died of alcoholism at age 27. Thomas Edison had two children who became alcoholics, one of whom committed suicide. Alfred Stieglitz s daughter was psychotic and committed to a mental institution. James Joyce had two children. His son became an alcoholic his daughter went mad and, as discussed, was admitted to an asylum for schizophrenia. Numerous other examples demonstrate the frequent problems of geniuses children. Many of these children tried unsuccessfully to pursue careers similar to their eminent parents, but it is not clear if this played any role in their mental problems. 

Evidence indicates that the long-term outcome for a patient with schizophrenia is better when treatment of the acute episode is initiated rapidly. After a patient s first psychotic episode, treatment with the antipsychotic medication should be continued for at least 1 year after a full remission of psychotic symptoms. A trial period without medication may then be considered, except for patients with a history of serious suicide attempts or violent aggressive behavior... 

Meltzer, H.Y., Alphs, L., Green, A.I., et al. Clozapine treatment for suicidality in schizophrenia International Suicide Prevention Trial flhterSePT). Arch. Gen. Psychiatry 60(1), 82-91, 2003. 

Radomsky ED, Haas GL, Mann JJ, et al. Suicidal behavior in patients with schizophrenia and other psychotic disorders. Am J Psychiatry 1999 156 1590-1595. 

By far, the most important contributor to suicide is a serious psychiatric disorder, with MOD, bipolar disorder, schizophrenia, and substance abuse being most closely associated with suicide. The male-to-female ratio is less pronounced among psychiatric patients than in the general population, with a higher rate in unmarried psychiatric patients living alone. The lifetime probability of death by suicide in various psychiatric disorders is estimated to be between 10% and 15%, contrasting with less than a 1 % lifetime probability in those without a psychiatric disorder. 

Older persons account for one-third of all suicides in the United States even though this group represents only 12% of the population ( 36). Suicide is even more often related to major depression in the elderly than in younger individuals in whom other causes such as substance abuse, bipolar disorder, schizophrenia, and personality disorders often play a major role. In fact, suicide rates are highest in older white men relative to any other segment of the population. For example, white men older than 85 years age commit suicide 30 times as frequently as black women. 

Depression and schizophrenia -the primary psychiatric diagnoses associated with completed suicides... 

Middle-aged or older individuals who complete suicide tend to suffer from a depressive disorder. Younger individuals who complete suicide usually suffer from schizophrenia or a bipolar disorder. The risk factors for suicide attempts versus completions are the following ... 

Benzodiazepines are used as hypnotics because they have the ability to increase total sleep time. They demonstrate minimal cardiovascular effects, but do have the ability to increase heart rate and decrease cardiac output. Most CNS depressants, including the benzodiazepines, exhibit the ability to relax skeletal muscles. Clozapine, a dibenzodiazepine, is used in the treatment of schizophrenia. It has both sedative and antipsychotic actions, and is the only FDA-approved medication indicated for treatment-resistant schizophrenia, and for reducing the risk of suicidal behavior in patients with schizophrenia. This drug can have potentially life-threatening side effects, but appears to have no abuse potential and will not be considered further. 

Few strong biological findings demonstrating lesions in specific psychiatric disorders Example discovery of changes in serotonin receptors and metabolites in depression, schizophrenia, and suicidal behavior... 

Although schizophrenia is the commonest and best known psychotic illness, it is not synonymous with psychosis but is just one of many causes of psychosis. Schizophrenia affects 1% of the population, and in the United States there are over 300,000 acute schizophrenic episodes annually. Between 25 and 50% of schizophrenia patients attempt suicide, and 10% eventually succeed, contributing to a mortality rate eight times as high as that of the general population. In the United States over 20% of all Social Security benefit days are used for the care of schizophrenic patients. The direct and indirect costs of schizophrenia in the United States alone are estimated to be in the tens of billions of dollars every year. 

In view of the risk/benefit ratio for clozapine, this agent is not generally considered a first-line agent for the treatment of psychosis but one to consider when several other agents have failed. It is especially useful in quelling violence and aggression in difficult patients, may reduce suicide rates in schizophrenia, and may reduce tardive dyskinesia severity, especially over long treatment intervals. 

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