Gökhan UMUT, Zeren Ozturk ALTUN, Birim S. DANIŞMANT, İlker KÜÇÜKPARLAK, Nesrin KARAMUSTAFALIOĞLU, Mehmet Cem İLNEM

The Correlation of Suicide Attempt and Suicidal Ideation with Insight, Depression and Severity of Illness in Schizophrenic Patients

Amaç: Bu çalışmada şizofreni hastalarında özkıyım girişimi ve özkıyım düşüncesinin hastalık şiddeti, depresyon ve içgörü ile ilişkisi araştırılarak, şizofreni hastalarında özkıyım riskini yordayabilecek ölçütlerin gelişmesine katkı sağlanması amaçlanmıştır. Yöntem: Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi psikiyatri servislerinde DSM-IV-TR ölçütlerine göre şizofreni tanısı ile yatarak tedavi gören, 20-65 yaş arasındaki 104 hasta rastgele seçilmiş, hastalar hastaneye yattıktan sonraki 72 saat içinde değerlendirilmiştir. Olgular, İçgörünün Üç Bileşenini Değerlendirme Ölçeği (İÜBDÖ), Pozitif ve Negatif Sendrom Ölçeği (PANSS) ve Calgary Şizofrenide Depresyon Ölçeği (CŞDÖ) kullanılarak değerlendirilmiştir. Bulgular: Özkıyım girişimi öyküsü olan hastalarda depresyon puanları, özkıyım girişimi öyküsü olmayan hastalara göre daha yüksek bulunmuştur. Özkıyım düşüncesi olanların içgörü ve depresyon puanları, özkıyım düşüncesi olmayanlara göre daha yüksek bulunmuştur. Lojistik regresyon analizinde CŞDÖ özkıyım girişimi ve özkıyım düşüncesini, PANSS negatif toplam puanı özkıyım düşüncesini, kendine zarar veren davranış ise özkıyım girişimi öyküsünü belirleyen değişken olmuştur. Sonuç: Özkıyım girişimi ve özkıyım düşüncesini belirleyen ortak etken depresyon olduğundan, şizofreni hastalarında depresif belirtiler varlığında özkıyım düşüncesinin daha dikkatli ve ayrıntılı sorgulanması gerekmektedir. Kolaylıkla uygulanabilecek CŞDÖ'nün, şizofreni hastalarındaki depresyonu kolaylıkla saptayabileceğini, uygun tedavi yöntemleri ile depresyonun tedavisinin özkıyım riskini azaltabileceğini düşünmekteyiz

Şizofreni hastalarında özkıyım girişimi ve özkıyım düşüncesinin, hastalık şiddeti, depresyon ve içgörü ile ilişkisi

The correlation of suicide attempt and suicidal ideation with insight, depression and severity of illness in schizophrenic patients Objective: At this study, it is aimed to determine criteria to predict the suicidal risks of schizophrenic patients and to explore the correlation of suicide attempt and suicidal ideation with insight, depression and severity of illness as well.Method: Randomly selected 104 inpatients between 20 and 65 years of age, treated with a diagnosis of schizophrenia according to DSM-IV-TR criteria at Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery were included, and patients were examined at the period of first 72 hours of admission. The patients were evaluated with Schedule for Assessing the Three Components of Insight (SAI), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale for Schizophrenia (CDSS).Results: Depression scores were higher in the patients who had suicide attempt compared to those without suicide attempt. Depression and insight scores of the patients who had suicidal ideation were found to be higher compared to those without suicidal ideation. In the logistic regression analysis, CDSS was found to be the determinant of suicide attempt and suicidal ideation, PANSS negative total score was found to be the determinant of suicidal ideation, and self destructive behavior was found to be the determinant of suicide attempt. Conclusion: As depression was the common factor that determines the suicidal ideation and suicide attempts, suicidal ideation should be inquired more carefully and in more detail in the presence of depressive symptoms in patients with schizophrenia. We consider that CDSS can be easily applied and can determine the depression in patients with schizophrenia and the treatment of depression with eligible methods in turn, decreases risk of suicide

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1. Tel H, Uzun S. Social support and coping with stress in patients who were accepted to the emergency room with the suicide. Anatolian Journal of Psychiatry 2003; 4:151-158. (Turkish)
2. Yuksel N. Neurobiology of suicide. Journal of Clinical Psychiatry 2001; 4:5-15. (Turkish)
3. Saginc H, Kugu N, Akyuz G, Dogan O. The research about suicide history among the inpatients. Anatolian Journal of Psychiatry 2000; 1:83-88. (Turkish)
4. Intihar istatistikleri 2011. Türkiye İstatistik Kurumu. http://www. tuik.gov.tr/Kitap.do?metod=KitapDetay&KT_ID=11&KITAP_ ID=23. (Turkish)
5. Isik E. Sizofreni ve Depresyon. Guncel Sizofreni. Second Ed., G.M. Matbaacilik ve Ticaret, Ankara, 2007, 266-272. (Turkish) 6. Caldwell CB, Gottesman II. Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophr Bull 1990; 16:571- 589.
7. Yildiz M, Yazici A, Boke O. Demographic and clinical characteristics in schizophrenia: a multi center cross-sectional case record study. Turk Psikiyatri Derg 2010; 21:213-224. (Turkish)
8. Raymont V. Suicide in schizophrenia – how can research influence training and clinical practice? Psychiatric Bulletin 2001; 25:46-50.
9. Saarinen PI, Hehtonen J, Umnqvist J. Suicide risk in schizophrenia: an analysis of 17 consecutive suicides. Schizophr Bull 1999; 25:533-542.
10. Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, Montross LP, Mortensen PB, Povl Munk-Jorgensen P, Nielsen J, Nordentoft M, Saarinen PI, Zisook S, Wilson ST and Tatarelli R. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry 2007; 6:10.
11. Kelly DL, Shim JC, Feldman SM, Yu Y, Conley RR. Lifetime psychiatric symptoms in persons with schizophrenia who died by suicide compared to other means of death. J Psychiatr Res 2004; 38:531-536.
12. Weismann M, Fox K, Klerman GL. Hostility and depression associated with suicide attempts. Am J Psychiatry 1973; 130:450- 455.
13. Harkavy–Friedmann JM, Nelson AE, Venarde DF. Suicidal behavior in schizophrenia and schizoaffective disorder. Clin Neurosci Res 2001; 1:345-350.
14. Hellerstein D, Frosch W, Koenigsberg W. The clinical significance of command hallucinations. Am J Psychiatry 1987; 144:219-221.
15. Addington DE, Addington JM. Attempted suicide and depression in schizophrenia. Acta Psychiatr Scand 1992; 85:288-291.
16. Roy A. Suicide in cronic schizophrenia. Br J Psychiatry 1982; 141:171-177.
17. Semiz UB. Sizofreni Hastalarında Depresif Durumlar. Ceylan ME, Cetin M (Editors). Arastirma ve Klinik Uygulamada Biyolojik Psikiyatri, Sizofreni–II. Third Ed., Istanbul, Yerkure Yayincilik, 2005:1197-1215. (Turkish)
18. Roy A, Mazonson A, Pickar D. Attempted suicide in chronic schizophrenia. Br J Psychiatry 1984; 144:303-306.
19. Bourgeois M, Swendsen J, Young F, Amador X, Pini S, Cassano GB, Lindenmayer JP, Hsu C, Alphs L, Meltzer HY. Awareness of disorder and suicide risk in the treatment of schizophrenia: results of the international suicide prevention trial. Am J Psychiatry 2004; 161:1494–1496.
20. Cotton PG, Drake RE, Gates C. Critical treatment issues in suicide among schizophrenics. Hosp Community Psychiatry 1985; 36:534-536.
21. Strauss JS. Subjective experiences of schizophrenia. Schizophr Bull 1989; 15:179-187.
22. Amador XF, Friedman JH, Kasapis C, Yale SA, Flaum M, Gorman JM. Suicidal behavior in schizophrenia and its relationship to awareness of illness. Am J Psychiatry 1996; 153:1185- 1188.
23. Schwartz RC, Petersen S. The relationship between insight and suicidality among patients with schizophrenia. J Nerv Ment Dis 1999; 187:376-378.
24. Tandon R. Suicidal behavior in schizophrenia. Expert Rev Neurother 2005; 5:95-99.
25. Corapcioglu A, Aydemir O, Yildiz M, Esen A, Koroglu E. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinical Version. Hekimler Yayin Birligi, Ankara, 1999. (Turkish)
26. David AS. Insight and psychosis. Br J Psychiatry 1990; 156:798- 808.
27. Arslan S, Gunay Kilic B, Karakilic H. Reliability and validity study of the Schedule for Assesing the Three Components of Insight. Psychiatry in Türkiye 2000; 3:17-24. (Turkish)
28. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13:261-275.
29. Kostakoglu AE, Batur S, Tiryaki A. Reliability and validity of the Turkish version of the Positive and Negative Syndrome Scale (PANSS). Turk Psikiyatri Derg 1999; 14:23-32. (Turkish)
30. Addington D, Addington J, Maticka-Tyndale E, Joyce J. Reliability and validity of a depression rating scale for schizophrenics. Schizophr Res 1992; 6:201-208.
31. Aydemir O, Esen Danaci A, Deveci A, Icelli I. Reliability and validity of Turkish Calgary Depression Rating Scale. Archives of Neuropsychiatry 2000; 37:82-86. (Turkish)
32. Hafner H. Gender differences in schizophrenia. Psychoneuroendocrinology 2003; 28:17-54.
33. Rossau CD, Mortensen PB. Risk factors for suicide in patients with schizophrenia: nested case-control study. Br J Psychiatry 1997; 171:355-359.
34. Kaneda Y. Suicidality in schizophrenia as a separate symptom domain that may be independent of depression or psychosis. Schizophr Res 2006; 81:113-114.
35. Phillips MR, Li XY, Zhang YP. Suicide and the unique prevalence pattern of schizophrenia in mainland China: a retrospective observational study. Lancet 2004; 364:1062-1068.
36. Reutfors J, Brandt L, Ekbom A. Risk factors for suicide in schizophrenia: findings from a Swedish population–based case– control study. Schizophr Res 2009; 108:231-237.
37. Allebeck P, Varla A, Kristjansson E, Wistedt B. Risk factors for suicide among patients with schizophrenia. Acta Psychiatr Scand 1987; 76:414-419.
38. Uzun O, Tamam L, Ozculer T, Doruk A, Unal M. Specific characteristics of suicide attempts in patients with schizophrenia in Turkey. Isr J Psychiatry Relat Sci 2009; 46:189-194.
39. Ran MS, Wu QH, Conwell Y, Chen EY, Chan CL. Suicidal behavior among inpatients with schizophrenia and mood disorders in Chengdu, China. Suicide Life Threat Behav 2004; 34:311-319.
40. 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.
41. Evren EC, Evren B, Erkiran M. Suicidal ideation in schizophrenia: relationship with positive and negative symptoms, depression and insight. Turk Psikiyatri Derg 2002; 13:255-264. (Turkish)
42. Limosin F, Loze JY, Philippe A. Ten–year prospective follow–up study of the mortality by suicide in schizophrenic patients. Schizophr Res 2007; 94:23-28.
43. De Leo D, Klieve H. Communication of suicide intent by schizophrenic subjects: data from the Queensland Suicide Register. Int J Ment Health Syst 2007;1:6.
44. Mcgirr, A Tousignant, M, Routhier, D, Pouliot L, Chawky N, Margolese HC, Turecki G. Risk factors for completed suicide in schizophrenia and other chronic psychotic disorders: a case– control study. Schizophr Res 2006; 84:132-143.
45. Xiang YT, Weng YZ, Leung CM. Socio–demographic and clinical correlates of lifetime suicide attempts and their impact on quality of life in Chinese schizophrenia patients. J Psychiatr Res 2008; 42:495-502.
46. Aydemir O, Esen Danaci A, Pirildar S. Distinguishing depressive from nondepressive patients in schizophrenia in terms of symptomatology. Turk Psikiyatri Derg 2002; 13:173-178. (Turkish)
47. Strosahl K, Chiles JA, Linehan M. Prediction of suicide intent in hospitalized parasuicides: reasons for living, hopelessness, and depression. Compr Psychiatry 1992; 33:366-373.
48. Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10–year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry 1985; 142:559-563.
49. Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999; 256:181-189.
50. Harkavy–Friedman JM, Restifo K, Malaspina D, Kaufmann CA, Amador XF, Yale SA, Gorman JM. Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. Am J Psychiatry 1999; 156:1276-1278.
51. Gupta S, Black DW, Arndt S, Hubbard WC, Andreasen NC. Factors associated with suicide attempts among patients with schizophrenia. Psychiatr Serv 1998; 49:1353-1355.
52. Drake RE, Cotton PG. Depression, hopelessness and suicide in chronic schizophrenia. Br J Psychiatry 1986; 148:554-559.
53. Minkoff K, Bergman E, Beck AT, Beck R. Hopelessness, depression, and attempted suicides. Am J Psychiatry 1973; 130:455-459.
54. Yen CF, Yeh ML, Chen CS, Chung HH. Predictive value of insight for suicide, violence, hospitalization, and social adjustment for outpatients with schizophrenia: a prospective study. Compr Psychiatry 2002; 43:443-447.
55. Schwartz–Stav O, Apter A, Zalsman G. Depression, suicidal behavior and insight in adolescents with schizophrenia. Eur Child Adolesc Psychiatry 2006; 15:352-359.
56. Fenton WS. Depression, suicide, and suicide prevention in schizophrenia. Suicide Life Threat Behav 2000; 30:34-49.
57. Whitehead C, Moss S, Cardno A, Lewis G. Antidepressants for the treatment of depression in people with schizophrenia: a systematic review. Psychol Med 2003; 33:589-599.
58. Jones JS, Stein DJ, Stanley B, Guido JR, Winchel R, Stanley M. Negative and depressive symptoms in suicidal schizophrenics. Acta Psychiatr Scand 1994; 89:81-87.
59. Pompili M, Ruberto A, Kotzalidis GD, Girardi P, Tatarelli R. Suicide and awareness of illness in schizophrenia: an overview. Bull Menninger Clin 2004; 68:297-318.