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Factors predicting suicide in psychotic patients

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Summary

Death rate and causes of death during a mean period of 5.8 years were investigated in 250 male inpatients with psychotic disorders (DSM-III). Fifty patients died during the observation period. Suicide was confirmed in 11 of these patients and could not be excluded in 7 cases, where the cause of death was reported as uncertain. Clinical and neurobiological characteristics (DST-non-suppression, CSF proteins, and monomaine metabolites) were compared in patients who committed suicide and non-suicide patients of the same age, with or without suicidal behaviour. A highly increased mortality rate was seen among the patients and the rate of suicide was more than 20 times higher than that expected in a normal population of the same age. The estimated annual incidence of suicide was 2.5%, 1.3%, 1.0% and 0.4% for patients with bipolar disorder, paranoid psychosis, major depression and schizophrenic disorder, respectively. The following factors were significantly positively correlated with completed suicide: depressive mood, elated mood, paranoid ideas, and paternal age. All suicides had previously shown suicidal behaviour and the suicide occurred during or shortly after a period of hospitalisation. No correlations were found with age at onset of illness, duration of illness, substance abuse or neurobiological parameters.

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References

  • Allebeck P, Allgulander C (1980) Suicide among young men: psychiatric illness, deviant behaviour and substance abuse. Acta Psychiatr Scand 81:565–570

    Google Scholar 

  • Allebeck P, Allgulander C (1990) Psychiatric diangoses as predictors of suicide. A comparison of diagnoses at conscription and in psychiatric care in a cohort of 50465 young men. Br J Psychiatry 157:339–344.35

    Google Scholar 

  • Allebeck P, Wistedt B (1986) Mortality in schizophrenia. A ten year follow-up based on the Stockholm County in-patient register. Arch Gen Psychiatry 43:650–653

    Google Scholar 

  • Allebeck P, Allgulander C, Fisher LD (1988) Predictors of completed suicide in a cohort of 50465 young men: role of personality and deviant behaviour. BMJ 297:176–178

    Google Scholar 

  • Allgulander C, Fisher LD (1990) Clinical Predictors of completed suicide and repeated self-poisoning in 8895 self-poisoning patients. Eur Arch Psychiatr Neurol Sci 239:270–276

    Google Scholar 

  • American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders. 3rd ed. Washington DC: APA

    Google Scholar 

  • Andersen O, Johansson BB, Svennehrolm L (1981) Monoamine metabolites in successive samples of spinal fluid. Acta Neurol Scand 63:247–254

    Google Scholar 

  • Åsberg M, Träskman L, Thoren P (1976) 5-HIAA in the cerebrospinal fluid — A biochemical suicide predictor? Arch Gen Psychiatry 33:1193–1197

    Google Scholar 

  • Åsgård U (1990) A psychiatric study of suicide among urban Swedish women. Acta Psychiatr Scand 82:115–124

    Google Scholar 

  • Beck AT, Steer RA (1989) Clinical predictors of eventual suicide: a 5- to 10-year prospective study of suicide attempters. J Affective Disord 17:203–209

    Google Scholar 

  • Blumenthal S, Bell V, Neumann N-U, Schüttler R, Vogel R (1989) Mortality and rate of suicide of first admission psychiatric patients. Psychopathology 22:50–56

    Google Scholar 

  • Bradley JV (1968) Distribution-free statistical tests. Prentice-Hall, London

    Google Scholar 

  • Bulik CM, Carpenter LL, Kupfer DJ, Frank E (1990) Features associated with suicide attempts in recurrent major depression. J Affective Disord 18:29–37

    Google Scholar 

  • Carroll BJ, Feinberg M, Greden FI (1981) A specific laboratory test for the test diagnosis of melancholia: standardization, validation and clinical utility. Arch Gen Psychiatry 38:15–22

    Google Scholar 

  • Carroll BJ, Greden JF, Feinberg M (1981) Suicide, neuroendocrine dysfunction and CSF 5-HIAA concentrations in depresion. In: Angrist B (ed) Recent advances in neuropsychopharmacology. Pergamon, Oxford, 307–313

    Google Scholar 

  • Chemtob CM, Hamada RS, Bauer G, Kinney B, Torigoe RY (1988) Patients' suicides: Frequency and Impact on Psychiatrists. Am J Psychiatry 145:2:224–228

    Google Scholar 

  • Cheng KK, Leung CM, Lo WH, Lam TH (1990) Risk factors of suicide among schizophrenics. Acta Psychiatr Scand 81:220–224

    Google Scholar 

  • Cohen LJ, Test MA, Brown RL (1990) Suicide and schizophrenia: Data from a prospective community treatment study. Am J Psychiatry 147:4:602–607

    Google Scholar 

  • Fawcett J (1988) Predictors of early suicide: Identification and appropriate intervention. J Clin Psychiatry 49:10:7–8

    Google Scholar 

  • Fawcett J, Scheftner WA, Fogg J, Clark DC, Young MA, Hedeker D, Gibbson R (1990) Time related-predictors of suicide in major affective disorder. Am J Psychiatry 147:9:1189–1227

    Google Scholar 

  • Hawton K, Fagg J (1988) Suicide, and other causes of death, following attempted suicide. Br J Psychiatry 152:359–366

    Google Scholar 

  • Jones SJ, Stanley B, Mann JJ, Frances AJ, Guido JR, Träskman-Bendz L, Winchel R, Brown RP, Stanley M (1990) CSF 5-HIAA and HVA concentrations in elderly depressed patients who attempted suicide. Am J Psychiatry 147:9:1225–1227

    Google Scholar 

  • Kelleher MJ, Daly M (1990) Suicide in Cork and Ireland. Br J Psychiatry 157:533–538

    Google Scholar 

  • Kienhorst CWM, Wilde EJ de, Bout J van den, Diekstra RFW, Wotters WHG (1990) Characteristics of Suicide attempters in a population-based sample of dutch adolescents. Br J Psychiatry 156:243–248

    Google Scholar 

  • Kotila L, Lönnqvist J (1988) Adolescent suicide attempts: Sex differences predicting suicide. Acta Psychiatry Scand 77:264–270

    Google Scholar 

  • Laurell CB (1972) Electroimmunoassay. Scand J Clin Lab Invest 124 [Suppl 29]:21–37

    Google Scholar 

  • Lemus CZ, Lieberman JA, Johns CA, Pollack S, Bookstein P, Cooper TB (1990) CSF 5-Hydroxyindoleacetic acid levels and suicide attempts in schizophrenia. Biol Psychiatry 27:923–926

    Google Scholar 

  • Linden R, Davis JM, Rubinstein J (1988) Maintenance Medication in schizophrneia, In: The Schizophrenias. Flach F (ed) Norton, New York, pp 137–149

    Google Scholar 

  • Link H, Tibbling G (1977) Principles of albumin and IgG analysis in neurological disorders. II. Relation of the concentrations of the proteins in serum and cerebrospinal fluid. Scand J Clin Lab. Invest 37:391–396

    Google Scholar 

  • Merrill J, Owens J (1990) Age and attempted suicide. Acta Psychiatr Scand 82:385–388

    Google Scholar 

  • Miles CP (1977) Conditions predisposing to suicide: A review. J Nerv Ment Dis 164:231–246

    Google Scholar 

  • National Central Bureau of Statistics, Sweden 1985

  • Nielsen B, Wang AG, Brille-Brahe U (1990) Attempted suicide in Denmark. IV. A five-year follow-up. Acta Psychiatr Scand 81: 250–254

    Google Scholar 

  • Nilsson A, Axelsson R (1989) Psychopathology during long-term lithium treatment of patients with major affective disorders. Acta Psychiatr Scand 80:375–388

    Google Scholar 

  • Pandey GN, Pandey SC, Janicak PG, Marks RC, Davis JM (1990) Platelet Serotonin-2 receptor binding sites in depression and suicide. Biol Psychiatry 28:215–222

    Google Scholar 

  • Perris C, Brockington IF (1981) Cycloid psychoses and their relation to the major psychoses. In: Perris C, Struwe G, Jansson B (eds) Biological Psychiatry. Elsevier, Amsterdam, pp 447–450

    Google Scholar 

  • Petrie K, Chamberlain K, Clarke D (1988) Psychological predictors of future suicidal behaviour in hospitalized suicide attempters. Br J Clin Psychol 27:247–257

    Google Scholar 

  • Popoli G, Sobelman S, Kanarek NF (1989) Suicide in the state of Maryland, 1970–80. Public Health Rep 104:3:298–301

    Google Scholar 

  • Praag HM van, Haan S de (1979) Central serotonin metabolism and the frequency of depression. Psychiatr Res I:219–224

    Google Scholar 

  • Rich CL, Young JG, Fowler RC, Wagner J, Black NA (1990) Guns and suicide: Possible effects of some specific legislation. Am J Psychiatry 147:3:341–346

    Google Scholar 

  • Roy A, Lamparski D, De Jong J, Adinoff B, Ravitz B, George DT, Nutt D, Linnoila M (1990) Cerebrospinal fluid monoamine metabolites in alocholic patients who attempt suicide. Acta Psychiatr Scand 81:58–61

    Google Scholar 

  • Runesson B (1989) Mental disorder in youth suicide DSM-III-R Axes I and II. Acta Psychiatr Scand 79:490–497

    Google Scholar 

  • Rydin E, Åseberg M, Edman G, Schalling D (1990) Violent and nonviolent suicide attempts — a controlled Roschach study. Acta Psychiatr Scand 82:30–39

    Google Scholar 

  • Ryngestad T (1988) A prospective 5-year follow-up study of selfpoisoned patients. Acta Psychiatry Scand 77:328–331

    Google Scholar 

  • Sedvall G, Fyrö B, Gullberg B, Nybäck H, Wiesel FA, Wode-Helgodt B (1980) Relationship in healthy volunteers between concentrations of monoamine metabolites in cerebrospinal fluid and family history of psychiatric morbidity. Br J Psychiatry 136:366–374

    Google Scholar 

  • Tibbling G, Link H, Öhman S (1977) Principles of albumin and IgG analyses in neurological disorders. I. Establishment of reference values. Scand J Clin Lab Invest 37:385–390

    Google Scholar 

  • Tsuang MT, Woolson RF (1978) Excess mortality in schizophrenia and affective disorders. Arch Gen Psychiatry 35:1181–1185

    Google Scholar 

  • Welte JW, Abel EL, Wieczorek W (1988) The role of alcohol in suicides In Erie County. Public Health Rep 103:6:648–652

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry and Neurochemistry, University of Lund, St. Lars Hospital, S-22009, Lund, Sweden

    R. Axelsson

  2. Department of Psychiatry III, University of Göteborg, Lillhagen Hospital, Göteborg, Sweden

    M. Lagerkvist-Briggs

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  1. R. Axelsson
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Axelsson, R., Lagerkvist-Briggs, M. Factors predicting suicide in psychotic patients. Eur Arch Psychiatry Clin Nuerosci 241, 259–266 (1992). https://doi.org/10.1007/BF02195974

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