Schizophrenia and the Risk for Suicide

According to Varcarolis (2017), Schizophrenia is a brain disease that is treatable, but not curable, and interrupts a person's ability to see reality accurately, to think clearly, to use language correctly, to experience normal emotions, or to participate in normal social/occupational experiences. (p. 244) This is a chronic and severe mental illness where people typically experience auditory and/or visual hallucinations.

Suicide is very common for those with schizophrenia. In fact, In a subsequent systematic review of seven population-based studies, people with schizophrenia had 12 times the risk of dying by suicide compared with the general population. (Foster, 2013) Schizophrenics are at risk for suicide related to psychiatric illness or disorder. Three interventions that can be taken to help decrease the suicide rate is the adherence with the administration of antipsychotic medications (clozapine), recognizing the risk factors for the increased risk of suicide, and managing depression with Electroconvulsive Therapy (ECT) and antidepressants.

The adherence with the administration of antipsychotic medications, specifically clozapine, has been shown to significantly decrease the risk of suicide in schizophrenic patients. Studies have shown that clozapine is very well established in the efficacy of patients with schizophrenia. In fact, according to Psychiatric Times, the first FDA-approved medication with an anti-suicide indication was clozapine for schizophrenia. (2016) A randomized study was done by the International Suicide Prevention Trial that showed suicidal behavior was significantly decreased with patients who were administered with clozapine. This antipsychotic is associated with a significantly lower risk of suicide than any other antipsychotic. Antipsychotics in general lower the suicide rate. In Psychiatric Times (2016) it states that there was only 1 suicide for patients taking antipsychotics compared to 26 suicides in patients not taking them. Another study showed that the risk for suicide increased when patients interrupted their clozapine treatment with olanzapine or risperidone. Overall, antipsychotic mediations are critical components in preventing suicide.

Furthermore, recognizing the risk factors associated with the increased risk for suicide is vital in preventing it from happening. According to Popovic et al. (2014), results in a study have confirmed this and how it is imperative to improve clinical management and develop approaches to decrease the occurrence of suicide. The main risk factors associated with a higher risk of suicide is depression, history of suicide attempt, number of psychiatric admissions, hopelessness, age, closeness to illness onset, older age at illness onset, gender, number of hospital admissions, and substance or history of (mis)use and dependence. Nurses and other health care professionals being able to recognize these factors can help provide the correct clinical care and management for each individual. Care for the patients should be individually based on their certain risk factors to provide the most helpful care possible.

A major part of the risk of suicide in people with schizophrenia is early detection of depression and psychosis; therefore, managing depression with Electroconvulsive therapy (ECT) and antidepressants plays a key role. Electroconvulsive therapy is when electrodes are placed to the head of the patient to induce a convulsion and is done using general anesthetic. The first-line of treatment for depression is antidepressant medications, and when patients are not responsive to that therapy, ECT may be tried; however, ECT and antidepressants should not be prescribed simulataneously. According to (Song et al, 2015), Previous studies suggested that 80-90% of patients with depression showed marked effective response to ECT alone. This study was done to see whether patients should take antidepressants with ECT therapy or just ECT therapy alone. Electroconvulsive therapy is an effective treatment, even though the mechanism of it is still unceratin. (Song et al, 2015) The outcome showed that ECT therapy with antidepressants increased the incidence of memory deterioration more than ECT alone. (Song et al, 2015).

All in all, there are very many different interventions that can be done to help prevent the risk for suicide in patients with schizophrenia. Some of these include: adherence with the administration of antipsychotic medications, specifically clozapine, recognizing the risk factors for the increased risk of suicide, and managing depression with Electroconvulsive Therapy (ECT) and antidepressants. Schizophrenia is a non-curable, but treatable brain disease that takes many interventions to keep the patients as safe as possible and living their life to the fullest.

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