Suicide linked to Schizophrenia is a leading cause of premature deaths. The schizophrenic patients are at risk of attempting suicide, as manifested by records from the 1960s. It is reported that out of all schizophrenic patients’ deaths, suicide accounts for at least 13%. Leading causes of suicide among these patients include social isolation, hospitalization, awareness of the condition, and sense of helplessness, health deterioration, limited or lack of support due to family instability. Efforts to reduce the cases of suicide among these patients do not seem to have yielded much success to date. Therefore, it is critical to adopt approaches aimed at reducing this phenomenon or preventing it all together (1). This paper will outline possible strategies for the prevention of suicide in people with Schizophrenia.
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Improved recognition of vulnerability
There is a need to tackle the challenge associated with suicide among schizophrenic patients in a comprehensive manner. One major approach to achieving this goal is through improving the recognition of schizophrenia patients who are vulnerable to committing suicide. Widespread evidence indicates that a highly vulnerable group constitutes the young. Both young schizophrenic males and females have been identified as likely to commit suicide as compared to their older counterparts. Among the whites, the unmarried patients who have had post-psychotic depression or previously abused drugs have a higher likelihood of attempting suicide.
Patients who have also earlier attempted suicide or communicated about it may end up committing suicide. As such, when a patient mentions an intention to commit suicide, he/she should be placed under close supervision because such patients could end up committing the act. Another way to identify a schizophrenic patient who is likely to commit suicide involves observing characteristics such as hopelessness and a tendency to isolate oneself. Patients who may have undergone a long hospitalization period and have become aware of their condition also tend to attempt suicide, and such patients should thus be monitored closely (2).
It is postulated that such patients fear that they could deteriorate further, or due to increased dependence on medication, they may lose faith in the possibility of ever recovering. Therefore, they opt for induced death in order to alleviate their suffering. Suicide in individuals with Schizophrenia is also influenced by the active phase of the condition. Also, this can be influenced by notable psychotic symptoms that trigger paranoid delusions and thought insertion.
Evidently, patients diagnosed with the paranoid subtype of this condition are at risk of committing suicide. Medication, though meant to mollify Schizophrenia, may increase the likelihood of suicide in the patient. This is associated with the increased awareness of the illness and insight about the condition. Therefore, patients under medication should be observed more closely as the immediate effect of the drug may trigger suicidal thoughts.
Having identified all these possibilities among the schizophrenic patients, efforts should be made to ensure the patient who displays the characteristics is accorded the necessary support either socially or therapeutically. This is to avoid the patient resorting to suicide. Awareness should also be created for families and other stakeholders involved in caring for this class of patients. With the relevant information and skills, they will be able to detect the traits early enough and possibly take the most appropriate step towards rehabilitating the patient or preventing suicide attempts (2).
Psychological and social interventions
Psychological and social treatment methods have been found to reduce cases of suicide among schizophrenic patients when used alongside pharmacological methods. Cognitive-behaviour therapy is one method that would greatly help in reducing and/or preventing suicide among patients. Through this therapy, patients are trained so as to learn the behaviors exhibited by other people in normal society. The training may entail the simple chores that people undertake in their daily routine, such as shopping, washing, making friends, or being able to initiate a conversation. The training can be focused on activities that help patients gain self-care skills in order to help them have self-value.
The activities to be emphasized include proper nutrition, personal hygiene, and the ability for patients to sustain themselves economically. Such efforts greatly help to overcome challenges associated with the condition, such as withdrawal and hallucinations. The interventions should also target family members to enable them to live and assist patients in an appropriate manner. This can be achieved by clearly understanding how to treat and monitor the patient while helping them in the rehabilitation process. To avoid relapses and hospitalizations, which increase the likelihood of suicide, the patients should be encouraged to take their medication (3).
Although there is no definite cure for Schizophrenia, the condition can be maintained over along time through the use of medication alongside other therapies. The most commonly used medication involves the use of antipsychotic drugs. As a strategy to prevent suicide in schizophrenic patients, the drugs are aimed at controlling the symptoms associated with the condition. These drugs target the psychotic symptoms displayed by the patients, such as hallucinations, withdrawals, and delusions. The drugs can reduce, eliminate, and prevent relapses. Drugs such as Risperdal, Zyprexa, chlorpromazine, trifluoperazine, quetiapine, and haloperidol have been found to be effective in putting Schizophrenia under control.
These medications are taken throughout a patient’s life. Unpleasant side effects may make patients unwilling to continue taking the medication, but to avoid relapses, they must continue taking them. The use of the medication must be undertaken under close observation. This is because the impromptu improvement of a patient’s consciousness and insight may arouse an awareness in them that may propel them towards committing suicide. The patients must also be ready to undergo regular medical tests since some of the medications, such as clozapine, may result in life-threatening effects (1).
Optimizing Clinical Practice to Prevent Suicide among People with Schizophrenia
The clinical practice should aim at ensuring that patients with Schizophrenia are under control from any deterioration that may trigger suicidal thoughts. The scope of intervention should thus encompass all factors that influence the performance of the patient. Antipsychotic medication should be administered in a friendly approach, especially in combination with other interventions. This will ensure that the patient is willing to cooperate with the rehabilitation regimen.
It is important to study the response of different patients to medication. This forms the basis for the most appropriate approach to treat the patient since the variations in patients’ responses may create a negative impression on other would-be patients. Similarly, the response to medication by the patient may negatively affect him or her, leading the patient to contemplate suicide. This can be such as demonstrated by sudden increased awareness and insight. The pharmacological based tests should cover areas of neurocognitive ability, body mass index, motor disorders, lipid profiles, and illegal substances in the blood (4).
For successful rehabilitation, psychosocial interventions play a significant role. The approach taken should also be dependent on the given patient. This ensures that the patient owns the rehabilitation process for improved outcomes to be realized. A professional with skills in handling such patients would be recommended. This is because such professionals would have the ability to determine the most effective interventions that would be fruitful for the individual patient. Among the most effective interventions that could facilitate the recovery of the patient to normalcy include cognitive-behavioral therapy.
This method is beneficial in treating hallucinations, increase adherence to treatment, reduce symptomatology, and accelerate recovery. The use of supportive psychotherapy helps create harmony and emotionally support an individual. This should also incorporate the patient’s input to succeed. The clinical practice should also involve psychodynamic psychotherapy. This method involves a broad analysis of the patient’s experiences to help the professional develop a personalized treatment approach. It is also important to incorporate the patient and family members in the rehabilitation plan.
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This is achievable through the sharing of information between the health professional and the family members. Through psycho-education, the family will learn to adopt family intervention programs as advised to help in the social improvement of the patient, and in effect, minimize the chances of suicide (5).
Prevention of suicide in people with Schizophrenia requires a multifaceted approach. The first step towards achieving this is the ability to identify or detect the signs that most probably indicate suicidal motives in schizophrenic patients. The factors that increase the vulnerability of patients to suicide should be understood properly to ensure that the patient is kept under control. Such factors include demographic, effects of medication, and psychosocial factors. The medical practitioners should also maim to work hand in hand with other stakeholders such as the family and patients to ensure that the regimen employed in treatment is effective.
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- Tatarelli R, Maurizio P & Paolo G. Suicide in Schizophrenia. Hauppauge, N.Y: Nova Science, 2006.
- Wayne S. Depression, Suicide and Suicide Prevention in Schizophrenia. Suicide and Life-Threatening Behaviour. 2000; 30(1): 34–49.
- Cohen D & Carl E. Integrated Textbook of Geriatric Mental Health. Baltimore: Johns Hopkins University Press, 2011.
- Stroup TS & Jeffrey A. Lieberman. Antipsychotic Trials in Schizophrenia: The Catie Project. Cambridge: Cambridge University Press, 2010.