Suicide risk in schizophrenia: learning from the past to change the future

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the results of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophenia patients

Fertility Regulation

In the past two centuries the proportion of couples using some form of conscious pregnancy-prevention has risen from close to zero to about two-thirds. In European populations this radical change in behaviour occurred largely between 1870 and 1930 without the benefit of highly effective methods. In Asia, Africa and Latin America, the change took place after 1950 since when the global fertility rate has halved from 5.0 births to 2.5 births per woman. In this chapter we describe the controversies surrounding the idea of birth control and the role of early pioneers such as Margaret Sanger; the advances in contraceptive and abortion technologies; the ways in which family planning has been promoted by many governments, particularly in Asia; trends in use of specific methods; the problems of discontinuation of use; and the incidence of unintended pregnancies and abortions

Rebels without a conscience: the evolution of the rogue states narrative in US security policy

This article examines how the foundations of the ‘rogue states’ security narrative in the United States developed prior to the declaration of the George W. Bush administration’s ‘Global War on Terror’ and President Bush’s representation of Iraq, Iran and North Korea as an ‘axis of evil’. The article argues that the puzzle of how US post-Cold War foreign and defence policy came to be focused on ‘irrational’ — but militarily inferior — adversaries can be understood through analysing how actors within the US defence community discursively constructed discrete international crises as the trigger for a major shift in US threat scenarios. This is developed through an examination of two crucial episodes in the construction of post-Cold War US national security interests: the crisis in the Persian Gulf in 1990–1 and the North Korean nuclear crisis in 1993–4. The article suggests the importance of historicizing contests over the interpretation of international crises in order to both better understand the process through which a country’s national security interests are defined and to gain greater analytical purchase on how security narratives are reconstructed during processes of systemic change

Hosts and Hostilities: Base Politics in Italy and Japan

One of the characteristics Japan and Italy share in the post-war period is the presence of a vast network of American bases on their respective sovereign territories. The aim of these bases varied since they were set up. During the early postwar period the bases contributed to keeping Washington’s former enemies under control. During the Cold War, they were essential elements of what the literature refers to as double containment policy. After the Cold War they become fundamental elements of the American so-called ‘command of the commons’. Even if the purpose of the US bases has been someway similar, ‘base politics’ have had a very different impact on Italian and Japanese domestic and foreign policies. In Japan, the opposition has been constant and intense, while in Italy US military presence was in essence welcome. In this chapter, I will highlight how dynamics related to local, domestic and international politics determined these different approaches to the presence of US military bases in Italy and Japa

Stormy Seas: Anglo-American Negotiations on Ocean Surveillance

On April 14, 1986, 18 US F-111 fighter-bombers passed unhindered over the Strait of Gibraltar on a mission intended to assassinate Libyan president Muammar Gaddafi. The mission failed, and Gaddafi would not be ousted from power until the Arab Spring and subsequent uprising of 2011. Yet the episode was important for another reason: This was the first time that the US administration invoked the UN International Convention on the Law of the Sea (UNCLOS III) to assert free passage through sea straits for ships and aircraft in order to launch an air attack without violating the airspace of neighboring European countries. This was a decisive move, especially because the Strait of Gibraltar has long been the site of various tensions, even between “special” allies. Gibraltar has been a British bastion for centuries, but the Spanish government has always contested the right of free passage through the Strait, and the United States and France have also vied for control of these strategically vital waters

Understanding suicidal ideation in psychosis: findings from the Psychological Prevention of Relapse in Psychosis (PRP) Trial

Objective: To examine the clinically important phenomenon of suicidal ideation in psychosis in relation to affective processes and the multidimensional nature of hallucinations and delusions.Method: In a cross-sectional study of 290 individuals with psychosis, the associations between level of suicidal ideation, affective processes, positive symptoms, clinical and demographic variables were examined.Results: Forty-one per cent of participants expressed current suicidal ideation. Suicidal ideation was associated with depressed mood, anxiety, low self-esteem, negative illness perceptions, negative evaluative beliefs about the self and others and daily alcohol consumption. Frequency of auditory hallucinations and preoccupation with delusions were not associated with suicidal ideation; however, positive symptom distress did relate to suicidal thoughts.Conclusion: Affective dysfunction, including distress in response to hallucinations and delusions, was a key factor associated with suicidal ideation in individuals with psychotic relapse. Suicidal ideation in psychosis appears to be an understandable, mood-driven process, rather than being of irrational or 'psychotic' origin