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

Professional Service Utilisation among Patients with Severe Mental Disorders

<p>Abstract</p> <p>Background</p> <p>Generally, patients with serious mental disorders (SMD) are frequent users of services who generate high care-related costs. Current reforms aim to increase service integration and primary care for improved patient care and health-care efficiency. This article identifies and compares variables associated with the use by patients with SMD of services offered by psychiatrists, case managers, and general practitioners (GPs). It also compares frequent and infrequent service use.</p> <p>Method</p> <p>One hundred forty patients with SMD from five regions in Quebec, Canada, were interviewed on their use of services in the previous year. Patients were also required to complete a questionnaire on needs-assessment. In addition, data were collected from clinical records. Descriptive, bivariate, and multivariate analyses were conducted.</p> <p>Results</p> <p>Most patients used services from psychiatrists and case managers, but no more than half consulted GPs. Most patients were followed at least by two professionals, chiefly psychiatrists and case managers. Care access, continuity of care, and total help received were the most important variables associated with the different types of professional consultation. These variables were also associated with frequent use of professional service, as compared with infrequent service use. In all, enabling factors rather than need factors were the core predictors of frequency of service utilisation by patients with SMD.</p> <p>Conclusion</p> <p>This study reveals that health care system organisation and professional practice - rather than patient need profiles - are the core predictors of professional consultation by patients with SMD. The homogeneity of our study population, i.e. mainly users with schizophrenia, recently discharged from hospital, may partly account for these results. Our findings also underscored the limited involvement of GPs in this patient population's care. As comorbidity is often associated with serious mental disorders, closer follow-up by GPs is needed. Globally, more effort should be directed at increasing shared-care initiatives, which would enhance coordination among psychiatrists, GPs, and psychosocial teams (including case managers). Finally, there is a need to increase awareness among health care providers, especially GPs, of the level of care required by patients with disabling and serious mental disorders.</p

Suicide risk and prevention during the COVID-19 pandemic

No abstract available

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

Gestione clinica del comportamento suicida in schizofrenia

Circa 1 persona su 20 affetta da schizofrenia morir\ue0 prematuramente per suicidio (Inskip, Harris, e Barraclough, 1998; Palmer, Pankratz, e Bostwick, 2005) e si stima che il 20% 50% realizzer\ue0 almeno un tentativo di suicidio nel corso della vita (Caldwell &amp; Gottesman, 1990; Meltzer, 2002). La maggior parte dei suicidi portati a termine si verificano precocemente nel corso della malattia, con un rischio particolarmente alto nelle prime settimane dopo la dimissione dal primo ricovero (Appleby, Dennehy, Thomas, Faragher, e Lewis, 1999; Rossau &amp; Mortensen, 1997), seguite dal primo anno e dai primi dieci anni dopo la diagnosi (Nordentoft et al, 2004; Palmer et al, 2005). Anche il periodo precedente alla prima presentazione \ue8 particolarmente critico, poich\ue9 fino al 10% degli individui commette almeno un tentativo di suicidio, prima di accedere per la prima volta alle cure psichiatriche (Clarke et al, 2006; Melle et al, 2006). La gestione del comportamento suicidario rappresenta una questione importante per la pratica clinica, soprattutto perch\ue9 la gravit\ue0 dei tentativi di suicidio (Harkavy- Friedman et al., 1999) realizzati dagli individui affetti da schizofrenia pu\uf2 avere conseguenze ugualmente devastanti per il paziente e la sua famiglia. Il comportamento suicidario nella schizofrenia pu\uf2 essere cronico o intermittente e richiede un monitoraggio continuo da parte di medici, pazienti e loro familiari e amici. \uc8 importante identificare i potenziali fattori di rischio per ogni singolo paziente e intervenire prima che si intensifichi il comportamento suicidario. \uc8 importante non farsi prendere dal panico e non rinunciare di fronte a pazienti con grave malattia mentale, dal momento che il miglioramento e il raggiungimento della qualit\ue0 della vita desiderata pu\uf2 essere un impegno a lungo termine che offre gratificazioni significative. La comunicazione con i colleghi pu\uf2 aiutare il clinico nei momenti di preoccupazione per il rischio suicidario ed \ue8 altrettanto importante una comunicazione diretta con il paziente. I trattamenti farmacologici e sociali per la psicosi, la depressione e le altre condizioni di comorbidit\ue0 sono in grado di prevenire o ridurre il comportamento suicidario. Il comportamento suicidario \ue8 un sintomo della schizofrenia che pu\uf2 essere affrontato con attenzione e cura. Migliorare la qualit\ue0 della vita per le persone con schizofrenia d\ue0 la possibilit\ue0 di ridurre il rischio di comportamenti suicidari

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