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Suicidality in Schizophrenia Spectrum Disorders: The Relationship to Hallucinations and Persecutory Delusions

Published online by Cambridge University Press:  16 April 2020

E. Kjelby ,
I. Sinkeviciute ,
R. Gjestad ,
R.A. Kroken ,
E.-M. Løberg ,
H.A. Jørgensen ,
K. Hugdahl  and
E. Johnsen
E. Kjelby*
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
I. Sinkeviciute
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
R. Gjestad
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
R.A. Kroken
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway
E.-M. Løberg
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Bergen, Norway Department of Clinical Psychology, University of Bergen, Norway
H.A. Jørgensen
Affiliation:
Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway
K. Hugdahl
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Bergen, Norway Department of Biological and Medical Psychology, University of Bergen, Norway NORMENT Centre of Excellence, University of Oslo, Norway
E. Johnsen
Affiliation:
Division of Psychiatry, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, Section of Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Norway
*
*Corresponding author. E-mail address: [email protected] (E. Kjelby).
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Abstract

Background:

Assessment of suicide risk is crucial in schizophrenia and results concerning risk contributed by hallucinations and persecutory delusions are inconsistent. We aimed to determine factors associated with suicidal ideation and plans at the time of acute admission in patients suffering from schizophrenia spectrum disorders.

Methods:

One hundred and twenty-four patients older than 18 years admitted to an acute psychiatric ward due to psychosis were consecutively included. Predictors of suicidal ideation and suicide plans at the time of admission were examined with multinominal logistic regression and structural equation modelling (SEM). The study design was pragmatic, thus entailing a clinically relevant representation.

Results:

Depression Odds Ratio (OR) 12.9, Drug use OR 4.07, Hallucinations OR 2.55 and Negative symptoms OR 0.88 significantly predicted Suicidal ideation. Suspiciousness/ Persecution did not. Only Depression and Hallucinations significantly predicted Suicide plans. In the SEM-model Anxiety, Depression and Hopelessness connected Suspiciousness/Persecution, Hallucinations and Lack of insight with Suicidal ideation and Suicide plans.

Conclusions:

The study contributes to an increasing evidence base supporting an association between hallucinations and suicide risk. We want to emphasise the importance of treating depression and hallucinations in psychotic disorders, reducing hopelessness while working with insight and reducing drug abuse in order to lower suicide risk.

Trial registration:

ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/NCT00932529.

Keywords

Schizophrenia and psychosisSuicidePsychiatry in Europe
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 7 , October 2015 , pp. 830 - 836
Copyright
European Psychiatric Association 2015

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References

Addington, D, Addington, JAbout the Calgary Depression Scale for Schizophrenia; 2015 Available from: http://www.ucalgary.ca/cdss/node/9 [accessed 3.5.15].CrossRefGoogle Scholar
Addington, D, Addington, J, Schissel, B. A depression rating scale for schizophrenics. Schizophr Res 1990;3(4):247–251.Google ScholarPubMed
Altman, DGPractical statistics for medical research London: Chapman & Hall; 1991.Google Scholar
American Psychiatric Association Diagnostic and statistical manual of mental disorders. Washington, DC: Author; 2000.Google Scholar
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Ohlenschlaeger, J, le Quach, P, et al.Suicidal behaviour and mortality in first-episode psychosis: the OPUS trial. Br J Psychiatry Suppl 2007;51:s140–s146.CrossRefGoogle ScholarPubMed
Birchwood, M, Iqbal, Z, Upthegrove, R. Psychological pathways to depression in schizophrenia: studies in acute psychosis, post psychotic depression and auditory hallucinations. Eur Arch Psychiatry Clin Neurosci 2005;255(3):202–212.CrossRefGoogle ScholarPubMed
Boter, H, Derks, EM, Fleischhacker, WW, Davidson, M, Kahn, RS, Group, ES. Generalizability of the results of efficacy trials in first-episode schizophrenia: comparisons between subgroups of participants of the European First Episode Schizophrenia Trial (EUFEST). J Clin Psychiatry 2010;71(1):58–65.CrossRefGoogle Scholar
Brugnoli, R, Novick, D, Haro, JM, Rossi, A, Bortolomasi, M, Frediani, S, et al.Risk factors for suicide behaviors in the observational schizophrenia outpatient health outcomes (SOHO) study. BMC Psychiatry 2012;12:83.CrossRefGoogle ScholarPubMed
Bucci, S, Birchwood, M, Twist, L, Tarrier, N, Emsley, R, Haddock, G. Predicting compliance with command hallucinations: anger, impulsivity and appraisals of voices’ power and intent. Schizophr Res 2013;147(1):163–168.CrossRefGoogle ScholarPubMed
Buchanan, RW, Kreyenbuhl, J, Kelly, DL, Noel, JM, Boggs, DL, Fischer, BA, et al.The schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull 2009;36(1):71–93.Google ScholarPubMed
Carlborg, A, Winnerback, K, Jonsson, EG, Jokinen, J, Nordstrom, P. Suicide in schizophrenia. Expert Rev Neurother 2010;10(7):1153–1164.CrossRefGoogle Scholar
De Hert, M, McKenzie, K, Peuskens, J. Risk factors for suicide in young people suffering from schizophrenia: a long-term follow-up study. Schizophr Res 2001;47(2–3):127–134.CrossRefGoogle ScholarPubMed
de Irala, JRFC, del Castillo, NAS. Abnormally wide confidence intervals in logistic regression: interpretation of statistical program results. Pan Am J Public Health 1997;2(4):268–271.CrossRefGoogle Scholar
Drake, RE, Rosenberg, SD, Mueser, KT. Assessing substance use disorder in persons with severe mental illness. New Dir Ment Health Serv 1996;70:3–17.CrossRefGoogle Scholar
Fenton, WS, McGlashan, TH, Victor, BJ, Blyler, CR. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. Am J Psychiatry 1997;154(2):199–204.Google ScholarPubMed
Gefen, D, Straub, DW, Boudreau, MStructural equation modeling and regression: guidelines for research practice 2000 4; available from: http://aisel.aisnet.org/cais/vol4/iss1/7/.CrossRefGoogle Scholar
Gold, JM, Queern, C, Iannone, VN, Buchanan, RW. Repeatable battery for the assessment of neuropsychological status as a screening test in schizophrenia I: sensitivity, reliability, and validity. Am J Psychiatry 1999;156(12):1944–1950.Google Scholar
Harkavy-Friedman, JM, Kimhy, D, Nelson, EA, Venarde, DF, Malaspina, D, Mann, JJ. Suicide attempts in schizophrenia: the role of command auditory hallucinations for suicide. J Clin Psychiatry 2003;64(8):871–874.CrossRefGoogle ScholarPubMed
Haro, JM, Salvador-Carulla, L. The SOHO (Schizophrenia Outpatient Health Outcome) study: implications for the treatment of schizophrenia. CNS Drugs 2006;20(4):293–301.CrossRefGoogle ScholarPubMed
Haukka, J, Suominen, K, Partonen, T, Lonnqvist, J. Determinants and outcomes of serious attempted suicide: a nationwide study in Finland, 1996–2003. Am J Epidemiol 2008;167(10):1155–1163.CrossRefGoogle Scholar
Hawton, K, Sutton, L, Haw, C, Sinclair, J, Deeks, JJ. Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry 2005;187:9–20.CrossRefGoogle ScholarPubMed
Heila, H, Isometsa, ET, Henriksson, MM, Heikkinen, ME, Marttunen, MJ, Lonnqvist, JK. Suicide and schizophrenia: a nationwide psychological autopsy study on age- and sex-specific clinical characteristics of 92 suicide victims with schizophrenia. Am J Psychiatry 1997;154(9):1235–1242.Google Scholar
Hor, K, Taylor, M. Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol 2010;24(4 Suppl.):81–90.CrossRefGoogle ScholarPubMed
Huf, G, Coutinho, ES, Adams, CE, Group, TC. Rapid tranquillisation in psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol plus promethazine. BMJ 2007;335(7625):869.CrossRefGoogle ScholarPubMed
IBM. IBM SPSS Statistics for Windows 21.0 ed., Armonk, NY: IBM Corp.;2012.Google Scholar
Inskip, HM, Harris, EC, Barraclough, B. Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. Br J Psychiatry 1998;172:35–37.CrossRefGoogle Scholar
Iqbal, Z, Birchwood, M, Chadwick, P, Trower, P. Cognitive approach to depression and suicidal thinking in psychosis. 2. Testing the validity of a social ranking model. Br J Psychiatry 2000;177:522–528.CrossRefGoogle ScholarPubMed
Johnsen, E, Kroken, RA, Wentzel-Larsen, T, Jorgensen, HA. Effectiveness of second-generation antipsychotics: a naturalistic, randomized comparison of olanzapine, quetiapine, risperidone, and ziprasidone. BMC Psychiatry 2010;10:26.Google ScholarPubMed
Jones, PB, Barnes, TR, Davies, L, Dunn, G, Lloyd, H, Hayhurst, KP, et al.Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry 2006;63(10):1079–1087.CrossRefGoogle Scholar
Kahn, RS, Fleischhacker, WW, Boter, H, Davidson, M, Vergouwe, Y, Keet, IPM, et al.Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008;371(9618):1085–1097.CrossRefGoogle ScholarPubMed
Kay, SR, Sevy, S. Pyramidical model of schizophrenia. Schizophr Bull 1990;16(3):537–545.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13(2):261–276.CrossRefGoogle Scholar
Lako, IM, Bruggeman, R, Knegtering, H, Wiersma, D, Schoevers, RA, Slooff, CJ, et al.A systematic review of instruments to measure depressive symptoms in patients with schizophrenia. J Affect Disord 2012;140(1):38–47.CrossRefGoogle ScholarPubMed
Laroi, F, Sommer, IE, Blom, JD, Fernyhough, C, Ffytche, DH, Hugdahl, K, et al.The characteristic features of auditory verbal hallucinations in clinical and nonclinical groups: state-of-the-art overview and future directions. Schizophr Bull 2012;38(4):724–733.CrossRefGoogle ScholarPubMed
Leucht, S, Komossa, K, Rummel-Kluge, C, Corves, C, Hunger, H, Schmid, F, et al.A meta-analysis of head-to-head comparisons of second-generation antipsychotics in the treatment of schizophrenia. Am J Psychiatry 2009;166(2):152–163.CrossRefGoogle ScholarPubMed
Lieberman, JA, Stroup, TS, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, et al.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005;353(12):1209–1223.CrossRefGoogle ScholarPubMed
March, JS, Silva, SG, Compton, S, Shapiro, M, Califf, R, Krishnan, R. The case for practical clinical trials in psychiatry. Am J Psychiatry 2005;162(5):836–846.CrossRefGoogle ScholarPubMed
Montoya, A, Valladares, A, Lizan, L, San, L, Escobar, R, Paz, S. Validation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) in a naturalistic sample of 278 patients with acute psychosis and agitation in a psychiatric emergency room. Health Qual Life Outcomes 2011;9:18.CrossRefGoogle Scholar
Munro, ADelusional disorder – paranoia and related illnesses. Cambridge: Cambridge University Press; 1999.CrossRefGoogle Scholar
Muthén, LK, Muthén, BOMplus user's guide. 7th ed.Los Angeles, CA: Muthén&Muthén; 2012 [cited 20.2.15].Google Scholar
Nordentoft, M, Jeppesen, P, Abel, M, Kassow, P, Petersen, L, Thorup, A, et al.OPUS study: suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis. One-year follow-up of a randomised controlled trial. Br J Psychiatry Suppl 2002;43:s98–s106.CrossRefGoogle ScholarPubMed
Palmer, BA, Pankratz, VS, Bostwick, JM. The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry 2005;62(3):247–253.CrossRefGoogle ScholarPubMed
Penn, DL, Meyer, PS, Evans, E, Wirth, RJ, Cai, K, Burchinal, M. A randomized controlled trial of group cognitive-behavioral therapy vs. enhanced supportive therapy for auditory hallucinations. Schizophr Res 2009;109(1–3):52–59.CrossRefGoogle ScholarPubMed
Pompili, M, Amador, XF, Girardi, P, Harkavy-Friedman, J, Harrow, M, Kaplan, K, et al.Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry 2007;6:10.CrossRefGoogle ScholarPubMed
Qin, P. The impact of psychiatric illness on suicide: differences by diagnosis of disorders and by sex and age of subjects. J Psychiatr Res 2011;45(11):1445–1452.CrossRefGoogle ScholarPubMed
Qin, P, Nordentoft, M. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry 2005;62(4):427–432.CrossRefGoogle ScholarPubMed
Randolph, CRBANS repeatable battery for the assessment of neuropsychological status. Manual San Antonio: The Psychological Corporation; 1998.Google Scholar
Schennach, R, Obermeier, M, Seemuller, F, Jager, M, Schmauss, M, Laux, G, et al.Evaluating depressive symptoms in schizophrenia: a psychometric comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale. Psychopathology 2012;45(5):276–285.CrossRefGoogle ScholarPubMed
Siris, SG. Suicide and schizophrenia. J Psychopharmacol 2001;15(2):127–135.CrossRefGoogle Scholar
Siris, SG, Acosta, FJ. Qualitative content of auditory hallucinations and suicidal behavior in schizophrenia. Schizophr Res 2012;134(2–3):298–299.CrossRefGoogle Scholar
Sommer, IE, Slotema, CW, Daskalakis, ZJ, Derks, EM, Blom, JD, van der Gaag, M. The treatment of hallucinations in schizophrenia spectrum disorders. Schizophr Bull 2012;38(4):704–714.CrossRefGoogle ScholarPubMed
Suokas, JT, Perala, J, Suominen, K, Saarni, S, Lonnqvist, J, Suvisaari, JM. Epidemiology of suicide attempts among persons with psychotic disorder in the general population. Schizophr Res 2010;124(1–3):22–28.CrossRefGoogle ScholarPubMed
Tandon, R, Nasrallah, HA, Keshavan, MS. Schizophrenia, “just the facts” 4. Clinical features and conceptualization. Schizophr Res 2009;110(1–3):1–23.CrossRefGoogle ScholarPubMed
Trower, P, Birchwood, M, Meaden, A, Byrne, S, Nelson, A, Ross, K. Cognitive therapy for command hallucinations: randomised controlled trial. Br J Psychiatry 2004;184:312–320.CrossRefGoogle ScholarPubMed
Upthegrove, R, Birchwood, M, Ross, K, Brunett, K, McCollum, R, Jones, L. The evolution of depression and suicidality in first episode psychosis. Acta Psychiatr Scand 2010;122(3):211–218.CrossRefGoogle ScholarPubMed
Witt, K, Hawton, K, Fazel, S. The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Schizophr Res 2014;154(1–3):61–67.CrossRefGoogle ScholarPubMed
World Health Organization International Statistical Classification of Diseases and Related Health Problems, 10th Revision 2007 Available from: http://apps.who.int/classifications/icd10/browse/2010/en [accessed 6.10.14].Google Scholar
World Medical Association World Medical Association Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects 2013 Available from: http://www.wma.net/en/30publications/10policies/b3/ [cited 7.3.15].Google Scholar
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