What is the role of schizophrenia in the development of suicidal behaviors?

Updated: Jul 26, 2021
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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Schizophrenic patients are at a significantly high risk for suicide. They may experience hallucinations, often auditory, such as voices commanding them to kill themselves (command hallucinations). In addition, these individuals may, in the context and as a result of their illness, become depressed; they realize that they are different from others.

Persons with schizophrenia may also have moments of insight during which they realize that they may not achieve some life goals that others can accomplish. Individuals who are considered highly functional seem to be at high risk for suicide, perhaps because of their ability to appreciate how they are different from others and how their life is different from what they wish it to be.

Finally, the suspicions and fears associated with schizophrenia may promote isolation and withdrawal.

The high rate of suicide in patients with schizophrenia is higher when physical comorbidity or substance abuse is also present. [22]

A 2-year study comparing the risk for suicidal behavior in patients treated with clozapine versus olanzapine was conducted in 980 patients with schizophrenia or schizoaffective disorder, 26.8% of whom were refractory to previous treatment, who were considered at high risk for suicide because of previous suicide attempts or current suicidal ideation. Results show that clozapine was superior to olanzapine in preventing suicide attempts in patients with schizophrenia and schizoaffective disorder at high risk for suicide. [23]

Although there is at least modest evidence suggesting that antipsychotic medications protect against suicidal risk, the evidence appears to be most favorable for second-generation antipsychotics, particularly clozapine, which is the only medication approved by the US FDA for preventing suicide in patients with schizophrenia. [24]

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