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

Maurizio Pompili, Xavier F Amador, Paolo Girardi, Jill Harkavy-Friedman, Martin Harrow, Kalman Kaplan, Michael Krausz, David Lester, Herbert Y Meltzer, Jiri Modestin, Lori P Montross, Preben Bo Mortensen, Povl Munk-Jørgensen, Jimmi Nielsen, Merete Nordentoft, Pirjo Irmeli Saarinen, Sidney Zisook, Scott T Wilson, Roberto Tatarelli, Maurizio Pompili, Xavier F Amador, Paolo Girardi, Jill Harkavy-Friedman, Martin Harrow, Kalman Kaplan, Michael Krausz, David Lester, Herbert Y Meltzer, Jiri Modestin, Lori P Montross, Preben Bo Mortensen, Povl Munk-Jørgensen, Jimmi Nielsen, Merete Nordentoft, Pirjo Irmeli Saarinen, Sidney Zisook, Scott T Wilson, Roberto Tatarelli

Abstract

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 result 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 schizophrenia patients.

Figures

Figure 1
Figure 1
A summary of risk factors for suicide in schizophrenia.

References

    1. Pompili M. Suicide risk in schizphrenia. In: Tatarelli R, Pompili M, Girardi P, editor. Suicide in schizophrenia. New York: Nova Science Publishers Inc; 2006.
    1. Miles CP. Conditions predisposing to suicide: a review. J Nerv Ment Dis. 1977;164:231–246.
    1. Caldwell CB, Gottesman II. Schizophrenics kill themselves too: A review of risk factors for suicide. Schizophr Bull. 1990;16:571–589.
    1. Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: a reexamination. Arch Gen Psychiatry. 2005;62:247–53. doi: 10.1001/archpsyc.62.3.247.
    1. Inskip HM, Harris EC, Barraclough B. Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. Br J Psychiatry. 1998;172:35–7.
    1. Meltzer HY. Suicidality in schizophrenia: pharmacologic treatment. Clin Neuropsychiatry. 2005;2:76–83.
    1. Ettlinger R. Evaluation of suicide prevention after attempted suicide. Acta Psychiatr Scand Suppl. 1975;260:1–135.
    1. Meltzer HY. Suicidality in schizophrenia: a review of the evidence for risk factors and treatment options. Curr Psychiatry Rep. 2002;4:279–283.
    1. Pompili M, Mancinelli I, Ruberto A, Kotzalidis GD, Girardi P, Tatarelli R. Where schizophrenic patients commit suicide: a review of suicide among inpatients and former inpatients. Int J Psychiatry Med. 2005;35:171–190. doi: 10.2190/9CA1-EL73-1VXD-9F2V.
    1. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997;170:205–28.
    1. Brown S. Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry. 1997;171:502–508.
    1. Munk-Jorgensen P, Mortensen PB. Incidence and other aspects of the epidemiology of schizophrenia in Denmark, 1971–87. Br J Psychiatry. 1992;161:489–95.
    1. Licht RW, Mortensen PB, Gouliaev GH, Lund J. Mortality in Danish psychiatric long-stay patients, 1972–82. Acta Psychiatr Scand. 1993;87:336–41.
    1. 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;154:1235–42.
    1. Meltzer HY, Conley RR, De Leo D, Green AI, Kane JM, Knesevich MA, Lieberman JA, Lindenmayer JP, Potkin SG. Intervention strategies for suicidality. J Clin Psychiatry. 2003;6:1–16. [audiograph series]
    1. Nordentoft M, Laursen TM, Agerbo E, Qin P, Hoyer EH, Mortensen PB. Change in suicide rates for patients with schizophrenia in Denmark, 1981–97: nested case-control study. BMJ. 2004;329:261. doi: 10.1136/bmj.38133.622488.63.
    1. Landmark J, Cernovsky ZZ, Merskey Correlates of suicide attempts and ideation in schizophrenia. Br J Psychiatry. 1987;151:18–20.
    1. Planasky K, Johnston R. The occurence and characteristics of suicidal preoccupation and acts in schizophrenia. Acta Psychiatr Scand. 1971;47:473–83.
    1. Drake RE. Suicide attempts and completed suicides among achizophrenia patients. In: Tatarelli R, Pompili M, Girardi P, editor. Suicide in schizophrenia. New York: Nova Science Publishers Inc; 2006.
    1. Fenton WS, McGlashan TH, Victor BJ, Blyler CR. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. Am J Psychiatry. 1997;154:199–204.
    1. Fenton WS. Depression, suicide, and suicide prevention in schizophrenia. Suicide Life Threat Behav. 2000;30:34–49.
    1. Hu WH, Sun CM, Lee CT, Peng SL, Lin SK, Shen WW. A clinical study of schizophrenic suicides. 42 cases in Taiwan. Schizophr Res. 1991;5:43–50. doi: 10.1016/0920-9964(91)90052-S.
    1. Westermeyer JF, Harrow M, Marengo J. Risk for suicide in schizophrenia and other psychotic and nonpsychotic disorders. J Nerv Ment Disease. 1991;5:259–265.
    1. 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;47:127–134. doi: 10.1016/S0920-9964(00)00003-7.
    1. Saarinen PI, Lehtonen J, Lonnqvist J. Suicide risk in schizophrenia: an analysis of 17 consecutive suicides. Schizophr Bull. 1999;25:533–542.
    1. Krupinski M, Fischer A, Grohmann R, Engel RR, Hollweg M, Moller HJ. Schizophrenic psychoses and suicide in the clinic. Nervenarzt. 2000;71:906–911. doi: 10.1007/s001150050682.
    1. Roy A. Suicide in chronic schizophrenia. Br J Psychiatry. 1982;141:171–177.
    1. Zisook S, Byrd D, Kuck J, Jeste DV. Command hallucinations in outpatients with schizophrenia. J Clin Psychiatry. 1995;56:462–465.
    1. Kelly DL, Shim JC, Feldman SM, Yu Y, Conley RR. Lifetime psychiatric symptoms in persons with schizophrenia who died by suicide compared to other means of death. J Psychiatr Res. 2004;38:531–356. doi: 10.1016/j.jpsychires.2004.02.001.
    1. 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. doi: 10.1192/bjp.187.1.9.
    1. Cooper SJ, Kelly CB, King DJ. 5-Hydroxyindoleacetic acid in cerebrospinal fluid and prediction of suicidal behaviour in schizophrenia. Lancet. 1992;340:940–941. doi: 10.1016/0140-6736(92)92819-2.
    1. Invernizzi R, Berettera C, Garattini S, Samanin R. d- and lisomers of fenfluramine differ markedly in their interaction with brain serotonin and catecholamines in the rat. Eur J Pharmacol. 1986;120:9–15. doi: 10.1016/0014-2999(86)90633-3.
    1. Correa H, Duval F, Mokrani MC, Bailey P, Tremeau F, Staner L, Diep TS, Crocq MA, Macher JP. Serotonergic function and suicidal behavior in schizophrenia. Schizophr Res. 2002;56:75–85. doi: 10.1016/S0920-9964(01)00181-5.
    1. Mann JJ, Stanley M, McBride PA, McEwen BS. Increased serotonin2 and beta-adrenergic receptor binding in the frontal cortices of suicide victims. Arch Gen Psychiatry. 1986;43:954–959.
    1. Meyer JH, Kennedy S, Brown GM. No effect of depression on [[15]O]H2O PET response to intravenous d-fenfluramine. Am J Psychiatry. 1998;155:1241–1246.
    1. Siever LJ, Buchsbaum MS, New AS, Spiegel-Cohen J, Wei T, Hazlett EA, Sevin E, Nunn M, Mitropoulou V. d,l-fenfluramine response in impulsive personality disorder assessed with [18F]fluorodeoxyglucose positron emission tomography. Neuropsychopharmacology. 1999;20:413–423. doi: 10.1016/S0893-133X(98)00111-0.
    1. Plocka-Lewandowska M, Araszkiewicz A, Rybakowski JK. Dexamethasone suppression test and suicide attempts in schizophrenic patients. Eur Psychiatry. 2001;16:428–431. doi: 10.1016/S0924-9338(01)00602-2.
    1. Keshavan MS, Reynolds CF, Montrose D, Miewald J, Downs C, Sabo EM. Sleep and suicidality in psychotic patients. Acta Psychiatr Scand. 1994;89:122–125.
    1. Jones JS, Stein DJ, Stanley B, Guido JR, Winchel R, Stanley M. Negative and depressive symptoms in suicidal schizophrenics. Acta Psychiatr Scand. 1994;89:81–87.
    1. Lewis CF, Tandon R, Shipley JE, DeQuardo JR, Jibson M, aylor SF, Goldman M. Biological predictors of suicidality in schizophrenia. Acta Psychiatr Scand. 1996;94:416–20.
    1. Hinze-Selch D, Mullington J, Orth A, Lauer CJ, Pollmacher T. Effects of clozapine on sleep: a longitudinal study. Biol Psychiatry. 1997;42:260–6. doi: 10.1016/S0006-3223(96)00347-2.
    1. Gupta S, Black DW, Arndt S, Hubbard WC, Andreasen NC. Factors associated with suicide attempts among patients with schizophrenia. Psychiatr Serv. 1998;49:1353–1355.
    1. Roy A, Mazonson A, Pickar D. Attempted suicide in chronic schizophrenia. Br J Psychiatry. 1984;144:303–306.
    1. Drake RE, Gates C, Cotton PG. Suicide among schizophrenics: a comparison of attempters and completed suicide. Br J Psychiatry. 1986;149:784–787.
    1. Hansen L, Jones RM, Kingdon D. No association between akathisia or Parkinsonism and suicidality in treatment-resistant Schizophrenia. J Psychopharmacol. 2004;18:384–387. doi: 10.1177/026988110401800309.
    1. Muller DJ, Barkow K, Kovalenko S, Ohlraun S, Fangerau H, Kolsch H, Lemke MR, Held T, Nothen MM, Maier W, Heun R, Rietschel M. Suicide attempts in schizophrenia and affective disorders with relation to some specific demographical and clinical characteristics. Eur Psychiatry. 2005;20:65–9. doi: 10.1016/j.eurpsy.2004.06.024.
    1. Haw C, Hawton K, Sutton L, Sinclair J, Deeks JJ. Schizophrenia and deliberate self-harm: a systematic review of risk factors. Suicide Life Threat Behav. 2005;35:50–62. doi: 10.1521/suli.35.1.50.59260.
    1. Amador XF, Strauss DH, Yale SA, Gorman JM. Awareness of illness in schizophrenia. Schizophr Bull. 1991;17:113–132.
    1. Amador XF, Kronengold . Understanding and Assessing Insight. In: Amador X, David A, editor. Insight and Psychosis. 2. New York: Oxford University Press; 2004.
    1. Farberow NL, Shneidman ES, Leonard CV. Suicide among schizophrenic mental hospital patients. In: Farberow NL, Shneidman ES, editor. The Cry for Help. New York: McGraw-Hill; 1961. pp. 78–109.
    1. Warnes H. Suicide in schizophrenia. Dis Nerv Syst. 1968;29:35–40.
    1. Drake ER, Gates C, Cotton PG, Whitaker A. Suicide among schizophrenics. Who is at risk? J Nerv Ment Dis. 1984;172:613–617.
    1. Cotton PG, Drake RE, Gates C. Critical treatment issues in suicide among schizophrenics. Hosp Community Psychiatry. 1985;36:534–536.
    1. Drake RE, Gates C, Whitaker A, Cotton PG. Suicide among schizophrenics: a review. Compr Psychiatry. 1985;26:90–100. doi: 10.1016/0010-440X(85)90053-7.
    1. Drake RE, Gates C, Cotton PG. Suicide among schizophrenics. Br J Psychiatry. 1986;149:784–787.
    1. Amador XF, Strauss DH. The Scale to Assess Unawareness of Mental Disorder (SUMD) Columbia New York: University and New York State Psychiatric Institute; 1990.
    1. David AS. Insight and Psychosis. Br J Psychiatry. 1990;156:789–808.
    1. McEvoy JP, Apperson LJ, Appelbaum PS, Ortlip P, Brecosky J, Hammill K. Insight in schizophrenia: Its relationship to acute psychopathology. J Nerv Ment Dis. 1989;177:43–7. doi: 10.1097/00005053-198901000-00007.
    1. Kim CH, Jayathilake K, Meltzer HY. Hopelessness, neurocognitive function, and insight in schizophrenia: Relation to suicidal behavior. Schizophr Res. 2002;60:71–80. doi: 10.1016/S0920-9964(02)00310-9.
    1. Bourgeois M, Swendsen J, Young F, Amador X, Pini S, Cassano GB, Lindenmayer JP, Hsu C, Alphs L, Meltzer HY. Awareness of disorder and suicide risk in the treatment of schizophrenia: Results of the international suicide prevention trial. Am J Psychiatry. 2004;161:1494–1496. doi: 10.1176/appi.ajp.161.8.1494.
    1. Meltzer HY, Alphs L, Green AI, Altamura AC, Anand R, Bertoldi A, Bourgeois M, Chouinard G, Islam MZ, Kane J, Krishnan R, Lindenmayer JP, Potkin S, International Suicide Prevention Trial Study Group Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT) Arch Gen Psychiatry. 2003;60:82–91.
    1. Beck AT. Depression: Clinical, Experimental, and Theoretical Aspects. New York: Harper & Row; 1967.
    1. Bedrosian RC, Beck AT. Cognitive aspects of suicidal behavior. Suicide Life Threat Behav. 1979;2:87–96.
    1. Westermeyer JF, Harrow M, Marengo JT. Hopelessness, depression, and suicidal intent. J Clin Psychol. 1991;41:159–160.
    1. Smith TE, Hull JW, Huppert JD, Silverstein SM, Anthony DT, McClough JF. Insight and recovery from psychosis in chronic schizophrenia and schizoaffective disorder patients. J Psychiatr Res. 2004;38:169–176. doi: 10.1016/S0022-3956(03)00091-8.
    1. Lewis L. Mourning, insight, and reduction of suicide risk in schizophrenia. Bull Menninger Clin. 2004;68:231–244. doi: 10.1521/bumc.68.3.231.40405.
    1. Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry. 1999;256:181–189.
    1. Harkavy-Friedman JM, Nelson EA, Venarde DF, Mann JJ. Suicidal behavior in schizophrenia and schizoaffective disorder: Examining the Role of Depression. Suicide Life Threat Behav. 2004;34:66–76. doi: 10.1521/suli.34.1.66.27770.
    1. Harkavy-Friedman JM, Restifo K, Malaspina D, Kaufmann CA, Amador XF, Yale SA, Gorman JM. Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. Am J Psychiatry. 1999;156:1276–1278.
    1. Guze SB, Robbins E. Suicide and primary affective disorders. Br J Psychiatry. 1970;117:437–438.
    1. Fawcett J, Scheftner W, Clark D, Hedeker D, Gibbons R, Coryell W. Clinical predictors of suicide of patients with major affective disorders: A controlled prospective study. Am J Psychiatry. 1987;144:35–40.
    1. Roy A. Depression, attempted suicide, and suicide in patients with chronic schizophrenia. Psychiatr Clin North Am. 1986;9:193–206.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. Fourth. Washington DC: APA Press; 1994.
    1. Strosahl K, Chiles JA, Linehan M. Prediction of suicide intent in hospitalized parasuicides: reasons for living, hopelessness, and depression. Compr Psychiatry. 1992;33:366–373. doi: 10.1016/0010-440X(92)90057-W.
    1. Osman A, Gifford J, Jones T, Lickiss L, Osman J, Wenzel R. Psychometric evaluation of the reasons for living inventory. Psychol Assess. 1993;5:154–158. doi: 10.1037/1040-3590.5.2.154.
    1. Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry. 1985;142:559–563.
    1. Mazeh D, Shahai B, Saraf R, Melamed Y. Venlafaxine for the treatment of depressive episode during the course of schizophrenia. J Clin Psychopharmacol. 2004;24:653–655. doi: 10.1097/01.jcp.0000144894.37611.0a.
    1. Whitehead C, Moss S, Cardno A, Lewis G. Antidepressants for the treatment o f depression in people with schizophrenia: A systematic review. Psychol Med. 2003;33:589–599. doi: 10.1017/S0033291703007645.
    1. Jones JS, Stein DJ, Stanley B, Guido JR, Winchel R, Stanley M. Negative and depressive symptoms in suicidal schizphrenics. Acta Psychiatrica Scand. 1994;89:81–87.
    1. Pickar D, Roy A, Breier A, Doran A, Wolkowitz O, Colison J, Agren H. Suicide and aggression in schizophrenia. Neurobiologic correlates. Ann N Y Acad Sci. 1986;487:189–196. doi: 10.1111/j.1749-6632.1986.tb27898.x.
    1. Fenton WS. Depression, suicide, and suicide prevention in schizophrenia. Suicide Life Threat Behav. 2000;30:34–49.
    1. Pompili M, Girardi P, Ruberto A, Tatarelli R. Toward a new prevention of suicide in schizophrenia. World J Biol Psychiatry. 2004;5:201–210. doi: 10.1080/15622970410029934.
    1. Barraclough BM. Suicide: Clinical and epidemiological studies. London: Croom Helm; 1987.
    1. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism. J Consult Clin Psychol. 1974;42:861–865. doi: 10.1037/h0037562.
    1. Beck AT, Brown G, Berchick RJ, Stewart BL, Steer RA. Relationship between hopelessness and ultimate suicide. Am J Psychiatry. 1990;147:190–195.
    1. Nordentoft M, Jeppesen P, Abel M, Kassow P, Petersen L, Thorup A, Krarup G, Hemmingsen R, Jorgensen P. OPUS study: Suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis. Br J Psychiatry. 2002;181:S98–S106. doi: 10.1192/bjp.181.43.s98.
    1. Drake RE, Cotton PG. Depression, hopelessness and suicide in chronic schizophrenia. Br J Psychiatry. 1986;148:554–559.
    1. Aguilar EJ, Haas G, Manzanera FJ, Hernandez J, Gracia R, Rodado MJ, Keshavan MS. Hopelessness and first-episode psychosis. Acta Psychiatr Scand. 1997;96:25–30.
    1. Strauss JS. Subjective experiences of schizophrenia. Schizophr Bull. 1989;15:179–187.
    1. Stahl SM. Mixed anxiety and depression: Clinical implications. J Clin Psychiatry. 1993. pp. 33–38.
    1. Wittchen HU, Essau CA. Comorbidity and mixed anxiety-depressive disorders: Is there epidemiologic evidence? J Clin Psychiatry. 1993. pp. 9–15.
    1. Shuwall M, Siris SG. Suicidal ideation in postpsychotic depression. Compr Psychiatry. 1994;35:132–134. doi: 10.1016/0010-440X(94)90058-P.
    1. Goodwin R, Lyons JS, McNally RJ. Panic attacks in schizophrenia. Schizophr Res. 2002;58:213–220. doi: 10.1016/S0920-9964(01)00373-5.
    1. Stephens JH, Richard P, McHugh PR. Suicide in patients hospitalized for schizophrenia 1913–1940. J Nerv Ment Disease. 1913;187:10–14. doi: 10.1097/00005053-199901000-00003.
    1. Cem Atbasoglu E, Schultz SK, Andreasen NC. The relationship of akathisia with suicidality and depersonalization among patients with schizophrenia. J Neuropsychiatry Clin Neurosci. 2001;13:336–341.
    1. Zilboorg G. Differential diagnostic types of suicide. Arch Neurol Psych. 1936;35:270–291.
    1. Dassori AM, Mezzich JE, Keshavan M. Suicidal indicators in schizophrenia. Acta Psychiatr Scand. 1990;81:409–413.
    1. Sinclair JMA, Mullee MA, King EA, Baldwin DS. Suicide in schizophrenia: a retrospective case-control study of 51 suicides. Schizophr Bull. 2004;30:803–811.
    1. Heilä H, Isometsä ET, Henriksson MM, Heikkinen ME, Marttunen MJ, Lönnqvist JK. Suicide victims with schizophrenia in different treatment phases and adequacy of antipsychotic medication. J Clin Psychiatry. 1999;60:200–208.
    1. Farberow NL, Shneidman ES, Leonard CV. Suicide among schizophrenic mental hospital patients. In: Farberow NL, Shneidman ES, editor. The Cry for Help. New York-Toronto-London: McGraw-Hill; 1961. pp. 78–97.
    1. Wolfersdorf M, Neher F, Working Group „Suicidality and psychiatric hospital“ Schizophrenia and suicide – results of a control group comparison of schizophrenic suicides with schizophrenic inpatients without suicide. Psychiatr Prax. 2003;30:272–278. doi: 10.1055/s-2003-40776.
    1. Drake RE, Gates C, Cotton PG, Whitaker A. Suicide among schizophrenics: Who is at risk? J Nerv Ment Dis. 1984;172:613–618.
    1. Virkkunen M. Attitude to psychiatric treatment before suicide in schizophrenia and paranoid psychoses. Br J Psychiatry. 1976;128:47–49.
    1. Havaki-Kontaxaki BJ, Kontaxakis VO, Protopappa VA, Christodoulou GM. Suicides in a large psychiatric hospital: risk factors for schizophrenic patients. In: Christodoulou GM, Kontaxakis VO, editor. Topics in Preventive Psychiatry. Karger, Basel: Bibliotheca Psychiatrica; Karger, Basel; 1994. pp. 63–71.
    1. Andreasen NC, Olsen S. Negative v positive schizophrenia. Definition and validation. Arch Gen Psychiatry. 1982;39:789–794.
    1. Crow TJ. Molecular pathology of schizophrenia: more than one disease process? Br Med J. 1980;280:66–68.
    1. Dingman CW, McGlashan TH. Discriminating characteristics of suicides. Chestnut Lodge follow-up sample including patients with affective disorder, schizophrenia and schizoaffective disorder. Acta Psychiatr Scand. 1986;74:91–97.
    1. Strauss JS, Carpenter WT., Jr The prediction of outcome in schizophrenia: I. Characteristics of outcome. Arch Gen Psychiatry. 1972;26:739–746.
    1. Schmitt W, Mundt C. Differential typology among patients with hard and soft suicide methods. Nervenarzt. 1991;62:440–444.
    1. Salvatore A. Professional ethics and suicide: toward an ethical typology. J Ethics Law Aging. 2000;6:257–269.
    1. Durkheim E. Le suicide. Paris: Alcan; 1897.
    1. Bronisch T. The typology of personality disorders – diagnostic problems and their relevance for suicidal behavior. Crisis. 1996;17:55–58.
    1. Batel P. Addiction and schizophrenia. Eur Psychiatry. 2000;15:115–122. doi: 10.1016/S0924-9338(00)00203-0.
    1. Modestin J, Zarro I, Waldvogel D. A study of suicide in schizophrenic in-patients. Br J Psychiatry. 1992;160:398–401.
    1. Mundt Ch. Suicides by schizophrenics – comments on genesis and prevention based on several case reports. Psychother Psychosom Med Psychol. 1984;34:187–222.
    1. Robins E. The final months. New York: Oxford University Press; 1981.
    1. Barraclough B, Bunch J, Nelson B, Sainsbury P. A hundred cases of suicide: Clinical aspects. Br J Psychiatry. 1974;125:355–373.
    1. Dorpat TL, Ripley HS. A study of suicide in the Seattle area. Compr Psychiatry. 1960;1:349–359.
    1. Robins E, Murphy OE, Wilkinson RH, Jr, Gassner S, Kayes J. Some clinical considerations in the prevention of suicide in a study of 134 successful suicides. Am J Public Health. 1959;49:888–899.
    1. Hendin H. Suicide: A review of new directions in research. Hosp Community Psychiatry. 1986;37:148–153.
    1. Weismann M, Fox K, Klerman GL. Hostility and depression associated with suicide attempts. Am J Psychiatry. 1973;130:450–455.
    1. Minkoff K, Bergman E, Beck AT, Beck R. Hopelessness, depression, and attempted suicides. Am J Psychiatry. 1973;130:455–459.
    1. Jackson JJ. Remarks on evolution and dissolution of the nervous system. J Ment Sci. 1887;33:25–48.
    1. Kraepelin E. Dementia praecox and paraphrenia. Edimburgh: Livingstone; 1919.
    1. Pogue-Geile MF, Zubin J. Negative symptomatology and schizophrenia: A conceptual and empirical review. Int J Ment Health. 1988;16:3–45.
    1. Andreasen NC, Olsen SA, Dennert JW, Smith MR. Ventricular enlargement in schizophrenia: relationship to positive and negative symptoms. Am J Psychiatry. 1982;139:297–302.
    1. Andreasen NC. Negative symptoms in schizophrenia. Definition and reliability. Arch Gen Psychiatry. 1982;39:784–8.
    1. Chapman LJ, Chapman J. Disordered thought in schizophrenia. New York: Appleton' Century-Croft; 1973.
    1. Allen HA. Do positive symptom and negative symptom subtypes of schizophrenia show qualitative differences in language production? Psychol Med. 1983;13:787–97.
    1. Kaplan KJ, Harrow M. Psychosis and functioning as risk factors for later suicidal activity among schizophrenia and schizoaffective patients: a disease-based interactive model. Suicide Life Threat Behav. 1999;29:10–24.
    1. Strauss JS, Carpenter WT., Jr Prediction of outcome in schizophrenia: III. Five year outcome and its predictors. Arch Gen Psychiatry. 1977;34:159–163.
    1. Rubin NS, Harrow M. Deficit-negative and -positive symptoms during the acute and post-hospital phases of schizophrenia: A longitudinal study. In: Cromwell RL, Snyder CR, editor. Schizophrenia Origins, processes treatment and outcome. New York: Oxford University Press; 1993.
    1. Falloon I, Talbot R. Persistent auditory hallucinations: Coping mechanisms and implications for management. Psychol Med. 1981;11:329–339.
    1. Levy S, Southcombe R. Suicide in a state hospital for the mentally ill. J Nerv Ment Dis. 1953;117:504–514.
    1. Miller F, Chabrier LA. The relation of delusional content in psychotic depression to life-threatening behavior. Suicide Life Threat Behav. 1987;17:13–17.
    1. Miller F, Chabrier LA. Suicide attempts correlate with delusional content in major depression. Psychopathology. 1988;21:34–37.
    1. Fawcett J, Scheftner WA, Fogg L, Clark DC, Hedeker D, Gibbons R, Coryell W. Time-related predictors of suicide in major affective disorder. Am J Psychiatry. 1990;147:1189–1194.
    1. Kaplan KJ, Harrow M. Psychosis and functioning as risk factors for later suicidal activity among schizophrenia and schizoaffective patients: A disease-based interactive model. Suicide Life Threat Behav. 1998;29:10–24.
    1. Kaplan KJ, Harrow M. Positive and negative symptoms as risk factors for later suicidal activity in schizophrenics versus depressives. Suicide Life Threat Behav. 1996;26:105–121.
    1. Kaplan KJ, Harrow M, Faull R. Early Positive and Negative Symptoms and Poor Functioning and Later Suicidal Activity among Schizophrenia, Schizoaffective and Depressive Patients. In: Tatarelli R, Pompili M, Girardi P, editor. Suicide in schizophrenia. New York: Nova Science Publishers Inc; 2006.
    1. Hellerstein D, Frosch W, Koenigsberg W. The clinical significance of command hallucinations. Am J Psychiatry. 1987;144:219–221.
    1. 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;64:871–874.
    1. Rudnick A. Relation between command hallucinations and dangerous behavior. J Am Acad Psychiatry Law. 1999;27:253–257.
    1. Rogers P, Watt A, Gray NS, MacCulloch M, Gournay K. Content of command hallucinations predicts self-harm but not violence in a medium secure unit. Am J Forensic Psychiatry. 2002;13:251–262. doi: 10.1080/09585180210150096.
    1. McNiel DE, Eisner JP, Binder RL. The relationship between command hallucinations and violence. Psychiatr Serv. 2000;51:1288–1292. doi: 10.1176/appi.ps.51.10.1288.
    1. Rogers R, Gillis R, Turner E, Frise-Smith T. The clinical presentation of command hallucinations in a forensic population. Am J Psychiatry. 1990;147:1304–1307.
    1. Buckley PF, Hrouda DR, Friedman L, Noffsinger SG, Resnick PJ, Camlin-Shingler K. Insight and its relationship to violent behavior in patients with schizophrenia. Am J Psychiatry. 2004;161:1712–1714. doi: 10.1176/appi.ajp.161.9.1712.
    1. Erkwoh R, Willmes K, Eming-Erdmann A, Kunert HJ. Command hallucinations: who obeys and who resists when? Psychopathology. 2002;35:272–279. doi: 10.1159/000067065.
    1. Cheung P, Schweitzer I, Crowley K, Tuckwell V. Violence in schizophrenia: role of hallucinations and delusions. Schizophr Res. 1997;26:181–190. doi: 10.1016/S0920-9964(97)00049-2.
    1. Pompili M, Tatarelli C, Kotzalidis GD, Tatarelli R. Suicide risk in substance abusers with schizophrenia. In: Tatarelli R, Pompili M, Girardi P, editor. Suicide in schizophrenia. New York: Nova Science Publishers Inc; 2006.
    1. Rich CL, Fowler RC, Fogarty LA, Young D. San Diego suicide study. III. Relationship between diagnosis and stressors. Arch Gen Psychiatry. 1988;45:589–592.
    1. Rich CL, Motooka MS, Fowler RC, Young D. Suicide by psychotics. Biol Psychiatry. 1988;24:595–601. doi: 10.1016/0006-3223(88)90170-9.
    1. Fowler RC, Rich CL, Young D. San Diego suicide study. II. Substance abuse in young cases. Arch Gen Psychiatry. 1986;43:962–965.
    1. Shafii M, Carrigan S, Whittinghill JR, Derrick A. Psychological autopsy of completed suicide in children and adolescents. Am J Psychiatry. 1985;142:1061–1064.
    1. Wilcox HC, Conner KR, Caine ED. Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend. 2004;76:S11–19. doi: 10.1016/j.drugalcdep.2004.08.003.
    1. Barbee JG, Clarck PD, Crapanzaro MS, Heintz GC, Kehoe CE. Alcohol and substance abuse among schizophrenic patients presenting to an emergency psychiatric service. J Nerv Ment Dis. 1989;177:400–407. doi: 10.1097/00005053-198907000-00003.
    1. Osher FC, Drake RE, Teague GB, Hurlbut SC, Beaudett MS, Paskus TS. Correlates of alcohol abuse among rural schizophrenic patients. New Hampshire-Dartmouth: Psychiatric Research Center; 1991. pp. 30–38.
    1. Lorenzen U. Problematik psychiatrischer Patienten mit doppel Diagnose „Schizophrenie und Suchtmittelmissbrauch“ am Beispiel der Lebenslaufanalyse ehemaliger Bewohnerinnen eines psychiatrischen übergans Wohnheimes. Hamburg: Diss. Universität; 1990.
    1. Yesavage JA, Zarcone V. History of drug abuse and dangerous behavior in inpatient schizophrenics. J Clin Psychiatry. 1983;41:259–261.
    1. Safer DJ. Substance abuse by young adult chronic patients. Hosp Community Psychiatry. 1987;38:511–514.
    1. Drake RE, Wallach MA. Substance abuse among the chronic mentally ill. Hosp Community Psychiatry. 1989;40:1041–1045.
    1. Lindqvist P, Allebeck P. Schizophrenia and assaultive behaviour: the role of alcohol and drug abuse. Acta Psychiatr Scand. 1990;82:191–195.
    1. Krausz M, Mass R, Haasen C, Gross J. Psychopathology in patients with schizophrenia and substance abuse. Psychopathology. 1996;29:95–103.
    1. Allgulander C, Ljungberg L, Fisher LD. Long-term prognosis in addiction on sedative and hypnotic drug analyzed with the Cox regression model. Acta Psychiatr Scand. 1987;75:521–531.
    1. Bowers MB, Jr, Mazure CM, Nelson JC, Jatlow PI. Psychotogenic drug use and neuroleptic response. Schizophr Bull. 1990;16:81–85.
    1. Duke PJ, Pantelis C, Barnes TRE. South Westminster schizophrenia survey. Alcohol use and its relationship to symptoms, tardive dyskinesia and illness onset. Br J Psychiatry. 1994;164:630–636.
    1. Miller FT, Tanenbaum JH. Drug abuse in schizophrenia. Hosp Community Psychiatry. 1989;40:847–849.
    1. Pompili M, Tatarelli R. Schizofrenia, suicidio e abuso di sostanze. Personalità/Dipendenze. 2003;9:323–332.
    1. Safer DJ. Substance abuse by young adult chronic patients. Hosp Community Psychiatry. 1998;38:511–514.
    1. Pompili M, Mancinelli I, Girardi P, Tatarelli R. Preventing suicide in young schizophrenics who are substance abusers. Subst Use Misuse. 2004;39:1437–1441.
    1. Berglund M. Suicide in alcoholism. A prospective study of 81 suicides. I. The multidimensional diagnosis at first admission. Arch Gen Psychiatry. 1984;41:888–891.
    1. Murphy GE, Robins E. Social factors in suicide. JAMA. 1967;199:303–308. doi: 10.1001/jama.199.5.303.
    1. Murphy GE, Amstrong JW, Herlene SL, Fischer JR, Clendenin WW. Suicide and alcoholism: interpersonal loss confirmed as a predictor. Arch Gen Psychiatry. 1979;36:65–69.
    1. Silver H, Abboud E. Drug abuse in schizophrenia: comparison of patients who began drug abuse before their first admission with those who began abusing drugs after their first admission. Schizophr Res. 1994;13:57–63. doi: 10.1016/0920-9964(94)90060-4.
    1. Soyka M. Substance abuse, psychiatric disorders and violent and disturbed behaviour. Br J Psychiatry. 2000;176:345–350. doi: 10.1192/bjp.176.4.345.
    1. Soyka M, Albus M, Kathmann N, Finelli A, Hofstetter S, Holzbach R, Immler B, Sand P. Prevalence of alcohol and drug abuse in schizophrenic inpatients. Eur Arch Psychiatry Clin Neurosci. 1993;242:362–372. doi: 10.1007/BF02190250.
    1. Grunebaum MF, Oquendo MA, Harkavy-Friedman JM, Ellis SP, Li S, Haas GL, Malone KM, Mann JJ. Delusions and suicidality. Am J Psychiatry. 2001;158:742–747. doi: 10.1176/appi.ajp.158.5.742.
    1. Krausz M, Mass R, Haasen C, Gross J. Psychopathology in patients with schizophrenia and substance abuse. Psychopathology. 1996;29:95–103.
    1. Qin P, Nordentoft M. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry. 2005;62:427–432. doi: 10.1001/archpsyc.62.4.427.
    1. Appleby L, Shaw J, Amos T, McDonnell R, Harris C, McCann K, Kiernan K, Davies S, Bickley H, Parsons R. Suicide within 12 months of contact with mental health services: national clinical survey. BMJ. 1999;318:1235–1239.
    1. Goldacre M, Seagroatt V, Hawton K. Suicide after discharge from psychiatric inpatient care. Lancet. 1993;342:283–286. doi: 10.1016/0140-6736(93)91822-4.
    1. Lawrence DM, Holman CD, Jablensky AV, Fuller SA. Suicide rates in psychiatric in-patients: an application of record linkage to mental health research. Aust N Z J Public Health. 1999;23:468–470.
    1. Mortensen PB, Juel K. Mortality and causes of death in first admitted schizophrenic patients. Br J Psychiatry. 1993;163:183–189.
    1. Rossau CD, Mortensen PB. Risk factors for suicide with schizophrenia: nested case-control study. Br J Psychiatry. 1997;171:355–359.
    1. Munk-Jorgensen P. Has deinstitutionalization gone too far? Eur Arch Psychiatry Clin Neurosci. 1999;249:136–143. doi: 10.1007/s004060050078.
    1. Osby U, Correia N, Brandt L, Ekbom A, Sparen P. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res. 2000;45:21–28. doi: 10.1016/S0920-9964(99)00191-7.
    1. Wolfersdorf M, Keller F, Schmidt-Michel PO, Weiskittel C, Vogel R, Hole G. Are hospital suicides on the increase? A survey of reports on hospital suicides in the psychiatric literature of the 19th and 20th century. Soc Psychiatry Psychiatr Epidemiol. 1988;23:207–216. doi: 10.1007/BF01787819.
    1. Mortensen PB, Agerbo E, Erikson T, Qin P, Westergaard-Nielsen N. Psychiatric illness and risk factors for suicide in Denmark. 153. Lancet. 2000;355:9–12. doi: 10.1016/S0140-6736(99)06376-X.
    1. Qin P, Agerbo E, Mortensen PB. Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. Am J Psychiatry. 2003;160:765–772. doi: 10.1176/appi.ajp.160.4.765.
    1. Nordentoft M, Laursen TM, Agerbo E, Qin P, Hoyer EH, Mortensen PB. Change in suicide rates for patients with schizophrenia from 1981 to 1997. A nested case-control study. Ugeskr Laeger. 2004;166:4602–4606.
    1. Burgess P, Pirkis P, Morton J, Croke E. Lessons From a Comprehensive Clinical Audit of Users of Psychiatric Services who Committed Suicide. Psychiatr Serv. 2000;51:1555–1560. doi: 10.1176/appi.ps.51.12.1555.
    1. Rossberg JI, Friis S. Staff Members' Emotional Reactions to Aggressive and Suicidal Behavior of Inpatients. Psychiatric Serv. 2003;54:1388–1394. doi: 10.1176/appi.ps.54.10.1388.
    1. Ramberg IL, Wasserman D. The roles of knowledge and supervision in work with suicidal patients. Nord J Psychiatry. 2003;57:365–371. doi: 10.1080/08039480310002705.
    1. Saarinen P, Hintikka J, Lehtonen J. Somatic symptoms and risk of suicide. Nord J Psychiatry. 1998;52:311–317. doi: 10.1080/08039489850149750.
    1. Cohen S, Leonard C, Farberow NL, Shneidman ES. Tranquilizers and suicide in the schizophrenic patients. Arch Gen Psychiatry. 1964;11:312–324.
    1. Farberow NL, Shneidman ES, Leonard C. Suicide among schizophrenic mental hospital patients. In: Farberow NL, Shneidman ES, editor. The Cry for Help. New York: McGraw-Hill; 1965. pp. 78–109.
    1. Farberow NL, Shneidman ES, Leonard C. Suicidal Risk among Schizophrenic Patients. In: Shneidman ES, Farberow NL, Litman R, editor. The Psychology of Suicide. New York: Jason Aronson; 1976. pp. 307–324.
    1. Virkkunen M. Attitude to psychiatric treatment before suicide in schizophrenia and paranoid psychosis. Br J Psychiatry. 1976;128:47–49.
    1. Crammer J. The special characteristics of suicide in hospital inpatients. Br J Psychiatry. 1984;145:460–476.
    1. Pompili M, Ruberto A, Girardi P, Tatarelli R. Suicide in schizophrenia. What are we going to do about it? Ann Ist Sup Sanita. 2004;40:463–473.
    1. Drake RE, Bartels S, Torrey W. Suicide in schizophrenia: Clinical approaches. In: Williams R, Dalby JT, editor. Depression in Schizophrenics. New York: Plenum Publishing Corp; 1989. pp. 171–183.
    1. Volkan V. The Infantile Psychotic Self and Its Fates. Northvale: Jason Aronson, Inc; 1995.
    1. Siris SG. Diagnosis of Secondary Depression in Schizophrenia: Implications for DSM-IV. Schizophr Bull. 1991;17:75–98.
    1. Taiminen T. Depression among schizophrenic patients. A selective review. Psychiatria Fennica. 1994;25:185–194.
    1. Ramberg IL, Wasserman D. Suicide-preventive activities in psychiatric care: Evaluation of an educational programme in suicide prevention. Nord J Psychiatry. 2004;58:389–394. doi: 10.1080/08039480410005954.
    1. Tähkä V. Mind and Its Treatment A Psychoanalytic Approach. Madison: International Universitas Press, Inc; 1993. pp. 69–73. 188–189, 205–216.
    1. Maltsberger JT. Suicide Risk The Formulation of Clinical Judgment. New York: University Press; 1986.
    1. Maltsberger JT. The descent into suicide. Int J Psychoanal. 2004;85:653–658. doi: 10.1516/3C96-URET-TLWX-6LWU.
    1. Ringel E. The Presuicidal Syndrome. Suicide Life Threat Behav. 1976;6:131–149.
    1. Jensen V, Petty T. The Fantasy of Being Rescued in Suicide. Psychoanal Q. 1958;27:327–339.
    1. Menninger KA. Man Against Himself. New York: Harcourt, Brace & Co; 1938.
    1. Litman R. When Patients Commit Suicide. Am J Psychother. 1965;19:570–76.
    1. Meissner W. The Paranoid Process. New York: Jason Aronson Inc; 1978.
    1. Axelsson R, Lagerkvist-Briggs M. Factors Predicting Suicide in Psychotic Patients. Eur Arch Psychiatry Clin Neurosci. 1992;241:259–266. doi: 10.1007/BF02195974.
    1. American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, second edition. Am J Psychiatry. 2004;2:1–56.
    1. Fawcett J, Leff M, Bunney WE., Jr Suicide. Clues From Interpersonal Communication. Arch Gen Psychiatry. 1969;21:129–137.
    1. Motto JA. An Integrated Approach to Estimating Suicide Risk. Suicide Life Threat Behav. 1991;21:74–89.
    1. Wasserman D, (ed) Suicide An unnecessary death. London: Martin Dunitz Ltd; 2001.
    1. Berman AL, (Ed) Case Consultation. Suicide Postvention. Suicide Life Threat Behav. 1990;20:187–192.
    1. American Psychiatric Association Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviour. Am J Psychiatry. 2003;11:1–60.
    1. Schulman A, Håkanson E, Michaélsen H. Psychologic support of personnel on psychiatric wards and psychologic autopsy after a patient's suicide. Nord J Psychiatry. 1991;5:337–344.
    1. Siris S. Suicide and schizophrenia. J Psychopharmacol. 2001;15:127–35.
    1. Khan A, Khan SR, Leventhal RM, Brown WA. Symptom reduction and suicide risk among patients treated with placebo in antipsychotic clinical trials: an analysis of the food and drug administration database. Am J Psychiatry. 2001;158:1449–54. doi: 10.1176/appi.ajp.158.9.1449.
    1. Meltzer HY, Okayli G. Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk-benefit assessment. Am J Psychiatry. 1995;152:183–190.
    1. Modestin J, Dal Pian D, Agarwalla P. Clozapine diminishes suicidal behavior: a retrospective evaluation of clinical records. J Clin Psychiatry. 2005;66:534–538.
    1. Walker AM, Lanaza LL, Arellano F, Rothman KJ. Mortality in current and former users of clozapine. Epidemiology. 1997;8:671–677. doi: 10.1097/00001648-199710000-00010.
    1. Reid WH, Mason M, Hogan T. Suicide prevention effects associated with clozapine therapy in schizophrenia and schizoaffective disorder. Psychiatr Serv. 1998;49:1029–1033.
    1. Munro J, O'Sullivan D, Andrews C, Arana A, Mortimer A, Kerwin R. Active monitoring of 12,760 clozapine recipients in the UK and Ireland: beyond pharmacovigilance. Br J Psychiatry. 1999;175:576–580.
    1. Alphs L, Anand R, Islam MZ, Meltzer HY, Kane JM, Krishnan R, Green AI, Potkin S, Chouinard G, Lindenmayer JP, Kerwin R. The international suicide prevention trial (interSePT): rationale and design of a trial comparing the relative ability of clozapine and olanzapine to reduce suicidal behavior in schizophrenia and schizoaffective patients. Schizophr Bull. 2004;30:577–586.
    1. Hennen J, Baldessarini RJ. Suicidal risk during treatment with clozapine: a meta-analysis. Schizophr Res. 2004;73:139–145. doi: 10.1016/j.schres.2004.05.015.
    1. Nyman AK, Jonsson H. Patterns of self-destructive behavior in schizophrenia. Acta Psychiatr Scand. 1986;73:252–262.
    1. Mueser KT, Berenbaum H. Psychodynamic treatment of schizophrenia: is there a future? Psychol Med. 1990;20:253–62.
    1. Robbins M. Psychoanalytic and biological approaches to mental illness: schizophrenia. J Am Psychoanal Ass. 1992;40:425–454.
    1. Shapiro S. Affect integration in psychoanalysis: a clinical approach to self-destructive behavior. Bull Menninger Clin. 1991;55:363–374.
    1. Weiden P, Havens L. Psychotharapeutic management techniques in the treatment of outpatients with schizophrenia. Hosp Comm Psychiatry. 1994;45:549–555.
    1. Weiden PJ. Communicating with acutely psychotic patients: the initial evaluation. J Prac Psychiatry Behav Health. 1996;2:47–50.
    1. Weiden PJ. Communicating with psychotic patients during the course of acute treatment. J Prac Psychiatry Behav Health. 1996;2:122–124.
    1. Hogarty GE, Kornblith SJ, Greenwald D, DiBarry AL, Cooley S, Ulrich RF, Carter M, Flesher S. Three-year trials of personal therapy among schizophrenic patients living with or independent of family. I: description of study and effects on relapse rates. Am J Psychiatry. 1997;154:1504–1513.
    1. Hogarty GE, Greenwald D, Ulrich RF, Kornblith SJ, DiBarry AL, Cooley S, Carter M, Flesher S. Three-year trials of personal therapy among schizophrenic patients living with or independent of family. II: effects on adjustment of patients. Am J Psychiatry. 1997;154:1514–1524.
    1. Marder AR, Wirshing WC, Wirshing DA. New strategies with conventional antipsychotics. In: Bentliff S, de Souza, Rabson J, editor. Strategies for managing acute schizophrenia. London: Arnold; 2000. pp. 211–214.
    1. Pompili M, Ruberto A, Kotzalidis GA, Girardi P, Tatarelli R. Awareness of illness and suicide in schizophrenia: an overview. Bull Menninger Clin. 2004;68:297–318. doi: 10.1521/bumc.68.4.297.56643.
    1. Hesso R. Suicide in Norwegian, Finnish, and Swedish psychiatric hospitals. Arch Psychiatr Nervenkr. 1977;224:119–127.
    1. Currier GW. Psychiatric bed reductions and mortality among persons with mental disorders. Psychiatr Serv. 2000;51:851. doi: 10.1176/appi.ps.51.7.851.
    1. Salokangas RK, Honkonen T, Stengard E, Koivisto AM. Mortality in chronic schizophrenia during decreasing number of psychiatric beds in Finland. Schizophr Res. 2002;54:265–275. doi: 10.1016/S0920-9964(01)00281-X.
    1. Barak Y, Mirecki I, Knobler HY, Natan Z, Aizenberg D. Suicidality and second generation antipsychotics in schizophrenia patients: a case-controlled retrospective study during a 5-year period. Psychopharmacology. 2004;175:215–219. doi: 10.1007/s00213-004-1801-2.
    1. Addington DD, Azorin JM, Falloon IR, Gerlach J, Hirsch SR, Siris SG. Clinical issues related to depression in schizophrenia: an international survey of psychiatrists. Acta Psychiatr Scand. 2002;105:189–195. doi: 10.1034/j.1600-0447.2002.1o458.x.
    1. Allebeck P, Varla A, Kristjansson E, Wistedt B. Risk factors for suicide among patients with schizophrenia. Acta Psychiatr Scand. 1987;76:414–419.
    1. Heila H, Isometsa ET, Henriksson MM, Heikkinen ME, Marttunen MJ, Lonnqvist JK. Antecedents of suicide in people with schizophrenia. Br J Psychiatry. 1998;173:330–3.
    1. Roy A. Family history of suicide. Arch Gen Psychiatry. 1983;40:971–974.
    1. Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, Hegerl U, Lonnqvist J, Malone K, Marusic A, Mehlum L, Patton G, Phillips M, Rutz W, Rihmer Z, Schmidtke A, Shaffer D, Silverman M, Takahashi Y, Varnik A, Wasserman D, Yip P, Hendin H. Suicide prevention strategies: a systematic review. JAMA. 2005;294:2064–2074. doi: 10.1001/jama.294.16.2064.
    1. Pompili M, Mancinelli I, Girardi P, Tatarelli R. Nursing schizophrenic patients who are at risk of suicide. J Psychiatr Ment Health Nurs. 2003;10:622–624. doi: 10.1046/j.1365-2850.2003.00658.x.
    1. Pompili M, Mancinelli I, Girardi P, Tatarelli R. Making sense of nurses' role in the prevention of suicide in schizophrenia. Issues Ment Health Nurs. 2004;25:5–7.
    1. Pompili M, Mancinelli I, Tatarelli R. GPs' role in the prevention of suicide in schizophrenia. Fam Pract. 2002;19:221. doi: 10.1093/fampra/19.3.221.
    1. Pompili M, Girardi P, Tatarelli R. Suicide in schizophrenia: a neglected issue in family medicine. Am Fam Physician. 2004;70:648–650.
    1. Pompili M, Mancinelli I, Girardi P, Tatarelli R. Preventing suicide in schizophrenia inside family environment. Crisis. 2003;24:181–182.
    1. Harkavy-Friedman JM, Nelson EA. Assessment and intervention for the suicidal patient with schizophrenia. Psychiatr Q. 1997;68:361–75. doi: 10.1023/A:1025447115067.

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