Siris S G
Department of Psychiatry, Hillside Hospital Division of the North Shore, Long Island Jewish Health System and The Albert Einstein College of Medicine, New York, USA.
J Psychopharmacol. 2001 Jun;15(2):127-35. doi: 10.1177/026988110101500209.
Suicide and suicide attempts occur at a significantly greater rate in schizophrenia than in the general population. Common estimates are that 10% of people with schizophrenia will eventually have a completed suicide, and that attempts are made at two to five times that rate. Demographically associated with suicidality in schizophrenia are being young, being early in the course of the illness, being male, coming from a high socioeconomic family background, having high intelligence, having high expectations, not being married, lacking social supports, having awareness of symptoms, and being recently discharged from the hospital. Also associated are reduced self-esteem, stigma, recent loss or stress, hopelessness, isolation, treatment non-compliance and substance abuse. Clinically, the most common correlates of suicidality in schizophrenia are depressive symptoms and the depressive syndrome, although severe psychotic and panic-like symptoms may contribute as well. This review specifically explores the issue of depression in schizophrenia, in relation to suicide, by organizing the differential diagnosis of this state and highlighting their potentially treatable or correctable causes. This differential diagnosis includes both acute and chronic disappointment reactions, the prodrome of an acute psychotic episode, neuroleptic induced akinesia and akathisia, the possibility of direct neuroleptic-induced depression, negative symptoms of schizophrenia, and the possible co-occurrence of an independent depressive diathesis. The potential beneficial roles of 'atypical' antipsychotic agents, including both clozapine and more novel agents, and adjunctive treatment with other psychopharmacological medications are considered, and the important roles of psychosocial factors and interventions are recognized.
精神分裂症患者自杀及自杀未遂的发生率显著高于普通人群。普遍估计，10%的精神分裂症患者最终会自杀身亡，而自杀未遂的发生率是这一比例的两到五倍。与精神分裂症自杀倾向在人口统计学上相关的因素包括：年轻、病程早期、男性、来自社会经济地位较高的家庭背景、智商高、期望高、未婚、缺乏社会支持、有症状自知力以及近期出院。与之相关的还有自尊降低、耻辱感、近期的丧失或压力、绝望、孤独、治疗依从性差以及药物滥用。临床上，精神分裂症自杀倾向最常见的相关因素是抑郁症状和抑郁综合征，不过严重的精神病性症状和类似惊恐的症状也可能起作用。本综述通过梳理这种状态的鉴别诊断并突出其潜在可治疗或可纠正的病因，专门探讨了精神分裂症中的抑郁问题与自杀的关系。这种鉴别诊断包括急性和慢性失望反应、急性精神病性发作的前驱期、抗精神病药物所致的运动不能和静坐不能、直接由抗精神病药物所致抑郁的可能性、精神分裂症的阴性症状以及独立抑郁素质可能的共病情况。文中考虑了“非典型”抗精神病药物（包括氯氮平和更新的药物）的潜在有益作用以及与其他精神药物的辅助治疗，同时认识到心理社会因素和干预措施的重要作用。
