Mamo David C
Centre for Addiction and Mental Health, Assisstant Professor of Psychiatry, University of Toronto, Ontario.
Can J Psychiatry. 2007 Jun;52(6 Suppl 1):59S-70S.
The primary objective of this review article is to provide a coherent, systematic synthesis of the literature on the management of suicidality in schizophrenia that is relevant to the front-line clinician.
Literature searches were conducted on MEDLINE (1996 to 2007) and PubMed (1993 to 2007), using the key words "schizophrenia" and "suicide," as well as references from the resulting articles. I used my own clinical experience to create fictional case examples to illustrate the applicability of the literature discussed in this paper.
Suicidality in schizophrenia is high, and early detection relies on the appreciation and evaluation of the clinical manifestations of depression, despair, and hopelessness, as well as on the nature and severity of the psychotic experience itself, particularly in recent-onset patients with higher cognitive function and educational background. Clinical management includes ensuring immediate safety, the use of psychosocial techniques to address depression and psychosocial stressors, targeted pharmacotherapy for depression and psychosis, and adequate discharge planning. Clozapine is the only antipsychotic with good evidence for efficacy in decreasing suicidal behaviour in schizophrenia.
The optimal management of suicidality in schizophrenia involves the incorporation of traditional bedside clinical skills, selection of psychosocial modalities based on individual needs, and selective pharmacotherapy directed primarily at psychotic and depressive symptoms.
这篇综述文章的主要目的是对与一线临床医生相关的精神分裂症自杀行为管理方面的文献进行连贯、系统的综合分析。
在MEDLINE（1996年至2007年）和PubMed（1993年至2007年）上进行文献检索，使用关键词“精神分裂症”和“自杀”，以及所得文章的参考文献。我利用自己的临床经验创建虚构病例示例，以说明本文所讨论文献的适用性。
精神分裂症患者的自杀行为发生率较高，早期检测依赖于对抑郁、绝望和无助等临床表现的认识与评估，以及对精神病体验本身的性质和严重程度的判断，特别是在认知功能较高和教育背景较好的近期发病患者中。临床管理包括确保即刻安全、运用心理社会技巧应对抑郁和心理社会应激源、针对抑郁和精神病进行有针对性的药物治疗以及充分的出院计划。氯氮平是唯一有充分证据表明能有效降低精神分裂症患者自杀行为的抗精神病药物。
精神分裂症自杀行为的最佳管理包括结合传统的床边临床技能、根据个体需求选择心理社会治疗方式以及主要针对精神病性和抑郁症状的选择性药物治疗。
