Department of Psychiatry Medical School, University of Patras, General University Hospital, 26504 Rion, Patras, Greece.
Compr Psychiatry. 2011 Sep-Oct;52(5):479-85. doi: 10.1016/j.comppsych.2010.10.011. Epub 2010 Dec 23.
Patients with schizophrenia are at high risk for suicide ideation, attempts, and completed suicide. However, suicidal behavior during the prodromal phase of schizophrenia and a possible association between prodromal suicidal behavior and suicidality after the onset of overt psychosis are not studied.
One hundred six consecutively admitted schizophrenia patients with recent onset were evaluated retrospectively for prodromal symptoms and suicidality during the prodromal phase and after the onset of frank psychosis. In addition, 106 matched control subjects from the general population were evaluated for suicidality during the same age period of the prodromal phase of the corresponding patient.
Suicide ideation and attempt during the prodromal period were reported in 25.5% and 7.5% of the patients, which are 3.8- and 8-fold greater than in the controls, respectively. Patients with suicidal behavior experienced a greater number of prodromal symptoms than those without. Prodromal depressive mood, marked impairment in role functioning, and tobacco smoking exerted an independent effect on suicide ideation, whereas depressive mood was the symptom significantly more frequent in patients with suicide attempt. Suicide attempts were associated with an earlier onset of prodromal symptoms and frank psychosis. All patients with prodromal suicide attempts were cigarette smokers. Suicide ideation during the prodromal phase was strongly associated with lifetime suicidality after the onset of frank psychosis.
Suicidal behavior is quite common during the prodromal period. The association of smoking, depressive mood, impaired functioning, and a large number of prodromal symptoms, particularly in patients with an early onset of symptomatology, carries a substantially increased risk for suicide ideation. Particular care is needed in patients with prodromal suicide ideation after the onset of frank psychosis because the risk to attempt suicide is high.
精神分裂症患者有很高的自杀意念、自杀企图和自杀死亡风险。然而，精神分裂症前驱期的自杀行为，以及前驱期自杀行为与明显精神病发作后的自杀之间的可能关联，尚未得到研究。
回顾性评估了 106 例近期发病的连续入院精神分裂症患者在前驱期和明显精神病发作后的前驱症状和自杀意念。此外，在同期的患者前驱期，还对 106 例来自普通人群的匹配对照者进行了自杀意念评估。
前驱期有自杀意念和自杀企图的患者分别为 25.5%和 7.5%，分别是对照组的 3.8 倍和 8 倍。有自杀行为的患者经历的前驱症状比没有自杀行为的患者多。前驱期抑郁情绪、角色功能明显受损和吸烟对自杀意念有独立影响，而抑郁情绪是自杀企图患者更常见的症状。自杀企图与前驱症状和明显精神病发作的较早出现有关。所有前驱期自杀企图的患者都是吸烟者。前驱期的自杀意念与明显精神病发作后的终生自杀意念密切相关。
自杀行为在前驱期相当常见。吸烟、抑郁情绪、功能受损和大量前驱症状的出现，特别是在症状出现较早的患者中，与自杀意念的风险显著增加有关。在明显精神病发作后出现前驱期自杀意念的患者中，需要特别注意，因为自杀企图的风险很高。
