Fenton W S, McGlashan T H, Victor B J, Blyler C R
Chestnut Lodge Research Institute, Rockville, MD 20850, USA.
Am J Psychiatry. 1997 Feb;154(2):199-204. doi: 10.1176/ajp.154.2.199.
Suicide is the single largest cause of premature death among individuals with schizophrenia. This report examines the relationship between positive or negative symptoms, illness subtype, and suicidal behavior among patients with schizophrenia and schizophrenia spectrum disorders in a long-term follow-up cohort.
Based on index admission records, patients from the Chestnut Lodge Follow-Up Study with schizophrenia (N = 187), schizoaffective disorder (N = 87), schizophreniform disorder (N = 15), and schizotypal personality disorder (N = 33) were retrospectively assessed with the Positive and Negative Syndrome Scale, classical subtype criteria, and criteria for the deficit syndrome. Completed suicide, suicide attempts, and suicidal ideation during the follow-up period (average = 19 years) were ascertained by means of interviews with patients and/or surviving relatives.
Over the follow-up period, 40% of the patients reported suicidal ideation, 23% reported suicide attempts, and 6.4% died from suicide. Patients dead from suicide had significantly lower negative symptom severity at index admission than patients without suicidal behaviors. Two positive symptoms (suspiciousness and delusions), however, were more severe among successful suicides. The paranoid schizophrenia subtype was associated with an elevated risk (12%) and the deficit subtype was associated with a reduced risk (1.5%) of suicide.
The impact of positive and negative symptoms on suicide risk has not been reported. These findings suggest that prominent negative symptoms, such as diminished drive, blunted affect, and social and emotional withdrawal, counter the emergence of suicidality in patients with schizophrenia spectrum disorders and that the deficit syndrome defines a group at relatively low risk for suicide. Prominent suspiciousness in the absence of negative symptoms defines a relatively high-risk group.
自杀是精神分裂症患者过早死亡的单一最大原因。本报告在一个长期随访队列中研究了精神分裂症及精神分裂症谱系障碍患者的阳性或阴性症状、疾病亚型与自杀行为之间的关系。
基于首次入院记录，对栗树屋随访研究中的精神分裂症患者（N = 187）、分裂情感性障碍患者（N = 87）、精神分裂症样障碍患者（N = 15）和分裂型人格障碍患者（N = 33），采用阳性和阴性症状量表、经典亚型标准以及缺陷综合征标准进行回顾性评估。通过与患者和/或幸存亲属访谈，确定随访期间（平均 = 19年）的自杀死亡、自杀未遂和自杀意念情况。
在随访期间，40%的患者报告有自杀意念，23%报告有自杀未遂，6.4%死于自杀。自杀死亡的患者在首次入院时的阴性症状严重程度显著低于无自杀行为的患者。然而，有两项阳性症状（猜疑和妄想）在成功自杀者中更为严重。偏执型精神分裂症亚型与自杀风险升高（12%）相关，缺陷型亚型与自杀风险降低（1.5%）相关。
此前尚未报道阳性和阴性症状对自杀风险的影响。这些发现表明，突出的阴性症状，如动力减退、情感迟钝以及社交和情感退缩，可对抗精神分裂症谱系障碍患者自杀行为的出现，且缺陷综合征定义了一个自杀风险相对较低的群体。在无阴性症状的情况下突出的猜疑定义了一个相对高风险群体。
