Suicide and schizophrenia:: risk evaluation and prevention

Suicide is a major public health problem throughout the world, especially among schizophrenic patients. Despite the progress in therapeutics, it still represents 9 to 13% of the deaths among this population. A clinical description of the patients who commit suicide and the identification of risk factors are fundamental for the design of care strategies. Most suicide acts occur during a period of high vulnerability: the first year of disease. The main risk factors are trait-dependent (young males, Caucasians, with a schizoaffective disorder or a chronic paranoid form of schizophrenia, with a personal or family history of suicide) or state-dependent (social isolation, low global functioning, depression and despair, substance abuse or dependence, extrapyramidal side-effects). Several models have tried to explain the physiopathology of suicide (genetic phenomena, serotoninergic deficiency, psychosociologic and cognitive factors). The prevention of suicide must be a major priority for psychiatrists, but also for the family and of health and social workers: research and correction of risk factors, evaluation and treatment of suicidal behaviours. Carers can use pharmacological means (clozapine, antidepressant drugs), psychotherapy, psychosocial and psycho-educative programs to fight against loss of social insertion and stigmatization. (c) 2005 Elsevier SAS. Tous droits reserves.