[A clinical study of suicidal behavior in schizophrenic patients]

117 subjects admitted to the Department of Emergency and Critical Care Medicine at Sapporo City General Hospital due to suicide attempts between June 1983 and August 1986 were studied. Various aspects of attempted suicide and successful suicide in patients with schizophrenia were compared with those same aspects in patients with other psychiatric conditions. Similarly, 30 patients with schizophrenia who attempted suicide between January 1975 and December 1989 while inpatients or discharged outpatients in the Department of Neuro-Psychiatry at Sapporo City General Hospital were also examined. 1) In both the transverse study in the Department of Emergency and Critical Care Medicine and the longitudinal study in the Department of Neuro-Psychiatry at Sapporo City General Hospital, suicidal behavior in patients with schizophrenia increased significantly over a 5 year period after the onset of the disease. 2) Schizophrenic patients used more lethal methods for suicide (such as a direct and violent injury to the body) than did other psychiatric patients. With regards to body injury method, there was no difference between schizophrenics and other psychiatric patients between the ages of 20 and 30, though significantly more schizophrenics between the ages of 30 and 50 chose a violent body injury method. 3) Schizophrenics attempted suicide more often at any other place out of their houses than did other psychiatric patients (depressives, neurotics, etc.) and normal subjects. The difference between schizophrenics and other psychiatric patients was particularly distinct between the ages of 30 and 50. 4) Most schizophrenic patients who attempted suicide were in an exacerbated period of the illness. Interviews immediately after suicide attempts revealed that most patients attempted suicide against their will, moved by delusional and hallucinatory experiences. It is therefore presumed that most suicide in schizophrenics, even though seemingly unexpected or impulsive, is actually provoked by rapid fluctuation of the psychosis. 5) Positive symptoms reported at the time of attempted suicide included delusion of persecution, imperious auditory hallucinations, hypochondriacal delusions, and delusion of guilt. The abnormal experience which induced suicide attempts generally consisted of delusional perceptions regarding an inability to recover health, hallucinatory commands, and acute self-disruption generated by experiences such as sudden delusional ideas. These drove the patients toward suicide. 6) Most suicide attempts were within several days or several hours of abrupt symptom exacerbation. It is noteworthy that these attempts were clustered within limited periods of time. Overt suicidal tendencies continued for several months, suggesting that there is a period in which suicide may be easily induced.(ABSTRACT TRUNCATED AT 400 WORDS)