F57. EVALUATION OF SUICIDE RISK IN SCHIZOPHRENIA SPECTRUM DISORDERS - A LITERATURE REVIEW

Patients diagnosed with schizophrenia have a higher risk for suicide than general population, and the elevated prevalence of suicidal ideation and attempts represents a challenge for this population. Data in the literature sustain a lifetime risk of suicide in schizophrenia between 5 and 15%, and the rate of suicide attempts is even higher, varying from 20 to 40%. Suicide ideation and suicide attempts are observed in patients both during acute phase of schizophrenia spectrum disorder and between psychotic episodes. Post-psychotic depression, affective symptoms within psychotic acute episodes, specific positive symptoms that could trigger suicide behaviors, and co-morbid substance use disorders are the most supported suicide risk factors. A literature search was performed in the main electronic databases (Cochrane, PubMed, EMBASE, CINAHL, Thomson Reuters/Web of Science) using as keywords “suicide risk”, “suicide ideation”, “suicide attempts”, “schizophrenia”, “schizoaffective disorder”, and “psychotic disorders”. All papers published between 1998 and 2018 have been included in the primary analysis. Inclusion criteria: observational, interventional, randomized, single/double-blind or open trial, national registry analysis, retrospective chart analysis or outpatient recordings review; age between 18 and 65; patients diagnosed with schizophrenia, schizoaffective disorder, psychotic disorder not otherwise specified who presented at least one episode of suicidal ideation or at least one suicide attempt; use of structured methods for evaluation of the suicide risk. Exclusion criteria: unspecified trial design, case reports, case series, systematic reviews and meta-analyses, age under 18 and above 65, multiple somatic and psychiatric co-morbidities, lack of a specified instrument for suicide risk evaluation. A number of 82 papers were found after the primary search, but only 4 remained after inclusion and exclusion criteria filters were applied. These four papers were retrospective analyses based on hospital charts and outpatients’ recordings analysis (n=3), and one prospective clinical trial. A total number of 17,582 patients diagnosed with schizophrenia and related disorders were included in these four papers. Higher Calgary Depression Scale for Schizophrenia (CDSS) score, anxiety, guilt, gender, age, number of previous hospitalizations, previous suicide attempts, financial or relationship losses, multiple psychiatric co-morbidities were the most reported risk factors for suicide in schizophrenia spectrum disorders. Patients diagnosed with schizophrenia spectrum disorders should be carefully evaluated and monitored for suicide risk. The use of structured interviews and/or validated scales for suicide ideation and behaviors may be very helpful in the early detection of patients at risk, especially in the context of communicational difficulties frequently observed in psychoses.

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