F57. EVALUATION OF SUICIDE RISK IN SCHIZOPHRENIA SPECTRUM DISORDERS - A LITERATURE REVIEW
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.026 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.005 |
| Bibliometrics | 0.027 | 0.021 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".