Many Things to look for in a person with schizophrenia is social whithdrawl, hostility ,inability to express feelings, Depression, insomnia ,and strange use of words are many common signs of schizophrenia disorder.(smith,2004,pg1.) In a biological perspective it is said that there is a strong relationship schizophrenia being hereditary.
Later observations did not find systematical effectiveness of the metrazol shock on schizophrenia. The treatment was still used for depressed patients, and was ultimately replaced with electroconvulsive treatment (ECT). Nevertheless, Meduna and others ask only questions that could be answered with the scientific methods of their times. These methods were based on experiments with animals and patients, often without having justifications for what they observed.
The review of risk factors for suicide in schizophrenia indicated that the most important risk factors were: male gender, young age, short duration of illness, many admissions during last year, current inpatient, short time since discharge, co-morbid depression, previous suicide attempt, drug abuse, poor compliance with medication, poor adherence to treatment, high IQ, and suicidal ideations.
A randomised clinical trial of 547 first-episode patients with schizophrenia spectrum disorders, comparing integrated treatment and standard treatment. The integrated treatment lasted for two years and consisted of assertive community treatment with programmes for family-involvement and social skills training. A more detailed description of the methods used in integrated treatment is available in an ethnographic study of the integrated treatment and in a handbook written by the staff members in integrated treatment [Larsen, 2002; Nordentoft et al., 2002c]. The differences between the services provided in integrated treatment and standard treatment are presented, and it is evident that frequency of outpatient visits is much higher and families are much more involved in integrated treatment than in standard treatment, and that psychoeducational groups for relatives hardly existed in standard treatment. Standard treatment offered contact with a community mental health centre. Patients were assessed at entry and after one and two years by investigators that were not involved in treatment. The main outcome measures were psychotic and negative symptoms at one-year and two-year follow-up. These were assessed with Schedule for Assessment of Positive Symptoms in Schizophrenia (SAPS) and Schedule for Assessment of Negative Symptoms in Schizophrenia (SANS) [Andreasen and Olsen, 1982]. Suicidal ideation, suicidal behaviour and depression were also investigated at one- and two-year follow-up.
Risk factors for repeated non-fatal suicide act were previous suicide attempt, alcohol and drug abuse, depression, schizophrenia, previous inpatient treatment, sociopathy, unemployment, frequent change of address, hostility, hopelessness, living alone, low social class or unemployment, self-discharge before evaluation. Conflicting results were found with regard to whether suicidal intention predicted repetition.
Patients aged between 18 and 45 were included if they met the criteria for ICD-10 diagnoses of schizophrenia, acute or transient psychotic disorder, schizotypal disorder, schizoaffective disorder or other delusional disorders in the F.2-spectrum. All patients should be able to speak and understand Danish, none of the patients had been treated with antipsychotic medication for more than 12 weeks.
It was previously assumed that de-institutionalization was associated with increased risk of suicide [Rossau and Mortensen, 1997; Osby et al., 2000b]. It was contrary to our expectation that suicide rates actually decreased. Therefore, we extracted information about the structural reorganization of psychiatric treatment. We can reject the hypothesis, previously put forward, that de-institutionalization would lead to increased suicide rate. The mechanism through which this positive time change occurred is unknown. It is possible that the suicide rate among patients with schizophrenia decreased due to better treatment facilities, or that they responded to the same factors as the general population. These factors that are only partly identified, but among them the change in the availability of several dangerous means for suicide is likely to play a role.
Throughout the period 1981-1997, suicide risk among patients with schizophrenia was much higher than among never-admitted persons in the general population. The suicide rate among patients with schizophrenia and related disorders has declined in the period 1981-1997, as has the suicide rate in the general population. It is unclear whether the reason for the reduction in suicide risk among patients with schizophrenia and related disorders is due to factors affecting the general population such as decreased availability of suicide means, or to factors that affect only patients with schizophrenia and related disorders such as changes in psychiatric services, or both. Priority must continuously be given to suicide preventive efforts directed towards the general population as well as towards psychiatric patients. The finding that the suicide risk is especially high during the first month after discharge should lead to systematic evaluation of suicide risk among inpatients prior to discharge and increased treatment and support immediately after discharge. Young first-episode patients are at high risk for suicide, and more intensive treatment and support should be offered to this patient group.
Combined results from this study suggest that intensive clinical care and maintaining care beyond the point of clinical recovery are important to reduce risk of suicide in patients with psychiatric disorders. These findings should lead to systematic evaluation of suicide risk among inpatients prior to discharge and corresponding outpatient treatment as well as family support should be initiated immediately after the discharge. There are some differences but also a substantial overlap in risk factors for suicide, suicide attempt and suicidal ideation in schizophrenia [Haw et al., 2005; Hawton et al., 2005; Nordentoft et al., 2002b]. The most striking difference is that males have a higher risk of suicide but not for suicidal ideation or suicide attempt. Even though the predictive value of suicidal ideation is likely to be low, it is, together with history of attempted suicide and comorbid depression, the most important risk factors that should be assessed before discharge. There are no high- quality intervention studies that can provide guidance as to which kind of service should actually be provided in order to reduce suicide mortality. As the base rate of suicide is low even in mental illness, and because suicide attempt is not an ideal proxy variable for suicide, since risk factors for suicide are not completely overlapping with risk factors for suicide attempt, very large randomised studies would be necessary to evaluate the effect on suicide rates of different treatments. A more pragmatic approach is to ensure that patients actually are taken care of and provided evidence-based treatment for the underlying psychiatric condition such as depression or schizophrenia.
We found patients with a length of admission shorter that the median length had a higher risk of suicide. This might indicate that these patients did not receive sufficient treatment and that they might have benefited from the treatment they could have had during a longer admission. On the other hand, we do have information from paper IV [Nordentoft et al., 2004] that the suicide risk for patients with schizophrenia was reduced at the same speed as for the general population during the period where the median length of admissions was dramatically reduced. Therefore, it cannot be concluded that psychiatric admissions of a certain length are necessary to prevent suicide. The finding that patients with short admissions have a higher risk of suicide might be a result of a common underlying factor determining both the short duration of admission and the increased risk of suicide. Such an underlying condition could be, for example, illness-related factors. Hawton and colleagues identified poor compliance as such a risk factor [Hawton et al., 2005], and comorbid substance abuse might be another example of such a factor. It could be argued that the finding of increased suicide risk the first week after discharge represents reversed causality, namely that inpatient stays were interrupted by patients' suicide, but only patients who were discharged for at least one day were included in analyses of suicide risk after discharge.
This study demonstrates that there are two sharp peaks of risk for suicide around psychiatric hospitalisation, one in the first week after admission while another in the first week after discharge; suicide risk is significantly higher in patients who had less than median duration of hospital treatment; affective disorders impact suicide at the strongest in terms of both its effect size and population attributable risk; and suicide risk associated with affective and schizophrenia spectrum disorders declines quickly after treatment and recovery while the risk associated with substance abuse disorders declines relatively slower. This study also indicates that an admission history increases suicide risk relatively more in women than in men; and suicide risk is substantial for substance disorders and for multiple admissions in women but not in men.