SUICIDAL BEHAVIOR IN SCHIZOPHRENIA

自杀是精神分裂症患者的主要死亡原因， 终生患病风险估计在16到40倍之间 普通人口。年自杀危险的流行病学研究 精神分裂症几乎完全集中在粗俗的人口统计学和 具有预测自杀风险的特异性的临床变量。 对临床、心理社会和环境的综合评估 需要变量来充分识别和测试假定的预测因素 精神分裂症患者有自杀风险。到目前为止还没有研究同时进行 采用前瞻性研究方法，考察了 精神病理学、心理社会功能和环境应激源 精神分裂症患者的自杀行为。因此，我们建议进行一项2- 200例DSM-III-R特征良好的队列的1年随访研究 精神分裂症患者，包括100名高危未遂者，50人 “理想家”，以及50名“低风险”的非自杀患者。这项研究将 评估与(1)临床相关的自杀行为的风险 特征，包括情感症状和绝望--风险 在情感性精神障碍中自杀的研究中已经确定的因素； 和(2)心理社会因素--人际解决问题的能力， 应激性生活事件和社会/家庭因素，如高表达 情感和社会支持。通过将后续部分添加到正在进行的 现在我们的自杀支持的横断面和回溯性研究 MHCRC，这项研究将遵循这一独特的和特征良好的队列 在他们自杀风险最高的临终后时期。 通过遵循这一独特的和具有良好特征的患者样本，我们将 能够区分与状态和特质相关的心理社会和临床 风险因素，并前瞻性地评估它们在 预测自杀行为。这项关于临床和临床的综合研究 心理社会变量将提供改善的经验基础 临床风险评估和临床有效性的发展 心理社会治疗干预。

Suicide is a leading cause of death among patients with schizophrenia, with lifetime morbid risk estimates ranging from 16 to 40 times that of the general population. Epidemiologic studies of risk for suicide in schizophrenia have focused almost exclusively on gross demographic and clinical variables with specificity for predicting suicide risk. Comprehensive assessment of clinical, psychosocial, and environmental variables is needed to adequately identify and test putative predictors of risk for suicide in schizophrenia. No study to date has concurrently examined, using prospective study methods, the influence of psychopathology, psychosocial functioning, and environmental stressors on suicidal behavior in schizophrenia. Therefore, we propose to conduct a 2- year follow-up study of a well-characterized cohort of 200 DSM-III-R Schizophrenia Disorder patients, including 100 "high-risk" attempters, 50 "ideators", and 50 "low risk" non-suicidal patients. This study will assess risk for suicidal behavior associated with (1) clinical characteristics, including affective symptomatology and hopelessness--risk factors already identified in studies of suicide in affective disorders; and (2) psychosocial factors--interpersonal problem-solving skills, stressful life events, and social/familial factors such as high Expressed Emotion and social support. By adding a follow-up component to the ongoing cross-sectional and retrospective studies now supported by our Suicide MHCRC, this study will follow this unique and well-characterized cohort through the posthospital period when they are at highest risk for suicide. By following this unique and well-characterized patient sample, we will be able to differentiate state- and trait-related psychosocial and clinical risk factors and prospectively assess their relative importance in predicting suicidal behavior. This comprehensive study of clinical and psychosocial variables will provide an empirical basis for improved clinical risk assessment and for the development of clinically effective psychosocial treatment interventions.