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American Journal of Psychiatry
1996 (153):9, 1185-1188
Suicidal Behavior in Schizophrenia
and Its Relationship to Awareness of Illness
Amador XF; Friedman JH; Kasapis C; Yale
SA; Flaum M & Gorman JM.
RELEVANCE FOR EARLY INTERVENTION
Most clinicians believe that poor insight in patients with
schizophrenia, though problematic for treatment adherence, may be protective with respect
to suicide. The assumption is that patients who do not believe that they are ill are less
likely to be suicidal. Alternatively, those patients with schizophrenia who recognize and
acknowledge the illness will be more suicidal.
This study found that only awareness of particular symptoms
was correlated to increased suicidal thoughts and behavior. Contrary to clinical lore,
awareness of having an illness was not associated with increased suicidal thoughts or
behavior. Patients who have poor insight into having an illness and are not taking their
prescribed medication are just as likely to become suicidal as any other person with
schizophrenia.
Estimates are that as many as one out of every ten persons
with this illness will kill themselves. This study suggests that poor insight into having
an illness is not a protective factor as previously believed and argue against the
strategy of leaving such patients who refuse treatment to fend for themselves.
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