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Prevention of Suicide in People with Schizophrenia

Strategies for prevention of suicide in people with Schizophrenia
Introduction
            Suicide linked to schizophrenia is a leading cause of premature deaths. The schizophrenic patients are at risk of attempting suicide as manifested by records from the 1960s. It is reported that out of all schizophrenic patients’ deaths, suicide accounts for at least 13%. Leading causesof suicide among these patients include social isolation, hospitalization, awareness of the condition and sense of helplessness, health deterioration, limited or lack of support due to family instability. Efforts to reduce the cases of suicide among these patients do not seem to have yielded much success to date. It is therefore important to adopt approachesaimed at reducing this phenomenon or preventing it altogether (3). This paper will outline possible strategies for prevention of suicide in people with schizophrenia.
Improved recognition of vulnerability
To comprehensively tackle the challenge associated with suicide among schizophrenic patients, one major approach is to improve recognition of schizophrenia patients who are vulnerable to committing suicide. Widespread evidence indicates that a highly vulnerable group constitutes the young. Both young schizophrenic males and females have been identified as likely to commit suicide as compared to their older counterpart. Among the whites, the unmarried patients who have had post-psychotic depression or previously abused drugs have higher likelihood of attempting suicide. Patients who have also earlier attempted suicide or communicated about it may end up actually committing suicide. As such, when a patient mentions of an intention to commit suicide, he/she should be under more close supervision as they could end up committing the act. Another way to identify a schizophrenic patient who is likely to commit suicide involves observing characteristics such as hopelessness and a tendency to isolate oneself. Patients who may have undergone a long hospitalization period and has become aware of their condition also tend to attempt suicide and such patients should therefore be monitored closely (1).
It is postulated that such patients fear that they could deteriorate further or due to increased dependence on medication, they may lose faith in the possibility of ever recovering. They therefore opt for induced death to alleviate their suffering. Suicide in schizophrenia has also been shown to be influenced by the active phase of the condition and notable psychotic symptoms which trigger paranoid delusions and thought insertion.Evidently, patients diagnosed with the paranoid subtype of this condition are at risk of committing suicide. Medication, though meant to mollify schizophrenia may increase the likelihood of suicide in the patient. This is associated with the increased awareness of the illness and insight about the condition. Therefore, patient under medication should be observed more closely as the immediate effect of the drug may trigger suicidal thoughts. By identifying all these possibilities among the schizophrenic patients, efforts should be made to ensure the patient who displays the characteristics is accorded the necessary support either socially or therapeutically. This is to avoid the patient resorting to suicide. Awareness should also be created to families and other stakeholders involved in caring for this class of patients. With the relevant information and skills, they will be able to detect the traits early enough and possibly take the most appropriate step towards rehabilitating the patient or preventing suicide attempts (1).
 
Psychological and social interventions
Psychological and social treatment methods have been found to effectively reduce cases of suicide among schizophrenic patients when used alongside pharmacological methods. Cognitive-behaviour therapy is one method that would greatly help in reducing and/or preventing suicide among the patients. Through this therapy, patients are trained so as to learn the specific behaviours exhibited by other people in the normal society. The training may entail the simple chores that people undertake in their daily routine such as shopping, washing, making friends or being able to initiate a conversation. To help the patients value themselves more, the training can be focused to activities that help them gain self-care skills including proper nutrition, personal hygiene and the ability to sustain themselves economically. Such efforts greatly help to overcome challenges associated with the condition such as withdrawal and hallucinations. The interventions should also target family members to help them cope with the patients by clearly understanding how to treat and monitor the patient while helping them in the rehabilitation process. To avoid relapses and hospitalizations which increase the likelihood of suicide, the patients should be encouraged to take their medication (2).
Pharmacological interventions
Although there is no definite cure for schizophrenia, the condition can be maintained over along time through use of medication alongside other therapies. The most commonly used medication involves use of anti psychotic drugs. As a strategy to prevent suicide in schizophrenic patients, the drugs are aimed at controlling the symptoms associated with the condition. These drugs target the psychotic symptoms displayed by the patients such as hallucinations, withdrawals and delusions. The drugs can reduce, eliminate and prevent relapses. Drugs such as Risperdal, Zyprexa, chlorpromazine, trifluoperazine, quetiapine and haloperidol have been found to be effective in putting schizophrenia under control. These medications are taken throughout a patient’s life. Unpleasant side effects may make patients unwilling to continue taking the medication but to avoid relapses, the must continue taking them. The use of the medication must be undertaken under close observation since impromptu improvement of a patient’s consciousness and insight may arouse an awareness in them that may propel them towards committing suicide. The patients must also be ready to undergo regular medical tests since some of the medications such as clozapine may result in life threatening effects (3).
OptimisingClinical Practice to Prevent Suicide among People with Schizophrenia
The clinical practice should aim at ensuring that patients with schizophrenia are under control from any deterioration that may trigger suicidal thoughts. The scope of intervention should therefore encompass all factors that influence the performance of the patient. The antipsychotic medication should be administered in a friendly approach more so in combination with other interventions to ensure the patient is willing to cooperate in the rehabilitation regimen. It is important to study the response of different patients to medication. This forms the basis on the most appropriate approach to treat the patient since the variations in patients’ responses may create a negative impression on other would be patients. Similarly, the response to medication by the patient may negatively affect him/her to an extent of contemplating suicide such as demonstrated by sudden increased awareness and insight. The pharmacological based tests should cover areas of neurocognitive ability, body mass index, motor disorders, lipid profiles and illegal substances in blood (4).
For successful rehabilitation, psychosocial interventions play a significant role. The approach taken should also be dependent on the particular patient. This ensures that the patient owns the rehabilitation process for improved outcomes to be realized. A professional with skills in handling such patients would be recommended as only they have the ability to determine the most effective interventions would be fruitful for the individual patient. Among the most effective interventions that could facilitate recovery of the patient to normalcy include the cognitive-behavioural therapy. This method is beneficial in treating hallucinations, increase adherence to treatment, reduce symptomatology and accelerate recovery. Use of supportive psychotherapy helps create harmony and emotionally support an individual. This should also incorporate the patient’s input to succeed. The clinical practice should also involvepsychodynamic psychotherapy. This method involves a broad analysis of the patient’s experiences to help the professional develop a personalized treatment approach. It is also important to incorporate the patient and family members in the rehabilitation plan. This is achievable through sharing of information between the health professional and the family members. Through psychoeducation, the family will learn to adopt family intervention programs as advised to help in social improvement of the patient and in effect minimize the chances of suicide (5).
Conclusion
Prevention of suicide in people with Schizophrenia requires a multi-thronged approach. The first step towards achieving this is the ability to identify or detect thesigns that most probably indicate suicidal motives in schizophrenic patients. The factors that increase vulnerability of patients to suicide such as demographic, effects of medication and psychosocial factors should be well understood to ensure the patient is kept under control. The medical practitioners should also maim to work hand in hand with other stakeholders such as the family and the patients to ensure that the regimen employed in treatment is effective.
 

 


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