Suicide Attempt in Schizophrenia

Suicide is a very important sosial phenomenon and requires attention not only from psychiatrists but also the general public. The phenomenon of suicide has spread to almost all parts of the world, both in countries with advanced technology and in developing countries, from rich countries to poor countries. The risk of suicide among people with schizophrenia is higher than the general population. Attempted suicide is an act of self-injury that is done intentionally and aims to die, but does not cause death. These actions represent psychological difficulties and there are several risk factors associated with suicide attempts. Schizophrenia is a chronic and severe psychiatric disorder with a huge global health burden. Among those suffering from schizophrenia, the lifetime suicide rate is around 5% and suicide is the leading cause of premature death.

Keywords: Suicide, Suicide Attempt, Schizophrenia

Introduction

Currently, not only the role of psychiatrists is very important in dealing with the phenomenon of suicide, but also the general public. Suicide is a social phenomenon and has been widespread in al- most all parts of the world, both in developed and developing countries, from rich to poor countries. Suicide is an act to kill oneself intentionally. It is estimated that by 2020, 1.53 million people will die from suicide worldwide, meaning that there will be 1 death every 20 seconds. One of the world’s psychological problems that are threatening at this time is suicide. In 2003, in Indonesia, there were 112 suicides and during the first 6 months of 2004, 92 cases were found. So we can conclude that the number of suicides in Indonesia increases from year to year.[1]Due to the complexity and difficulty of schizophrenia symptoms, people with schizophrenia are more likely to attempt suicide than those without schizophrenia. The prevalence of lifetime suicide attempts in those with schizo- phrenia ranges from 20% to 40%. When compared with those who do not suffer from schizophrenia, the chances of suicide attempts in schizophrenic patients are higher. Among the various causative factors, depression and anxiety explain the bulk of the association between schizophrenia and suicide attempts, suggesting that half of the schizophren- ic patients suffer from depressive symptoms and these symptoms are associated with an increase in suicide attempts. Among schizophrenic patients, it was reported that depression was associated with a seven-fold higher risk of suicide attempts, and de- pression with anxiety together explained 17.5% of the variability in suicide attempts. These findings suggest that it is important for health care profes- sionals working in the community to recognize the need to assess the presence of other mental health problems along with symptoms of schizophrenia. The prevalence of suicide attempts among those who live in the community can be reduced by de- veloping best practices to support patients who have schizophrenia with other comorbid mental health conditions.[2]

Discussion

According to PPDGJ III, schizophrenia is a syn- drome with a variety of causes (not yet known)

and extensive disease course (not always chronic or deteriorating), and many consequences that de- pend on the balance of genetic, physical, and so- cio-cultural influences.[3]

Epidemiology

World Health Organization (WHO) states that more than 66% of the total number of schizophren- ic patients in developing countries do not receive adequate control measures. In Indonesia, the cov- erage of schizophrenia patients is 15.1%, and only 48.9% of the population who seek treatment reg- ularly take the medication.[4]There is no differ- ence in the prevalence of schizophrenia between men and women. Based on the onset and course of the disease, there are differences between men and women. The onset in men is found earlier than in women. In men, the onset of schizophrenia is at the age of 10 to 25, while in women, it is between 25 and 35 years old.[5]Approximately 3% to 10% of women with schizophrenia present with the on- set of the disease after the age of 40. In general, the outcomes for female patients with schizophrenia are better than for men.[6]

Pathophysiology

There are various theories about the etiology of schizophrenia that are currently widely adopted, among others:[7]

1. Genetics
2. Neurochemistry: several hypotheses regarding

the effects of neurochemistry, namely:

1. The dopamine hypothesis suggests that schizo- phrenia is caused by overactivity in the mesolim- bic dopamine pathway
2. Neurodevelopmental hypothesis

Diagnosis

In Indonesia, the diagnosis criteria for schizo- phrenia still use the Guidelines Diagnosis of Men- tal Disorders in Indonesia edition III (PPDGJ-III), which refers to the International Statistical Classi- fication of Diseases and Related Health Problems 10th Revision.[3]

Management

Patients with schizophrenia have a poor quality of life as a result of poor medical care, homelessness, unemployment, financial constraints, lack of edu-

cation, and poor social skills. Thus, a review of the factors associated with the holistic management of schizophrenia is essential. Importantly, one of the achievements of the management of this disorder is not only alleviating some of the symptoms but also improving the quality of life of patients (by having a successful job and human relations).[8]

Suicide Attempt Suicide

Suicide comes from the Latin “suicide”, with “sui” which means itself, and “cidium” which means murder. According to Schneidman, suicide is the behavior of conscious destruction aimed at oneself by an individual who views suicide as the best solution. Suicide can also be described as a mental state that which an individual has experi- enced psychological pain and feelings of frustra- tion that last a long time so that the individual sees suicide as the only solution to the problem at hand that can stop the pain he feels. Baechler said that suicide is a behavior that seeks a solution to an existential problem by experimenting with some- one’s life. According to Nabe and Corr (2003), death can be called suicide, if accompanied by an intention to die.[9]

There are 4 definitions of suicide according to Maris, Berman, Silverman, and Bongar (2000), among others:

1. Intentional suicide
2. Performed with intention
3. Performed by oneself to oneself
4. Can occur directly (active) or indirectly (pas- sive)

So it can be said that suicide in general is the be- havior of killing oneself to die as a solution to a problem.

The terms include ideas and suicidal behavior:[10]

1. Suicidal ideation: the

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