Schizophrenia Bulletin最新文献

Background and hypothesis: Suicide rates among people with schizophrenia and other primary psychotic disorders are high, with the steepest increase in risk in the first years following contact with mental health services. Evidence suggests early intervention in psychosis services may reduce suicide risk for people experiencing first-episode psychosis. We aimed to compare the characteristics of patients with a recent (<12 month) onset of schizophrenia and other primary psychotic disorders with patients with a longer duration of illness (12 months and over) to identify key characteristics for patient suicide to aid services to effectively support patients during a particularly high-risk time.

Study design: A national clinical survey of patients with schizophrenia and other primary psychotic disorders who died by suicide in England and Wales between January 1, 2008 and December 31, 2021.

Study results: Of the 2828 (N = 18 487, 16%) patients with a diagnosis of schizophrenia and other primary psychotic disorders who died by suicide, ten percent (n = 288) were ill for less than 12 months. These patients were more often under the care of crisis teams or recently discharged from in-patient services than patients with a longer duration of illness (12 months and over), and they were more often seen by services within the week before they died. Patients with recent illness onset had fewer factors conventionally associated with suicide, such as alcohol or drug misuse, a history of violence, and self-harm. They were less likely to live alone and be unemployed.

Conclusions: Though all patients had contact with mental health services in the 12 months prior to death, patients with a recent onset of schizophrenia and other primary psychotic disorders were more commonly in recent contact with services at the time of death. They had fewer social and behavioral factors known to be common to suicide, suggesting lives recently disrupted by illness. Services should provide intensive support for patients who have been recently diagnosed, encouraging engagement and monitoring for deteriorating social factors.

Background and hypothesis: Formal thought disorder (FTD), studied even before the inception of the concept of schizophrenia, remains a deeply isolating experience for patients as well as a difficult one for their interlocutors, including clinicians.

Study design: The views on language, paralinguistic, and extralinguistic features exhibited by patients with severe mental ill health are reviewed, including the contributions from 19th-century European authors to the last third of the 20th century.

Study results: Stages in the construction of FTD are described, including its merging with Dementia Praecox, and its subsequently being shaped by notions such as primitive archaic thinking, paralogical or autistic thinking, concretism, overinclusive thinking, and the return of the efforts to describing it with increased reliability.

Conclusions: It appears that some features of communication in schizophrenia, but not others, have been selected at different points in time for clinical and research use without realizing that by carrying out that selection, the phenomenon under study itself is changed. Remarkably, some theories of FTD remained in use, despite being empirically disproved (eg, word association disorder, concrete thinking, paralogical thinking) or despite its highly problematic and discriminatory nature. We would suggest that studies of FTD should explicitly consider which and why some of its features are included or excluded when assessing it. Furthermore, we would suggest that the study of FTD should incorporate the complexity of human communication, including the pragmatic, paralinguistic, non-verbal, and cognitive dimensions of the localized and unique situation where it takes place.