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Depression, Suicide, Incarceration and Homelessness:
Serious Issues for Our Patient Population
Fall 2001
Individuals with schizophrenia are vulnerable to a number of
problems that can undermine the quality of their lives. This
issue
focuses on some of the most tragic outcomes that are associated
with the disease. These include depression during the course
of the illness; suicide that is related to depression or psychosis;
incarceration; and homelessness. Other problems that could be
added to this list are violent or aggressive behaviors and substance
abuse.
The management of depression is an everyday issue for patients with schizophrenia and the clinicians who treat them. At any given time, as many as 25% of these patients will describe themselves as depressed. Depression can occur when patients are experiencing an acute relapse of their illness or when an individual's psychosis has been stabilized on medication. However, the approach to depression in these different phases will differ. When depression emerges during an acute psychotic episode, the focus of drug treatment should be on the psychosis itself. In the great majority of cases, the individual's depression will improve as the psychotic symptoms improve. Patients who become depressed while psychosis is stable will often benefit from the addition of an antidepressant medication.
As noted in this newsletter, as many as 10% of individuals with schizophrenia will end their own life. Some of these suicides are related to the same factors that are associated with suicide in individuals who do not have schizophrenia. That is, there is an increase in the likelihood of suicide when patients are depressed, when they are living alone, and when they are drinking excessively. Other suicides are more directly related to the illness itself. Patients who are experiencing command hallucinations or frightening delusions may attempt suicide. Others may become hopeless or demoralized when they realize that they are suffering from a serious and chronic illness. All of these potential causes of suicide can be addressed by family members and clinicians when they are aware of them. Unfortunately, some patients with schizophrenia are poor describers of their internal experience. They can suffer silently since they are unable to articulate the pain that they are experiencing.
Issues such as incarceration and homelessness are more difficult for clinicians to address. The extraordinary number of seriously ill patients in our prisons is probably a relatively new phenomenon. As noted in this issue, incarceration, substance abuse, and homelessness are problems that tend to occur in the same individuals. Unfortunately, relatively little is known about the characteristics of these individuals. As a result, Jim McQuire from this MIRECC and Robert Rosenheck from the MIRECC in New England are studying the needs of seriously mentally ill patients in jail. The goal of this work is to develop new strategies for improving the lives of this growing population of patients.
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Disclaimer:
This web site, is offered as a public service and is not intended to substitute for professional medical care.
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