Negative and depressive symptoms in suicidal schizophrenics

The aim of this study was to determine the value of positive, negative and depressive symptoms, and of the dexamethasone suppression test (DST), in differentiating schizophrenics with and without a history of suicide. Fifty-seven hospitalized patients with schizophrenia were assessed at the end of a neuroleptic free interval with the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HRSD), and with a dexamethasone challenge. Suicide attempters were significantly more likely to meet criteria for major depression than nonattempters. Scores on the HRSD differentiated the two groups whereas the sums of positive and negative symptom items from the BPRS did not. DST a.m. and p.m. cortisol values differentiated suicide attempters from nonattempters and HRSD scores correlated significantly with cortisol levels. This study confirms the importance of depressive symptoms in schizophrenic patients with a history of suicide. Assessment of the hypothalamic-pituitary-adrenal axis in schizophrenia may also provide useful information.