The influence of cognitive-behavioural therapy on suicidality in schizophrenia

Abstract

Aims:

1.  To investigate the null hypothesis that CBT does not influence suicidality in different sub-groups of patients with schizophrenia.

2.  To investigate whether the links between certain symptoms of schizophrenia and suicidality is influenced by CBT.

3.  To investigate if a correlation between a validated suicide rating scale for patients with schizophrenia and two single items from large, general psychopathological scales exists.

Material & Method:  Three studies, Socrates (SOC), Insight (IN) and London-Newcastle (LN), including in all 821 patients with schizophrenia were investigated.  The three studies included patients at both acute and chronic stages in their illness.

Conclusions:  Suicidality can safety be said not to be increased by CBT at any stage during the illness of schizophrenia.  It seems that suicidality improves significantly more in the CBT group than other interventions when given over 20 sessions in the chronic subgroup.  Because of the limitations and unclear results in two of the three studies the null-hypothesis regarding CBT’s impact on suicidality cannot be rejected at this stage.  Patients with grandiose beliefs benefit from CBT without experiencing an increase in suicidality while patients without experiencing an increase in suicidality while patients without grandiose beliefs do exceptionally well.  The "friendly fire" - theory of rendering grandiose patients more suicidal by therapeutic input was not supported in this study.  Again it appears that the longer term therapy is more helpful with regard to suicidality for patients with all subgroups of delusions.  Patients with negative symptoms in the acute subgroup remained suicidal in the active intervention groups, CBT and SC.  No such link existed in the TAU group.  This is a clear indication that this group of patients should be treated with outmost caution early on in their illness.  Depression turned out to be strongly linked with suicidality at baseline across all three studies.

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