TO THE EDITOR: We read with great i...

TO THE EDITOR: We read with great interest the article (1) at Drs. Stovall and Domino onward approaching the suicidal patient, which is a fundamental enslave in everyday clinical practice. In fact, according to estimates from the World Health Organization, approximately 1 million the public died from suicide, and 10 to 20 times more populace attempted suicide worldwide in the year 2000 This averages not at home to one death every 40 secondarys and one attempt every three others Persons affected by psychiatric illness are more depicted among those who manifest suicidal behavior. Patients who have schizophrenia contribute excessively to the number of patients who commit or attempt suicide. Family physicians are likely to experience the los of a schizophrenic patient at suicide. Accurate analysis of follow-up studies estimated that 10 to 13 percent of schizophrenic patients die through suicide. (2)

Family physicians may have a part in the prevention of suicide in patients who have schizophrenia, which is the first cause of death among patients affected by dint of this illness; however, its part is underestimated and seldom recognized. A search of PubMed/Med-line set only one English scientific paper (editorial) (3) that inclemencyed plainly the need for prevention of suicide in patients with schizophrenia in general practice. the same study (4) found that 63 percent of patients who committed suicide had seen their general practitioners in the month before death and 36 percent had seen them in the week before death. A later report (5) set up fewer patients having seen general practitioners shortly before death, which may be a consequence of improved detection and treatment of patients at risk. Thus, the recognition of risk factors is an proper sphere of prevention and prediction.

most numerous authors agree that the schizophrenic patient who is more likely to commit suicide is young, male, white, has in no degree been married, has good premorbid function and postpsychiatric depression, and a history of substance abuse and suicide attempts. Hopelessnes social isolation, awareness of ill-ness, and hospitalization also are important risk factors in schizophrenic patients who commit suicide. Deteriorating health with a high horizontal of premorbid functioning, recent los or rejection, limited external support, and family stres or instability are other risk factors for attempted suicide in patients with schizophrenia. These patients usually fear further mental deterioration and experience excessive treatment concatenation or a loss of faith in the treatment. These risk factors should always be traced by dint of family physicians to assess the patients' suicide risk.

Although family physicians may have an ancillary part in the treatment of schizophrenic patients, they may be in a strategic position to discover early risk factors or to contribute to the changing of state-dependent risk factors. Also, family physicians may have a fundamental part in dealing with patients' family members. chiefly often the family is enslaveed to stigma because of the schizophrenic member, and family members may make known hostility toward the sick family member that may contribute to the unravelling of suicidal behavior. (6) Family physicians may advance patient information and assist families during exhausting periods or when they perceive isolated and lacking adequate support.

REFERENCES

(1) Stovall J Domino FJ Approaching the suicidal patient. Am Fam Physician 2003;68:1814-8

(2) Caldwell CB Gottesman II. Schizophrenics kill them-selves too: a review of risk factors for suicide. Schizophr gross mistake 1990;16:571-89.

(3.) Pompili M Mancinelli I, Tatarelli R GP's part in the prevention of suicide in schizophrenia. Fam Pract 2002;19:221

(4) Barraclough BM cluster J, Nelson B, Sainsbury P A hun-dr cases of suicides: clinical aspects. Br J Psychiatry 1974;125:355-73

(5) Vassilas CA, Morgan HG General practitioners' contact with victims of suicide. BMJ 1993;307:300-1

(6) Pompili M Mancinelli I, Girardi P Tatarelli R Preventing suicide in schizophrenia inside the family environment. Crisis 2003;24:181-2

MAURIZIO POMPILI, MD

PAOLO GIRARDI, MD

ROBERTO TATARELLI, MD

University of Rome "La Sapienza"

Ospedale Sant' Andrea

Via di Grottarossa, 1035-9

Rome Italy 00189

COPYRIGHT 2004 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group