Clinical and neuropsychological aspects of non-fatal self-harm in schizophrenia

• Published in: European psychiatry Vol. 28; no. 6; pp. 344 - 348
• Main Authors: Pluck, G, Lekka, N.P, Sarkar, S, Lee, K.H, Bath, P.A, Sharif, O, Woodruff, P.W.R
• Format: Journal Article
• Language: English
• Published: Paris Elsevier SAS 01-08-2013; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Biological and medical sciences; Cognition; Depression; Female; Humans; Impulsive Behavior - complications; Impulsive Behavior - psychology; Internal Medicine; Male; Medical sciences; Middle Aged; Mood disorders; Neuropsychological Tests; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Schizophrenia; Schizophrenia - complications; Schizophrenic Psychology; Self-harm; Self-Injurious Behavior - complications; Self-Injurious Behavior - psychology; Substance abuse; Suicide; Suicide, Attempted - psychology; Schizophrenia; IQ; Depression; Substance abuse; Suicide; Self-harm; Mood disorder; Self injury; Cognition; Psychosis; Intellectual ability; Self destruction; Intelligence quotient
• ISSN: 0924-9338; 1778-3585
• DOI: 10.1016/j.eurpsy.2012.08.003

Abstract Purpose To investigate demographic, clinical and neuropsychological aspects of self-harm in schizophrenia and identify which are independently predictive of and therefore the most relevant to clinical intervention. Subjects and methods Eighty-seven patients with schizophrenia were interviewed regarding substance misuse, depression, hopelessness, negative/positive symptoms and illness insight. Neuropsychological assessment included premorbid IQ, continuous performance test, cognitive-motor and trait impulsivity. A prospective three-month review of medical records was also undertaken. Results Fifty-nine patients (68%) reported past self-harm (including attempted suicide). Those with past self-harm, compared to those without, were significantly more likely to report depression, hopelessness, impulsivity, a family history of self-harm, polysubstance abuse and had higher premorbid IQ. Logistic regression revealed that depression, higher premorbid IQ and polysubstance abuse were independently linked to self-harm. Five participants attempted self-harm during the 3-month prospective follow-up period. These all had a history of past self-harm and were significantly more likely to have been depressed at the initial interview than those who did not go on to self-harm. Discussion and conclusions Independent predictors of self-harm in schizophrenia are premorbid IQ and polysubstance abuse. In addition, depression was both independently associated with past self-harm and predictive of self-harm in the follow-up period.