The suicide risk for people with schizophrenia between the ages of 18 to 34 years is ten times higher than that for the general US population, according to a new study published in May.
The study from the Columbia University Department of Psychiatry looked at a large population of adults diagnosed with schizophrenia and found that the youngest group (18-34) had the highest suicide risk and those aged 65 and older the lowest. By comparison, in the general US population, the reverse is true: younger adults have a smaller risk and older age groups have a greater risk.
The Columbia study, published online in the journal JAMA Psychiatry also showed that people with schizophrenia, overall, have a 4.5-fold increased risk of dying from suicide, the 10th leading cause of death in the United States.
“When a person with schizophrenia is becoming suicidal, an attempt can happen with little warning,” said Mark Olfson, Elizabeth K. Dollard professor of psychiatry at Columbia and lead author of the study. “Often, suicidal behavior in schizophrenia is driven by psychotic processes. This aspect can make it difficult to anticipate and prevent.”
The study, which provides a significant amount of data on age and suicide risk, could help suicide prevention efforts for people with schizophrenia. “Knowing more about which age groups and what personal characteristics are linked to higher risk could increase attention and support for the most vulnerable patients,” Olfson said.
Colorado Recovery founder Richard Warner believed that recovery rates for schizophrenia and suicidal thoughts are also linked to the social and economic environment.
In his classic Recovery from Schizophrenia, Dr. Warner pointed out a strong statistical correlation between lack of employment and suicidal ideation. “Work problems, economic stress, and unemployment appear to be important in precipitating suicide.” (2nd edition, 1994)
Unfortunately, discrimination and stigma prevent many people with a mental illness such as schizophrenia and bipolar disorder from finding purposeful employment. Too many of their fellow citizens believe people with such mental disorders are unable to work.
In a more recent book, The Environment of Schizophrenia, Warner wrote that “the mentally ill are among the most alienated people in our society, daily confronting the key elements of alienation—meaninglessness, powerlessness, normlessness, and estrangement from society and from work.” This induces an “existential neurosis” which in turn drives a significantly higher risk of suicide. “Many people with mental illness face lives of aimlessness and boredom,” wrote Warner.
Work can help overcome that sense of aimlessness and provide a better chance of recovery. “Productive activity is basic to a person’s sense of identity and worth. Given training and support, most people with schizophrenia can work,” Warner wrote. A productive life in recovery can also shield from suicidal ideation.
Colorado Recovery approaches care for mental health based on a path of self-reliance through developed practiced skills. This non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.
Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.
Around ten million adults in the United States currently experience both mental illness and a substance use disorder (SUD). It’s a well-established correlation, often complicating the treatment of both conditions. One such co-occurring disorder is schizophrenia
In a recent webinar for Harmony Foundation, Colorado Recovery’s medical director Alan Fine, M.D., talked about the symptoms of schizophrenia and substance use disorder and why it is frequently difficult to tell the two conditions apart.
First off, Dr. Fine presented a diagnostic flowchart to illustrate where SUD and schizophrenia can be found in the mental healthcare realm. If the symptoms are acute and were caused by taking drugs or drinking alcohol then we’re looking at substance misuse and a possible addiction scenario. If the diagnosis is psychosis without a physical cause, the condition is often diagnosed as schizophrenia or bipolar disorder.
The diagnosis of schizophrenia itself is complicated and based on the work of three trailblazers in the field whose impact can still be felt today: Emil Kraepelin (1856–1926), Eugen Bleuler (1857–1939), and Kurt Schneider (1887–1967).
Kraepelin is considered one of the founders of modern scientific psychiatry. His views dominated the field at the start of the 20th century. Bleuler renamed Kraepelin’s “dementia praecox” schizophrenia and established the classic four As of the condition: ambivalence, affect, alogia, and autism (preoccupation with self). Schneider in turn formulated the first-rank symptoms of schizophrenia: auditory hallucinations, feelings of external control, thoughts connected to others, and other delusions.
In his book, The Environment of Schizophrenia, Colorado Recovery founder Richard Warner wrote that “schizophrenia is a psychosis. That is to say, it is a severe mental disorder in which the person’s emotions, thinking, judgment, and grasp of reality are so disturbed that his or her functioning is seriously impaired.”
What about substance use then?
By definition, schizophrenia is not caused by the effects of a substance or another medical condition. That, however, is not quite all.
Mental health conditions and SUDs frequently co-occur because many people with addiction are primarily misusing addictive substances to self-medicate emotional pain caused by serious mental health disorders.
“The proportion of schizophrenic patients of comorbidity of substance abuse varies in published studies from 10–70 percent, depending on how patients are diagnosed with schizophrenia, the types of populations studied, and the different ways of defining drug and alcohol disorders,” said Dr. Fine. “There’s a remarkable overlap in both directions.”
People with schizophrenia are at a higher risk of engaging in substance misuse because many of them will be tempted to self-medicate the severe symptoms of their mental illness as well as some of the side effects of their antipsychotic medications. At the same time, substance misuse may cause syndromes that are similar or even identical to schizophrenia.
In the short term (acute intoxication), schizophrenia-like symptoms may include delusions (stimulants and inhalants), loose associations (stimulants, alcohol, sedatives, and inhalants), and hallucinations (stimulants, alcohol, and inhalants). Both alcohol and sedative withdrawal symptoms include hallucinations and paranoia.
In the long term (prolonged misuse), “amphetamine use is associated with long-term psychosis—thirty percent of all amphetamine-induced psychoses become chronic,” Dr. Fine explained. Chronic alcohol misuse may cause persistent dementias such as Korsakoff syndrome and delirium tremens.
People with schizophrenia also engage in substance misuse to cope with the deterioration of their social environment, an area that Dr. Warner explored extensively.
So, the answer to the question “Is It schizophrenia or is it substance misuse?” is often: both! That means, should both conditions be present, both need to be treated because they may reinforce each other. An important element in this regard is empowerment.
Empowering people with schizophrenia reduces the need to self-medicate and often improves symptoms. Believing in their ability to take charge of their lives and manage the complex challenges of their illness is crucial for people with schizophrenia.
Over the course of his long professional career, the late Dr. Warner realized that social inclusion empowers people with mental illnesses and improves outcomes. “Work helps people recover from schizophrenia,” Warner concluded. “Productive activity is basic to a person’s sense of identity and worth.”
Colorado Recovery has been utilizing the Warner method to empower adults with mental illness for many years now. Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.
With a heavy heart Colorado Recovery announces that Ruth Arnold, CEO will be retiring this month. She has served as CEO for Colorado Recovery for four years and she will be missed. She has been a compassionate leader and brought a vast amount of knowledge about mental health to our organization.
While at Colorado Recovery she helped support and develop the Bridge to You program, she helped create a marketing position, oversaw the transition of our website platform, spearheaded Colorado Recovery’s membership with the American Residential Treatment Association, supported the expansion of wilderness therapy programming, and much more!
Ruth began her career at Mental Health Partners(MHP) in 1974 and she left MHP in 2016 to join Colorado Recovery. During her years of service, she worked closely with Colorado Recovery’s founder, Dr. Richard Warner and she was able to maintain his vision while serving as CEO at Colorado Recovery.
She held many positions during her career at MHP; she was the Team Leader for the vocational rehabilitation program, a Therapist at MHP’s intensive residential program, and a Team Leader for the assertive community treatment team. She was well-liked and respected in all of her roles.
She can take credit for many accomplishments that have had a great impact on the mental health community. She started WATBusiness Services, a thriving workplace that employed many people with serious mental illness for many years. She was instrumental in starting MHP’s very successful Chinook Clubhouse which helped people with major mental illness find a sense of belonging to a social community, develop job skills, secure supported employment, and succeed in independent employment.
Ruth is a founding Board Member for The Center for People with Disabilities where she is still an active Board Member and she will continue to serve on the board during her retirement.
The entire community of staff, clients, and families at Colorado Recovery wishes Ruth a heartfelt farewell. We feel lucky to have had the opportunity to work with Ruth. She has shown us how to create and leave a lasting legacy.
June Bianchi, Transitional Housing Program Manager says, “The Colorado Recovery community is very grateful for the effort that Ruth put forth to make our agency thrive. We have been very grateful for her determination, passion, and unrelenting optimism for those struggling with mental health and the unrelenting support of the staff that serves this community. The experience that Ruth held regarding mental health, budgets, and developing programs will strengthen Colorado Recovery for years to come. We will always be grateful for her and the immense change and improvements she made. Ruth has a quiet strength, intelligence, wisdom, flexibility, openness, and a great sense of humor. She made so many difficult, important, and lasting decisions for our community. For this, she will always be remembered and we will always be grateful for her guidance and leadership.”
In 2018, Colorado Recovery will continue to offer monthly In-Services to staff and clients. These In-Services are a key component of continuing mental health education for our professional staff and can offer informative material for clients.
In December 2017, the Employee Owners of Colorado Recovery voted to add an additional employee management Director position to the Board of Director’s. Congratulations to Balsam House’s Program Manager, Karen Sturgis, on becoming a new Director.
In December 2017, Colorado Recovery staff celebrated the holidays with an Ugly Sweater Day and a pot luck.
In November 2017, Colorado Recovery Psychiatrists, clinicians and CEO attended the “Innovative Approaches for Bipolar Disorder” presentation which discussed cutting edge approaches to treating Bipolar Disorder.
In November 2017, Balsam House finished doing a remodel and upgrade of the residential facility.
In October 2017, clients and staff organized and held a fundraiser to help support natural disaster relief. It was a huge success and received donations of over $1,400 that was presented to the Red Cross.
In September 2017, clients and staff participated in “Wilderness Solos” and enjoyed the pleasure of a beautiful outdoor day in the nearby mountains of Boulder.
In August 2017, clients continued to participate in the summer “Garden Group” which produced a welcome abundance of lettuce, zucchini, cucumbers, tomatoes, peppers, sweet basil and much more; all of which was used by clients and staff in helping to prepare Balsam House meals.