***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Previous reports regarding risk factors for suicide in schizophrenia have been inconclusive . We performed a matched case-control study of  in-patient-treated schizophrenia patients in order to assess the suicide risk associated with socioeconomic , demographic , and psychiatric factors . The cases were 84 patients who died by suicide within five years after diagnosis in a cohort of all patients discharged for the first time from psychiatric hospitals in Stockholm County , Sweden , with a diagnosis of schizophrenia , schizophreniform disorder or schizoaffective disorder between the years 1984 and 2000 . One control was individually and r and omly matched with each case from the same cohort by date ( + /-1 year ) and age ( + /-5 years ) at index diagnosis . Data were retrieved from clinical records of the case-control pairs in a blind fashion . Of the suicides , 54 % were men and 46 % were women . In multivariate analyses , higher educational attainment ( odds ratio [ OR ] 3.0 , 95 % confidence interval [ CI ] 1.03 - 8.0 ) , age > or=30 years at onset of symptoms ( OR 4.8 , CI 1.1 - 21.2 ) , and a history of a suicide attempt requiring non-psychiatric medical treatment ( OR 5.0 , CI 1.6 - 15.4 ) were found to be significantly associated with an increased suicide risk . Gender did not significantly affect the suicide risk , nor did a history of self-discharge , compulsory in-patient treatment , substance-use disorder or a family history of mental disorders or suicide . In schizophrenia , certain suicide risk factors may differ from those in the general population . Clinical suicide risk assessment for schizophrenia patients should be performed taking this into account Abstract Objective To study the association between prescribed antipsychotic drugs and outcome in schizophrenia or schizoaffective disorder in the community . Design Prospect i ve cohort study using national central registers . Setting Community care in Finl and . Participants Nationwide cohort of 2230 consecutive adults hospitalised in Finl and for the first time because of schizophrenia or schizoaffective disorder , January 1995 to December 2001 . Main outcome measures Rates of discontinuation of drugs ( all causes ) , rates of rehospitalisation , and mortality associated with monotherapy with the 10 most commonly used antipsychotic drugs . Multivariate models and propensity score methods were used to adjust estimates of effectiveness . Results Initial use of clozapine ( adjusted relative risk 0.17 , 95 % confidence interval 0.10 to 0.29 ) , perphenazine depot ( 0.24 , 0.13 to 0.47 ) , and olanzapine ( 0.35 , 0.18 to 0.71 ) were associated with the lowest rates of discontinuation for any reason when compared with oral haloperidol . During an average follow-up of 3.6 years , 4640 cases of rehospitalisation were recorded . Current use of perphenazine depot ( 0.32 , 0.22 to 0.49 ) , olanzapine ( 0.54 , 0.41 to 0.71 ) , and clozapine ( 0.64 , 0.48 to 0.85 ) were associated with the lowest risk of rehospitalisation . Use of haloperidol was associated with a poor outcome  among women .  Mortality was markedly raised in patients not taking antipsychotics ( 12.3 , 6.0 to 24.1 ) and the risk of suicide was high ( 37.4 , 5.1 to 276 ) . Conclusions The effectiveness of first and second generation antipsychotics varies greatly in the community . Patients treated with perphenazine depot , clozapine , or olanzapine have a substantially lower risk of rehospitalisation or discontinuation ( for any reason ) of their initial treatment than do patients treated with haloperidol . Excess mortality is seen mostly in patients not using antipsychotic drugs BACKGROUND Long-term mortality and the risk factors for premature death among patients with schizophrenia living in rural communities are unknown . AIMS To explore the 10-year mortality and its risk factors among patients with schizophrenia . METHOD We used data from a 10-year prospect i ve follow-up study ( 1994 - 2004 ) of mortality among people with schizophrenia , and death registration data for Xinjin County , Chengdu , China . RESULTS The mortality rate was 2228 per 100,000 person-years during follow-up . Both all-cause mortality and suicide rates were significantly greater in male than in female patients . Age at illness onset ( > 45 years ) , duration of illness ( > or = 10 years ) , age greater than 50 years , physical illness , in ability to work , male gender , and never having received treatment were identified as independent predictors of increased mortality . CONCLUSIONS Higher mortality rates in male patients may contribute to the higher prevalence of schizophrenia in women compared with men in China . The findings of risk factors for mortality should be taken into account when developing interventions to improve outcomes among people with schizophrenia The aim of the study was to investigate transcultural differences between schizophrenia spectrum disorder patients who did or did not attempt suicide . DSM-IV schizophrenia ( N=609 ) or schizoaffective disorder ( N=371 ) patients who participated in the multicentre International Suicide Prevention Trial ( InterSePT ) were studied . Patients were sub-divided into 5 groups according to the different geographical regions of recruitment : North America ( NA ) , Europe ( EUR ) , East Europe ( EEUR ) , South Africa ( SAf ) , and South America ( SA ) . The main lifetime clinical variables were compared , within each group , between attempters and non-attempters . The presence of comorbid substance abuse disorder and smoking was associated with suicide attempts in all the geographical groups considered ( NA : chi(1)(2)=7.575 , p<0.01 and chi(1)(2)=69.549 , p<0.0001 ; EUR : chi(1)(2)=55.068 , p<0.0001 , and chi(1)(2)=48.431 , p<0.0001 ; EEUR : chi(1)(2)=164.628 , p<0.000 , and chi(1)(2)=5.127 , p<0.01 ; SA : chi(1)(2)=30.204 , p<0.0001 and chi(1)(2)=11.710 , p=0.001 ) except for SAf . For the other clinical variables various differences were found across the different groups . Variables related to suicide behavior were similar across the five groups investigated , with differences only in the age at the first suicide attempt ( earlier in the NA sample ) and the number of lifetime suicide attempts ( higher in the NA sample ) . Results from this study show that , while some suicide-related clinical characteristics in schizophrenia patients are consistent worldwide suggesting the influence of stable biological traits , other variables may vary across different geographical areas suggesting environmental influences OBJECTIVE Schizophrenia is characterized by high suicide risk and low awareness of disorder . Although awareness has benefits for medication compliance and clinical outcome , it is unclear how it may relate to suicide risk in this population . METHOD This multicenter investigation assessed  awareness  and suicide-related behavior in 980 patients with schizophrenia or schizoaffective disorder . Patients were followed over 2 years and assessed by blinded raters for suicide-related events . RESULTS Awareness of psychiatric condition at baseline was associated with increased risk of suicide events over the follow-up . This effect was mediated by depression and hopelessness levels . By contrast , changes in awareness associated with treatment decreased the risk of suicide . CONCLUSIONS Although some patients may become depressed after acknowledging the clinical h and icaps of their disorder , treatment-related changes in awareness are generally associated with a positive outcome relative to suicide risk . The complex interactions and mediation effects of these clinical variables require careful monitoring Background  Suicide rate among schizophrenia patients may vary for several reasons , one of the most important being the time point of the suicide during the illness process . However , prospect i ve studies on suicide risk in population -based cohort of individuals with new-onset schizophrenia have been lacking . Method The data were collected for 10,934 individuals alive in Finl and at the age of 16 from the genetically homogenous , population -based Northern Finl and 1966 Birth Cohort ascertained already during mid-pregnancy . The Finnish Hospital Discharge Register was used until the end of 1997 ( age 31 ) to identify cases with mental disorder . Case records were scrutinized and diagnoses were re-checked for DSM-III-R criteria . One hundred subjects met the DSM-III-R criteria for schizophrenia . Deaths by the end of year 2005 ( age 39 ) were ascertained from death certificates . Results Suicides ( n = 7 ) accounted for 50 % of all the deaths at age from 16 to 39 . Seven ( 7.0 % ) subjects with schizophrenia had committed suicide ; suicide rate being 2.9 % ( 1/35 ) for women and 9.2 % ( 6/65 ) for men . Furthermore , 71 % of suicides in schizophrenia occurred during the first 3 years after onset of illness . Conclusion The suicide rate for patients with new-onset schizophrenia followed until the age of 39 was high and accounted for half of the deaths . Great majority of the suicides took place during the first years of the illness OBJECTIVE This study compared 5- and 10-year survival and absolute and relative mortality rates among first-admission patients with 1 of 4 psychotic disorders : schizophrenia/schizoaffective disorder , bipolar disorder , major depression , and other nonorganic psychoses . METHOD The authors conducted a prospect i ve 10-year follow-up of subjects first admitted with a diagnosis of nonorganic psychosis to any of 12 hospitals in Suffolk County , New York , during the period 1989 to 1995 . Information on their death status since study entry was ascertained from the Social Security Death Index and the National Death Index . Survival analyses were conducted using the Kaplan-Meier product-limit estimator . RESULTS There were no significant differences in survival rates among the 4 diagnostic groups at 5-year ( range , 96.3%-97.8 % ) or 10-year ( range , 90.2%-97.8 % ) follow-up . Absolute mortality over the study period ranged from 2.8 % of bipolars to 6.7 % of those with major depression . About 60 % of deaths among schizophrenic/schizoaffective subjects were due to unnatural causes , whereas for the other 3 groups , deaths were more evenly split between natural and unnatural causes . Suicides comprised most deaths from unnatural causes , most of which occurred during the 2- to 5-year follow-up period . Deaths due to natural causes tended to be related to lifestyle factors . CONCLUSIONS First-admission patients with psychosis experience similar patterns of mortality risk over the first 10 years after index admission regardless of underlying diagnosis . Causes of death ( both natural and unnatural ) were potentially preventable with more intensive medical and psychiatric follow-up and intervention . Many deaths from unnatural causes occurred during or shortly after discharge from an inpatient or residential treatment setting , highlighting this period as one needing close scrutiny by treating clinicians OBJECTIVE Schizophrenic patients in Taiwan have lower comorbidity of substance use disorders than do those in Western countries , and most of them live with their families . This study investigated the risk factors for completed suicide in this population with inherently lower rates of the confounding variables of substance abuse and social isolation . METHOD 4237 acute in patients with DSM-III , DSM-III-R , or DSM-IV schizophrenia admitted from January 1 , 1985 , to December 31 , 2000 , were followed through 2001 by record linkage to the Death Certification System . Seventy-eight subjects who died from suicide during this period were matched with  living controls  r and omly for age ( + /- 5 years ) , sex , and the same year of index admission . Demographic and clinical variables were collected from medical records and formally confirmed at every admission and outpatient follow-up . RESULTS Among 78 case-control pairs , the lifetime prevalence of substance use disorders was 7.1 % , and 93.6 % of the subjects lived with their families . Approximately half of the completed suicides occurred within 4 years after the first admission . Conditional logistic regression analysis revealed a strong association with the following 3 variables : depressive syndrome in residual phase ( adjusted odds ratio [ OR ] = 23.07 , p < .005 ) , higher suicide intensity ( adjusted OR = 2.78 , p < .05 ) , and later age at onset ( increase per year , adjusted OR = 1.07 , p < .05 ) . Fasting cholesterol level and clozapine use had no association with completed suicide . CONCLUSIONS The peak period for completed suicide was early years after the first admission . The target population for additional measures to prevent suicide should include patients with depressive syndrome in residual phase , higher suicide intensity , and later onset of illness BACKGROUND Those with first-episode psychosis are at high-risk of suicide . AIMS To identify predictive factors for suicidal thoughts , plans and attempts , and to investigate the rate of 
    Output:
    
Risk factors with a strong association with later suicide included being young , male , and with a high level of education .
Illness-related risk factors were important predictors , with number of prior suicide attempts , depressive symptoms , active hallucinations and delusions , and the presence of insight all having a strong evidential basis .
A family history of suicide , and comorbid substance misuse were also positively associated with later suicide .
The only consistent protective factor for suicide was delivery of and adherence to effective treatment .