Outcome of suicidal patients with schizophrenia and the possible genetic association: results from a naturalistic study

Background: The purpose of the present study was to assess outcome differences between suicidal and non suicidal patients with schizophrenia and to examine a possible genetic association. Methods: Biweekly PANSS, HAMD, CDS and UKU ratings were evaluated in 339 inpatients with schizophrenia spectrum disorders. Response was defined as an initial 20% PANSS total score reduction at discharge, remission was defined according to the proposed consensus criteria by the Remission in Schizophrenia Working Group. 139 patients were genotyped in the following genes (COMT, 5-HT1A, 5-HTTP, GRM3, GRM5, GRM8, Neuro D2, BDNF, DISC 1, NRG, RGS4, SNAP 25,Homer 1). Results: Suicidal patients (22%) scored significantly higher on the PANSS negative subscore, PANSS insight item, CDS total score and HAMD total score at admission and at discharge (p<0.001). They developed significantly more side effects (p<0.001). No differences were found concerning response and remission between the two patient subgroups. The 5-HT1A-1019C>G polymorphism was significantly associated with depressive symptoms and suicidal thougths at discharge (p=0.014 and p=0.007). Conclusion: Our results emphasize the need for monitoring and adequately treating negative and depressive symptoms in patients with schizophrenia especially when suicidality is additionally present. The genetic associations are in good agreement with current literature.