Blunted affect, social withdrawal and suicide in schizophrenia

Grigoriou, Markella (2021). Blunted affect, social withdrawal and suicide in schizophrenia. University of Birmingham. Ph.D.

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Abstract

Completed suicide in schizophrenia remains a significant unanswered challenge, requiring new perspectives and novel investigation. This thesis examines how previously under-investigated symptoms, including blunted affect and social withdrawal, may be associated with suicidal behaviour in people with schizophrenia. For this study, a multidisciplinary approach was used incorporating philosophy, psychiatry, and neuroimaging. I begin with Chapter 1, in which I give a philosophical consideration of why we should not regard suicide as an irrational action in schizophrenia. My arguments are based on the idea that overwhelming feelings and suffering such as isolation and of not belonging, which relate to negative symptoms including blunted affect, could be sufficient reasons for someone to end their life and therefore could be considered as rational acts. In chapter two, I present a systematic review on the negative symptom of blunted affect in suicide in schizophrenia, aiming to show the gaps in existing evidence and current knowledge. In summary, this highlights that blunted affect is likely to influence suicidal behaviour in the presence of depression, anxiety, or hopelessness. Following the systematic review’s findings, a primary data chapter then focuses on quantitative examination of suicidal behaviour in first-episode psychosis (FEP) patients examining the associations between blunted affect, social withdrawal, and suicidal behaviour in FEP. Specifically, a mediational analysis demonstrated that blunted affect and social withdrawal are associated with suicidal behaviour when hopelessness acts as a mediator. To further enhance our understanding of suicidal behaviour in people with schizophrenia, I present a second data chapter conducting a functional Magnetic Resonance Imaging (fMRI) study, which compared brain function in patients with FEP and high vs low suicidal behaviour during an emotional face response task, aiming to explore whether there are any differences in brain function between the two groups. Findings demonstrate that patients with high suicidal behaviour reported reduced activation in the prefrontal cortex: specifically, the Medial Frontal Gyrus and Anterior Cingulate Gyrus, in response to presentation of emotional faces; areas related to decision making and executive function. The summary and discussion chapter includes implications such the mechanisms of blunted affect and social withdrawal and how high scores on such symptoms might impact patient’s brain function, as well as early identification of suicide risk, and implications for treatment that focus on social connectedness and recovery. The novelty this thesis presents, focuses on the multidimensional examination of under-examined factors such as blunted affect and social withdrawal, that might play an indirect role to the development of suicidal behaviour. The symptoms of blunted affect and social withdrawal might lead to suicide when risk factors such as hopelessness act as mediator. Lastly, high scores on these symptoms might potentially be related to underlying brain dysfunction; however, this in itself does not automatically equate to suicide being irrational. Findings in this thesis could be seen as evidence which might lead to better identification of risk, and prevention of suicidal behaviour in people with schizophrenia.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):