Prodromal psychosis as an etiology of suicide: a case report and review of the literature

Suicides without apparent antecedent causes present great difficulties for medical examiners and families alike. A case is presented of a young male suicide victim whose antemortem course did not demonstrate apparent psychopathology to either his family or fellow students. A journal written by the decedent was found, however, which revealed extensive ruminations on death, depressive symptomatology, and evidence of possible delusions, and hallucinations. We opine that this represents the prodrome of a psychotic process, possibly schizophrenia, and the decedent's suicide was a response to his awareness of his deteriorating mental status. The prodrome of schizophrenia is a well-described entity that manifests as a decline in social and occupational functioning, along with increasingly bizarre behavior. Prodromal psychosis could represent an explanation for some cases of suicide seemingly without causation.