104 Schizophrenia Spectrum and Other Psychotic Disorders
Other symptom differences include less freque nt negative symptoms and disorganization.
Finally, social functioning tends to remain better preserved in females. There are, how-
ever, frequent exceptions to these general caveats. 
Suicide Risk 
Approximately 5%–6% of individuals with schizophrenia die by suicide, about 20% attempt
suicide on one or more occasions, and many mo re have significant suicidal ideation. Suicidal
behavior is sometimes in response to command  hallucinations to harm oneself or others.
Suicide risk remains high over the whole lifespan for males an d females, although it may be
especially high for younger males with comorb id substance use. Other risk factors include
having depressive symptoms or feelings of hopelessness and being unemployed, and the
risk is higher, also, in the period after a psychotic episode or hospital discharge.
Functional Consequences of Schizophrenia 
Schizophrenia is associated with significant social and occupational dysfunction. Making
educational progress and maintaining employment are frequently impaired by avolition
or other disorder manifestatio ns, even when the cognitive sk ills are sufficient for the tasks
at hand. Most individuals are employed at a lower level than their parents, and most, par-
ticularly men, do not marry or have limited social contacts outside of their family.
Differential Diagnosis 
Major depressive or bipolar disorder with psychotic or catatonic features. The distinc-
tion between schizophrenia and major depre ssive or bipolar disorder with psychotic
features or with catatonia depends on the te mporal relationship between the mood distur-
bance and the psychosis, and on the severity of the depressive or manic symptoms. If de-
lusions or hallucinations occur exclusively during a major depressive or manic episode,
the diagnosis is depressive or bipolar disorder with ps ychotic features.