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Berardelli I, Sarubbi S, Trocchia MA, Longhini L, Moschillo A, Rogante E, Cifrodelli M, Erbuto D, Innamorati M, Pompili M. The Mediating Role of Insomnia Severity in the Relationship Between Anxiety Symptoms and Suicidal Ideation: A Real-World Study in a Psychiatric Inpatient Setting. J Nerv Ment Dis 2024:00005053-990000000-00175. [PMID: 39120957 DOI: 10.1097/nmd.0000000000001793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
ABSTRACT Insomnia and anxiety symptoms are independent clinical variables involved in suicidal ideation in psychiatric inpatients. In this article, we investigated the relationship among insomnia severity, severity of anxiety symptoms, and suicidal ideation in a sample of psychiatric inpatients with severe mental disorders. We used a mediation model considering insomnia severity as the possible mediator of the relationship between anxiety severity and suicidal ideation. We administered the Columbia Suicide Severity Rating Scale, the Insomnia Severity Index, and the Hamilton Anxiety Rating Scale to 116 consecutive inpatients to the psychiatric unit of Sant'Andrea Hospital in Rome. The effect of anxiety symptoms was mediated by insomnia severity; patients who perceive higher anxiety symptoms were more likely to experience higher levels of insomnia and, thus, higher suicidal ideation intensity. Results showed the importance of assessing and treating both insomnia and anxiety in clinical practice.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Maria Anna Trocchia
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Ludovica Longhini
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Antonella Moschillo
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Elena Rogante
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Mariarosaria Cifrodelli
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Psychiatry Unit, Sant'Andrea Hospital, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Cai D, Wang Y, Chen X. Relationship between nutrition indicators and pneumonia risk among stable schizophrenia patients: a retrospective study. Psychogeriatrics 2024; 24:861-867. [PMID: 38769596 DOI: 10.1111/psyg.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND It is reported that reduced physical activity and malnutrition may trigger pneumonia, and the utilisation of the geriatric nutritional risk index (GNRI) upon admission to long-term nursing care can enable the implementation of accurate and timely rehabilitation and nutritional support, which may, in turn, minimise pneumonia incidence. However, to date, there is no reported association between GNRI and pneumonia among stable schizophrenic patients. METHODS This is a retrospective investigation. We enrolled 434 hospitalised subjects aged ≥50 years, who were diagnosed with stable schizophrenia between January 2017 and June 2022. Baseline nutritional status information during the stable stage of schizophrenia was evaluated using body mass index, serum albumin, and GNRI. In addition, pneumonia-based information, including diagnosis and treatment, was retrospectively obtained within 1 year. To examine the potential association between nutrition indicators and pneumonia risk among stable schizophrenia patients, we employed a logistic regression analysis. RESULTS The pneumonia incidence among all stable schizophrenia patients was 10.14%, and there were no statistically significant difference between sexes (male vs. female, 10.63% vs. 9.44%, P = 0.687). Based on the univariate analysis of nutrition indicators and pneumonia, female patients exhibited a strong correlation between serum albumin and pneumonia (P = 0.022). Furthermore, we adjusted for potential influencing factors of pneumonia infection, and confirmed that only serum albumin was linked to pneumonia risk in female stable schizophrenia patients (odds ratio = 0.854, 95% CI: 0.749-0.975, P = 0.02). CONCLUSIONS Based on our analysis, serum albumin was strongly correlated with pneumonia risk in female stable schizophrenia patients.
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Affiliation(s)
- Duanfang Cai
- The Zigong Affiliated Hospital of Southwest Medical University, Zigong Mental Health Center, Zigong, China
| | - Yilin Wang
- The Zigong Affiliated Hospital of Southwest Medical University, Zigong Mental Health Center, Zigong, China
| | - Xiaoyan Chen
- The Zigong Affiliated Hospital of Southwest Medical University, Zigong Mental Health Center, Zigong, China
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DeLisi LE. A lifetime of mental health treatments for people with schizophrenia: update and narrative review. Curr Opin Psychiatry 2024; 37:140-146. [PMID: 38512852 DOI: 10.1097/yco.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW To provide a summary of the most up-to-date thoughts about treatment for schizophrenia at different stages of illness. RECENT FINDINGS The use of Coordinated Specialty Care clinics has arisen as the standard for early on in the treatment of psychosis, providing the notion that recovery is possible. New medications that do not depend on postsynaptic dopamine receptor blockade are soon becoming available. SUMMARY A focus should be made by clinicians to personalize treatment plans for each patient who has the possibility of being diagnosed with a primary psychosis and the plan should be to predict outcomes based on biological markers that include genetic vulnerability, early psychosocial combined with pharmacological treatments as needed and then a plan to determine or maintain treatments going forward into the future. It is important to individualize treatment by stage of illness, as well as characteristics of the individual patient. Research is ongoing to advance knowledge for interventions at each stage from the premorbid period through to chronicity.
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Affiliation(s)
- Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA
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Ayers N, McCall WV, Miller BJ. Sleep Problems, Suicidal Ideation, and Psychopathology in First-Episode Psychosis. Schizophr Bull 2024; 50:286-294. [PMID: 37086485 PMCID: PMC10919767 DOI: 10.1093/schbul/sbad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
Abstract
BACKGROUND AND HYPOTHESIS Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation and behavior, and psychopathology in schizophrenia. We explored associations between sleep problems, suicidal ideation, and psychopathology in a cohort of patients with first-episode psychosis. STUDY DESIGN We performed a secondary analysis of data for n = 403 subjects with data from the Recovery After an Initial Schizophrenia Episode study using regression models. STUDY RESULTS The prevalence of sleep problems and suicidal ideation at baseline was 57% and 15%, respectively. After controlling for potential confounders, in the study baseline sleep problems were associated with increased odds of suicidal ideation with evidence of a dose-dependent relationship (OR = 2.25, 95% CI 1.15-4.41, P = .018). Over 24 months, sleep problems at any time point were associated with an over 3-fold increased odds of concurrent suicidal ideation (OR = 3.21, 95% CI 1.45-7.14, P = .004). Subjects with persistent sleep problems were almost 14 times more likely to endorse suicidal ideation at least once over the study than those without sleep problems (OR = 13.8, 95% CI 6.5-53.4, P < .001). Sleep problems were also a predictor of higher Positive and Negative Syndrome Scale total (β = 0.13-0.22), positive (β = 0.14-0.25), and general (β = 0.16-0.27) subscale scores at baseline and multiple follow-up visits (P < .01 for each). CONCLUSIONS Sleep problems are highly prevalent and associated with suicidal ideation and greater psychopathology in first-episode psychosis. Formal assessment and treatment of insomnia appear relevant to the clinical care of patients with psychosis as a predictor of suicidal ideation and symptom severity.
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Affiliation(s)
- Nolan Ayers
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Brian J Miller
- Department of Psychiatry, Augusta University, Augusta, GA, USA
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Venger O, Bilous V, Striepetova O, Kulivets O, Oliynyk O. Prodromal period of psychosis: diagnostic criteria. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:47-54. [PMID: 38431807 DOI: 10.36740/wlek202401107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Aim: To study the psychopathological mechanisms of the development of the prodromal stage of psychosis in order to identify risk factors for the formation of psychosis. PATIENTS AND METHODS Materials and Methods: In this research 137 patients with newly diagnosed psychosis were examined: 65 patients with a diagnosis of paranoid schizophrenia; 72 patients - with a diagnosis of acute polymorphic psychotic disorder. RESULTS Results: According to the analysis of symptoms using the PANSS, the absence of signs of an anxious state, conceptual disorganization of thinking, emotional withdrowal are reliable signs of PPP in PS, and unusual thought content, absence of signs of stereotyped thinking, tension, anxiety, and hallucinations are reliable signs of PPP in APPD. According to the analysis of symptoms using the SOPS, unusual thought content/delusional ideas, bizarre thinking, social anhedonia, suspiciousness/persecutory ideas, decrease in expressiveness of emotions are reliable signs of PPP in PS, and bizarre thinking, impaired tolerance to normal stress, sleep disturbance, perceptual abnormalities/hallucinations, trouble with focus and attention are reliable signs of PPP in APPD. CONCLUSION Conclusions: In the process of studying the clinical-psychopathological and pathopsychological aspects of the development of the PPP, a number of risk factors for the formation of psychosis were identified. We found that he most important diagnostic signs of PPP in PS patients are: stereotyped thinking, social isolation, disorganizational thinking disorders, passive-apathetic social detachment, suspiciousness. The most informative prodromal symptoms of HP in PS patients are: conceptual disorganization of thinking, bizzare thinking, social isolation, suspiciousness/persecutory ideas, reduced expression of emotions.
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Affiliation(s)
- Olena Venger
- NATIONAL MEDICAL UNIVERSITY NAMED BY O.BOHOMOLETS, KYIV, UKRAINE
| | - Volodymyr Bilous
- NATIONAL MEDICAL UNIVERSITY NAMED BY O.BOHOMOLETS, KYIV, UKRAINE
| | | | - Oleksii Kulivets
- NATIONAL MEDICAL UNIVERSITY NAMED BY O.BOHOMOLETS, KYIV, UKRAINE
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Miola A, Gardea-Reséndez M, Ortiz-Orendain J, Nunez NA, Ercis M, Coombes BJ, Salgado MF, Gruhlke PM, Michel I, Bostwick JM, McKean AJ, Ozerdem A, Frye MA. Factors associated with suicide attempts in the antecedent illness trajectory of bipolar disorder and schizophrenia. Int J Bipolar Disord 2023; 11:38. [PMID: 38063942 PMCID: PMC10709261 DOI: 10.1186/s40345-023-00318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Factors associated with suicide attempts during the antecedent illness trajectory of bipolar disorder (BD) and schizophrenia (SZ) are poorly understood. METHODS Utilizing the Rochester Epidemiology Project, individuals born after 1985 in Olmsted County, MN, presented with first episode mania (FEM) or psychosis (FEP), subsequently diagnosed with BD or SZ were identified. Patient demographics, suicidal ideation with plan, self-harm, suicide attempts, psychiatric hospitalizations, substance use, and childhood adversities were quantified using the electronic health record. Analyses pooled BD and SZ groups with a transdiagnostic approach given the two diseases were not yet differentiated. Factors associated with suicide attempts were examined using bivariate methods and multivariable logistic regression modeling. RESULTS A total of 205 individuals with FEM or FEP (BD = 74, SZ = 131) were included. Suicide attempts were identified in 39 (19%) patients. Those with suicide attempts during antecedent illness trajectory were more likely to be female, victims of domestic violence or bullying behavior, and have higher rates of psychiatric hospitalizations, suicidal ideation with plan and/or self-harm, as well as alcohol, drug, and nicotine use before FEM/FEP onset. Based on multivariable logistic regression, three factors remained independently associated with suicidal attempts: psychiatric hospitalization (OR = 5.84, 95% CI 2.09-16.33, p < 0.001), self-harm (OR = 3.46, 95% CI 1.29-9.30, p = 0.014), and nicotine use (OR = 3.02, 95% CI 1.17-7.76, p = 0.022). CONCLUSION Suicidal attempts were prevalent during the antecedents of BD and SZ and were associated with several risk factors before FEM/FEP. Their clinical recognition could contribute to improve early prediction and prevention of suicide during the antecedent illness trajectory of BD and SZ.
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Affiliation(s)
- Alessandro Miola
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Neuroscience (DNS), University of Padova, Padua, Italy
| | - Manuel Gardea-Reséndez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - Nicolas A Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mete Ercis
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Brandon J Coombes
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Peggy M Gruhlke
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ian Michel
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Alastair J McKean
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
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Wang Q, Tang W, Zhang J, Wang Y, Wang Q, Ma Y, Mao JK, Ye C, Yu X. Visuospatial ability and attention as risk factors for suicidal ideation in middle-aged and elderly schizophrenia patients: a cross-sectional study. BMC Psychiatry 2023; 23:765. [PMID: 37853396 PMCID: PMC10585849 DOI: 10.1186/s12888-023-05272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Schizophrenia patients have a high risk of suicide, and their cognition function is impaired with increasing age. The association between neurocognitive and suicidality in schizophrenia patients are heterogeneous. We aimed to explore the relationship between neurocognitive function and suicidal ideation in schizophrenia patients across age groups. METHODS A total of 587 patients with schizophrenia were enrolled in this study. The schizophrenia patients were divided into young group (aged 18-44) and middle-aged and elderly group (aged 45-70). The schizophrenia patients were divided into suicidal ideation group and non-suicidal ideation group according to the evaluation results of the Beck Scale for Suicide Ideation. Insomnia symptoms were measured by the Insomnia Severity Index (ISI). Psychotic symptoms were measured by the Positive and Negative Syndrome Scale (PANSS), and cognitive function was measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RESULTS There was a negative correlation between the age and attention scores of RBANS (P = 0.018). The young schizophrenia patients had higher risk of suicidality than middle-aged and elderly schizophrenia patients (P = 0.001). In the logistic regression analysis, the scores of ISI and positive symptoms scores of PANSS were associated with suicidal ideation among young schizophrenia patients (All P < 0.05). Age, BMI, the scores of ISI, general symptoms scores of PANSS, visuospatial scores of RBANS and attention scores of RBANS were associated with suicidal ideation in middle-aged and elderly schizophrenia patients (All P < 0.05). CONCLUSIONS High visuospatial scores of RBANS and attention scores of RBANS were risk factors for suicidal ideation in middle-aged and elderly schizophrenia patients.
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Affiliation(s)
- Qiongzhang Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Wei Tang
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China.
| | - Junjie Zhang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yiwei Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Qing Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yimin Ma
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Jian Kai Mao
- Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Chengyu Ye
- Wenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, China.
| | - Xin Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.
- Peking University Institute of Mental Health (Sixth Hospital, Beijing, China.
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China.
- Beijing Municipal Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.
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Genetic Predisposition to Schizophrenia and Depressive Disorder Comorbidity. Genes (Basel) 2022; 13:genes13030457. [PMID: 35328011 PMCID: PMC8950769 DOI: 10.3390/genes13030457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Patients with schizophrenia have an increased risk of depressive disorders compared to the general population. The comorbidity between schizophrenia and depression suggests a potential coincidence of the pathophysiology and/or genetic predictors of these mental disorders. The aim of this study was to review the potential genetic predictors of schizophrenia and depression comorbidity. Materials and Methods: We carried out research and analysis of publications in the databases PubMed, Springer, Wiley Online Library, Taylor & Francis Online, Science Direct, and eLIBRARY.RU using keywords and their combinations. The search depth was the last 10 years (2010–2020). Full-text original articles, reviews, meta-analyses, and clinical observations were analyzed. A total of 459 articles were found, of which 45 articles corresponding to the purpose of this study were analyzed in this topic review. Results: Overlap in the symptoms and genetic predictors between these disorders suggests that a common etiological mechanism may underlie the presentation of comorbid depression in schizophrenia. The molecular mechanisms linking schizophrenia and depression are polygenic. The most studied candidate genes are GRIN1, GPM6A, SEPTIN4, TPH1, TPH2, CACNA1C, CACNB2, and BCL9.Conclusion: Planning and conducting genome-wide and associative genetic studies of the comorbid conditions under consideration in psychiatry is important for the development of biological and clinical predictors and a personalized therapy strategy for schizophrenia. However, it should be recognized that the problems of predictive and personalized psychiatry in the diagnosis and treatment of schizophrenia and comorbid disorders are far from being resolved.
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Ongeri L, Kariuki SM, Nyawira M, Schubart C, Tijdink JK, Newton CRJC, Penninx BWJH. Suicidal attempts and ideations in Kenyan adults with psychotic disorders: An observational study of frequency and associated risk factors. Front Psychiatry 2022; 13:1085201. [PMID: 36741571 PMCID: PMC9892760 DOI: 10.3389/fpsyt.2022.1085201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Psychotic disorders increase the risk for premature mortality with up to 40% of this mortality attributable to suicide. Although suicidal ideation (SI) and suicidal behavior (SB) are high in persons with psychotic disorders in sub-Saharan Africa, there is limited data on the risk of suicide and associated factors among persons with psychotic disorders. METHODS We assessed SI and SB in persons with psychotic disorders, drawn from a large case-control study examining the genetics of psychotic disorders in a Kenyan population. Participants with psychotic disorders were identified using a clinical review of records, and the diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (MINI). We conducted bivariate and multivariate logistic (for binary suicide outcomes) or linear regression (for suicide risk score) analysis for each of the suicide variables, with demographic and clinical variables as determinants. RESULTS Out of 619 participants, any current SI or lifetime suicidal attempts was reported by 203 (32.8%) with psychotic disorders, of which 181 (29.2%) had a lifetime suicidal attempt, 60 (9.7%) had SI in the past month, and 38 (20.9%) had both. Family history of suicidality was significantly associated with an increased risk of suicidality across all the following four outcomes: SI [OR = 2.56 (95% CI: 1.34-4.88)], suicidal attempts [OR = 2.01 (95% CI: 1.31-3.06)], SI and SB [OR = 2.00 (95% CI: 1.31-3.04)], and suicide risk score [beta coefficient = 7.04 (2.72; 11.36), p = 0.001]. Compared to persons aged <25 years, there were reduced odds for SI for persons aged ≥ 25 years [OR = 0.30 (95% CI: 0.14-0.62)] and ≥ 45 years [OR = 0.32 (95% CI: 0.12-0.89)]. The number of negative life events experienced increased the risk of SI and SB [OR = 2.91 (95% CI: 1.43-5.94)] for 4 or more life events. Higher negative symptoms were associated with more suicidal attempts [OR = 2.02 (95%CI: 1.15-3.54)]. Unemployment was also associated with an increased risk for suicidal attempts [OR = 1.58 (95%CI: 1.08-2.33)] and SI and SB [OR = 1.68 (95% CI: 1.15-2.46)]. CONCLUSION Suicidal ideation and SB are common in persons with psychotic disorders in this African setting and are associated with sociodemographic factors, such as young age and unemployment, and clinical factors, such as family history of suicidality. Interventions targeted at the community (e.g., economic empowerment) or at increasing access to care and treatment for persons with psychotic disorders may reduce the risk of suicide in this vulnerable population group.
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Affiliation(s)
- Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Symon M Kariuki
- Department of Public Health, Pwani University, Kilifi, Kenya.,Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Miriam Nyawira
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | | | - Joeri K Tijdink
- Department of Ethics, Law and Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R J C Newton
- Department of Public Health, Pwani University, Kilifi, Kenya.,Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Cederlöf E, Holm M, Lähteenvuo M, Haaki W, Hietala J, Häkkinen K, Isometsä E, Jukuri T, Kajanne R, Kampman O, Kieseppä T, Lahdensuo K, Lönnqvist J, Männynsalo T, Niemi-Pynttäri J, Suokas K, Suvisaari J, Tiihonen J, Turunen H, Wegelius A, Veijola J, Palotie A, Paunio T. Sleep in Psychotic Disorders: Results From Nationwide SUPER Finland Study. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac011. [PMID: 39144769 PMCID: PMC11206061 DOI: 10.1093/schizbullopen/sgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Objective Characterizing sleep in patients with schizophrenia, schizoaffective disorder, bipolar disorder, and psychotic depression. Methods This cross-sectional questionnaire study is based on the SUPER study sample, which is part of the Stanley Global Neuropsychiatric Genomics Initiative. The study is a multicentre, nationwide Finnish study consisting of patients (N = 8 623) both in primary and specialized health care. The main measurements were sleep duration, difficulties initiating sleep, early morning awakenings, and fatigue. These results were compared with a nationally representative sample of the Finnish population from the Health 2000 survey (N = 7 167) with frequency and logistic regression analyses. Results Patients had more sleep problems compared with the general population, especially young and middle-aged patients (Difficulties initiating sleep in young patients odds ratio = 12.3, 95% CI 9.8-15.4). Long sleep duration was the most deviating property of the sleep characteristics, being particularly common among young patients with schizophrenia (odds ratio = 27.9, 95% CI 22.1-35.2, 47.4% vs 3.3% prevalence). All sleep problems were associated with worse subjective health. We also conducted a latent class analysis, resulting in a cluster relatively free of sleep problems (58% of patients), an insomnia symptom cluster (26%), and a hypersomnia symptom cluster (15%). Conclusions In our sample, patients with psychotic disorders have more sleep problems-especially long sleep duration but also insomnia symptoms-compared with the general population. The patients can in a latent class analysis of their sleep symptoms be divided into groups with differing sleep profiles.
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Affiliation(s)
- Erik Cederlöf
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Minna Holm
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markku Lähteenvuo
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
- Niuvanniemi Hospital, University of Eastern Finland, Finland
| | - Willehard Haaki
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Katja Häkkinen
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Jukuri
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Risto Kajanne
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Olli Kampman
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Department of Psychiatry, University of Tampere, Tampere, Finland
| | - Tuula Kieseppä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaisla Lahdensuo
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lönnqvist
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Teemu Männynsalo
- Social Services and Health Care Sector; City of Helsinki, Helsinki, Finland
| | | | - Kimmo Suokas
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Social Services and Health Care Sector; City of Helsinki, Helsinki, Finland
| | - Jaana Suvisaari
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Niuvanniemi Hospital, University of Eastern Finland, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Hannu Turunen
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Asko Wegelius
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Veijola
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
- Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Tiina Paunio
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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11
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Miller BJ, McCall WV, Xia L, Zhang Y, Li W, Yao X, Liu H. Insomnia, suicidal ideation, and psychopathology in Chinese patients with chronic schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110202. [PMID: 33285266 DOI: 10.1016/j.pnpbp.2020.110202] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation, and psychopathology in patients with schizophrenia. We explored these associations in a cross-sectional study of a large sample of patients with chronic schizophrenia in China. We hypothesized that insomnia would be associated with an increased odds of current suicidal ideation and higher current psychopathology scores. METHODS We recruited 328 inpatients with chronic schizophrenia, all of whom were prescribed psychotropics. We investigated relationships between current insomnia, suicidal ideation over the past two weeks, and current psychopathology for subjects using regression models. RESULTS After controlling for multiple potential confounding factors, current insomnia was an indicator of a significant, 2.5-fold increased odds of suicidal ideation (OR = 2.56, 95% CI 1.10-5.95, p = 0.029). Insomnia was also a significant indicator of lifetime suicide attempt (OR = 1.07) as well as higher Positive and Negative Syndrome Scale total (β = 0.134, p = 0.017), positive (β = 0.154, p = 0.006) and general (β = 0.145, p = 0.010) subscale scores. CONCLUSION Insomnia is associated with suicidal ideation, lifetime suicide attempt, and higher psychopathology scores in inpatients with chronic schizophrenia. Formal assessment of insomnia appears relevant to the clinical care of patients with schizophrenia as an indicator of suicidal thinking and behavior, depression, and symptom severity.
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Affiliation(s)
- Brian J Miller
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia.
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Yulong Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Wenzheng Li
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, Anhui Province, China
| | - Xianhu Yao
- Department of Psychiatry, Maanshan Fourth People's Hospital, Maanshan, Anhui Province, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, China.
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12
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Gupta M, Gupta N, Ramar D. Three confounded high-risk groups for suicide in adolescents and young adults. CNS Spectr 2021; 28:1-3. [PMID: 34895383 DOI: 10.1017/s1092852921001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Suicide rates among adolescents and young adults have been increasing in the last decade. The current knowledge of the warning signs, risk factors, and the use of screening tools has many gaps. There are many views from within, critics, survivors, and advocacy groups to focus more on the contextual understanding of symptomatology. In clinical practice, many of these high-risk groups fail to raise the red flags due to the complex and ambiguous nature of presentations. Therefore, these groups need greater attention, and given their counter-initiative nature, they challenge the current approaches to address suicidality in adolescents and young adults.
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Affiliation(s)
| | - Nihit Gupta
- Reynolds Memorial Hospital, Glendale, WV, USA
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13
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Haining K, Karagiorgou O, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Prevalence and predictors of suicidality and non-suicidal self-harm among individuals at clinical high-risk for psychosis: Results from a community-recruited sample. Early Interv Psychiatry 2021; 15:1256-1265. [PMID: 33372364 PMCID: PMC8451831 DOI: 10.1111/eip.13075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/03/2020] [Accepted: 11/15/2020] [Indexed: 01/04/2023]
Abstract
AIM Suicidal thoughts and behaviours are prevalent in individuals with schizophrenia. However, research examining the prevalence and predictors of suicidality and self-harm in participants at clinical high-risk for psychosis (CHR-P) is limited and mostly focuses on help-seeking participants recruited through clinical pathways. The current study sought to assess the prevalence of suicidality and self-harm and identify predictors of current suicidal ideation in community-recruited CHR-P participants. METHODS Data were available for 130 CHR-P participants, 15 participants with first-episode psychosis (FEP), 47 participants not fulfilling CHR-P criteria (CHR-Ns) and 53 healthy controls. Current and lifetime suicidality and self-harm were assessed using the Mini-International Neuropsychiatric Interview and the Comprehensive Assessment of At-Risk Mental States (CAARMS). Multivariable logistic regression analysis was used to determine predictors of current suicidal ideation in the CHR-P group. RESULTS A considerable proportion of CHR-P participants disclosed current suicidal ideation (34.6%). Overall, FEP individuals were at greatest risk, with considerably high prevalence rates for current suicidal ideation (73.3%), lifetime self-harm behaviour (60.0%) and lifetime suicide attempt (60.0%). In the CHR-P sample, current suicidal ideation was predicted by lifetime suicide attempts, lower CAARMS severity, impaired social functioning and greater comorbidity. CONCLUSIONS Our findings suggest that suicidality and self-harm are highly prevalent in community-recruited CHR-P and FEP individuals. Accordingly, these results highlight the importance of further research into the determinants of suicidality and self-harm during at-risk and early stages of psychosis, and the implementation of intervention strategies to reduce adverse outcomes in these populations.
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Affiliation(s)
- Kate Haining
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK
| | - Olga Karagiorgou
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, Scotland, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, Scotland, UK
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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14
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Girgis RR, Basavaraju R, France J, Wall MM, Brucato G, Lieberman JA, Provenzano FA. An exploratory magnetic resonance imaging study of suicidal ideation in individuals at clinical high-risk for psychosis. Psychiatry Res Neuroimaging 2021; 312:111287. [PMID: 33848727 PMCID: PMC8137659 DOI: 10.1016/j.pscychresns.2021.111287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/18/2020] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
Suicide is a major cause of death in psychosis and associated with significant morbidity. Suicidal ideation (SI) is very common in those at clinical high-risk for psychosis (CHR) and predicts later suicide. Despite substantial work on the pathobiology of suicide in schizophrenia, little is known of its neurobiological underpinnings in the CHR or putatively prodromal state. Therefore, in this pilot study, we examined the neurobiology of SI in CHR individuals using structural MRI. Subjects were aged 14-30 and met criteria for the Attenuated Positive Symptom Psychosis-Risk Syndrome (APSS) delineated in the Structured Interview for Psychosis-Risk Syndromes (SIPS). Suicidality was assessed using the Columbia Suicide Severity Rating Scale (C-SSRS). Volumetric MRI scans were obtained on a 3T Phillips scanner. MRI data were available for 69 individuals (19 CHR without SI, 31 CHR with SI and 19 healthy control subjects). CHR individuals with SI had thicker middle temporal and right insular cortices than CHR individuals without SI and healthy control subjects. The location of these findings is consistent with neurobiological findings regarding suicide in syndromal psychosis. These findings underscore the potential for the use of brain imaging biomarkers of suicide risk in CHR individuals.
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Affiliation(s)
- Ragy R Girgis
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A.
| | - Rakshathi Basavaraju
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Jeanelle France
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Melanie M Wall
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Gary Brucato
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Jeffrey A Lieberman
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
| | - Frank A Provenzano
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, N.Y., U.S.A
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15
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Rinne GR, O'Brien MP, Miklowitz DJ, Addington JM, Cannon TD. Depression, family interaction and family intervention in adolescents at clinical-high risk for psychosis. Early Interv Psychiatry 2021; 15:360-366. [PMID: 32232954 PMCID: PMC8175016 DOI: 10.1111/eip.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/21/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
AIM The relationship between family behaviour and depression in adolescents at clinical high risk (CHR) for psychosis remains understudied despite high rates of depression in this population. This study examines the relationship between family problem-solving behaviours and depression in CHR adolescents and the impact of family interventions targeting subthreshold symptoms of psychosis on reducing symptoms of depression over 2-years. METHODS Participants were a subset of the North American Prodrome Longitudinal Study who were randomized to 6-months of family focused therapy for individuals at CHR or family psychoeducational treatment. We evaluated the relationship between communication during family conflict discussion and adolescents' symptoms of depression before treatment. At follow-up assessments the family treatment groups were compared on depression. Finally, we compared those in family treatment with matched controls. RESULTS Adolescents' constructive communication was associated with less severe symptoms of depression before treatment. Symptoms of depression improved for adolescents in both family treatment groups. However, there were no significant group by treatment interactions. When adolescents who participated in either type of family intervention were compared to CHR adolescent controls, symptoms of depression improved for adolescents in treatment and control groups, but there were no significant time by treatment interactions. CONCLUSIONS The communication skills of CHR adolescents are related to both depression and their parents' communication skills pre-treatment. However, reductions in depression over the course of the treatment trial cannot be attributed to family treatment. It is imperative to incorporate interventions that directly target depression into future family treatment studies.
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Affiliation(s)
- Gabrielle R Rinne
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Mary P O'Brien
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - David J Miklowitz
- Semel Institute, University of California, Los Angeles, California, USA
| | - Jean M Addington
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut, USA.,Department of Psychiatry, Yale University, New Haven, Connecticut, USA
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16
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Izon E, Berry K, Wearden A, Carter L, Law H, French P. Investigating expressed emotion in individuals at‐risk of developing psychosis and their families over 12 months. Clin Psychol Psychother 2021; 28:1285-1296. [DOI: 10.1002/cpp.2576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Emma Izon
- Division of Psychology and Mental Health, Manchester Academic Health Science Centre The University of Manchester Manchester UK
- The Psychosis Research Unit Greater Manchester Mental Health NHS Foundation Trust Manchester UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Manchester Academic Health Science Centre The University of Manchester Manchester UK
- Complex Trauma Research Unit Greater Manchester Mental Health NHS Foundation Trust Manchester UK
| | - Alison Wearden
- Division of Psychology and Mental Health, Manchester Academic Health Science Centre The University of Manchester Manchester UK
| | - Lesley‐Anne Carter
- Division of Psychology and Mental Health, Manchester Academic Health Science Centre The University of Manchester Manchester UK
| | - Heather Law
- Division of Psychology and Mental Health, Manchester Academic Health Science Centre The University of Manchester Manchester UK
- The Psychosis Research Unit Greater Manchester Mental Health NHS Foundation Trust Manchester UK
- Youth Mental Health Research Unit Greater Manchester Mental Health NHS Foundation Trust Manchester UK
| | - Paul French
- Department of Psychology Manchester Metropolitan University Manchester UK
- Department of Research and Innovation Pennine Care NHS Foundation Trust Lancashire UK
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17
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Berardelli I, Rogante E, Sarubbi S, Erbuto D, Lester D, Pompili M. The Importance of Suicide Risk Formulation in Schizophrenia. Front Psychiatry 2021; 12:779684. [PMID: 34975579 PMCID: PMC8716825 DOI: 10.3389/fpsyt.2021.779684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/02/2021] [Indexed: 12/31/2022] Open
Abstract
Suicide is a cause of early mortality in nearly 5% of patients with schizophrenia, and 25-50% of patients with schizophrenia attempt suicide in their lifetime. Evidence points to numerous individual, clinical, social, and psychological risk factors for suicide in patients with schizophrenia. Although recognizing suicidal risk factors in schizophrenia is extremely important in suicidal risk assessment, we have recently witnessed a change in suicide risk management that shifts the focus from suicide risk assessment to suicide risk formulation. Suicide risk formulation is dependent on the data gathered in the suicide risk assessment and assigns a level of suicide risk that is indispensable for the choice of treatment and the management of patients with a high suicidal risk. In this article, we extend the suicide risk formulation model to patients with schizophrenia. Suicide risk formulation results from four different areas that help clinicians collect as much information as possible for the management of suicidal risk. The four distinct judgments comprise risk status (the risk relating to the specific group to which the patient belongs), risk state (the risk for the person compared with his baseline or another reference point in the course of his life), available resources (on whom the person can count during a crisis) and foreseeable events (which can exacerbate the crisis). In schizophrenia, the suicide risk formulation model allows the clinician to evaluate in depth the clinical context of the patient, the patient's own history and patient-specific opportunities for better choosing and applying suicide prevention strategies.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Rogante
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ, United States
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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18
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Bowman S, McKinstry C, Howie L, McGorry P. Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review. Early Interv Psychiatry 2020; 14:655-676. [PMID: 32026624 DOI: 10.1111/eip.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
AIM Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment. METHOD This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school. RESULTS In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature. CONCLUSION Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, School of Allied Health, LaTrobe University, Melbourne, Australia
| | - Carol McKinstry
- Department of Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Melbourne, Australia
| | - Linsey Howie
- Department of Occupational Therapy, School of Clinical and Community Allied Health, LaTrobe University, Melbourne, Australia
| | - Patrick McGorry
- The National Centre of Excellence in Youth Mental Health, Orygen, The University of Melbourne, Melbourne, Australia
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19
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Abstract
The lifetime risk of dying by suicide in schizophrenia and related psychoses has been estimated to be approximately between 5% and 7%, though some have estimated that the number is closer to 10%. The highest risk for suicide occurs within the first year after presentation, when patients have a 12 times greater risk of dying by suicide than the general population, or a 60% higher risk compared with patients in other phases of psychosis, although the risk continues for many years. Some 31% of all deaths in first and early episode samples are due to suicide. Studies in individuals at clinical high-risk for psychosis (CHR) or with attenuated positive symptoms also demonstrate that suicidality is common and problematic in these individuals. Therefore, suicide in psychosis is a particularly severe problem. In order to develop interventions aimed at reducing the risk of suicide in psychotic individuals, it will be critical to understand the neurobiology of suicide in psychosis. In this paper, I report on the results of a systematic review of the work done to date on the neurobiology of suicide in psychosis and on suicidality in the CHR period. I will also identify gaps in knowledge and discuss future strategies for studying the neurobiology of suicidality in psychosis that may help to disentangle the links between suicide and psychosis and, by doing so, allow us to gain a greater understanding of the relationship between suicide and psychosis, which is critical for developing interventions aimed at reducing the risk of suicide in psychotic individuals.
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Affiliation(s)
- Ragy R Girgis
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY, USA
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20
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Pelizza L, Poletti M, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Pompili M, Raballo A. Suicide risk in young people at Ultra-High Risk (UHR) of psychosis: Findings from a 2-year longitudinal study. Schizophr Res 2020; 220:98-105. [PMID: 32249122 DOI: 10.1016/j.schres.2020.03.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide risk is high in first episode schizophrenia. Little data are available in young individuals at Ultra-High Risk (UHR) of psychosis. Purposes of the study were: (1) to assess prevalence and incidence rates of suicide attempts, suicidal ideation, and completed suicide in UHR individuals compared with First Episode Psychosis (FEP) and non-FEP/UHR help-seeking peers at baseline and over a 24-month follow-up time, and (2) to explore any association of suicidal ideation with other psychopathological parameters at baseline. METHODS 273 young people (13-35 years) were evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory - II Edition (BDI), and the World Health Organization Quality Of Life scale - Brief version (WHOQOL-BREF). The BDI item 9 cut-off score of ≥1 dichotomized the presence/absence of suicidal ideation. RESULTS UHR individuals showed more severe suicidal ideation and a higher percentage of individuals with a history of attempted suicide than FEP and non-UHR/FEP samples, and a higher 2-year incidence rate of suicide attempts than non-UHR/FEP subjects. No inter-group differences in incidence rates of completed suicide were found. In the UHR group, suicidal ideation was associated with BDI-II and CAARMS "Anhedonia" scores, and showed a negative correlation with all WHOQOL-BREF scores. CONCLUSIONS Suicidal ideation is frequent in UHR subjects, supporting the routine monitoring of suicide risk in people at risk of psychosis. Suicide risk is correlated with severity of depression and anhedonia, and with a poorer quality of life.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy.
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendolan.2, 42100 Reggio Emilia (RE), Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Bologna, Via Castiglione n.29, 40124 Bologna (BO), Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 42100 Reggio Emilia (RE), Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa n.1035, 00189 Rome, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Piazza Università n.1, 06123 Perugia (PG), Italy
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21
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Miller BJ, Parker CB, Rapaport MH, Buckley PF, McCall WV. Insomnia and suicidal ideation in nonaffective psychosis. Sleep 2020; 42:5165662. [PMID: 30407600 DOI: 10.1093/sleep/zsy215] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
Study Objectives Insomnia is a common symptom in the clinical course of schizophrenia. There is a robust association between insomnia and suicidality in other psychiatric disorders. Two previous studies found associations between insomnia and suicide attempt or completed suicide in patients with schizophrenia. We hypothesized that greater insomnia would be associated with greater levels of suicidal ideation in patients with schizophrenia and other nonaffective psychoses. Methods We recruited 108 inpatients and outpatients age 18-65 between July 2010 and July 2016 with DSM-IV nonaffective psychosis (schizophrenia, schizoaffective disorder, or schizophreniform disorder). We investigated relationships between current insomnia (Insomnia Severity Index [ISI]), suicidal ideation over the past week, and lifetime history of suicide attempt (Beck Scale for Suicide Ideation [BSS]) in regression analyses. Results After controlling for potential confounders, insomnia was a significant indicator of suicidal ideation (β = 0.27, p = 0.032). Insomnia was also a significant indicator of a high BSS score (≥16; OR = 1.14, 95% CI: 1.01-1.28, p = 0.029). Furthermore, participants with severe insomnia were almost 15 times more likely to have a lifetime history suicide attempt than participants without current insomnia (OR = 14.8, 95% CI: 1.4-157, p = 0.025). Insomnia was also an indicator of greater PANSS total (β = 0.33, p = 0.001), positive subscale (β = 0.32, p = 0.002), and general subscale (β = 0.40, p < 0.001) scores. Conclusions Insomnia is associated with suicidal ideation, lifetime suicide attempt, and greater psychopathology in patients with schizophrenia. Our findings suggest that formal assessment of insomnia may be germane to the clinical care of patients with schizophrenia as a marker of suicide risk and symptom severity.
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Affiliation(s)
- Brian J Miller
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | - Carmen B Parker
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Mark H Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
| | - Peter F Buckley
- School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
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22
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Pelizza L, Poletti M, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Pupo S, Raballo A. Suicidal Thinking and Behavior in Adolescents at Ultra-High Risk of Psychosis: A Two-year Longitudinal Study. Suicide Life Threat Behav 2019; 49:1637-1652. [PMID: 30932235 DOI: 10.1111/sltb.12549] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 01/14/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Suicide risk in subjects at Ultra-High Risk of psychosis (UHR) has been rarely assessed in adolescence, but it is of obvious importance for prognostic and clinical care reasons. In this study, we aimed to prospectively assess suicide risk and behaviors in UHR adolescents. METHOD We examined 112 help-seeking adolescents (13-18 years, 50% males, 83.9% Caucasian) that were enrolled in the Reggio Emilia At-Risk Mental States (ReARMS) project and followed up for 2 years. Specific items derived from the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Beck Depression Inventory-II (BDI-II) were used to assess suicide risk. Suicide attempts and completed suicides were also recorded. RESULTS Baseline assessment detected 40 UHR adolescents, 32 FEP (first-episode psychosis), and 40 non-UHR/FEP. We found that 67.5% of UHR adolescents had suicidal ideation, and 18.5% to severe degree. Attempted suicide before enrollment was higher in the UHR group than in non-UHR/FEP peers (17.5% vs. 2.5%). BDI-II suicidal ideation severity was stable at 12-month follow-up and decreased at 24-month follow-up. CONCLUSIONS A high prevalence of suicidal ideation among UHR adolescents was found and supports the routine monitoring of risk of self-injurious thinking and behavior in this at-risk population.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL di Bologna, Bologna, Italy
| | - Simona Pupo
- Intensive Care Unit, Guastalla Civil Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Raballo
- Psychodiagnostic and Clinical Psychopharmacology Unit, Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy
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Abstract
AIMS Suicide attempt is an important indicator of suicide and potential future mortality. However, the prevalence of suicide attempts has been inconsistent across studies. This meta-analysis aimed to examine the prevalence of suicide attempts in individuals with schizophrenia and associated correlates. METHODS Relevant publications in Embase, PsycINFO, PubMed, Web of science and Cochrane were systematically searched. Data on the prevalence of suicide attempts in individuals with schizophrenia were pooled using a random-effects model. RESULTS Thirty-five studies with 16 747 individuals with schizophrenia were included. The pooled lifetime prevalence of suicide attempts was 26.8% (95% CI 22.1-31.9%; I2 = 97.0%), while the 1-year prevalence, 1-month prevalence and the prevalence of suicide attempts from illness onset were 3.0% (95% CI 2.3-3.7%; I2 = 95.6%), 2.7% (95% CI 2.1-3.4%; I2 = 78.5%) and 45.9% (95% CI 42.1-49.9%; I2 = 0), respectively. Earlier age of onset (Q = 4.38, p = 0.04), high-income countries (Q = 53.29, p < 0.001), North America and Europe and Central Asia (Q = 32.83, p < 0.001) were significantly associated with a higher prevalence of suicide attempts. CONCLUSIONS Suicide attempts are common in individuals with schizophrenia, especially those with an early age of onset and living in high-income countries and regions. Regular screening and effective preventive measures should be implemented as part of the clinical care.
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Grivel MM, Leong W, Masucci MD, Altschuler RA, Arndt LY, Redman SL, Yang LH, Brucato G, Girgis RR. Impact of lifetime traumatic experiences on suicidality and likelihood of conversion in a cohort of individuals at clinical high-risk for psychosis. Schizophr Res 2018; 195:549-553. [PMID: 28935167 PMCID: PMC5857405 DOI: 10.1016/j.schres.2017.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/29/2017] [Accepted: 09/04/2017] [Indexed: 01/25/2023]
Abstract
Recent research suggests that trauma history (TH) is a strong socio-environmental risk factor for the development of psychosis. While reported rates of childhood trauma are higher among individuals at clinical high-risk (CHR) for psychosis than in the general population, little research has explored the effects of trauma upon the severity of attenuated positive symptoms. We aimed to explore the specific relationships between TH and baseline symptom severity; likelihood of conversion to full-blown psychosis; suicidal ideation (SI); and suicidal behavior (SB) in a cohort of 200 help-seeking CHR individuals. Participants were evaluated every three months for up to two years using the Structured Interview for Psychosis-Risk Syndromes (SIPS). More trauma history was reported by females and Hispanic/Latino participants, while age and race did not significantly distinguish those with and without TH. Individuals with TH reported higher rates of SI and SB than those without. While TH was positively associated with several SIPS subscales, including Unusual Thought Content, Perceptual Abnormalities/Hallucinations, Bizarre Thinking, Sleep Disturbances, and Dysphoric Mood, and negatively associated with Expressed Emotion, results indicated that TH was not significantly related to conversion to psychosis. Moreover, baseline SI was unrelated to conversion and baseline DSM diagnosis, with the exception of Post-Traumatic Stress Disorder (PTSD). These results suggest that traumatic experiences may significantly impact the severity of attenuated positive symptoms and suicidality in the CHR state, providing new windows for further research and potential intervention.
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25
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Abstract
BACKGROUND A strong association has been shown to exist between schizophrenia and suicide; however, research examining suicidality in the prodromal phase of psychotic disorders is limited. This study aimed to meet this need by examining potential risk factors for lifetime suicide attempts in a population of individuals with attenuated psychosis syndrome (APS), as defined in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders as a condition for further study. METHODS A retrospective chart review was conducted to identify individuals with APS during a 5-year period across a large medical university's inpatient and outpatient settings. Sociodemographic and clinical factors were examined in relation to suicide attempts to identify risk factors for suicide attempts. χ analyses were used to analyze dichotomous variables, and t test analyses were used to compare means of continuous predictors among those with versus without suicide attempts. Final analyses consisted of fitting multivariate logistic regression models to control for sociodemographic factors. RESULTS In total, 26.3% of the APS population had at least 1 lifetime suicide attempt. Six covariates were found to be statistically significant predictors of suicide attempts: Axis II disorders (P=0.006); history of trauma as a whole (P=0.022); the subcategory of sexual trauma (P=0.005); tobacco use (P=0.039); family history of nonpsychotic Axis I disorders (P=0.042); and number of hospitalizations (P=0.001). CONCLUSIONS Suicidality is a prominent feature of APS, and a number of risk factors increase the likelihood of suicide attempts in this population.
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26
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Cosgrave J, Haines R, van Heugten-van der Kloet D, Purple R, Porcheret K, Foster R, Wulff K. The interaction between subclinical psychotic experiences, insomnia and objective measures of sleep. Schizophr Res 2018; 193:204-208. [PMID: 28711475 PMCID: PMC5861320 DOI: 10.1016/j.schres.2017.06.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 06/13/2017] [Accepted: 06/28/2017] [Indexed: 11/17/2022]
Abstract
Investigations into schizophrenia have revealed a high incidence of comorbidity with disturbed sleep and circadian timing. Acknowledging this comorbidity on a dimensional level, we tested prospectively whether subclinical psychotic symptoms are more prevalent in individuals with insomnia. An insomnia group (n=21) and controls (n=22) were recruited on their subjective sleep quality, recorded actigraphically for 3weeks and assessed for psychotic-like experiences with The Prodromal Questionnaire-16. Using multivariate Poisson regression analyses, we found that objective and subjective sleep measures interact to predict the highest risk for psychotic experiences. Objective measures of sleep and statistical modelling are rarely used in either clinical trials or practice for schizophrenia, yet this study highlights their value in these areas.
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Affiliation(s)
- Jan Cosgrave
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - Ross Haines
- Department of Statistics, University of Oxford, United Kingdom
| | - Dalena van Heugten-van der Kloet
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Oxford Brookes University, Faculty of Health and Life Sciences, Department of Psychology, Social Work and Public Health, Oxford, United Kingdom
| | - Ross Purple
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Kate Porcheret
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Russell Foster
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Katharina Wulff
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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27
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D'Angelo EJ, Lincoln SH, Morelli N, Graber K, Tembulkar S, Gonzalez-Heydrich J. Suicidal behaviors and their relationship with psychotic-like symptoms in children and adolescents at clinical high risk for psychosis. Compr Psychiatry 2017; 78:31-37. [PMID: 28803039 DOI: 10.1016/j.comppsych.2017.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Previous research has demonstrated elevated rates of suicide attempts and ideation in individuals with psychosis. This study investigated rates and severity of suicidal behavior in youth with and at clinical high risk for psychosis, and examined the positive, negative, and disorganized symptoms associated with suicidal behaviors among the clinical high risk group. METHODS Eighty-six youth ages 7-18 (n=21 non-clinical controls [NCC], n=40 clinical high risk [CHR], n=25 diagnosed psychotic disorder [PD]) were recruited. CHR and PD participants were identified using the Structured Interview for Prodromal Symptoms (SIPS) and Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL). All participants completed the Suicide Behaviors Questionnaire-Revised (SBQ-R). RESULTS Findings indicated significantly higher levels of suicidal behavior among CHR and PD relative to NCC participants (F=7.64, p=0.001). 17.5% of CHR participants had previously attempted suicide. Dysphoric Mood and Odd Behavior or Appearance were significantly correlated with suicidal behavior severity among CHR youth. CONCLUSION Suicidal behavior was observed with greater frequency and severity in the CHR and PD groups than in the NCC group. CHR suicidal behavior severity was correlated most strongly with Dysphoric Mood and Odd Behavior or Appearance, a relationship which warrants further investigation.
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Affiliation(s)
- Eugene J D'Angelo
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Sarah Hope Lincoln
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; McLean Hospital, Department of Psychiatry, 115 Mill Street, Belmont, MA 02478, USA.
| | - Nicholas Morelli
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Kelsey Graber
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sahil Tembulkar
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Joseph Gonzalez-Heydrich
- Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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28
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Lindgren M, Manninen M, Kalska H, Mustonen U, Laajasalo T, Moilanen K, Huttunen MO, Cannon TD, Suvisaari J, Therman S. Suicidality, self-harm and psychotic-like symptoms in a general adolescent psychiatric sample. Early Interv Psychiatry 2017; 11:113-122. [PMID: 25582971 DOI: 10.1111/eip.12218] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 10/15/2014] [Accepted: 12/02/2014] [Indexed: 01/21/2023]
Abstract
AIM We investigated the associations between clinical high-risk for psychosis (CHR), psychotic-like symptoms and suicidality among adolescent psychiatric patients. METHODS The sample consisted of 54 CHR and 107 non-CHR psychiatric patients aged 15-18 in Helsinki, Finland, who were assessed at the beginning of their psychiatric treatment with the Structured Interview for Prodromal Syndromes (SIPS). Current suicidality was measured with the Beck Depression Inventory (item 9), while lifetime suicidality was evaluated from all available data, including patient files. The participants were followed for 2.8-8.9 years via the national hospital discharge register, with the follow-up outcome being intentional self-harm. Data on suicides were also gathered from the Causes of Death statistics. RESULTS Only 30.5% of the adolescents had no suicidal ideation at the beginning of their treatment. CHR risk state and SIPS-assessed delusions, suspiciousness, and hallucinations were associated with higher current suicidality. Of the 154 adolescents with register follow-up, there were five (3.2%) with intentional self-harm resulting in hospital treatment, all female. CHR status was not associated with self-harm. Current suicidality, familial risk of psychosis, and SIPS decreased expression of emotions were associated with self-harm during follow-up. In a Cox regression analysis model among girls, only decreased expression of emotions remained a significant predictor of intentional self-harm. Baseline suicidality measures were not associated with transitions to psychosis. CONCLUSIONS CHR status was associated with higher current suicidality but did not predict follow-up intentional self-harm in treatment-seeking adolescents. Decreased expression of emotions may indicate higher risk of intentional self-harm in adolescent treatment-seeking girls.
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Affiliation(s)
- Maija Lindgren
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, Helsinki, Finland
| | - Marko Manninen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, Helsinki, Finland
| | - Hely Kalska
- Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, Helsinki, Finland
| | - Ulla Mustonen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Taina Laajasalo
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, Helsinki, Finland
| | - Kari Moilanen
- Adolescence Unit, Helsinki University Central Hospital, Helsinki, Finland
| | - Matti O Huttunen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Jaana Suvisaari
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Sebastian Therman
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, Helsinki, Finland
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29
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Lincoln SH, Norkett E, Graber K, Tembulkar S, Morelli N, Gonzalez-Heydrich J, D'Angelo E. Suicidal behaviors in children and adolescents with psychotic disorders. Schizophr Res 2017; 179:13-16. [PMID: 27707531 DOI: 10.1016/j.schres.2016.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/09/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Abstract
Suicide is the leading cause of premature death in individuals with psychotic disorders. Risk for onset of suicidal behaviors tends to begin in adolescence, remaining high into young adulthood. The present study aims to evaluate the interplay of early onset psychosis and suicide risk by examining suicidal behaviors (ideation, planning, and attempts) in children and adolescents with psychotic disorders (PD) compared to typically developing peers (TD). Twenty five youths were recruited and were diagnostically evaluated for psychosis. We found that the PD children exhibited significantly higher levels of suicidal behaviors than TD children, even when parsed into individual at-risk behaviors.
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Affiliation(s)
- Sarah Hope Lincoln
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Emily Norkett
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Kelsey Graber
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Sahil Tembulkar
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Nicholas Morelli
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Joseph Gonzalez-Heydrich
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Eugene D'Angelo
- Boston Children's Hospital/Harvard Medical School, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, United States.
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30
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Stigma and suicidal ideation among young people at risk of psychosis after one year. Psychiatry Res 2016; 243:219-24. [PMID: 27419651 DOI: 10.1016/j.psychres.2016.06.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/06/2016] [Accepted: 06/12/2016] [Indexed: 11/22/2022]
Abstract
Suicidality is common among individuals at risk of psychosis. Emerging findings suggest that mental illness stigma contributes to suicidality. However, it is unclear whether stigma variables are associated with suicidality among young people at risk of psychosis. This longitudinal study assessed perceived public stigma and the cognitive appraisal of stigma as a stressor (stigma stress) as predictors of suicidal ideation among individuals at risk of psychosis over the period of one year. One hundred and seventy-two participants between 13 and 35 years of age were included who were at high or ultra-high risk of psychosis or at risk of bipolar disorder. At one-year follow-up, data were available from 73 completers. In multiple logistic regressions an increase of stigma stress (but not of perceived stigma) over one year was significantly associated with suicidal ideation at one-year follow-up, controlling for age, gender, symptoms, comorbid depression and suicidal ideation at baseline. Interventions to reduce public stigma and stigma stress could therefore improve suicide prevention among young people at risk of psychosis.
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31
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Davies G, Haddock G, Yung AR, Mulligan LD, Kyle SD. A systematic review of the nature and correlates of sleep disturbance in early psychosis. Sleep Med Rev 2016; 31:25-38. [PMID: 26920092 DOI: 10.1016/j.smrv.2016.01.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 11/25/2022]
Abstract
Sleep disturbances are common in people with a diagnosis of schizophrenia and have been associated with increased symptom severity, neurocognitive deficits and reduced quality of life. Despite a significant body of literature in this field, there has been limited investigation of sleep disturbance in the early course of the illness. This systematic review aims to synthesise and evaluate the available data exploring sleep in early psychosis, with two key research questions: 1) What is the nature of sleep disturbance in early psychosis? and 2) What are the correlates of sleep disturbance in early psychosis? From an initial search, 16,675 papers were identified, of which 21 met inclusion/exclusion criteria. The preliminary evidence suggests that self-reported sleep disturbances are prevalent in early psychosis and may be associated with symptom severity, as well as elevated rates of both help-seeking and suicidality. Abnormalities in sleep architecture and sleep spindles are also commonly observed and may correlate with symptom severity and neurocognitive deficits. However, due to significant methodological limitations and considerable heterogeneity across studies, evidence to support the reliability of these associations is limited. We outline a research agenda, emphasising the prospective use of gold-standard sleep measurement to investigate the prevalence and nature of sleep disturbances in early psychosis, as well as how these may be related to the onset and persistence of psychotic symptoms.
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Affiliation(s)
- Gabriel Davies
- School of Psychological Sciences, University of Manchester, UK; Manchester Mental Health and Social Care NHS Trust, Manchester, UK.
| | - Gillian Haddock
- School of Psychological Sciences, University of Manchester, UK; Manchester Mental Health and Social Care NHS Trust, Manchester, UK
| | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Greater Manchester West NHS Trust, Manchester, UK
| | | | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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32
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Ventriglio A, Gentile A, Bonfitto I, Stella E, Mari M, Steardo L, Bellomo A. Suicide in the Early Stage of Schizophrenia. Front Psychiatry 2016; 7:116. [PMID: 27445872 PMCID: PMC4921745 DOI: 10.3389/fpsyt.2016.00116] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/13/2016] [Indexed: 12/11/2022] Open
Abstract
Suicide is a relevant leading cause of death among patients affected by schizophrenia. Even if suicidal ideation may be present in different stages of disease, some differences have been described between the risk of suicide in patients experiencing first episode of psychosis and those with long-term schizophrenia. It is particularly higher during the first year of illness and reaches a steady decline over the following years. Suicidal ideation and attempts may also be common among subjects with subthreshold psychotic experiences. Factors associated with the risk of suicide in the early phase of schizophrenia are previous suicidal attempts and social aspects: the lack of social support and stable relationships, social drift after the first episode, and social impairment. Also, several psychotic symptoms (suspiciousness, paranoid delusions, mental disintegration and agitation, negative symptoms, depression and hopelessness, and command hallucinations) and substance abuse are associated with higher risk of suicide. It has been described that perfectionism and good levels of insight among individuals who have recently developed psychotic symptoms are significantly associated with higher numbers of suicidal attempts. Moreover, recent evidences show that prefrontal cortex-based circuit dysfunction may be related to suicide in the early stage of schizophrenia. This narrative review summarizes available evidences on suicide in the early stage of schizophrenia and deals with issues to be further studied and discussed.
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Affiliation(s)
- Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Department of Mental Health, Regione Marche, ASUR, Area Vasta 2, Jesi, Italy
| | | | - Iris Bonfitto
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
| | - Eleonora Stella
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
| | - Massimo Mari
- Department of Mental Health, Regione Marche, ASUR, Area Vasta 2 , Jesi , Italy
| | - Luca Steardo
- Department of Psychiatry, University of Naples SUN , Naples , Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
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33
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Sankaranarayanan A, Mancuso S, Wilding H, Ghuloum S, Castle D. Smoking, Suicidality and Psychosis: A Systematic Meta-Analysis. PLoS One 2015; 10:e0138147. [PMID: 26372218 PMCID: PMC4570823 DOI: 10.1371/journal.pone.0138147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 08/25/2015] [Indexed: 12/22/2022] Open
Abstract
The aim of this study is to systematically review the literature that explored the association between smoking and suicidal risk among those with serious mental illness and to estimate the risk of suicidal behaviors attributable to smoking among this patient group. Multiple databases (CINAHL, PsycINFO, EMBASE, Informit Health Collection and the Cochrane Library databases) were searched from 1 January 1975 through 15 January 2014, along with references from relevant articles for observational studies that ascertained the association between smoking and suicidal behaviors among patients with psychotic disorders conducted in adult patients. Thirteen studies involving 6813 patients with severe mental illness were included. We found that smoking was significantly associated with suicidality in psychosis with an Odds Ratio of 2.12 (95% CI 1.67–2.7). Smoking is associated with suicidal risk amongst individuals with a severe mental illness; however, it is still unclear whether this represents a true risk factor or a confounder or a mediator via mechanisms, hitherto unknown, needs to be studied further.
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Affiliation(s)
- Anoop Sankaranarayanan
- Department of Geriatrics, Hamad Medical Corporation, Doha Qatar
- Department of Psychiatry, Weil Cornell Medical College, Doha Qatar
- * E-mail:
| | - Serafino Mancuso
- St Vincent’s Hospital, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | | | - Suhaila Ghuloum
- Department of Psychiatry, Weil Cornell Medical College, Doha Qatar
- Department of Psychiatry, Hamad Medical Corporation, Doha Qatar
| | - David Castle
- St Vincent’s Hospital, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Department of Psychiatry, Australian Catholic University, Melbourne, Australia
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34
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Sanchez-Gistau V, Baeza I, Arango C, González-Pinto A, de la Serna E, Parellada M, Graell M, Paya B, Llorente C, Castro-Fornieles J. The affective dimension of early-onset psychosis and its relationship with suicide. J Child Psychol Psychiatry 2015; 56:747-755. [PMID: 25256792 DOI: 10.1111/jcpp.12332] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The affective dimension has scarcely been studied in early-onset psychosis. Our aims were to investigate the prevalence and type of affective symptoms in the prodromal and acute phases of early-onset psychosis and to examine their relationship with suicide. We also sought to establish whether the presence of premorbid antecedents or the presence of affective symptoms during the prodromal and acute phase might predict a later diagnosis of bipolar disorder (BP) or schizophrenia (SZ). METHOD Participants were 95 youths, aged 9-17 years, experiencing a first episode of a psychotic disorder (FEP) according to DSM-IV criteria. Prodromal affective symptoms in the year prior to the onset of full-blown psychosis were assessed by means of the K-SADS. Affective symptoms during the acute episode were evaluated using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Suicidality was assessed during the acute episode and at 6 and 12 months. RESULTS Half of the patients experienced affective symptoms during the prodrome, with depressive symptoms being the most frequently reported. During the acute episode, 23.2% presented depressive, 41.4% mixed and 18.9% manic symptoms. After logistic regression analysis, only the presence of depressive symptoms was significantly associated with suicidality during the 12 months following the FEP. Neither early premorbid antecedents nor the prevalence or type of affective symptoms during the FEP predicted a diagnosis of BP or SZ at 12 months. However, both depressive and manic prodromal symptoms were associated with a later diagnosis of BP. CONCLUSIONS The FEP of both SZ and BP is preceded by an identifiable prodromal phase. Early detection programs should target young people at clinical risk for the extended psychosis phenotype. The high prevalence of affective symptoms during the early phases of psychosis may encourage clinicians to identify and treat them in order to prevent suicide behaviour.
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Affiliation(s)
- Vanessa Sanchez-Gistau
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Barcelona, 2009-SGR-1119, Generalitat de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Barcelona, 2009-SGR-1119, Generalitat de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Celso Arango
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Hospital Santiago Apóstol, EHU/University of the Basque Country, Vitoria, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain
| | - Mara Parellada
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Beatriz Paya
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Child and Adolescent Mental Health Unit, Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Cloe Llorente
- Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Barcelona, 2009-SGR-1119, Generalitat de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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35
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Gill KE, Quintero JM, Poe SL, Moreira AD, Brucato G, Corcoran CM, Girgis RR. Assessing suicidal ideation in individuals at clinical high risk for psychosis. Schizophr Res 2015; 165:152-6. [PMID: 25960038 PMCID: PMC4457707 DOI: 10.1016/j.schres.2015.04.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The majority of individuals with schizophrenia and other psychotic illnesses have had suicidal ideation at some point during the illness. However, little is known about the variation in level and intensity of suicidal ideation and symptoms in the attenuated stage of psychotic illness. Our aims were to assess prevalence of suicidal ideation in this at risk group, and to examine the severity and intensity of suicidal ideation, and their relation to symptoms. METHODS Suicidal ideation was assessed in 42 clinical high-risk participants using the Columbia Suicide Severity Rating Scale (C-SSRS). We hypothesized that prevalence rates would be similar to what was found in previous studies, and individuals with suicidal ideation would have higher positive and negative symptoms, with poorer functioning. We assessed levels of severity and intensity of suicidal ideation related to these symptoms, and examined how depressive symptoms affected these relationships. RESULTS Nearly half (42.9%) of participants reported having current suicidal ideation. We found no relationship to positive symptoms. However, severity and intensity of suicidal ideation were found to be related to negative symptoms and level of functioning. When controlling for depressive symptoms during exploratory analysis, this relationship still emerged. CONCLUSIONS This study adds to the literature demonstrating the complex nature of suicidal ideation in psychotic illness. The C-SSRS has shown to be helpful in determining relationships between severity and intensity in suicidal ideation in relation to specific symptoms in a research setting.
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Affiliation(s)
- Kelly E. Gill
- Department of Psychiatry at Columbia University Medical Center, New York, NY,Department of Psychology at The Catholic University of America, Washington, DC
| | - Jean M. Quintero
- Department of Psychiatry at Columbia University Medical Center, New York, NY
| | - S. Lucy Poe
- Department of Psychiatry at Columbia University Medical Center, New York, NY
| | - Alvaro D. Moreira
- Department of Psychiatry at Columbia University Medical Center, New York, NY
| | - Gary Brucato
- Department of Psychiatry at Columbia University Medical Center, New York, NY
| | - Cheryl M. Corcoran
- Department of Psychiatry at Columbia University Medical Center, New York, NY
| | - Ragy R. Girgis
- Department of Psychiatry at Columbia University Medical Center, New York, NY
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36
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Yamaguchi T, Fujii C, Nemoto T, Tsujino N, Takeshi K, Mizuno M. Differences between subjective experiences and observed behaviors in near-fatal suicide attempters with untreated schizophrenia: a qualitative pilot study. Ann Gen Psychiatry 2015; 14:17. [PMID: 25904969 PMCID: PMC4405822 DOI: 10.1186/s12991-015-0055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 03/31/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In cases of untreated schizophrenia, the patients' entourage often does not recognize the psychotic symptoms of the patient and the possibility that the patient may attempt suicide. The aim of this study was to investigate the discrepancies between the subjective experiences and observed behaviors in near-fatal suicide attempters with untreated schizophrenia. METHODS A semi-structured interview was carried out with seven near-fatal suicide attempters with untreated schizophrenia to examine the subjective experiences at the time of the suicide attempt. The families of the patients were also interviewed to determine their recognition of the patients' psychotic symptoms and the suicidal ideation. The interview data were analyzed qualitatively. RESULTS Six subjects were undergoing exacerbation of the psychotic symptoms at the time of exhibiting the suicide-related ideation. One subject had been in a prolonged depressive state before attempting suicide. Although all the patients experienced severe distress due to psychotic symptoms and depressive mood, they all exhibited only low level or no help-seeking behavior, and six of seven families had not recognized the change in the patient's mental condition. CONCLUSIONS Appropriate information about schizophrenia should be provided to the general public so that any help-seeking by the patients with this disease is not overlooked. In addition, accessible early intervention services for psychosis should be established.
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Affiliation(s)
- Taiju Yamaguchi
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
| | - Chiyo Fujii
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 1878553 Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
| | - Kiyoaki Takeshi
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
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Samsom JN, Wong AHC. Schizophrenia and Depression Co-Morbidity: What We have Learned from Animal Models. Front Psychiatry 2015; 6:13. [PMID: 25762938 PMCID: PMC4332163 DOI: 10.3389/fpsyt.2015.00013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/24/2015] [Indexed: 12/15/2022] Open
Abstract
Patients with schizophrenia are at an increased risk for the development of depression. Overlap in the symptoms and genetic risk factors between the two disorders suggests a common etiological mechanism may underlie the presentation of comorbid depression in schizophrenia. Understanding these shared mechanisms will be important in informing the development of new treatments. Rodent models are powerful tools for understanding gene function as it relates to behavior. Examining rodent models relevant to both schizophrenia and depression reveals a number of common mechanisms. Current models which demonstrate endophenotypes of both schizophrenia and depression are reviewed here, including models of CUB and SUSHI multiple domains 1, PDZ and LIM domain 5, glutamate Delta 1 receptor, diabetic db/db mice, neuropeptide Y, disrupted in schizophrenia 1, and its interacting partners, reelin, maternal immune activation, and social isolation. Neurotransmission, brain connectivity, the immune system, the environment, and metabolism emerge as potential common mechanisms linking these models and potentially explaining comorbid depression in schizophrenia.
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Affiliation(s)
- James N Samsom
- Department of Molecular Neuroscience, Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute , Toronto, ON , Canada ; Department of Pharmacology, Faculty of Medicine, University of Toronto , Toronto, ON , Canada
| | - Albert H C Wong
- Department of Molecular Neuroscience, Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute , Toronto, ON , Canada ; Department of Pharmacology, Faculty of Medicine, University of Toronto , Toronto, ON , Canada ; Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, ON , Canada
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38
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Chiappelli J, Kochunov P, DeRiso K, Thangavelu K, Sampath H, Muellerklein F, Nugent KL, Postolache TT, Carpenter WT, Hong LE. Testing trait depression as a potential clinical domain in schizophrenia. Schizophr Res 2014; 159:243-8. [PMID: 25171855 PMCID: PMC4177287 DOI: 10.1016/j.schres.2014.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 11/16/2022]
Abstract
The DSM-5 includes depression as a dimension of psychosis. We tested whether persistent experience of depression, called 'trait depression', is a clinical feature separate from psychosis and several well-known, trait-like deficits of schizophrenia. 126 individuals with schizophrenia and 151 control participants completed the Maryland Trait and State Depression questionnaire, with a subset completing measures of cognition and functional capacity, and diffusion tensor imaging (n=73 patients and 102 controls for imaging analysis). Subjectively experienced, longitudinal trait depression is significantly higher in patients with schizophrenia compared with controls. Higher trait depression scores were associated with more severe psychosis. Surprisingly, individuals with higher trait depression manifested less cognitive and global functioning deficits. In addition, trait depression scores were positively associated with fractional anisotropy of white matter. Trait depression appears to be a highly relevant clinical domain in the care of patients with schizophrenia that also has distinct relationships with some other known traits of the disease. Trait depression may be an important contributor to the clinical heterogeneity of schizophrenia.
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Affiliation(s)
- Joshua Chiappelli
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine DeRiso
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kavita Thangavelu
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hemalatha Sampath
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Florian Muellerklein
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katie L. Nugent
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Teodor T. Postolache
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William T. Carpenter
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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Challis S, Nielssen O, Harris A, Large M. Systematic meta-analysis of the risk factors for deliberate self-harm before and after treatment for first-episode psychosis. Acta Psychiatr Scand 2013; 127:442-54. [PMID: 23298325 DOI: 10.1111/acps.12074] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 10/26/2012] [Accepted: 12/05/2012] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Attempted suicide and deliberate self-injury can occur before or after presentation with a first-episode of psychosis. The aim of the study is to identify the factors associated with suicide attempts or deliberate self-injury before and after treatment for first-episode psychosis. METHOD A systematic review and meta-analysis of controlled studies of factors associated with either suicide attempts or deliberate self-injury, referred to here as deliberate self-harm (DSH). RESULTS The pooled proportion of patients who reported DSH prior to treatment for first-episode psychosis was 18.4% (95% Confidence Interval (CI) 14.4-23.3, N = 18 studies, I(2) = 93.8). The pooled proportion of patients with DSH during the period of untreated psychosis was 9.8%, (95% CI 6.7-14.2, N = 5 studies, I(2) = 58.9). The pooled proportion of patients committing DSH during periods of follow up of between 1 and 7 years was 11.4%, (95% CI, 8.3-15.5, N = 13 studies, I(2) = 89.2). Categorical factors associated with an increased risk of DSH were a prior history of DSH (OR = 3.94), expressed suicide ideation (OR = 2.34), greater insight (OR = 1.64), alcohol abuse (OR = 1.68) and substance use (OR = 1.46). Continuous variables associated with an increased risk of DSH were younger age of onset (Standardized Mean Difference (SMD) = -0.28), younger age at first treatment (SMD = -0.18), depressed mood (SMD = 0.49) and the duration of untreated psychosis (SMD = 0.20). Depressed mood and substance use were associated with DSH both before and after treatment, negative symptoms were associated with DSH after treatment but not before treatment. Positive symptoms and social and global functioning were not associated with DSH. Younger age and the duration of untreated psychosis were associated with DSH before treatment but not after treatment. CONCLUSION Earlier treatment of first-episode psychosis and successful treatment of depression and substance use could prevent some episodes of DSH and might reduce suicide mortality in early psychosis.
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Affiliation(s)
- S Challis
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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40
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Dome P, Gonda X, Rihmer Z. Effects of smoking on health outcomes in bipolar disorder with a special focus on suicidal behavior. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tandon N, Shah J, Keshavan MS, Tandon R. Attenuated psychosis and the schizophrenia prodrome: current status of risk identification and psychosis prevention. NEUROPSYCHIATRY 2012; 2:345-353. [PMID: 23125875 PMCID: PMC3483069 DOI: 10.2217/npy.12.36] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recent efforts in the prevention of schizophrenia have focused on defining psychosis-risk syndromes and evaluating treatments that can prevent transition to psychosis in these ultra-high risk groups. In this review, different kinds of prevention approaches are enumerated and necessary conditions for a disease-prevention strategy are summarized. The broad overlap as well as the significant difference between a schizophrenia prodrome and a 'psychosis-risk syndrome' is discussed and the present status of approaches to identify individuals at increased risk for developing psychosis and schizophrenia are critically examined along with evaluations on therapeutic interventions to reduce these risks. Finally, to conclude, recommendations for current best clinical practice and key questions for the future are suggested.
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Affiliation(s)
- Neeraj Tandon
- Department of Psychiatry, Beth Israel Deaconess Medical Center & Massachusetts Mental Health Center, Harvard Medical School, 401 Park Drive, Room 2P12, The Landmark Center, Boston, MA 02215, USA
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Hutton P, Bowe S, Parker S, Ford S. Prevalence of suicide risk factors in people at ultra-high risk of developing psychosis: a service audit. Early Interv Psychiatry 2011; 5:375-80. [PMID: 22032551 DOI: 10.1111/j.1751-7893.2011.00302.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little data is available on the prevalence of suicide risk factors in people at ultra-high risk (UHR) of developing psychosis. AIM The aim of this study was to provide an estimate of the cross-sectional prevalence of possible suicide risk factors in those attending a routine clinical service for people at UHR of developing psychosis. METHODS For all patients in treatment (n=34) over a 4-week period, levels of suicidal ideation and depression upon entry to the service were assessed by auditing intake scores on the Beck Depression Inventory, second edition. Level of engagement with services, social isolation, substance and alcohol misuse, ready access to means, current suicidal ideation, previous suicide attempts, current or previous self-harm, expressions of concern from others, depression, agitation, hopelessness, worthlessness, suspiciousness and fears of mental disintegration were all assessed by case note review and interview with the treating clinician. RESULTS There was a high prevalence of at least mild suicidal ideation (58.8%, n=20) and severe depressed mood (47%, n=16) in this client group at point of entry to the service. Seven people (20.6%) had engaged in serious self-harm (including attempted suicide) during the time they were in contact with the service. Forty-seven per cent (n=16) reported at least 27 suicide attempts between them; the mean number of attempts being 1.69 (standard deviation=1.08). CONCLUSION Suicide risk was high in this small sample of people at UHR of developing psychosis. Controlled research with larger samples and better methodology is urgently required to inform legal, ethical and scientific debates surrounding this group.
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Affiliation(s)
- Paul Hutton
- Psychosis Research Unit (PRU) Early Detection and Intervention Team (EDIT), Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester, UK.
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