The Prevalence of Self-injurious Behavior in Patients With Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis

The Role of Verbal Auditory Hallucinations in Influencing and Retrospectively Predicting Physical Harm Prevalence in Early Psychosis

Background

Research has established a relationship between psychosis and physical harm in the early course of psychosis. However, little is known about the relationship between specific psychosis symptoms, such as hearing voices, and physical harm.

Objective

This study aimed to determine the prevalence and typology of physical harm related to hearing voices, as well as what aspects of the voice-hearing experience retrospectively predicted incidents of harm within an Early Intervention in Psychosis Service (EIPS).

Methods

We conducted a quality improvement project in a single EIPS. We reviewed case notes of patients and extracted information on the cognitive-phenomenological features of the voices patients heard, as well as any incidents of physical harm that were causally linked to these voices.

Results

It was found that 32.2% of EI patients had an actual incident of physical harm in their case notes that was causally linked to hearing voices. The most common type of physical harm was neglect. In terms of cognitive phenomenological binary correlations that retrospectively predicted physical harm in the case notes, patients were 20 and 7 times more likely to have harmed themselves if they heard self-harm commands (i.e., directions to harm themselves physically) and perceived the voice as omnipotent, respectively. Patients were 6 times more likely to have harmed someone else if they heard violent commands.

Conclusion

Verbal auditory hallucinations commonly influence physical harm in the early course of psychosis. Hearing commands and/or believing the voice to be omnipotent are strong retrospective-correlative predictors that may aid in the assessment and therapeutic intervention.

Association between adverse childhood experiences and suicidal behavior in schizophrenia spectrum disorders: A systematic review and meta-analysis

Assessing and managing suicide behaviors is highly relevant to individuals with schizophrenia spectrum disorders. Our study aims to assess the association between adverse childhood experiences and suicidal behaviors in individuals with schizophrenia spectrum disorders. We included observational studies comparing the probability of suicide behaviors in adults with schizophrenia spectrum disorders exposed and unexposed to adverse childhood experiences. Odds ratio estimates were obtained by pooling data using a random-effects pairwise meta-analysis. Standardized criteria were used to assess the strength of the association of the pooled estimate. We found 21 eligible studies reporting outcomes for 6257 individuals from 11 countries. The primary outcome revealed an association between any suicidal behavior and adverse childhood experiences, which resulted "highly suggestive" according to validated Umbrella Criteria. Similarly, a positive association was confirmed for suicidal ideation and suicide attempt and for any subtype of adverse childhood experience. This meta-analysis showed that exposure to adverse childhood experiences strongly increases the probability of suicide behaviors in people with schizophrenia spectrum disorders.