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Rogers E, Gresswell M, Durrant S. The relationship between sleep and suicidality in schizophrenia spectrum and other psychotic disorders: A systematic review. Schizophr Res 2023; 261:291-303. [PMID: 37879227 DOI: 10.1016/j.schres.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 09/06/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023]
Abstract
Individuals with Schizophrenia Spectrum Disorders (SSDs) have significantly higher rates of suicidal thoughts, attempts, and death by suicide in comparison to the general population. Sleep disturbances (reduced duration, timing and quality of sleep) are risk factors for suicidality in the general population, with research indicating the relationship is both immediate and accumulative. Sleep disturbances are also considered to be implicated in the onset and exacerbation of psychotic symptoms in SSDs. Reducing the risk of suicidality in SSDs remains an important public health priority, thus exploration of contributing risk factors is warranted. Sleep monitoring may also offer an adjunct risk monitoring method to suicidality assessments in SSDs, and a potential treatment target for psychotic symptoms. This review aimed to explore proximal and longitudinal relationships between self-reported and objectively measured sleep and suicidality in SSDs and other psychotic disorders. A comprehensive search of four databases was conducted. Eleven studies met the inclusion criteria (10 cross sectional and 1 longitudinal). Narrative synthesis indicated that self-reported sleep disturbances and sleep disorders (e.g. insomnia) were associated with increased risk of suicidal ideation and attempt. However, one study employing polysomnography did not find sleep to be associated with suicidality. Methodological limitations of the evidence base include: i) little experimental or longitudinal evidence, (ii) self-report and/or single item assessment of sleep disturbance, (iii) limited use of validated measures of suicidality, (iv) considerable research in long-term schizophrenia but sparse evidence in early psychosis. Future research should explore (i) cross-sectional and longitudinal relationships between specific aspects of suicidality and objective sleep parameters, (ii) use qualitative or mixed-methods designs to disentangle the nuances and bidirectionality in the sleep-suicide relationship, (iii) explore the psychological processes underpinning or mediating the sleep-suicide relationship in SSDs.
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Affiliation(s)
- Eva Rogers
- Xu Yafen Building, Jubilee Campus, University of Nottingham, NG8 1BB, United Kingdom; Nottinghamshire Healthcare NHS Foundation Trust, Duncan Macmillan House, Porchester Road, Nottingham, NG3 6AA, United Kingdom.
| | - Mark Gresswell
- Department of Clinical Psychology, Sarah Swift Building Brayford Wharf East, University of Lincoln, United Kingdom
| | - Simon Durrant
- School of Psychology, Sarah Swift Building Brayford Wharf East, University of Lincoln, United Kingdom
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Ghanem J, Orri M, Moro L, Lavigne KM, Raucher-Chéné D, Malla A, Joober R, Lepage M. Exploring the Relationship Between Suicidality and Persistent Negative Symptoms Following a First Episode of Psychosis. Schizophr Bull 2023:sbad146. [PMID: 37847817 DOI: 10.1093/schbul/sbad146] [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] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND HYPOTHESIS Suicide is a leading cause of death in first-episode psychosis (FEP), with an elevated risk during the first year following illness onset. The association between negative symptoms and suicidality remains contentious. Some studies suggest that negative symptoms may be associated with lower suicidality, while others fail to find an association between the two. No previous studies have specifically investigated suicidality in Persistent Negative Symptoms (PNS) and its associated subgroups. STUDY DESIGN In a large cohort of FEP patients (n = 515) from an early intervention service, we investigated suicidality in those with PNS, secondary PNS (ie, sPNS; PNS with clinical-level positive, depressive, or extrapyramidal symptoms), and non-PNS (all other patients) over 24 months. Patients were categorized into PNS groups based on symptoms from month 6 to month 12, and suicidality was evaluated using the Brief Psychiatric Rating Scale (BPRS). STUDY RESULTS Covarying for age and sex, we found that sPNS had higher suicidality relative to PNS and non-PNS throughout the 24-month period, but PNS and non-PNS did not differ. These differences were maintained after adjusting for depressive symptoms. CONCLUSION We observed that PNS did not significantly differ from non-PNS. However, we identified sPNS as a group with elevated suicidality above and beyond depression, suggesting that sPNS would benefit from targeted intervention and that PNS categorization identifies a subgroup for whom negative symptoms are not associated with lower suicidality.
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Affiliation(s)
- Joseph Ghanem
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Massimiliano Orri
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Laura Moro
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychology, Université de Montreal, Montreal, Canada
| | - Katie M Lavigne
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Delphine Raucher-Chéné
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Ashok Malla
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada
| | - Ridha Joober
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada
| | - Martin Lepage
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada
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Harvey C, Zirnsak TM, Brasier C, Ennals P, Fletcher J, Hamilton B, Killaspy H, McKenzie P, Kennedy H, Brophy L. Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis. Front Psychiatry 2023; 14:1259944. [PMID: 37779607 PMCID: PMC10539575 DOI: 10.3389/fpsyt.2023.1259944] [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: 07/17/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study aims to assess the effectiveness of community-based models of care (MoCs) supporting the recovery of individuals who experience persistent and complex mental health needs. Method We conducted a systematic review and narrative synthesis of MoC studies reporting clinical, functional, or personal recovery from October 2016 to October 2021. Sources were Medline, EMBASE, PsycInfo, CINAHL, and Cochrane databases. Studies were grouped according to MoC features. The narrative synthesis was led by our researchers with lived experience. Results Beneficial MoCs ranged from well-established to novel and updated models and those explicitly addressing recovery goals and incorporating peer support: goal-focused; integrated community treatment; intensive case management; partners in recovery care coordination; rehabilitation and recovery-focused; social and community connection-focused; supported accommodation; and vocational support. None of our diverse group of MoCs supporting recovery warranted a rating of best practice. Established MoCs, such as intensive case management, are promising practices regarding clinical and functional recovery, with potential for enhancements to support personal recovery. Emerging practice models that support personal and functional recovery are those where consumer goals and priorities are central. Conclusion Evidence for established models of care shows that there is a need for inevitable evolution and adaptation. Considering the high importance of effective MoCs for people experiencing persistent and complex mental health needs, further attention to service innovation and research is required. Greater emphasis on the inclusion of lived and living experience in the design, delivery, implementation, and research of MoCs is needed, to enhance MOCs' relevance for achieving individual consumer recovery outcomes.
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Affiliation(s)
- Carol Harvey
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- North West Area Mental Health, Division of Mental Health, Northern Health, Melbourne, VIC, Australia
| | - Tessa-May Zirnsak
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| | - Catherine Brasier
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| | | | - Justine Fletcher
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bridget Hamilton
- Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Helen Killaspy
- Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Peter McKenzie
- The Bouverie Centre, School of Psychology and Public Health, La Trobe University, Brunswick, VIC, Australia
| | - Hamilton Kennedy
- Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Lisa Brophy
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
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Mustafa SS, Malla A, Joober R, Abadi S, Latimer E, Schmitz N, Jarvis GE, Margolese HC, Casacalenda N, Abdel-Baki A, Iyer SN. Unfinished business: Functional outcomes in a randomized controlled trial of a three-year extension of early intervention versus regular care following two years of early intervention for psychosis. Acta Psychiatr Scand 2022; 145:86-99. [PMID: 34599603 DOI: 10.1111/acps.13377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/25/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether first-episode psychosis patients receiving extended early intervention had better functional outcomes than those in regular care and to examine the predictors of functional outcomes. METHODS This is a randomized controlled single-blind trial of 220 patients randomized after 2 years of early intervention to receive early intervention or regular care for the subsequent 3 years. Outcomes included cumulative time in functional recovery during the 3-year trial assessed using the Social and Occupational Functioning Assessment Scale (SOFAS); and employment/education at last assessment which were, respectively, analyzed using multiple linear regression and logistic regression, accounting for well-known predictors. Linear mixed and generalized linear models were also used to examine the course of SOFAS and employment/education over the 3-year period. RESULTS The extended early intervention and regular care groups did not differ on time in functional recovery (mean = 50.17 weeks, SD = 46.62 vs. mean = 46.18 weeks, SD = 51.54); percent employed/in school (60.4% vs. 68.8%) or change in SOFAS or employment/education status over time. SOFAS scores were stable between years 2 and 5. Individuals with longer periods of total symptom remission experienced significantly longer periods of functional recovery and were likelier to be employed/in school. Those who had completed high school were nine times likelier to be employed/studying. CONCLUSION Most individuals maintained functional gains accrued from 2 years of early intervention with no further improvement whether in extended early intervention or regular care. There was a gap between symptomatic and functional recovery, and one-third were unemployed/not in school at year 5. The lack of additional progress even in extended early intervention suggests that specific interventions addressing functional roles need to be provided beyond the first 2 years of early intervention. Sustaining symptom remission and high-school completion may be additional avenues for targeting functional recovery.
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Affiliation(s)
- Sally S Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sherezad Abadi
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Eric Latimer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Population-Based Medicine, Institute of Health Sciences, University Hospital Tuebingen, Tuebingen, Germany
| | - G Eric Jarvis
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Jewish General Hospital, Montreal, QC, Canada
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,McGill University Health Centre, Montreal, QC, Canada
| | - Nicola Casacalenda
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Jewish General Hospital, Montreal, QC, Canada
| | | | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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A systematic review of longitudinal studies of suicidal thoughts and behaviors in first-episode psychosis: course and associated factors. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2117-2154. [PMID: 34432071 DOI: 10.1007/s00127-021-02153-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSES To better assess and reduce suicidal risk in first-episode psychosis (FEP), we aimed to investigate the evolution of suicidal thoughts and behaviors (STBs) and associated factors in FEP. METHOD This systematic review (PROSPERO-CRD42020168050) meets PRISMA guidelines. PubMed, Medline, PsycINFO, Embase, EBM Reviews and references lists of relevant articles were searched (February 2020) to identify longitudinal studies, published in English or in French, that assessed the prevalence of STBs at entry to services and over follow-up, and examined factors associated with STBs among all persons with affective and non-affective FEP from a defined catchment area. Screening, data extraction and quality assessment using the adapted Newcastle Ottawa Scale were done independently by two reviewers. Results on prevalence and associated factors are presented by type of STB. RESULTS Of 3,177 references, 17 studies of 11 non-overlapping samples (n = 14,907) with varying lengths of follow-up (1-41.7 years) were included. The prevalence of STBs decreased over follow-up. Up to 21.6% made at least one suicide attempt, 27% had suicidal ideation, and 1-4.3% died by suicide during follow-up. Of 53 factors assessed across studies, only male sex, depressive symptoms, and STBs occurring early during follow-up were associated with subsequent STBs. Early intervention for psychosis decreased STBs in the first three years. Other factors were assessed in a single study, yielded conflicting results, or were not associated with STBs. CONCLUSIONS The high prevalence of STBs following onset of psychosis highlights the need for early detection and intervention and ongoing assessment of suicidal risk throughout follow-up, with attention to identified risk factors. The heterogeneity of the studies precluded a meta-analysis and several factors were each assessed by a single study. Additional well-designed longitudinal studies of STBs and associated factors are warranted.
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Pelizza L, Maestri D, Leuci E, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Individual psychotherapy can reduce suicidal ideation in first episode psychosis: Further findings from the 2-year follow-up of the 'Parma Early Psychosis' programme. Clin Psychol Psychother 2021; 29:982-989. [PMID: 34704336 DOI: 10.1002/cpp.2678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Suicidal thinking is relevant in patients with First Episode Psychosis (FEP). However, longitudinal studies specifically examining treatment response for suicidal ideation in FEP are still relatively scarce, especially with long-term design and in real-world clinical settings. The aims of this research were (A) to longitudinally assess suicidal thoughts in people with FEP along a 2-year follow-up period and (B) to overtime investigate any significant association of suicidal ideation levels with the specific treatment components of an 'Early Intervention in Psychosis' (EIP) protocol along the 2 years of follow-up. METHODS At entry, 232 FEP participants (aged 12-35 years) completed the Brief Psychiatric Rating Scale (BPRS), including a 'Suicidality' item subscore. Multiple linear regression analysis was then performed. RESULTS Across the follow-up, FEP subjects showed a relevant decrease in suicidal thinking levels overtime. This was specifically predicted by the total number of individual psychotherapy sessions offered within the 2-year EIP protocol and antidepressant dose (at least as regards the first year of our intervention). CONCLUSION Suicidal ideation is clinically relevant in FEP but seems to improve overtime together with the provision of specific, patient-tailored and integrated EIP treatments, especially individual psychotherapy.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
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