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Phalen P, Kimhy D, Jobes D, Bennett M. Emotional distress and dysregulation as treatment targets to reduce suicide in psychosis: a scoping review. Eur Arch Psychiatry Clin Neurosci 2024; 274:955-961. [PMID: 37597022 DOI: 10.1007/s00406-023-01675-x] [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: 05/09/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
There is a pressing need for effective treatments that address the high rate of suicide observed among people with psychosis. In this scoping review we highlight two suicidogenic treatment targets that have been relatively neglected in people with psychotic disorders: emotional distress and emotion dysregulation. We review the research on these constructs in psychosis and their relationship to suicide in this population, and then make clinical recommendations based on research findings. Emotional distress and emotional dysregulation may be promising treatment targets for suicide among people with psychosis.
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Affiliation(s)
- Peter Phalen
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA.
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine, New York, NY, USA
- Education and Clinical Center, James J. Peters VA Medical Center, Mental Illness Research, New York, NY, USA
| | - David Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
| | - Melanie Bennett
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, Baltimore, MD, USA
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Hazell CM, Hasapopoulos S, McGowan J, Hamza R, Ahmed Z, Gaughan B, Malillos MH, Gill A, Nomani A, Hickson E, Koruni A, Islam F, Souray J, Raune D. The Role of Verbal Auditory Hallucinations in Influencing and Retrospectively Predicting Physical Harm Prevalence in Early Psychosis. Clin Pract Epidemiol Ment Health 2024; 20:e17450179286452. [PMID: 39130189 PMCID: PMC11311800 DOI: 10.2174/0117450179286452240520070533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 08/13/2024]
Abstract
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.
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Affiliation(s)
- Cassie M. Hazell
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, GU2 7XH, UK
| | - Sophia Hasapopoulos
- Division of Psychology and Language Sciences, University College London, London, UK
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Jennifer McGowan
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Roman Hamza
- Division of Psychology and Language Sciences, University College London, London, UK
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Zareena Ahmed
- Division of Psychology and Language Sciences, University College London, London, UK
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Ben Gaughan
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | | | - Amber Gill
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Amber Nomani
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Emily Hickson
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Anjeza Koruni
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Faaisa Islam
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Jonathan Souray
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - David Raune
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
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Gill G, Jaka S, Yadav G, Kainth T, Segal Y, Srinivas S, Shah K, Kochhar H, Gunturu S. Examining Risk Factors for Suicidality in Adolescents and Adults Experiencing Their First Episode of Psychosis. Cureus 2023; 15:e43135. [PMID: 37622053 PMCID: PMC10445773 DOI: 10.7759/cureus.43135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
This narrative review aimed to identify the risk factors associated with suicidality in adolescents and adults with first-episode psychosis. The review included studies that examined various factors such as psychiatric, familial, and social factors, as well as previous self-harm, suicidal ideation, and comorbid mental health disorders. A comprehensive literature search was conducted across three publicly available databases (Embase, American Psychological Association PsycINFO, and PubMed) using specific search terms related to first-episode psychosis, suicide, self-harm, and children/adolescents and adults. The inclusion criteria included original articles focusing on prospective and retrospective cohort trials, with substantial data on first-episode psychosis and self-harm, measuring both suicidal intent and outcome. Non-original studies, case reports, case series, non-English-language publications, and studies examining violence and self-harm related to substance-induced psychosis were excluded. After manual screening and removing duplicate articles, 13 articles met the established criteria for inclusion in this review. Included studies adhered to similar inclusion and exclusion criteria, had long-term follow-up, and assessed outcomes at least twice. The findings suggest that depressive symptoms, substance use disorders, previous self-harm or suicidal ideation, and longer duration of untreated psychosis are associated with an increased risk of suicidality. However, insights into psychosis and premorbid intellectual functioning did not show a direct association with suicidality.
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Affiliation(s)
- Gurtej Gill
- Psychiatry, BronxCare Health System, Bronx, USA
| | - Sanobar Jaka
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Garima Yadav
- Research, Basaveshwara Medical College and Hospital, Chitradurga, IND
| | - Tejasvi Kainth
- Language Access and Internal Medicine, Winnipeg Regional Health Authority, Winnipeg, CAN
| | | | - Sushma Srinivas
- Psychiatry, A.J. Institute of Medical Sciences and Research Centre, Mangalore, IND
| | - Kaushal Shah
- Psychiatry, Griffin Memorial Hospital, Norman, USA
| | - Hansini Kochhar
- Clinical and Translational Research, Larkin Community Hospital, Miami, USA
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Ahuja V, Nair L, Das S, Sandhu S. Psychological stress among anesthesia residents during COVID-19 pandemic and how to mitigate them. J Anaesthesiol Clin Pharmacol 2022; 38:S3-S7. [PMID: 36060160 PMCID: PMC9438815 DOI: 10.4103/joacp.joacp_104_21] [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: 02/27/2021] [Revised: 04/05/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
The impact of the novel coronavirus disease 19 (COVID-19) has overburdened the anesthesia fraternity both physically and mentally. The academic and training schedule of the medical residents in the last year was also disrupted. Since we are in the early phase of the second peak of the COVID-19 pandemic, it is time to reconsider the causes of stress in anesthesia residents and methods to mitigate them. In this non-systematic review, authors have included articles from PubMed, Medline, and Google scholar with keywords “identify strategies” “preventing and treating psychological disorders,” and “medical students” from year 2010 onwards were included. Apart from these keywords, we have included the coping strategies and early psychiatric consultation methods. This review article aims at early identification, workplace environment changes, and implementation of early coping strategies in anesthesia residents during this second peak of COVID-19.
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Davis S, Patil J, Aziz S, Chaudhury S, Saldanha D. Suicidal behavior in schizophrenia: A case series. Ind Psychiatry J 2021; 30:S230-S234. [PMID: 34908696 PMCID: PMC8611567 DOI: 10.4103/0972-6748.328868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/09/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
Suicide/parasuicide is seen at a greater rate in schizophrenia than in the general population, yet the psychological basis of this risk is poorly understood. It is estimated that 10% of patients suffering from schizophrenia attempt suicide. The major risk factors implicated are male gender, chronic illness with multiple relapses, family history of suicide, past suicidal and impulsive behavior, negative attitude toward treatment, and concurrent substance use. Treatment must target the identified risk factors for prevention of suicide in these patients. Here, we discuss three cases with self-inflicted cuts over the anterior aspect of the neck and wrists. They were diagnosed to have paranoid schizophrenia and were treated with antipsychotics, on which they showed improvement.
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Affiliation(s)
- Supriya Davis
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Jaideep Patil
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Sadaf Aziz
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
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Barbeito S, Vega P, Sánchez-Gutiérrez T, Becerra JA, González-Pinto A, Calvo A. A systematic review of suicide and suicide attempts in adolescents with psychotic disorders. Schizophr Res 2021; 235:80-90. [PMID: 34332428 DOI: 10.1016/j.schres.2021.07.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Suicide is the main cause of premature death in patients with psychosis. Therefore, the goal of the present study was to review suicide in adolescents with psychotic disorders by evaluating factors associated with suicidal acts. Ours is the first systematic review of suicide in this population. METHOD We performed a systematic review of suicide in adolescents (10 to 19 years) with psychotic disorder. RESULTS We identified 10 studies, only 2 of which were randomized clinical trials. The results revealed high rates of suicidal behaviour in this population: the times of higher risk were the time before admission and the period immediately following discharge. The factors most associated with suicide attempts were depression, distress with psychotic symptoms, fewer negative symptoms at baseline, positive symptoms, and anxiety disorders. Associated factors included previous psychiatric history or psychiatric admissions, female sex, prior suicidal behaviour, family history of completed suicide, and nicotine dependence. LIMITATIONS Clinical and methodological diversity of the studies. CONCLUSIONS Adolescents with psychotic disorders had a major risk of suicidal behaviour, and specific factors were associated with the act. Early detection of adolescents with psychosis is vital, since it has been found that early intervention can prevent suicidal acts in young people. However, it is necessary to perform more studies, particularly randomized controlled trials, on suicide and suicide attempts, particularly in adolescents.
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Affiliation(s)
- Sara Barbeito
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM) (G10), Vitoria, Spain.
| | - Patricia Vega
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain; Bask Country University, Leioa, Bizkaia, Spain; University Hospital of Álava, BIOARABA, Spain.
| | | | - Juan Antonio Becerra
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain.
| | - Ana González-Pinto
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM) (G10), Vitoria, Spain; Bask Country University, Leioa, Bizkaia, Spain; University Hospital of Álava, BIOARABA, Spain
| | - Ana Calvo
- Faculty of Health Sciences, Universidad Internacional de la Rioja (UNIR), Spain.
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Shoja Shafti S, Memarie A, Rezaie M, Hamidi M. Suicides and Suicide Attempts Among Psychiatric Hospital Inpatients in Iran. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/2666082215666190917163630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background:
Suicidal behavior is seen in the context of a variety of mental disorders.
While many believe that, in general, first-episode psychosis is a particularly high-risk period for
suicide, no general agreement regarding higher prevalence of suicide in first-episode psychosis is
achievable.
Objective:
In the present study, suicides and suicide attempts among psychiatric in-patients have
been evaluated to assess the general profile of suicidal behavior among native psychiatric inpatients
and any relationship between serum cholesterol level and suicidal behavior.
Methods:
Five acute academic wards, which have been specified for admission of first episode adult
psychiatric patients, and five acute non-academic wards, which have been specified for admission of
recurrent episode adult psychiatric patients, were selected for the current study. All inpatients with
suicidal behavior (successful suicide and attempted suicide, in total), during the last five years
(2013-2018), were included in the present investigation. Also, the assessment of serum lipids, including
triglyceride, cholesterol, low-density lipoprotein and high-density lipoprotein, was done ,
for comparing the suicidal subjects with non-suicidal ones.
Results:
Among 19160 psychiatric patients hospitalized in Razi psychiatric hospital during a sixtymonths
period, 63 suicidal behaviors, including one successful suicide and sixty-two suicide attempts,
were recorded by the safety board of hospital. The most frequent mental illness was bipolar
I disorder, which was significantly more prevalent in comparison with other mental disorders
(p<0.04, p<0.02, p<0.007, and p<0.003 in comparison with schizophrenia, depression, personality
disorders and substance abuse, respectively). Self-mutilation, self-poisoning and hanging were the
preferred methods of suicide among 61.11%, 19.44% and 19.44% of cases, respectively. In addition,
no significant difference was evident between the first admission and recurrent admission inpatients,
totally and separately, particularly with respect to psychotic disorders. Besides, with respect to different
components of serum lipids, no specific or significant pattern was evident.
Conclusion:
While in the present study, the suicidal behavior was significantly more evident in
bipolar disorder in comparison with other psychotic or no-psychotic disorders, no significant difference
was evident between the first admission and recurrent admission of psychiatric inpatients.
Moreover, no significant relationship between suicidal behavior and serum lipids was found .
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Affiliation(s)
- Saeed Shoja Shafti
- University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Postal Code: 18669- 58891, P.O. Box: 18735-569, Tehran, Iran
| | - Alireza Memarie
- University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Postal Code: 18669- 58891, P.O. Box: 18735-569, Tehran, Iran
| | - Masomeh Rezaie
- University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Postal Code: 18669- 58891, P.O. Box: 18735-569, Tehran, Iran
| | - Masomeh Hamidi
- University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Postal Code: 18669- 58891, P.O. Box: 18735-569, Tehran, Iran
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Personality traits, theory of mind and their relationship with multiple suicide attempts in a sample of first episode psychosis patients: One-year follow-up study. J Affect Disord 2019; 256:176-182. [PMID: 31177045 DOI: 10.1016/j.jad.2019.05.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/12/2019] [Accepted: 05/31/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND High rates of suicidal behaviour (SB) have been found in first episode psychosis (FEP) patients. It has been suggested that the presence of multiple suicide attempts (mSA) increases the risk of later SA and the risk of eventual death by suicide. OBJECTIVE Our main objective was to study the baseline factors associated with the presence of mSA during the first year after FEP. In addition, a second aim was to find out whether there were any differences between single and multiple suicide attempters in the timing of the first SA after FEP. METHOD A total of 65 FEP patients were evaluated. The presence of SAs were recorded at two different times after FEP. Bivariate and multivariate analyses were performed to explore the relationship between SA with sociodemographic and clinical variables. RESULTS Multiple linear regression showed that mSA was associated with the presence of increased symptom severity (B = 0.35; t = 3.67; p < 0.01) and errors in first-order false-belief task (B = 0.48; t = 2.11; p = 0.04). There were significant differences in the timing of first SA after FEP between multiple and single suicide attempters. CONCLUSIONS Theory of mind impairments along with more severe symptoms during the first contact with mental health services for psychotic symptoms appeared to be important predictors of mSA. On the other hand, multiple suicide attempters tend to make a first SA after FEP earlier than single suicide attempters. These results could contribute to the implementation of preventive suicidal programs, however they must be confirmed by additional research.
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Austin AE, van den Heuvel C, Byard RW. Differences in local and national database recordings of deaths from suicide. Forensic Sci Med Pathol 2017; 13:403-408. [DOI: 10.1007/s12024-017-9853-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
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Kim J, Lee KS, Kim DJ, Hong SC, Choi KH, Oh Y, Wang SM, Lee HK, Kweon YS, Lee CT, Lee KU. Characteristic Risk Factors Associated with Planned versus Impulsive Suicide Attempters. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2015; 13:308-15. [PMID: 26598591 PMCID: PMC4662162 DOI: 10.9758/cpn.2015.13.3.308] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The present study aimed to investigate predictors for planned suicide attempters. METHODS This study included 1,003 patients who attempted suicide and visited emergency department. They were divided into two groups, planned suicide attempters (SAs; n=133 [13.3%]) and impulsive SAs (n=870, [86.7%]), and the demographic variables, clinical characteristics, factors related to suicide, and psychiatric resources of the groups were compared. RESULTS Major depressive disorder and substance use disorders were more common among planned SAs than among impulsive SAs. Additionally, the planned SAs were older, more likely to be divorced, separated or widowed, and more likely to have comorbid medical illnesses, severe depression, higher suicidality, and self-blaming tendencies than the impulsive SAs. Financial problems and physical illnesses were more common in planned SAs but interpersonal conflicts were more frequent in impulsive SAs. Planned SAs had fewer previous suicide attempts but these were more serious suicide attempts. The presence of the hope to die, a written will, and suicidal ideation of a repetitive, intense, and continuous nature were predictive of planned SAs. CONCLUSION The present findings demonstrated that planned SAs had more severe psychopathology and medical illnesses than impulsive SAs. Therefore, screening for depression, substance use disorders, and suicidal plans among old and medically ill patients may be important for preventing suicide attempts.
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Affiliation(s)
- Jaeha Kim
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Sook Lee
- Department of Preventive Medicine, Catholic Industrial Medical Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dai Jin Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Chul Hong
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Ho Choi
- Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngmin Oh
- Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sheng-Min Wang
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae-Kook Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Sil Kweon
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chung Tai Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung-Uk Lee
- Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Heelis R, Graham H, Jackson C. A Preliminary Test of the Interpersonal Psychological Theory of Suicidal Behavior in Young People With a First Episode of Psychosis. J Clin Psychol 2015; 72:79-87. [DOI: 10.1002/jclp.22233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chang WC, Chen ESM, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prevalence and risk factors for suicidal behavior in young people presenting with first-episode psychosis in Hong Kong: a 3-year follow-up study. Soc Psychiatry Psychiatr Epidemiol 2015; 50:219-26. [PMID: 25116203 DOI: 10.1007/s00127-014-0946-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Individuals with first-episode psychosis (FEP) have markedly elevated risk for suicide. Previous research investigating risk factors of suicidal behavior in FEP mainly focused on western populations. This study aimed to examine the prevalence, and pretreatment and early illness predictors of suicidal behavior in Chinese FEP patients. METHOD Seven hundred participants aged 15-25 years consecutively enrolled in a territory-wide treatment program for FEP in Hong Kong from July 2001 to August 2003 were studied. Baseline and 3-year follow-up variables were collected via systematic medical file review. Suicidal behavior evaluated in this study comprised suicide attempt and completed suicide. RESULTS Seventy-four (10.6%) participants attempted suicide before treatment. Ten percent (n = 70) exhibited suicidal behavior and 1% (n = 7) committed suicide during 3-year follow-up. The majority of post-treatment suicidal behaviors (51.4%) occurred in the first year of follow-up. Jumping from a height was the most common method of committing suicide. Multivariate regression analysis indicated that previous suicide attempt, history of substance abuse and poorer baseline functioning were significantly associated with an increased risk for suicidal behavior after treatment initiation. CONCLUSION In a large representative cohort of Chinese young FEP patients, the rates of suicidal behavior before and after treatment and risk factors for post-treatment suicidal behavior were comparable to the findings of previous research on early psychosis conducted in western populations. Close monitoring of high-risk patients with history of attempted suicide or substance abuse, and enhancement of psychosocial functioning may help reduce suicide risk in the early stage of psychotic illness.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong,
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Rimkeviciene J, O'Gorman J, De Leo D. Impulsive suicide attempts: a systematic literature review of definitions, characteristics and risk factors. J Affect Disord 2015; 171:93-104. [PMID: 25299440 DOI: 10.1016/j.jad.2014.08.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extensive research on impulsive suicide attempts, but lack of agreement on the use of this term indicates the need for a systematic literature review of the area. The aim of this review was to examine definitions and likely correlates of impulsive attempts. METHODS A search of Medline, Psychinfo, Scopus, Proquest and Web of Knowledge databases was conducted. Additional articles were identified using the cross-referencing function of Google Scholar. RESULTS 179 relevant papers were identified. Four different groups of research criteria used to assess suicide attempt impulsivity emerged: (a) time-related criteria, (b) absence of proximal planning/preparations, (c) presence of suicide plan in lifetime/previous year, and (d) other. Subsequent analysis used these criteria to compare results from different studies on 20 most researched hypotheses. Conclusions regarding the characteristics of impulsive attempts are more consistent than those on the risk factors specific to such attempts. No risk factors were identified that uniformly related to suicide attempt impulsivity across all criteria groups, but relationships emerged between separate criteria and specific characteristics of suicide attempters. LIMITATIONS Only published articles were included. Large inconsistencies in methods of the studies included in this review prevented comparison of effect sizes. CONCLUSIONS The vast disparities in findings on risk factors for impulsive suicide attempts among different criteria groups suggest the need to address the methodological issues in defining suicide attempt impulsivity before further research into correlates of such attempts can effectively progress. Specific recommendations are offered for necessary research.
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Affiliation(s)
- Jurgita Rimkeviciene
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia.
| | - John O'Gorman
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia; Griffith Health Institute, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia
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Kaleda VG. [Youth-onset schizophrenia: psychopathology, clinical presentation and therapy]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:26-33. [PMID: 26978249 DOI: 10.17116/jnevro201511511226-33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper reviews the clinical presentations and pathogenetic features of youth-onset schizophrenia with onset at the age of 16-25 years old. The clinical presentation of the disease in young people is different in comparison to adult patients. Psychopathological and biological characteristics of the first episode, the course of «progressive» schizophrenia and «malignant youth schizophrenia» in the pubertal period are described. Early diagnosis and prevention of disease manifestation are discussed. Recommendations on therapeutic measures at different stages of the endogenous process in this age are presented. The most important future goals of research in this field are formulated.
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Fedyszyn IE, Robinson J, Harris MG, Paxton SJ, Francey S, Edwards J. Suicidal behaviours during treatment for first-episode psychosis: towards a comprehensive approach to service-based prevention. Early Interv Psychiatry 2014; 8:387-95. [PMID: 23964750 DOI: 10.1111/eip.12084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 07/15/2013] [Indexed: 11/30/2022]
Abstract
AIM Suicidal behaviours (suicide attempts and suicides) are common among individuals experiencing, or having recently experienced, a first-episode psychosis (FEP). Current interventions for suicidal behaviours are crisis driven and focused on hospital admission of patients at imminent risk of ending their lives. This paper aims to describe ideas for universal, selective and indicated strategies that may complement existing practices to suicide risk management in first-episode patients. METHODS Key findings from the Suicidal Behaviours in FEP Project were used to develop suggested interventions. The project examined the temporal course of suicide risk, common characteristics of suicidal behaviours and predictors of suicidal behaviours in 699 patients with FEP. RESULTS Key findings included: (i) 12% of FEP cohort engaged in suicidal behaviours during treatment (up to 3 years); (ii) first month of treatment conferred the highest suicide risk; (iii) 64% of suicidal behaviours were overdoses, usually on antipsychotics; (iv) 20% of suicidal behaviours occurred on psychiatric units and all involved hanging/strangulation; (v) most suicidal behaviours were impulsive, precipitated by psychosocial stressors and with serious intent; and (vi) proximal non-suicidal self-injurious behaviour and proximal negative life events were the strongest predictors. CONCLUSION Comprehensive approach by mental health services to prevention of suicidal behaviours among first-episode patients could be facilitated by: delineating safe quantities of prescribed medications available to outpatients; regular audits of fixtures on inpatient units; enhancing risk recognition by family members; routinely monitoring suicide risk levels; developing crisis cards with all new FEP patients to facilitate help seeking during distress; and skills training programs targeting distress tolerance, interpersonal effectiveness and problem-solving.
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Affiliation(s)
- Izabela E Fedyszyn
- School of Psychological Science, La Trobe University, Melbourne, Queensland, Australia
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Mork E, Walby FA, Harkavy-Friedman JM, Barrett EA, Steen NE, Lorentzen S, Andreassen OA, Melle I, Mehlum L. Clinical characteristics in schizophrenia patients with or without suicide attempts and non-suicidal self-harm--a cross-sectional study. BMC Psychiatry 2013; 13:255. [PMID: 24106884 PMCID: PMC3852098 DOI: 10.1186/1471-244x-13-255] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/03/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To investigate whether schizophrenia patients with both suicide attempts and non-suicidal self-harm have earlier age of onset of psychotic and depressive symptoms and higher levels of clinical symptoms compared to patients with only suicide attempts or without suicide attempt. METHODS Using a cross-sectional design, 251 patients (18-61 years old, 58% men) with schizophrenia treated at hospitals in Oslo and Innlandet Hospital Trust, Norway, were assessed with a comprehensive clinical research protocol and divided into three groups based on their history of suicide attempts and non-suicidal self-harm. RESULTS Suicide attempts were present in 88 patients (35%); 52 had suicide attempts only (29%) and 36 had both suicide attempts and non-suicidal self-harm (14%). When compared with nonattempters and those with suicide attempts without non-suicidal self-harm, patients with both suicide attempts and non-suicidal self-harm were more frequently women, younger at the onset of psychotic symptoms, had longer duration of untreated psychosis, and had higher levels of current impulsivity/aggression and depression. Patients with both suicide attempts and non-suicidal self-harm were more likely to repeat suicide attempts than patients with suicide attempts only. CONCLUSIONS Patients with both suicide attempts and non-suicidal self-harm had different illness history and clinical characteristics compared to patients with only suicide attempts or patients without suicidal behavior. Our study suggests that patients with both suicide attempts and non-suicidal self-harm represent a distinct subgroup among patients with schizophrenia and suicidal behavior with their early onset of psychotic symptoms, high rate of repeated suicidal behavior and significant treatment delay.
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Affiliation(s)
- Erlend Mork
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, 0372 Oslo, Norway.
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, 0372 Oslo, Norway,Department of Psychiatry, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | | | - Elizabeth A Barrett
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway
| | - Nils E Steen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Steinar Lorentzen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ole A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, 0372 Oslo, Norway
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Fedyszyn IE, Robinson J, Harris MG, Paxton SJ, Francey S. Predictors of suicide-related behaviors during treatment following a first episode of psychosis: the contribution of baseline, past, and recent factors. Schizophr Res 2012; 140:17-24. [PMID: 22784686 DOI: 10.1016/j.schres.2012.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 06/12/2012] [Accepted: 06/19/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Suicide-related behaviors (suicide attempts and suicides) are common in the early phase of psychotic disorders. Studies have examined risk factors among baseline and historical (i.e., past) variables, yet little is known about recent characteristics that increase suicide risk during treatment for first-episode psychosis (FEP). This study had two aims: first, to determine the relative importance of baseline, past, and recent variables to the prediction of suicide-related behaviors in patients with FEP; second, to identify recent characteristics that exert most influence on suicide risk levels and which could become foci of preventive interventions. METHODS This was a case-control study of 180 patients from a cohort entering a specialist FEP service between 1/12/2002 and 30/11/2005. Data for 72 cases and 108 matched controls were obtained via medical record audit. Multivariate logistic regression models assessed the contribution of baseline, past, and recent domains. Suicide attempt or suicide during treatment was the outcome variable. RESULTS The strongest risk factors for suicide-related behaviors were: baseline depressive symptoms, baseline suicidal ideation/intent, past negative events, past non-suicidal self-injurious behavior, recent negative events, recent depressive symptoms, and recent non-suicidal self-injurious behavior. However, when these were entered into a hierarchical logistic regression model, only recent non-suicidal self-injurious behavior (AOR=72.96, p<0.001), and recent negative events (AOR=1.90, p=0.003) remained significant predictors. The final model accurately classified 75.5% of cases and 89.2% of controls, and explained 72.0% of variance in the suicide attempt status. CONCLUSIONS Since recent negative events and recent non-suicidal self-injurious behavior were the strongest predictors of suicide-related behaviors during treatment for FEP, psychiatric services could consider incorporating psychosocial interventions addressing affect regulation, interpersonal effectiveness, stress management and problem solving, alongside case management and pharmacotherapy, to help to reduce the rates of suicide attempts and suicides in first-episode patients.
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Affiliation(s)
- I E Fedyszyn
- School of Psychological Science, La Trobe University, Melbourne, VIC 3086, Australia.
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Affiliation(s)
- Scott Henderson
- Department of Psychiatry, The Canberra Hospital, Australian National University, Garran, ACT 2605.
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