1
|
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.
Collapse
Affiliation(s)
- Nolan Ayers
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Brian J Miller
- Department of Psychiatry, Augusta University, Augusta, GA, USA
| |
Collapse
|
2
|
Abstract
PURPOSE OF REVIEW Insomnia is common in schizophrenia. Insomnia has been associated with suicidal ideation and behavior, as well as greater severity of psychopathology, in schizophrenia. This review performs a meta-analysis of associations between insomnia, suicide, and psychopathology in patients with schizophrenia. RECENT FINDINGS We searched major electronic databases from inception until November 2022 for studies of insomnia, suicide, and psychopathology in patients with schizophrenia. Random effects meta-analysis calculating odds ratios (ORs, for suicide) and effect sizes (ESs, for psychopathology) and 95% confidence intervals (CIs) were performed. Ten studies met the inclusion criteria, comprising 3428 patients with schizophrenia. Insomnia was associated with a significant increased odds of suicidal ideation (OR = 1.84, 95% CI 1.28-2.65, P < 0.01) and suicide attempt or death (OR = 5.83, 95% CI 1.61-2.96, P < 0.01). Insomnia was also associated with total (ES = 0.16, 95% CI 0.09-0.23, P < 0.01), positive (ES = 0.14, 95% CI 0.08-0.20, P = 0.02), and general (ES = 0.17, 95% CI 0.08-0.27, P < 0.01) psychopathology. In meta-regression analyses, BMI was negatively associated with suicidal ideation. Otherwise, age, sex, and study year were all unrelated to the associations. SUMMARY Insomnia is associated with suicide and psychopathology in schizophrenia. Formal assessment and treatment of insomnia appears relevant to the clinical care of schizophrenia.
Collapse
Affiliation(s)
| | - William V McCall
- Medical College of Georgia, Augusta University
- Department of Psychiatry and Health Behavior, Augusta University, Augusta, Georgia, USA
| |
Collapse
|
3
|
Salagre E, Grande I, Jiménez E, Mezquida G, Cuesta MJ, Llorente C, Amoretti S, Lobo A, González-Pinto A, Carballo JJ, Corripio I, Verdolini N, Castro-Fornieles J, Legido T, Carvalho AF, Vieta E, Bernardo M. Trajectories of suicidal ideation after first-episode psychosis: a growth mixture modeling approach. Acta Psychiatr Scand 2021; 143:418-433. [PMID: 33501646 DOI: 10.1111/acps.13279] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The period immediately after the onset of first-episode psychosis (FEP) may present with high risk for suicidal ideation (SI) and attempts, although this risk may differ among patients. Thus, we aimed to identify trajectories of SI in a 2-years follow-up FEP cohort and to assess baseline predictors and clinical/functional evolution for each trajectory of SI. METHODS We included 334 FEP participants with data on SI. Growth mixture modeling was used to identify trajectories of SI. Putative sociodemographic, clinical, and cognitive predictors of the distinct trajectories were examined using multinomial logistic regression. RESULTS We identified three distinct trajectories: Non-SI trajectory (85.53% sample), Improving SI trajectory (9.58%), and Worsening SI trajectory (6.89%). Multinomial logistic regression model revealed that greater baseline pessimistic thoughts, anhedonia, and worse perceived family environment were associated with higher baseline SI followed by an Improving trajectory. Older age, longer duration of untreated psychosis, and reduced sleep predicted Worsening SI trajectory. Regarding clinical/functional evolution, individuals within the Improving SI trajectory displayed moderate depression at baseline which ameliorated during the study period, while the Worsening SI subgroup exhibited persistent mild depressive symptoms and greater functional impairment at follow-up assessments. CONCLUSION Our findings delineated three distinct trajectories of SI among participants with FEP, one experiencing no SI, another in which SI might depend on acute depressive symptomatology, and a last subset where SI might be associated with mild but persistent clinical and functional impairments. These data provide insights for the early identification and tailored treatment of suicide in this at-risk population.
Collapse
Affiliation(s)
- Estela Salagre
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Iria Grande
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Esther Jiménez
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IdiSNa), Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IdiSNa), Pamplona, Spain
| | - Cloe Llorente
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Sílvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana González-Pinto
- Department of Psychiatry, Hospital Universitario de Alava, BIOARABA Health Research Institute, University of the Basque Country, Vitoria, Spain
| | - Juan José Carballo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañon, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU), Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Clinic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Teresa Legido
- Neuroscience Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, the Centre for Addiction and Mental Health, Toronto, ON, Canada.,The IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
| | - Miquel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain.,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
- Ragy R Girgis
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|