Predictors of Suicide Attempt in Early-Onset, First-Episode Psychoses: A Longitudinal 24-Month Follow-Up Study

Department of Child and Adolescent Psychiatry and Psychology, Institut Clínic of Neurosciences, Hospital Clínic Universitari, Barcelona Villarroel, 170, Barcelona 08036, Spain .
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 11/2012; 74(1). DOI: 10.4088/JCP.12m07632
Source: PubMed


To study the prevalence of suicide attempts and factors associated with risk for suicide during the first episode of psychosis, and to identify early predictors of suicide attempts over a 24-month follow-up period in an early-onset, first-episode psychosis cohort.

110 subjects in their first episode of psychosis aged between 9 and 17 years were assessed by using the DSM-IV diagnostic interview Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and a battery of clinical instruments at baseline and at 12 and 24 months. Patients were enrolled in the study from March 2003 through November 2005. Suicide attempts and level of suicidality at each assessment were evaluated by using the Clinical Global Impression for Severity of Suicidality and the Hamilton Depression Rating Scale. Subjects were classified as being at high, low, or no risk of suicide, depending on their scores on certain items of these scales. Clinical associations between the outcome measures high risk for suicide during acute episode and suicide attempts during follow-up were investigated by 2 sets of logistic regression analyses.

The 24-month prevalence of suicide attempters was 12.4%. History of suicide attempts prior to psychotic episode (OR = 20.13; 95% CI, 1.83-220.55; P = .01), severe depressive symptoms (OR = 8.78; 95% CI, 1.15-67.11; P = .003), and antidepressant treatment (OR = 15.56; 95% CI, 2.66-90.86; P = .002) were associated with being classified as high suicide risk at baseline. The categorization of high suicide risk at baseline predicted suicide attempts during follow-up (OR = 81.66; 95% CI, 11.61-574.35; P = .000).

Suicide is a major concern in early-onset first-episode psychosis. Suicidal behavior and depressive symptoms at psychosis onset are important signs to be aware of to prevent suicide attempts during the early period after first-episode psychosis.

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    • "However, the lower age of onset for psychotic symptoms in the SA + NSSH group might also indicate that the emergence of psychotic symptoms during adolescence can increase the risk of self-harm [35], perhaps to regulate affect. Severity of depressive symptoms and suicidal behavior are robust predictors of future suicide attempts in adult samples of schizophrenia patients [4,36] and a recent study of children and adolescents with first episode psychoses also found that depressive symptoms and high suicidality at baseline was associated with increased risk for suicide attempts in the follow-up period [37]. That study did not report on NSSH, but such findings highlights that the higher severity of depressive symptoms and higher current suicidality in patients with both SA and NSSH increase the risk of future suicide attempts. "
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    ABSTRACT: 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. 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. 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. 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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    ABSTRACT: Recognition and treatment of psychosis in children remain challenging. This may be partly because of the subtle nature of prodromal features and partly because psychosis-like experiences are rather common in that a rich fantasy life is normative for developing children. Recent research suggests that only about 5% of patients with schizophrenia have an onset before age 15 years. To help with early recognition, an understanding of frequently used concepts and terms such as ultra high risk, attenuated symptoms, and clinical high risk for schizophrenia were reviewed as part of this article. During prodrome of schizophrenia, marked difficulties with emotions, cognition, motor skills, and socialization are seen. A careful workup of children in whom a psychotic process is suspected is warranted and may help with diagnostic clarification and likely treatment strategies. In treating a patient at ultra high risk, second-generation antipsychotics may reduce the severity of prodromal symptoms; however, high dropout rates and limited treatment adherence are significant concerns. Other helpful strategies may include treatment with selective serotonin reuptake inhibitors and omega-3 fatty acids and therapies such as cognitive-behavioral therapy. The most important aspect of the early treatment, however, may be working with a specialized multidisciplinary early psychosis treatment team that will address and support the individual and his or her family with academic needs, socialization, and other needs or components in a comprehensive manner.
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