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Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World J Psychiatry 2022; 12:1204-1232. [PMID: 36186500 PMCID: PMC9521535 DOI: 10.5498/wjp.v12.i9.1204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.
AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.
METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.
RESULTS This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.
CONCLUSION Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
| | - Navdeep Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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Suicide Behavior and Its Predictors in Patients with Schizophrenia in Ethiopia. SCHIZOPHRENIA RESEARCH AND TREATMENT 2021; 2021:6662765. [PMID: 33868728 PMCID: PMC8032509 DOI: 10.1155/2021/6662765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/12/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with schizophrenia (PWS) are at greater risk of suicide. However, suicide behaviors that occur in PWS are often overlooked, inadequately characterized, and not consistently integrated into treatment. Despite this burden and consequences in Ethiopia, there is a dearth of studies concerning suicide behavior in PWS. Therefore, this study is aimed at assessing the magnitude of suicide behavior and its predictors among PWS in Ethiopia. METHODS An institution based cross-sectional study was employed. Data were collected using the structured interviewer-administered questionnaire from a sample of 300 PWS at Amanuel Mental Specialized Hospital (AMSH). The revised version of Suicide Behavior Questionnaire (SBQ-R) was used to assess suicide behavior in PWS. The data was collected from March 1 to 30, 2019. Binary logistic regression was performed to identify independent predictors of suicidal behavior at 95% confidence level. Statistical significance was declared at p value <0.05. RESULT A total of 300 patients with schizophrenia participated in the study. More than two-thirds of 203 (67.7%) of the participants were males, and 116 (38.7%) participants were between the ages of 28 and 37 years. We found that the prevalence of suicide behavior among PWS was 30.3%. Being unemployed (AOR = 3.65, CI = 1.32, 10.05), family history of suicide (AOR = 3.16, CI = 1.38, 7.23), substance use (AOR = 2.51, CI = 1.13, 5.59), current positive psychotic symptoms (hallucination (AOR = 6.39, CI = 2.86, 14.29), and delusion (AOR = 4.15, CI = 1.95, 14.29) and presence of comorbid depression (AOR = 4.81, CI = 1.98, 11.68) were independent significant predictors with suicidal behavior in PWS. CONCLUSION The prevalence of suicidal behavior among PWS was found to be high. Hence, designing strategies for early screening and intervention is the most critical prevention strategy of suicide in PWS.
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Duffy ME, Gai AR, Rogers ML, Joiner TE, Luby JL, Joshi PT, Wagner KD, Emslie GJ, Walkup JT, Axelson D. Psychotic symptoms and suicidal ideation in child and adolescent bipolar I disorder. Bipolar Disord 2019; 21:342-349. [PMID: 31025487 PMCID: PMC6597286 DOI: 10.1111/bdi.12789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The purpose of this study was to explore associations between specific types of hallucinations and delusions and suicidal ideation in a sample of children and adolescents with bipolar I disorder. METHODS Participants (N = 379) were children and adolescents aged 6-15 years (M = 10.2, SD = 2.7) with DSM-IV diagnoses of bipolar I disorder, mixed or manic phase. The study sample was 53.8% female and primarily White (73.6% White, 17.9% Black, and 8.5% Other). Presence and nature of psychotic symptoms, suicidal ideation, and functioning level were assessed through clinician-administered measures. A series of logistic regressions was performed to assess the contribution of each subtype of psychotic symptom to the presence of suicidal ideation above and beyond age, sex, socio-economic status, age at bipolar disorder onset, and global level of functioning. RESULTS Hallucinations overall, delusions of guilt, and number of different psychotic symptom types were uniquely associated with increased odds of suicidal ideation after accounting for covariates. Other forms of delusions (eg, grandiose) and specific types of hallucinations (eg, auditory) were not significantly uniquely associated with the presence of suicidal ideation. CONCLUSIONS Findings of this study suggest the presence of hallucinations as a whole, delusions of guilt specifically, and having multiple concurrent types of psychotic symptoms are associated with the presence of suicidal ideation in children and adolescents with bipolar I disorder. Psychotic symptom subtypes, as opposed to psychosis as a whole, are an under-examined, potentially important, area for consideration regarding suicidal ideation in pediatric bipolar I disorder.
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Affiliation(s)
- Mary E Duffy
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Anna R Gai
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Megan L Rogers
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Paramjit T Joshi
- Department of Psychiatry, University of California, Irvine, California
| | - Karen D Wagner
- Department of Psychiatry, University of Texas Medical Branch, Galveston, Texas
| | - Graham J Emslie
- Division of Child and Adolescent Psychiatry, Children's Medical Center, Dallas, Texas
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John T Walkup
- Department of Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - David Axelson
- Nationwide Children's Hospital Research Institute, The Ohio State University College of Medicine, Columbus, Ohio
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Yazici E, Cimen Z, Akyollu IIU, Yazici AB, Turkmen BA, Erol A. Depressive Temperament in Relatives of Patients with Schizophrenia Is Associated with Suicidality in Patients with Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:302-309. [PMID: 30121980 PMCID: PMC6124869 DOI: 10.9758/cpn.2018.16.3.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/16/2017] [Accepted: 08/11/2017] [Indexed: 01/22/2023]
Abstract
Objective Suicide is a major cause of death in patients with schizophrenia; thus, predicting and preventing suicide in patients with schizophrenia is examined in various studies. Affective temperaments which are accepted as precursors of mood disorders may be an important factor in predicting suicidality. This study investigated the relationship between affective temperaments of relatives of schizophrenia patients and suicidal thoughts and other clinical correlates of patients with schizophrenia. Methods Patients with schizophrenia and their first degree relatives are included to the study. All of the participants were evaluated with Structured Clinical Interview for DSM-IV axis I disorders and relatives with active psychiatric diagnosis were excluded. Positive and Negative Symptom Scale, Clinical Global Impression Scale, Turkish version of cognitive assessment interview were administered congruently to the patients. Relatives of the patients were evaluated with Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto-questionnaire. Results Depressive temperament scores of relatives of schizophrenic patients who had suicidal thoughts were higher than the scores of the relatives of the patients who did not have suicidal thoughts. Depressive temperament also predicted number of suicide attempts in regression analysis. Number of suicide attempts was also related with number of hospitalization and functionality of the patient. Conclusion Suicidality in schizophrenia is related with relatives’ affective temperaments and patients’ own positive symptom scores. The relationship between suicidal thoughts and depressive temperament is high lightened in this study
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Affiliation(s)
- Esra Yazici
- Department of Psychiatry, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Zerrin Cimen
- Department of Psychiatry, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | | | - Ahmet Bulent Yazici
- Department of Psychiatry, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Betul Aslan Turkmen
- Department of Psychiatry, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Atila Erol
- Department of Psychiatry, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Huang X, Fox KR, Ribeiro JD, Franklin JC. Psychosis as a risk factor for suicidal thoughts and behaviors: a meta-analysis of longitudinal studies. Psychol Med 2018; 48:765-776. [PMID: 28805179 DOI: 10.1017/s0033291717002136] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Research has long noted higher prevalence rates of suicidal thoughts and behaviors among individuals with psychotic symptoms. Major theories have proposed several explanations to account for this association. Given the differences in the literature regarding the operationalization of psychosis and sample characteristics, a quantitative review is needed to determine to what extent and how psychosis confers risk for suicidality. METHODS We searched PsycInfo, PubMed, and GoogleScholar for studies published before 1 January 2016. To be included in the analysis, studies must have used at least one psychosis-related factor to longitudinally predict suicide ideation, attempt, or death. The initial search yielded 2541 studies. Fifty studies were retained for analysis, yielding 128 statistical tests. RESULTS Suicide death was the most commonly studied outcome (43.0%), followed by attempt (39.1%) and ideation (18.0%). The median follow-up length was 7.5 years. Overall, psychosis significantly conferred risk across three outcomes, with weighted mean ORs of 1.70 (1.39-2.08) for ideation, 1.36 (1.25-1.48) for attempt, and 1.40 (1.14-1.72) for death. Detailed analyses indicated that positive symptoms consistently conferred risk across outcomes; negative symptoms were not significantly associated with ideation, and were protective against death. Some small moderator effects were detected for sample characteristics. CONCLUSIONS Psychosis is a significant risk factor for suicide ideation, attempt, and death. The finding that positive symptoms increased suicide risk and negative symptoms seemed to decrease risk sheds light on the potential mechanisms for the association between psychosis and suicidality. We note several limitations of the literature and offer suggestions for future directions.
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Affiliation(s)
- X Huang
- Department of Psychology,Florida State University,Tallahassee, FL,USA
| | - K R Fox
- Department of Psychology,Harvard University,Cambridge, MA,USA
| | - J D Ribeiro
- Department of Psychology,Florida State University,Tallahassee, FL,USA
| | - J C Franklin
- Department of Psychology,Florida State University,Tallahassee, FL,USA
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Dong M, Wang SB, Li Y, Xu DD, Ungvari GS, Ng CH, Chow IHI, Xiang YT. Prevalence of suicidal behaviors in patients with major depressive disorder in China: A comprehensive meta-analysis. J Affect Disord 2018; 225:32-39. [PMID: 28779680 DOI: 10.1016/j.jad.2017.07.043] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Suicidal behaviors are common in major depressive disorder (MDD) and contribute significantly to premature death. The objective of this meta-analysis is to estimate the pooled prevalence of suicidal behaviors in patients with MDD in China. METHODS The relevant databases in English (PubMed, Embase, PsycINFO and Cochrane Library) and Chinese (Chinese National Knowledge Infrastructure, Wanfang and Chinese Biological Medical Literature) were systematically and independently searched from their inceptions until January 23, 2017. Original studies that reported the prevalence of suicidal behaviors including suicidal ideation (SI), suicide plan (SP), suicide attempt (SA) and completed suicide (CS) were included. RESULTS Thirty three articles that met the inclusion criteria were analyzed. The pooled lifetime prevalence of SI, SP and SA were 53.1% (95% CI: 42.4-63.4%), 17.5% (95% CI: 5.8-42.3%) and 23.7% (95% CI: 19.9-28.0%), respectively. One-month prevalence of SI and SA were 27.7% (95% CI: 15.4-44.5%) and 20.3% (95% CI: 12.1-32.2%), respectively. The pooled prevalence of SA during hospitalization and after onset of MDD were 17.3% (95% CI: 12.4-23.7%) and 42.1% (95% CI: 26.1-60.0%), respectively. Subgroup analyses revealed significant differences in both lifetime prevalence of SI and SA between genders, and between outpatients and inpatients with MDD. CONCLUSION Suicidal behaviors are common in MDD patients in China. Regular screening and effective intervention for suicidal behavior in MDD patients are warranted.
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Affiliation(s)
- Min Dong
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - Yan Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Dan-Dan Xu
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Gabor S Ungvari
- University of Notre Dame Australia/Marian Centre, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Ines H I Chow
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Abstract
BACKGROUND Suicidal behavior comprises a diverse set of behaviors with significant differences among several behavioral categories. One noteworthy category includes individuals who have made serious suicide attempts, epidemiologically very similar to those completing suicide. This behavioral category is important, since interviewing survivors of a potentially lethal incident of self-harm enables a detailed investigation of the psychological process leading to the suicidal act. AIM To achieve a consensus definition and operational criteria of serious suicide attempts. METHOD We reviewed studies that included the term serious suicide attempt or related terms (e.g., highly lethal), with a focus on the variety of operational criteria employed across studies. RESULTS More than 60 papers addressing various types of serious suicide attempt were explored. We found a large variety of operational definitions, reflecting the lack of consensus regarding terminology and criteria related to the term. CONCLUSION We undertook the challenge of developing an integrative and comprehensive set of criteria of serious suicide attempt and suggest a definition comprising three key dimensions: medical lethality, potential lethality of the method used, and severity of the objective circumstances of the suicide intent. Clinicians and researchers are strongly encouraged to consider using the term serious suicide attempt with its attendant components.
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Affiliation(s)
- Yossi Levi-Belz
- 1 Department of Behavioral Sciences, Ruppin Academic Center, Emek-Hefer, Israel
| | - Annette Beautrais
- 2 School of Health Sciences, University of Canterbury, Christchurch, New Zealand
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Aaltonen K, Näätänen P, Heikkinen M, Koivisto M, Baryshnikov I, Karpov B, Oksanen J, Melartin T, Suominen K, Joffe G, Paunio T, Isometsä E. Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders. J Affect Disord 2016; 193:318-30. [PMID: 26774520 DOI: 10.1016/j.jad.2015.12.033] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Substantial literature exists on risk factors for suicidal behaviour. However, their comparative strength, independence and specificity for either suicidal ideation or suicide attempt(s) remain unclear. METHODS The Helsinki University Psychiatric Consortium (HUPC) Study surveyed 287 psychiatric care patients with ICD-10-DCR depressive or bipolar disorders about lifetime suicidal behaviour, developmental history and attachment style, personality and psychological traits, current and lifetime symptom profiles, and life events. Psychiatric records were used to confirm diagnosis and complement information on suicide attempts. Multinomial regression models predicting lifetime suicidal ideation and single or repeated suicide attempts were generated. RESULTS Overall, 21.6% patients had no lifetime suicidal behaviour, 33.8% had lifetime suicide ideation without attempts, and 17.1% had a single and 27.5% repeated suicide attempts. In univariate analyses, lifetime suicidal behaviour was associated with numerous factors. In multivariate models, suicidal ideation was independently predicted by younger age, severe depressive disorder, bipolar disorder type II/nos, hopelessness, and childhood physical abuse. Repeated suicide attempts were independently predicted by younger age, female sex, severe depressive disorder with or without psychotic symptoms, bipolar disorder type II/nos, alcohol use disorder, borderline personality disorder traits, and childhood physical abuse. LIMITATIONS Cross-sectional and retrospective study design, utilization of clinical diagnoses, and relatively low response rate. CONCLUSIONS Risk factors for suicidal ideation and attempts may diverge both qualitatively and in terms of dose response. When effects of risk factors from multiple domains are concurrently examined, proximal clinical characteristics remain the most robust. All risk factors cluster into the group of repeated attempters.
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Affiliation(s)
- Kari Aaltonen
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petri Näätänen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martti Heikkinen
- Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maaria Koivisto
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilya Baryshnikov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Boris Karpov
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jorma Oksanen
- Department of Social Services and Health Care, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tarja Melartin
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Suominen
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland
| | - Grigori Joffe
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Paunio
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki Isometsä
- Department of Health, Mental Health Unit, National Institute of Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Abstract
BACKGROUND The life time risk of suicide among patients with long term psychosis is 5-15%. Suicide prevention in this group is a major clinical challenge. AIMS To capture specific characteristics of suicidal communication and critical events preceding suicide in patients with psychosis. METHODS Medical records were examined and a life event inventory applied to a one-year cohort of 21 cases of suicide in the clinical group in Stockholm county. RESULTS In most cases direct or indirect verbal communication of suicidal thoughts were documented before the suicide. Three months preceeding death, 20 of the 21 subjects had described one or more negative critical experiences, typically physical illness, loss of contact with an important other, loss of "home", and intolerable side effects of medication. In most cases the suicide appeared to be the culmination of prolonged suffering and suicidal deliberations. CONCLUSIONS Suicide prevention among patients with psychosis requires sensitivity, active listening, and responsiveness on the part of the care person to the patient's explicit suicidal communication and perceptions of care-related or other incidents or interactions, even when conveyed in an odd manner or with little emotion. To prevent suicide, attentive and long-term planning in collaboration with the patient is essential.
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Affiliation(s)
- Anne Stefenson
- 1 National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - David Titelman
- 1 National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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Gesi C, Carmassi C, Miniati M, Benvenuti A, Massimetti G, Dell'Osso L. Psychotic spectrum symptoms across the lifespan are related to lifetime suicidality among 147 patients with bipolar I or major depressive disorder. Ann Gen Psychiatry 2016; 15:15. [PMID: 27330540 PMCID: PMC4915160 DOI: 10.1186/s12991-016-0101-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/31/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Conflicting evidence exists about the relationship between psychotic symptoms and suicidality in mood disorders. We aimed to investigate the lifetime suicidality and its relationship with dimensions of the psychotic spectrum over the lifespan among subjects with bipolar I (BD I) or major depressive disorder (MDD). METHODS 147 Consecutive out- and inpatients with BD I or MDD presenting for treatment at 11 Italian Departments of Psychiatry were administered the Structured Clinical Interview for DSM-IV Axis I Disorders, the Structured Clinical Interview for the Psychotic Spectrum (SCI-PSY, lifetime version) and the Mood Spectrum Self-Report (MOODS-SR, lifetime version). RESULTS Subjects with psychotic features did not differ from those without for MOODS-SR suicidality score. Controlling for age, gender and diagnosis (MDD/BD I), the SCI-PSY total score (p = .007) and Paranoid (p = .042), Schizoid (p = .007) and Interpersonal Sensitivity (p < .001) domain scores independently predicted lifetime MOODS-SR suicidality score in the overall sample. CONCLUSIONS Psychotic features, as evaluated upon the presence of delusions or hallucinations, are not associated with suicidality among subjects with BD I or MDD. However, more subtle dimensions of the psychotic spectrum, such as Interpersonal Sensitivity, Paranoid and Schizoid symptoms, show a significant relationship with lifetime suicidality. Our findings highlight the potential usefulness of a spectrum approach in the assessment of psychotic symptoms and suicide risk among subjects with BD I or MDD.
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Affiliation(s)
- Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Antonella Benvenuti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
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Teraishi T, Hori H, Sasayama D, Matsuo J, Ogawa S, Ishida I, Nagashima A, Kinoshita Y, Ota M, Hattori K, Kunugi H. Relationship between lifetime suicide attempts and schizotypal traits in patients with schizophrenia. PLoS One 2014; 9:e107739. [PMID: 25226584 PMCID: PMC4166669 DOI: 10.1371/journal.pone.0107739] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/14/2014] [Indexed: 11/18/2022] Open
Abstract
Patients with schizophrenia are at increased risk for suicide. Various risk factors for suicide have been reported in schizophrenia; however, few studies have examined the association between personality traits and suicidal behavior. We administered the Schizotypal Personality Questionnaire (SPQ) to 87 Japanese patients with schizophrenia (49 males; mean age 38.1±10.6 years) with and without a history of suicide attempts (SA and nSA groups, respectively), and 322 controls (158 males; mean age 40.8±13.9 years). As expected, an analysis of covariance (ANCOVA) controlling for age and sex showed that all SPQ indices (total SPQ score and all three factors, i.e., cognitive-perceptual, interpersonal, and disorganized) were significantly higher in patients with schizophrenia (SA+nSA groups), than controls (p<0.001 for all comparisons). Furthermore, there were significant differences in the total score and the interpersonal and disorganized factors between the SA and nSA groups (nSA<SA, p<0.01 for all comparisons). Receiver operating characteristic analysis showed that a total SPQ score of 33.5 was the optimal cut-off value to discriminate the SA group from the nSA group (χ2[1] = 10.6, p = 0.002, odds ratio: 4.7, 95% confidence interval: 1.8–12.1, sensitivity: 0.70, specificity: 0.67). These results suggest that high schizotypy is associated with lifetime suicide attempts, and that the total SPQ score might be useful to assess the risk of suicide attempt in patients with schizophrenia.
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Affiliation(s)
- Toshiya Teraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Daimei Sasayama
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Junko Matsuo
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shintaro Ogawa
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ikki Ishida
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Anna Nagashima
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yukiko Kinoshita
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
- * E-mail:
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Li YH, Xiang YT, Su YA, Shu L, Yu X, Kilbourne AM, Ungvari GS, Chiu HF, Ma C, Wang GH, Bai PS, Liu XH, Sun LZ, Shi JG, Chen XS, Mei QY, Li KQ, Si TM. Long-term benzodiazepine use in patients with major depressive disorder in China. Perspect Psychiatr Care 2014; 50:149-54. [PMID: 24308911 DOI: 10.1111/ppc.12035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/20/2013] [Accepted: 06/27/2013] [Indexed: 02/05/2023] Open
Abstract
PURPOSE There have been no data about long-term benzodiazepine (BZD) use and its correlates in patients with major depressive disorder (MDD) in China. This study aimed to examine the prevalence of long-term BZD use (more than three months) and its demographic and clinical correlates in Chinese patients with MDD. DESIGN AND METHODS A total of 1,192 patients with MDD were examined in 10 mental health centers in China. Patients' socio-demographic and clinical characteristics and prescriptions for psychotropic drugs were recorded using a standardized form. FINDINGS A large portion of patients (36.2%) received long-term BZD treatment. Univariate analyses revealed that long-term BZD users were older, poorer, and had more impaired occupational functioning than patients not taking BZDs. Long-term BZD users had fewer psychotic symptoms and took less antipsychotic drugs. In multivariate analyses, long-term BZD use was independently associated with older age and more severe impaired occupational functioning; long-term BZD users were less likely to receive antipsychotic medications and traditional antidepressants (tricyclic antidepressants, tetracyclic antidepressant, and monoamine oxidase inhibitors). PRACTICE IMPLICATIONS Long-term BZD use was common in patients with MDD in China. A host of demographic and clinical factors were independently associated with long-term BZD use.
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Affiliation(s)
- You-Hong Li
- The Key Laboratory of Mental Health; Ministry of Mental Health & Peking University Institute of Mental Health; Beijing China
| | - Yu-Tao Xiang
- Beijing Anding Hospital; Capital Medical University; Beijing China
- Department of Psychiatry; Chinese University of Hong Kong; Hong Kong SAR China
| | - Yun-Ai Su
- The Key Laboratory of Mental Health; Ministry of Mental Health & Peking University Institute of Mental Health; Beijing China
| | - Liang Shu
- The Key Laboratory of Mental Health; Ministry of Mental Health & Peking University Institute of Mental Health; Beijing China
| | - Xin Yu
- The Key Laboratory of Mental Health; Ministry of Mental Health & Peking University Institute of Mental Health; Beijing China
| | - Amy M. Kilbourne
- Department of Psychiatry; University of Michigan Medical School; Ann Arbor Michigan USA
- Veterans Administration Ann Arbor Center for Clinical Management Research; Ann Arbor Michigan USA
| | - Gabor S. Ungvari
- The University of Notre Dame Australia/Marian Centre; Perth Western Australia Australia
- School of Psychiatry & Clinical Neurosciences; University of Western Australia; Perth Western Australia Australia
| | - Helen F.K. Chiu
- Department of Psychiatry; Chinese University of Hong Kong; Hong Kong SAR China
| | - Cui Ma
- Psychiatric Hospital; Guangzhou Guangdong Province China
| | - Gao-Hua Wang
- Department of Psychiatry; Renmin Hospital, Wuhan University; Wuhan Hubei Province China
| | - Pei-Shen Bai
- The First Hospital of Shanxi Medical University; Taiyuan Shanxi Province China
| | - Xie-He Liu
- West China Hospital; Sichuan University; Chengdu Sichuan China
| | - Li-Zhong Sun
- Neuropsychiatric Hospital; Changchun Jilin Province China
| | - Jian-Guo Shi
- Mental Health Center; Xi-an Shaanxi Province China
| | - Xian-Sheng Chen
- Jiangxi Psychiatric Hospital; Nanchang Jiangxi Province China
| | - Qi-Yi Mei
- Suzhou Guangji Hospital; Suzhou Jiangsu Province China
| | - Ke-Qing Li
- Hebei Mental Health Center; Tangshan Hebei Province China
| | - Tian-Mei Si
- The Key Laboratory of Mental Health; Ministry of Mental Health & Peking University Institute of Mental Health; Beijing China
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Hettige NC, Kennedy JL, De Luca V. Does a history of suicide attempt predict higher antipsychotic dosage in schizophrenia? Psychopharmacology (Berl) 2014; 231:2507-13. [PMID: 24402138 DOI: 10.1007/s00213-013-3419-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE Antipsychotic dosage is generally adjusted by physicians depending on the stability of the patient and the response to that particular drug. Our hypothesis is that patients with previous suicide attempt are prescribed higher doses of antipsychotics. OBJECTIVE We examined the dosage and patterns of antipsychotic use in regard to past suicidal behaviour. METHODS For this study, 304 subjects with schizophrenia spectrum disorders between the ages of 18 and 75 were recruited. A cross-sectional assessment was used for this study, in which data were collected from each patient through an interview and self-report questionnaires. The percentages of the Compendium of Pharmaceuticals and Specialties (CPS) maximum recommended daily dose were applied to standardize antipsychotic dosages across different treatments. We compared the standardized dosage of antipsychotics in schizophrenics with previous suicide attempts and those who have never attempted suicide. RESULTS Applying the ANCOVA, our preliminary results show no significant difference (P = 0.467) in antipsychotic dosage in the attempters and non-attempters. The prescribed clozapine dosage fails to show a significant relationship with suicidal history (P >0.05). CONCLUSIONS In summary, our analysis does not show antipsychotic dosage adjustment based on past suicide attempt, after controlling for the current suicidal ideation and hopelessness.
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Affiliation(s)
- Nuwan C Hettige
- Group for Suicide Studies, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
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14
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Risk factors for suicide among 34,671 patients with psychotic and non-psychotic severe depression. J Affect Disord 2014; 156:119-25. [PMID: 24388683 DOI: 10.1016/j.jad.2013.12.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/25/2013] [Accepted: 12/03/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Severe unipolar depression is associated with increased risk of suicide, but it remains unknown whether the same risk factors are present in the non-psychotic (non-PD) and psychotic (PD) subtypes respectively. Therefore, this study aimed to identify risk factors for suicide in non-PD and PD separately, and to investigate if the presence of psychotic symptoms is an independent risk factor for suicide in severe depression. METHODS This register-based, nationwide, historical prospective cohort study used logistic regression analyses to ascertain risk factors for suicide among all adults diagnosed with severe depression at Danish psychiatric hospitals between January 1, 1994 and December 31, 2010. The risk for suicide was expressed as adjusted odds ratios (AOR). RESULTS A total of 34,671 individuals with severe depression (non-PD: n=26,106 and PD: n=12,101) were included in the study. Of these, 755 completed suicide during follow up. PD was not found to be an independent risk factor for suicide in severe depression (AOR=0.97 [0.83-1.15]). Older age (non-PD AOR=1.05 [per year], PD AOR=1.04 [per year]), male sex (non-PD AOR=1.89, PD AOR=1.98), and a previous incident of self-harm (non-PD AOR=5.02, PD AOR=5.17) were significant risk factors for both groups. LIMITATIONS As the study population was comprised only of patients with contact to psychiatric hospitals, the results cannot be extrapolated to the primary care setting. CONCLUSION The following risk factors for non-PD and PD were identified: older age, male gender and previous incidents of self-harm. In suicide prevention efforts, equal attention should be paid to non-PD and PD patients.
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Suicide attempt and suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients. Soc Psychiatry Psychiatr Epidemiol 2013; 48:447-54. [PMID: 22847130 DOI: 10.1007/s00127-012-0555-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study aimed to examine the prevalence and correlates of lifetime suicide attempts and current suicidal ideation in community-dwelling schizophrenia patients in China. METHOD A sample of 540 schizophrenia patients was randomly selected in Beijing, China. All subjects were interviewed using standardized assessment instruments and their basic socio-demographic and clinical data including history of suicide attempts were collected. RESULTS The prevalence of lifetime suicide attempts and the point prevalence of suicidal ideation were 12.0%, and 21.1%, respectively. In multiple logistic regression analyses, the presence of lifetime suicide attempt was independently associated with rural residence, having major medical conditions and better social functioning, while higher likelihood of current suicidal ideation was associated with past suicide attempt, the severity of overall psychopathology and depressive symptoms and lower psychological quality of life (QOL). CONCLUSION Among Chinese outpatients with schizophrenia, increased current symptoms and poorer QOL were correlated with current suicidal ideation, while demographic factors and indicators of greater social support were mostly correlated with lifetime suicide attempts. This study may help to identify important subgroups of patients with schizophrenia at particularly high risk of suicidal behavior.
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Finseth PI, Morken G, Andreassen OA, Malt UF, Vaaler AE. Risk factors related to lifetime suicide attempts in acutely admitted bipolar disorder inpatients. Bipolar Disord 2012; 14:727-34. [PMID: 22998124 DOI: 10.1111/bdi.12004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The main aim of this study was to assess possible clinical characteristics of acutely admitted bipolar I disorder (BD-I) and bipolar II disorder (BD-II) inpatients at high risk of suicide by comparing patients who had made one or several serious suicide attempts with patients who had not. METHODS A total of 206 consecutive patients (mean age 42 ± 15 years; 54.9% women) with DSM-IV diagnosed BD-I (n = 140) and BD-II (n= 66) acutely admitted to a single psychiatric hospital department from November 2002 through June 2009 were included. Using a detailed retrospective questionnaire, patients with a history of a serious suicide attempt were compared to those with no history of a suicide attempt. RESULTS Ninety-three patients (45.1%) had a history of one or more serious suicide attempts. These constituted 60 (42.9%) of the BD-I patients and 33 (50%) of the BD-II patients (no significant difference). Lifetime suicide attempt was associated with a higher number of hospitalizations due to depression (p < 0.0001), antidepressant (AD)-induced hypomania/mania (p = 0.033), AD- and/or alcohol-induced affective episodes (p = 0.009), alcohol and/or substance use (p = 0.002), and a family history of alcohol abuse and/or affective disorder (p = 0.01). Suicide attempt was negatively associated with a higher Positive and Negative Syndrome Scale for Schizophrenia (PANSS) Positive Subscale score (p = 0.022) and more hospitalizations due to mania (p = 0.006). CONCLUSIONS The lifetime suicide attempt rate in BD inpatients is high. Risk factors of suicide attempts were: (i) a predominant depressive course of illness, (ii) comorbid alcohol and substance use disorders, and (iii) a history of AD- and/or alcohol-induced affective episodes. Risk-reducing factors were a preponderant manic or psychotic course of the illness. These risk factors may be signs of a clinical subgroup at risk of suicidal behaviour, and seem to be important for suicide risk assessment in acutely admitted BD patients.
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Affiliation(s)
- Per I Finseth
- Department of Neuroscience, Trondheim Norwegian University of Science and Technology (NTNU), Oslo, Norway.
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Lindström E, Eriksson L, Levander S. Suicides during 7 years among a catchment area cohort of patients with psychoses. Nord J Psychiatry 2012; 66:8-13. [PMID: 21958235 DOI: 10.3109/08039488.2011.577186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate a series of consecutive suicides at a psychosis clinic by using a psychological autopsy technique. METHOD The clinic serves an adult population of 225,000 individuals, of whom 0.5% have regular contact with the clinic. During a 7½-year period, 23 men and nine women committed suicide, which corresponds to an odds ratio of 14. RESULTS Most patients were schizophrenic, and 24 were outpatients. Suicide methods were violent in all but two cases. Nineteen had a history of at least one suicide attempt, and 24 were known to have had suicidal ideation. More than half had no social contacts over the last year except with psychiatric staff. The median time between the last contact with the psychiatric services and the suicide was 4 days. No warning signs were noted. At the time of death, 3 of the 24 who were prescribed antipsychotics, and none of the 10 who were prescribed antidepressants had plasma levels of the corresponding drug. CONCLUSION Findings of special interest are the lack of forewarnings and the poor drug compliance. Patients appear to have played "business as usual" with the care-givers, and did it well. Is it a sign of health and despair, or illness?
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Affiliation(s)
- Eva Lindström
- Department of Neurosience, Psychiatry, Uppsala University Hospital, S-75185 Uppsala, Sweden
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18
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Abstract
This paper aims to report a possible warning sign for dangerous behavior in delusional psychotic patients. We demonstrate an association between aggressive or auto-aggressive ideation and "ego-dystonic" grandiose delusions, where the patient believes to possess unique qualities but finds them unbearable. The study is based on the sample of seven interviews with five psychotic in-patients at the Kfar Shaul Mental Health Center, Jerusalem, Israel. All patients experienced an acute psychotic episode, and committed acts of aggression or suicidality. The research method is narrative analysis of semi-structured interviews. Patients report ideas of grandiose self-identification with deities, Biblical figures or celebrities, yet report their reluctance to be in these high positions due to feelings of unworthiness, withdrawal, and social isolation. Resulting frustration arguably leads to aggressive and suicidal ideation or actions. Contrary to the established view, grandiose delusions are not free of association with (auto-)aggression. The patient's ego-dystonic attitude towards his/her delusional identity may serve as the warning sign for dangerous behavior and, as such, should be searched for and recognized by the mental health professionals.
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Evensen J, Røssberg JI, Haahr U, ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld H, Larsen TK, Melle I, Opjordsmoen S, Rund BR, Simonsen E, Sundet K, Vaglum P, Friis S, McGlashan T. Contrasting monosymptomatic patients with hallucinations and delusions in first-episode psychosis patients: a five-year longitudinal follow-up study. Psychopathology 2011; 44:90-7. [PMID: 21228615 PMCID: PMC3031149 DOI: 10.1159/000319789] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 07/29/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND The main aim of this study was to identify subgroups of patients characterized by having hallucinations only or delusions only and to examine whether these groups differed with regard to demographic characteristics, clinical characteristics and outcome factors, including suicidality. METHODS Out of 301 consecutively admitted patients with first-episode psychosis, individuals with delusions only (D) and hallucinations only (H) were identified based on Positive and Negative Syndrome Scale (PANSS) items P1 (delusions) and P3 (hallucinations) scores at baseline and through 4 follow-up interviews over 5 years. The subgroups were compared with regard to demographic data, premorbid functioning, duration of untreated psychosis, clinical variables, time to remission and suicidality. RESULTS Two groups of patients were identified; H (n = 16) and D (n = 106). 179 patients experienced both hallucinations and delusions (dual symptom group). The H group was significantly younger, had a longer duration of untreated psychosis, poorer premorbid function and better insight than the D group. Notably, the H group scored higher on measures of suicidality, and at 5 years follow-up a significantly higher proportion of patients was lost to suicide in this group. The dual symptom group was closer to the D group on significant parameters, including suicidality and suicide rate. CONCLUSIONS Patients with hallucinations only can be separated from patients with delusions only and the subgroups differ with regard to demographical data, clinical variables and notably with regard to suicidality. These findings suggest distinctions in the underlying biological and psychological processes involved in hallucinations and in delusions.
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Affiliation(s)
- Julie Evensen
- Division of Psychiatry, Oslo University Hospital, Oslo, Norway.
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Mazzarini L, Colom F, Pacchiarotti I, Nivoli AMA, Murru A, Bonnin CM, Cruz N, Sanchez-Moreno J, Kotzalidis GD, Girardi P, Tatarelli R, Vieta E. Psychotic versus non-psychotic bipolar II disorder. J Affect Disord 2010; 126:55-60. [PMID: 20457470 DOI: 10.1016/j.jad.2010.03.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/30/2010] [Accepted: 03/31/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Psychotic symptoms in bipolar II disorder, allowed by definition only during a depressive episode, are present in a range between 3% and 45%. Little is known regarding the impact of psychotic symptoms on the clinical course of bipolar II patients. Findings from previous reports are controversial and focused specifically on bipolar I disorder. The aim of this study was to ascertain the clinical characteristics of individuals with bipolar II disorder with and without lifetime history of psychotic symptoms. METHODS The sample consisted of 164 DSM-IV Bipolar II patients consecutively recruited from the Barcelona Bipolar Disorder Program. Patients were divided in Bipolar II patients with (N=32) and without (N=132) lifetime history of psychotic symptoms. Clinical and sociodemographic features were compared. RESULTS Thirty-two out of 164 patients with bipolar II disorder had a history of psychosis during depression (19.5%). Bipolar II patients with a history of psychotic symptoms showed a higher number of hospitalizations than patients without such a history (p<0.001). They were also older but were less likely to have a family history of bipolar illness and any mental disorder than non-psychotic bipolar II patients. Melancholic and catatonic features were significantly more frequent in psychotic bipolar II patients (p<0.001). CONCLUSIONS Our findings confirm that the presence of psychotic symptoms in bipolar II disorder is not rare. Psychotic bipolar II disorder may be a different phenotype from non-psychotic bipolar disorder.
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Affiliation(s)
- Lorenzo Mazzarini
- Bipolar Disorders Programme, Institute of Clinical Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Ryu V, Jon DI, Cho HS, Kim SJ, Lee E, Kim EJ, Seok JH. Initial depressive episodes affect the risk of suicide attempts in Korean patients with bipolar disorder. Yonsei Med J 2010; 51:641-7. [PMID: 20635436 PMCID: PMC2908881 DOI: 10.3349/ymj.2010.51.5.641] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Suicide is a major concern for increasing mortality in bipolar patients, but risk factors for suicide in bipolar disorder remain complex, including Korean patients. Medical records of bipolar patients were retrospectively reviewed to detect significant clinical characteristics associated with suicide attempts. MATERIALS AND METHODS A total of 579 medical records were retrospectively reviewed. Bipolar patients were divided into two groups with the presence of a history of suicide attempts. We compared demographic characteristics and clinical features between the two groups using an analysis of covariance and chi-square tests. Finally, logistic regression was performed to evaluate significant risk factors associated with suicide attempts in bipolar disorder. RESULTS The prevalence of suicide attempt was 13.1% in our patient group. The presence of a depressive first episode was significantly different between attempters and nonattempters. Logistic regression analysis revealed that depressive first episodes and bipolar II disorder were significantly associated with suicide attempts in those patients. CONCLUSION Clinicians should consider the polarity of the first mood episode when evaluating suicide risk in bipolar patients. This study has some limitations as a retrospective study and further studies with a prospective design are needed to replicate and evaluate risk factors for suicide in patients with bipolar disorder.
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Affiliation(s)
- Vin Ryu
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyun Sang Cho
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Se Joo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Joo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Ho Seok
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
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Bakst S, Rabinowitz J, Bromet EJ. Antecedents and patterns of suicide behavior in first-admission psychosis. Schizophr Bull 2010; 36:880-9. [PMID: 19273582 PMCID: PMC2894600 DOI: 10.1093/schbul/sbp001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Persons with psychotic illnesses have an increased risk for suicide, especially early in the illness. Sufficient knowledge allowing for early recognition is lacking. OBJECTIVES To describe suicide behaviors before and during the 4 years following first psychiatric hospitalization, examine associations of demographic and psychiatric risk factors, and develop a suicide risk index. METHOD Data came from the Suffolk County Mental Health Project, a first-admission cohort (n = 529). Cox regression was used to study associations of risk factors to suicide behaviors; a summary suicide behavior risk index was also tested. RESULTS Prior to first admission, 28.0% (n = 148) of the cohort had attempted suicide. During the 4-year follow-up, 13.6% (n = 72) of the cohort attempted suicide (29.7% of those with previous attempts and 7.3% making their first attempt) and 3 respondents died of suicide. The significant predictors at index admission of subsequent attempts were prior attempts or ideation, severity of depressive symptoms and thought disorder, lifetime substance abuse, and younger age. Suicide ideation was predicted by the same variables with the addition of insight into illness and with the exception of age at admission. A 3-category risk index was created; 61.1% of those who made a suicide attempt were in the highest risk group (n = 44/72). CONCLUSION The current study confirms and extends previous research showing that risk factors early in the course of illness are predictive of subsequent ideation and attempts. The risk index may be a useful adjunct in identifying individuals likely to benefit from preventive interventions.
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Affiliation(s)
| | - Jonathan Rabinowitz
- Bar Ilan University, Ramat Gan, Israel,To whom correspondence should be addressed; Bar Ilan University, Ramat Gan, Israel, tel: 972 (9) 748-3679, fax: 972 (9) 740-1318, e-mail:
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Schennach-Wolff R, Jäger M, Seemüller F, Obermeier M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller HJ, Riedel M. Outcome of suicidal patients with schizophrenia: results from a naturalistic study. Acta Psychiatr Scand 2010; 121:359-70. [PMID: 19878135 DOI: 10.1111/j.1600-0447.2009.01484.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Purpose was to assess suicidality before and at the time of admission in patients with schizophrenia and compare outcome differences. METHOD Biweekly PANSS (Positive and Negative Syndrome Scale), HAMD (Hamilton Depression Rating Scale) and UKU (Udvalg for Klinske Undersogelser Side Effect Rating Scale) ratings were evaluated in 339 in-patients with schizophrenic spectrum disorders. Response was defined as an initial 20% PANSS total score reduction at discharge, remission was defined according to the proposed consensus criteria by the Remission in Schizophrenia Working Group. RESULTS Suicidal patients (22%) scored significantly higher on the PANSS negative subscore, PANSS insight item and HAMD total score at admission and at discharge. They developed significantly more side effects. No differences were found concerning response and remission between the two patient subgroups. CONCLUSION Despite receiving significantly more antidepressants the suicidal patients suffered from significantly more depressive symptoms up to discharge, yet without differing regarding response and remission.
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Affiliation(s)
- R Schennach-Wolff
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany.
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Xiang YT, Weng YZ, Leung CM, Tang WK, Chan SSM, Wang CY, Han B, Ungvari GS. Gender differences in sociodemographic and clinical characteristic and the quality of life of Chinese schizophrenia patients. Aust N Z J Psychiatry 2010; 44:450-5. [PMID: 20397787 DOI: 10.3109/00048670903489858] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the present study was to determine the sociodemographic and clinical correlates of the gender of Chinese schizophrenia outpatients and their impact on patients quality of life (QOL). METHODS Two hundred and fifty-five clinically stable schizophrenia outpatients were randomly selected in Hong Kong. Counterparts matched according to gender, age, age at onset, and length of illness were recruited in Beijing, China. All of the subjects at both sites were interviewed by the same investigator using standardized assessment instruments. RESULTS The combined Beijing-Hong Kong sample contained 251 male and 254 female patients. On univariate analysis more male patients were employed, they had a significantly higher monthly income, and took higher doses of antipsychotic drugs. No difference was found, however, in any of the QOL domains between the genders. On multivariate analysis being employed, taking a higher dose of antipsychotic drugs, having more severe extrapyramidal side-effects, and a higher score on the physical domain of QOL were independently associated with male gender. CONCLUSION Female gender is independently associated with lower scores on the physical aspects of QOL, but there is no difference between the genders in the psychological, social and environmental aspects.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Ground Floor, Multicentre Building, Tai Po Hospital, Tai Po, NT, Hong Kong.
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Magno LAV, Miranda DM, Neves FS, Pimenta GJ, Mello MP, De Marco LA, Correa H, Romano-Silva MA. Association between AKT1 but not AKTIP genetic variants and increased risk for suicidal behavior in bipolar patients. GENES BRAIN AND BEHAVIOR 2010; 9:411-8. [DOI: 10.1111/j.1601-183x.2010.00571.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ozyildirim I, Cakir S, Yazici O. Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder. Eur Psychiatry 2009; 25:47-51. [PMID: 19926262 DOI: 10.1016/j.eurpsy.2009.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 07/26/2009] [Accepted: 08/10/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE In this study, we aimed to compare the clinical features and response patterns to the long-term prophylaxis of bipolar patients with or without psychotic features. METHOD The life charts of patients with bipolar I disorder were evaluated. Two hundred and eighty-one patients who suffer with bipolar disorder for at least 4 years and who had at least three mood episodes were included to the study. The patients whose all episodes are psychotic (psychotic group) and the patients who never experienced psychotic episode (non-psychotic group) were assigned as comparison groups. The clinical features and the response to long-term prophylaxis were compared across the groups. RESULTS The psychotic group consists of 43 patients; non-psychotic group consists of 54 patients. The history of bipolar disorder among the first-degree relatives was remarkably more prevalent in non-psychotic group (p=0.032). The predominance of manic/hypomanic episodes was significantly higher in psychotic group than non-psychotic group; and the rate of depressive episodes were higher in non-psychotic group than psychotic group (p=0.013). Episodes were more severe (p<0.001) and hospitalization rates were higher (p=0.023) in psychotic group. The response to lithium monotherapy was better in non-psychotic group (p<0.001). CONCLUSION The well identified psychotic subtype of bipolar patients may give important predictions about long term course and prophylaxis of bipolar disorder.
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Affiliation(s)
- I Ozyildirim
- Department of Psychiatry, Unye State Hospital, 52300 Ordu, Turkey.
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Abreu LND, Lafer B, Baca-Garcia E, Oquendo MA. Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician. REVISTA BRASILEIRA DE PSIQUIATRIA 2009; 31:271-80. [DOI: 10.1590/s1516-44462009005000003] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 04/01/2009] [Indexed: 12/18/2022]
Abstract
OBJECTIVE: This article reviews the evidence for the major risk factors associated with suicidal behavior in bipolar disorder. METHOD: Review of the literature studies on bipolar disorder, suicidal behavior and suicidal ideation. RESULTS: Bipolar disorder is strongly associated with suicide ideation and suicide attempts. In clinical samples between 14-59% of the patients have suicide ideation and 25-56% present at least one suicide attempt during lifetime. Approximately 15% to 19% of patients with bipolar disorder die from suicide. The causes of suicidal behavior are multiple and complex. Some strong predictors of suicidal behavior have emerged in the literature such as current mood state, severity of depression, anxiety, aggressiveness, hostility, hopelessness, comorbidity with others Axis I and Axis II disorders, lifetime history of mixed states, and history of physical or sexual abuse. CONCLUSION: Bipolar disorder is the psychiatric condition associated with highest lifetime risk for suicide attempts and suicide completion. Thus it is important to clinicians to understand the major risk factors for suicidal behavior in order to choose better strategies to deal with this complex behavior.
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Chen WC, Chu H, Lu RB, Chou YH, Chen CH, Chang YC, O’Brien AP, Chou KR. Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia. J Clin Nurs 2009; 18:2187-96. [DOI: 10.1111/j.1365-2702.2008.02773.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Besnier N, Gavaudan G, Navez A, Adida M, Jollant F, Courtet P, Lançon C. Approche clinique du suicide au cours de la schizophrénie (I). Identification des facteurs de risque. Encephale 2009; 35:176-81. [DOI: 10.1016/j.encep.2008.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 02/25/2008] [Indexed: 11/28/2022]
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30
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Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS. Socio-demographic and clinical correlates of lifetime suicide attempts and their impact on quality of life in Chinese schizophrenia patients. J Psychiatr Res 2008; 42:495-502. [PMID: 17663994 DOI: 10.1016/j.jpsychires.2007.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 06/11/2007] [Accepted: 06/15/2007] [Indexed: 01/28/2023]
Abstract
This study determines the socio-demographic and clinical correlates of suicide attempts in Chinese schizophrenia outpatients and their impact on patients' quality of life (QOL). Two hundred and fifty-five clinically stable schizophrenia outpatients were randomly selected in Hong Kong (HK) and their counterparts matched according to sex, age, age at onset and length of illness were recruited in Beijing (BJ). All subjects at both sites were interviewed by the same investigator using standardized assessment instruments. Basic socio-demographic and clinical data and history of suicide attempts were collected. The lifetime prevalence of suicide attempts was 26.7% in the whole sample and 20% and 33.6% in the HK and BJ samples, respectively. Patients with a history of suicide attempts were less likely to receive depot antipsychotic (AP) medication, more likely to receive clozapine, benzodiazepines (BZD) and higher doses of APs; were younger at onset, had more hospitalizations; had more severe positive, depressive, anxiety and extrapyramidal (EPS) symptoms; were poorer QOL in the physical, psychological, social and environmental domains; and were more likely to be BJ residents. In multiple logistic regression analysis, early age at onset, poor physical QOL, use of clozapine and BZDs, and study site (HK vs BJ) were significant contributors to lifetime suicide attempts. Significant difference was found between matched samples in HK and BJ with respect to suicide attempts. HK is a cosmopolitan city with a Western social structure and mental health system, whereas in BJ more traditional Chinese cultural values predominate, with a mental health policy radically different from that of HK. These differences suggest that socio-cultural factors play a significant role in determining suicide attempts in schizophrenia.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
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31
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Chaudhury SR, Grunebaum MF, Galfalvy HC, Burke AK, Sher L, Parsey RV, Everett B, Mann JJ, Oquendo MA. Does first episode polarity predict risk for suicide attempt in bipolar disorder? J Affect Disord 2007; 104:245-50. [PMID: 17434597 PMCID: PMC2151386 DOI: 10.1016/j.jad.2007.02.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 02/28/2007] [Accepted: 02/28/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND Defining bipolar disorder (BD) subtypes with increased risk of suicidal behavior may help clinical management. We tested the hypothesis that the polarity of a patient's first mood episode would be a marker for BD subtypes with differential risk for suicidality. METHODS One hundred thirteen subjects with DSM-IV defined BD were classified based on whether their first reported episode was manic/hypomanic (FM) or depressed (FD). They were compared on demographic and clinical variables. Logistic regression adjusting for potential confounds tested the association between first episode polarity and history of suicide attempt. RESULTS Multiple logistic regression analysis showed that FD group membership was associated with eightfold odds of a past suicide attempt, adjusting for years ill and total number of lifetime major depressive episodes. LIMITATIONS Sample size, retrospective design, recall bias, assessment during a mood episode, and imprecise recall of hypomania. CONCLUSIONS Polarity of patients' first reported mood episode suggested a depression-prone subtype with a greater probability of past suicide attempt. The FM group had more alcoholism and psychosis, but less likelihood of past suicide attempt. Validation of these putative subtypes requires prospective study.
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Affiliation(s)
- Sadia R Chaudhury
- Department of Neuroscience, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Box 42, New York, NY 10032, United States
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Bolton C, Gooding P, Kapur N, Barrowclough C, Tarrier N. Developing psychological perspectives of suicidal behaviour and risk in people with a diagnosis of schizophrenia: We know they kill themselves but do we understand why? Clin Psychol Rev 2007; 27:511-36. [PMID: 17229508 DOI: 10.1016/j.cpr.2006.12.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
People with a diagnosis of schizophrenia are at increased risk of suicidal behaviour yet little is understood of the psychological underpinnings of this vulnerability. The biopsychosocial 'Cry of Pain' model [Williams, J.M.G. (1997). Cry of pain. Harmondsworth: Penguin.] provides a broad framework from which to understand suicidal behaviour. However, the utility of the model in relation to suicide in schizophrenia has not yet been explored. This was the primary goal of this paper. Six components of the 'Cry of Pain' model were identified and evaluated with respect to whether they contributed to i. common transdiagnostic factors underlying suicide, ii. factors relating to co-morbid depression which account for suicidal behaviour, or iii. factors which are specific to schizophrenia and underlie suicide risk. The potential for applying the model to clinical management of suicide in schizophrenia is illustrated.
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Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K, Krausz M, Lester D, Meltzer HY, Modestin J, Montross LP, Bo Mortensen P, Munk-Jørgensen P, Nielsen J, Nordentoft M, Saarinen PI, Zisook S, Wilson ST, Tatarelli R. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry 2007; 6:10. [PMID: 17367524 PMCID: PMC1845151 DOI: 10.1186/1744-859x-6-10] [Citation(s) in RCA: 210] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Accepted: 03/16/2007] [Indexed: 12/18/2022] Open
Abstract
Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5-13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the result of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophrenia patients.
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Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
- McLean Hospital – Harvard Medical School, USA
| | - Xavier F Amador
- Department of Psychiatry, Columbia University, New York, USA
| | - Paolo Girardi
- Department of Psychiatry, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
| | | | - Martin Harrow
- Department of Psychology, University of Illinois College of Medicine, Chicago, USA
| | - Kalman Kaplan
- Department of Psychology, University of Illinois College of Medicine, Chicago, USA
| | - Michael Krausz
- Psychiatric Clinic, University Hospital Eppendorf, Hamburg, Germany
| | | | - Herbert Y Meltzer
- Department of Psychiatry Vanderbilt University School of Medicine, USA
| | - Jiri Modestin
- Deptartment of Psychiatry (Burghölzli Hospital), University of Zurich, Switzerland
| | - Lori P Montross
- Department of Psychiatry, Division of Geriatric Psychiatry, University of California San Diego, USA
| | - Preben Bo Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Povl Munk-Jørgensen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Jimmi Nielsen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Merete Nordentoft
- Department of Psychiatry Copenhagen University, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Sidney Zisook
- Department of Psychiatry, Division of Geriatric Psychiatry, University of California San Diego, USA
| | - Scott T Wilson
- Department of Psychiatry, Columbia University, New York, USA
| | - Roberto Tatarelli
- Department of Psychiatry, Sant'Andrea Hospital, "Sapienza" University of Rome, Italy
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Olgiati P, Serretti A, Colombo C. Retrospective analysis of psychomotor agitation, hypomanic symptoms, and suicidal ideation in unipolar depression. Depress Anxiety 2007; 23:389-97. [PMID: 16823857 DOI: 10.1002/da.20191] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In bipolar depression, psychomotor agitation is relatively common and often is associated with other noneuphoric hypomanic symptoms and suicidal ideation. Our goal in this retrospective study was to ascertain the co-occurrence of agitation, bipolar features, and suicidal ideation in unipolar disorder. We retrospectively evaluated 314 inpatients with DSM-IV major depressive disorder (MDD) and no other Axis I diagnosis with the National Institutes of Mental Health (NIMH) Life Chart Method and the Operational Criteria for Psychotic Illness (OPCRIT) checklist to ascertain their symptom profiles across all episodes. Univariate and multivariate comparisons were performed between the subgroups with and without psychomotor agitation (OPCRIT item 23> or =1). Agitated depression (AD, a major depressive episode with psychomotor agitation) was present in 19% of the sample. Compared to nonagitated counterparts, patients with AD were older and had lower educational levels and more dysphoria, insomnia, positive thought disorder, and psychotic manifestations. Hypomanic symptoms other than agitation were relatively uncommon (<10%) and more represented in subjects with AD. No significant differences emerged between AD and control groups with respect to most bipolar validators (gender, familiarity, recurrence). Patients with AD had higher levels of suicidal ideation than non-AD controls; however, such a difference was no longer significant after controlling for psychotic features. Excessive self-reproach, early awakening, diurnal changes, poor appetite, and hypomanic symptoms were independently associated with suicidal thoughts in nonpsychotic MDD. Incomplete information on drug treatment, exclusion of patients with Axis I comorbidity, and tertiary care setting were the most important limitations of the study. Although we failed to support the bipolar nature of MDD-AD by common validators, probably because we used a more heterogeneous definition of agitation compared to similar studies, our data confirm the association of agitation with hypomanic symptoms and suicidal thoughts in major depression, and emphasize the complex phenomenology of AD in an inpatient setting.
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Affiliation(s)
- Paolo Olgiati
- Institute of Psychiatry, University of Bologna, Bologna, Italy
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35
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Ran MS, Xiang MZ, Li J, Huang J, Chen EYH, Chan CLW, Conwell Y. Correlates of lifetime suicide attempts among individuals with affective disorders in a Chinese rural community. Arch Suicide Res 2007; 11:119-27. [PMID: 17178647 DOI: 10.1080/13811110600993090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to compare the demographic and clinical characteristics of individuals with affective disorders who had attempted suicide at some time in their lives and those who had not made a suicide attempt. In a Chinese rural community, individuals with suicide attempt (N = 30) and those without suicide attempt (N = 166) were assessed with Present State Examination (PSE). Attempters had a significantly higher level of family economic status, higher rate of lifetime depressed mood and hopelessness, and delusions than nonattempters. The logistic regression models also indicated that depressed mood and hopelessness were the most important predictors of suicide attempts. No significant difference in treatment condition was found between attempters and non-attempters. Early identification and interventions focusing on reducing depressed mood, hopelessness, and controlling psychotic symptoms may be helpful in reducing the risk of suicide attempts among individuals with affective disorders residing in the community.
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Abstract
PURPOSE OF REVIEW The aim of this review is to highlight the traditional and newly recognized suicide risk factors in patients with mood disorders. RECENT FINDINGS Current research findings clearly suggest that suicidal behaviour in patients with mood disorder is a 'state-dependent' phenomenon. Recently, there is, however, a growing body of evidence that besides the well accepted clinically explorable suicide risk factors in mood disorders (e.g., severe depression, prior suicide attempt, comorbid anxiety, substance use, personality disorders and so on), mixed state of depression could also be an important precursor of suicidal behaviour. This might be particularly true in unrecognized cases of bipolar depressives, when antidepressant monotherapy (unprotected by mood stabilizers or atypical antipsychotics) can worsen the clinical picture and rarely induce an aggressive or self-destructive behaviour. SUMMARY In the majority of patients with mood disorders, suicidal behaviour is predictable and preventable, with a good chance. A careful and systematic exploration of suicide risk factors in patients with mood disorder helps clinicians to identify patients at high suicide risk. A successful, acute and long-term treatment of these patients substantially reduces the suicidal behaviour even in this high-risk population.
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Affiliation(s)
- Zoltán Rihmer
- National Institute for Psychiatry and Neurology and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary.
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37
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Grunebaum MF, Ramsay SR, Galfalvy HC, Ellis SP, Burke AK, Sher L, Printz DJ, Kahn DA, Mann JJ, Oquendo MA. Correlates of suicide attempt history in bipolar disorder: a stress-diathesis perspective. Bipolar Disord 2006; 8:551-7. [PMID: 17042828 DOI: 10.1111/j.1399-5618.2006.00304.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Distinguishing clinical characteristics of bipolar patients who have made a suicide attempt may help to identify at-risk individuals. We sought to identify such factors and to consider them within a stress-diathesis model of suicidal behavior. METHODS Patients with bipolar disorder (N = 96) were compared with respect to the presence or absence at baseline evaluation of a history of suicide attempt. We used multiple logistic regression analysis to assess the unique associations of independent variables to history of a past suicide attempt. RESULTS The regression analysis showed that a history of suicide attempt in bipolar disorder was associated with greater recent suicidal ideation, more psychiatric hospitalizations, lifetime aggressive traits and an earlier age at onset of a first mood episode. CONCLUSIONS Aggressive traits and early treatment of mood disorders, especially major depressive episodes, are potential targets for suicide prevention in bipolar disorder.
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Affiliation(s)
- Michael F Grunebaum
- Department of Neuroscience, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA.
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Fialko L, Freeman D, Bebbington PE, Kuipers E, Garety PA, Dunn G, Fowler D. Understanding suicidal ideation in psychosis: findings from the Psychological Prevention of Relapse in Psychosis (PRP) trial. Acta Psychiatr Scand 2006; 114:177-86. [PMID: 16889588 DOI: 10.1111/j.1600-0447.2006.00849.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the clinically important phenomenon of suicidal ideation in psychosis in relation to affective processes and the multidimensional nature of hallucinations and delusions. METHOD In a cross-sectional study of 290 individuals with psychosis, the associations between level of suicidal ideation, affective processes, positive symptoms, clinical and demographic variables were examined. RESULTS Forty-one per cent of participants expressed current suicidal ideation. Suicidal ideation was associated with depressed mood, anxiety, low self-esteem, negative illness perceptions, negative evaluative beliefs about the self and others and daily alcohol consumption. Frequency of auditory hallucinations and preoccupation with delusions were not associated with suicidal ideation; however, positive symptom distress did relate to suicidal thoughts. CONCLUSION Affective dysfunction, including distress in response to hallucinations and delusions, was a key factor associated with suicidal ideation in individuals with psychotic relapse. Suicidal ideation in psychosis appears to be an understandable, mood-driven process, rather than being of irrational or 'psychotic' origin.
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Affiliation(s)
- L Fialko
- Department of Psychology, Institute of Psychiatry, King's College London, University of London, London, UK.
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Bhatia T, Thomas P, Semwal P, Thelma B, Nimgaonkar V, Deshpande SN. Differing correlates for suicide attempts among patients with schizophrenia or schizoaffective disorder in India and USA. Schizophr Res 2006; 86:208-14. [PMID: 16781121 PMCID: PMC5487368 DOI: 10.1016/j.schres.2006.04.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 04/18/2006] [Accepted: 04/21/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Suicide is one of the most common causes of death among persons with schizophrenia. Differing risk factors have been identified in published studies. The differences may have arisen because a uniform set of variables was not analyzed. Alternatively, the nature and effect of risk factors may vary in different settings. To test these possibilities, we investigated the same set of variables in two independent cross-national samples ascertained using identical protocols. METHODS Patients with schizophrenia or schizoaffective disorder (DSM IV criteria) were recruited in India (n=460) and the USA (n=424). RESULTS Consistent with earlier publications, a diagnosis of schizoaffective disorder, history of depression, pattern of symptoms and educational status were significantly associated with suicide attempts in the US sample. None of these variables were significantly associated in the Indian sample. CONCLUSIONS The impact of known risk factors for suicide attempts among patients with schizophrenia differs across ethnic groups.
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Affiliation(s)
- Triptish Bhatia
- Indo-US Projects on Schizophrenia Genetics, Department of Psychiatry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Pramod Thomas
- Indo-US Projects on Schizophrenia Genetics, Department of Psychiatry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Prachi Semwal
- Indo-US Projects on Schizophrenia Genetics, Department of Psychiatry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - B.K. Thelma
- Department of Genetics, Delhi University South Campus, New Delhi, India
| | - V.L. Nimgaonkar
- Departments of Psychiatry and Human Genetics, University of Pittsburgh, School of Medicine and Graduate School of Public Health, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, Pennsylvania 15213, USA
- Corresponding author. Tel.: +1 412 246 6353; fax: +1 412 246 6350. (V.L. Nimgaonkar)
| | - Smita N. Deshpande
- Department of Psychiatry, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Abstract
There is a high prevalence of suicidal behavior in individuals suffering from schizophrenia and recent investigations substantially elucidate this problem and provide useful insights about clinical risk factors, neurobiologic underpinnings and the impact of various treatments on reducing such behavior. The risk of suicide is greatest early in the course of schizophrenic illness but continues throughout life; risk factors for suicidal behavior include psychosis, depression and substance abuse. Effectively treating positive symptoms and depression, reducing substance abuse, avoiding akathisia, addressing demoralization and instilling hope are important elements in this treatment approach. The newer generation of atypical antipsychotics (particularly clozapine) and new psychologic approaches (particularly cognitive behavioral therapy) appear to be useful in reducing suicidality in schizophrenia. The significant advances in defining the neurobiologic basis of suicidality may enable the development of more effective treatments. The renewed emphasis on resilience and recovery as desired outcomes in schizophrenia and the accompanying sense of hope encourage optimism about effectively reducing suicidality in schizophrenia. Over the past 10 years, much has been learnt and hopefully this momentum will be translated into increasingly better outcomes.
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Affiliation(s)
- Rajiv Tandon
- Department of Children and Families, Office of Mental Health, State of Florida, USA.
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41
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Gavaudan G, Besnier N, Lançon C. Suicide et schizophrénie : évaluation du risque et prévention. ANNALES MEDICO-PSYCHOLOGIQUES 2006. [DOI: 10.1016/j.amp.2005.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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42
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Ran MS, Xiang MZ, Mao WJ, Hou ZJ, Tang MN, Chen EYH, Chan CLW, Yip PSF, Conwell Y. Characteristics of suicide attempters and nonattempters with schizophrenia in a rural community. Suicide Life Threat Behav 2005; 35:694-701. [PMID: 16552985 DOI: 10.1521/suli.2005.35.6.694] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this study, demographic and clinical characteristics of individuals with schizophrenia in a Chinese rural community who had attempted suicide at some time in their lives and those who had not made a suicide attempt were compared. Among individuals with schizophrenia, subjects with (n = 38) and without (n = 472) a lifetime history of suicide attempt were assessed with the Present State Examination. The results indicate that attempters had a significantly younger age, higher level of education, higher rate of lifetime depressed mood and hopelessness, and a larger number of positive symptoms than patients without suicide attempts. The logistic regression models also indicated that hopelessness, the number of positive symptoms and age were the most important predictors. Early interventions focusing on reducing hopelessness and controlling positive symptoms may help reduce the risk of suicide attempts among patients with schizophrenia.
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Affiliation(s)
- Mao-Sheng Ran
- College of Professional Studies, University of Guam, Mangilao, Guam 96923.
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Niehaus DJH, Laurent C, Jordaan E, Koen L, Oosthuizen P, Keyter N, Muller JE, Mbanga NI, Deleuze JF, Mallet J, Stein DJ, Emsley R. Suicide attempts in an African schizophrenia population: an assessment of demographic risk factors. Suicide Life Threat Behav 2005; 34:320-7. [PMID: 15385186 DOI: 10.1521/suli.34.3.320.42778] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study investigated demographic variables, including affected sibling pair status, as risk factors for suicidal behavior in schizophrenia patients of African (Xhosa) descent. Xhosa subjects with schizophrenia were interviewed with the Diagnostic Interview for Genetic Studies (DIGS) and then stratified into two groups: those with ( n = 90) and those without ( n = 364) a history of previous suicide attempts. Demographic parameters (including gender, age, and social circumstances, sib ship) were then compared across these groups. Demographic predictors of suicide included sib ship status ( p = 0.038; OR = 1.7) and age of onset of illness ( p = 0.008; OR = 2.5). On further analysis of suicide in siblings, only a minority of sib pairs was found to be concordant for a lifetime history of suicide attempts (3%). These findings raise the possibility that affected sib pair status may be protective in nature. Given the counter-intuitive nature of this finding, further work is needed to replicate it, and to explore possible underlying mechanisms.
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Affiliation(s)
- D J H Niehaus
- Department of Psychiatry, PO Box 19090, University of Stellenbosch, Tygerberg 7505, South Africa.
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Abstract
Suicide is a leading cause of death, but it is not well understood or well researched. Our purpose in this review is to summarize extant knowledge on neurobiological and psychological factors involved in suicide, with specific goals of identifying areas particularly in need of future research and of articulating an initial agenda that may guide future research. We conclude that from both neurobiological and psychological perspectives, extant research findings converge on the view that two general categories of risk for suicide can be identified: (a) dysregulated impulse control; and (b) propensity to intense psychological pain (e.g., social isolation, hopelessness), often in the context of mental disorders, especially mood disorders. Each of these categories of risk is underlain at least to some degree by specific genetic and neurobiological factors; these factors in general are not well characterized, though there is emerging consensus that most if not all reside in or affect the serotonergic system. We encourage future theorizing that is conceptually precise, as well as epistemically broad, about the specific preconditions of serious suicidal behavior, explaining the daunting array of suicide-related facts from the molecular to the cultural level.
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Affiliation(s)
- Thomas E Joiner
- Psychology Department, Florida State University, Tallahassee, FL 32306-1270, USA.
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45
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Haw C, Hawton K, Sutton L, Sinclair J, Deeks J. Schizophrenia and deliberate self-harm: a systematic review of risk factors. Suicide Life Threat Behav 2005; 35:50-62. [PMID: 15843323 DOI: 10.1521/suli.35.1.50.59260] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Deliberate self-harm (DSH) is a strong predictor of suicide in schizophrenia. The aim of this review was to identify risk factors for DSH in schizophrenia. This systematic review of the international literature examined cohort and case-control studies of patients with schizophrenia or related diagnoses that reported DSH as an outcome. Studies were identified by searching electronic databases and reference lists, and by consulting international experts. Fourteen studies met the eligibility criteria. Of the 29 variables examined by two or more studies, five (past or recent suicidal ideation, previous DSH, past depressive episode, drug abuse or dependence, and higher mean number of psychiatric admissions) were associated with an increased risk of DSH, and one (unemployment) was associated with a reduced risk. Schizophrenic patients with these risk factors need careful follow-up and monitoring, with treatment of any associated comorbid depression or drug abuse. Large, prospective studies of DSH in schizophrenia are needed to further define risk factors and to build on the findings of this review.
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46
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Abstract
Literature on the assessment of suicide risk in individuals with schizophrenia is summarized, including the risk factors shared in common with the general population, illness-specific risk factors, and times of heightened risk in the course of the illness. Because depression emerges as a significant risk factor, it is differentiated from conditions that can mimic depression: mourning, aprosodia, and negative symptoms. Because insight or awareness of illness carries risk, as does the lack of insight, the psychological and neurocognitive components of impaired and of accurate insight are described. Finally, the role of mourning in the attainment of accurate, usable insight that can reduce suicidal risk is described.
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Affiliation(s)
- Lisa Lewis
- Menninger Department of Psychiatry at Baylor College of Medicine, The Menninger Clinic, Houston, Texas, USA.
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47
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Abstract
The relationship between violence directed at the self and violence directed at others has intrigued psychiatrists for several decades. The goal of this study was to examine the relationship between suicide and violence against others in patients with major psychiatric disorders and to compare psychiatric symptoms associated with suicide in violent and non-violent patients. Subjects included physically assaultive psychiatric inpatients and a nonviolent comparison group. Physical and verbal assaults were recorded prospectively for 4 weeks. History of suicide attempts was obtained through chart review and patient interviews. The Brief Psychiatric Rating Scale was administered at the end of the 4 weeks by raters who were blind to both suicidal and violent behavior. The suicide attempters did not differ from the non-attempters on any measure of violent behavior or hostility. Suicide attempts were not accompanied by different symptoms in violent and non-violent patients; however, violence and suicide attempts were accompanied by dissimilar psychiatric symptoms. The physically assaultive patients presented with more severe positive psychotic symptoms than the non-assaultive patients. The suicide attempters, on the other hand, did not differ from non-attempters on psychotic symptoms, but presented with more severe depression and anxiety. The relationship between these symptoms and suicide attempts was noteworthy in its temporal stability, as most of the patients had attempted suicide many years prior to this study.
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Affiliation(s)
- Menahem Krakowski
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
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48
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Abstract
The concept of lethality is essential to the assessment of suicide risk; yet operational definitions of lethality for purposes of its measurement have been loose and varied. A number of scaling measures have been published in the literature, with no relative consensus on the best of these. In addition, only a few of these scales have published data on their psychometric properties. Of these, we argue that the best is the Lethality of Suicide Attempt Rating Scale (LSARS; Smith, Conroy, & Ehler, 1984). Presented here is a significantly revised and redesigned listing of drugs and chemicals and lethal ranges of ingestion (in caps, tabs, or ounces) by body weight to update that scale.
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Affiliation(s)
- Alan L Berman
- American Association of Suicidology, Washington, DC 20008, USA.
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49
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Keck PE, McElroy SL, Havens JR, Altshuler LL, Nolen WA, Frye MA, Suppes T, Denicoff KD, Kupka R, Leverich GS, Rush AJ, Post RM. Psychosis in bipolar disorder: phenomenology and impact on morbidity and course of illness. Compr Psychiatry 2003; 44:263-9. [PMID: 12923703 DOI: 10.1016/s0010-440x(03)00089-0] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although psychosis is common in bipolar disorder, few studies have examined the prognostic significance of psychotic features. In addition, some studies suggest that the presence of mood-incongruent psychosis, in particular, is associated with poorer outcome compared with mood-congruent psychosis. We assesses the phenomenology and prevalence of mood-congruent and mood-incongruent psychotic symptoms in 352 patients with bipolar I disorder participating in the Stanley Foundation Bipolar Treatment Network. We compared the demographic and clinical features, and measures of psychosocial and vocational functioning in patients with and without a history of psychosis. The phenomenology of psychosis in this cohort of patients with bipolar disorder was similar to that reported in earlier studies and supported the lack of diagnostic specificity of any one type of psychotic symptom. There were no significant differences between patients with and without a history of psychosis on any demographic, psychosocial, vocational, or course of illness variables. Only family history of bipolar disorder was significantly more common in patients with nonpsychotic bipolar disorder compared to patients with a history of psychosis. Among bipolar patients with a history of psychosis, only the proportion of women and lifetime prevalence rates of anxiety disorders occurred significantly more in patients with mood-incongruent delusions. In this large cohort of outpatients with bipolar I disorder, neither a history of psychosis nor of mood-incongruent psychosis had prognostic significance at entry into the Network. The lack of observable prognostic impact may have been, in part, due to the relatively high morbidity and poor functional outcome of a substantial portion of the total cohort.
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Affiliation(s)
- Paul E Keck
- Department of Psychiatry, University of Cincinnati College of Medicine, OH 45267-0559, USA
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50
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Altamura AC, Bassetti R, Bignotti S, Pioli R, Mundo E. Clinical variables related to suicide attempts in schizophrenic patients: a retrospective study. Schizophr Res 2003; 60:47-55. [PMID: 12505137 DOI: 10.1016/s0920-9964(02)00164-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this study, we investigated the possible association between clinical or pharmacological variables and suicidal behavior in a sample of chronic schizophrenia or schizoaffective disorder patients. One hundred and three patients with a DSM-III-R diagnosis of chronic schizophrenia or schizoaffective disorder were studied. The sample was subdivided in two subsamples according to the presence/absence of suicidal attempts lifetime. The main demographic and clinical variables retrospectively collected were analyzed and compared between the two groups. Attempters had a significantly higher rate of nicotine abuse or dependence (chi-square=3.900, df=1, p<0.05, Odds Ratio (O.R.)=3.4), were more likely to have or have had lifetime major depressive episodes (chi-square=10.258, df=1, p<0.002, O.R.=6.5), were more likely to have a duration of untreated psychosis (DUP) > or =1 year (chi-square=6.228, df=1, p<0.02, O.R.=12.5), and were more frequently prescribed typical antipsychotics (chi-square=3.979, df=1, p<0.05, O.R.=6.5) than patients without suicidal attempts lifetime. Further investigations on larger samples and with prospective designs are warranted, particularly with respect to the role of early intervention and atypical antipsychotic treatment in reducing suicide risk in schizophrenic patients.
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Affiliation(s)
- A C Altamura
- Department of Psychiatry, University of Milan, School of Medicine, Milan, Italy
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