Suicidality in first episode psychosis

Abstract

Many studies have confirmed that the risk of suicide is high in the period after first presentation. There is relatively little information about the risk of suicide using illness onset as the starting point. We assessed suicidality in a cohort of 166 individuals from an urban catchment area during the period of untreated psychosis and at 4 year follow up. Nearly 10% of individuals attempted suicide prior to presentation. Four years later 18% had made a suicide attempt and 3% completed suicide. Suicide attempts prior to presentation were associated with a longer duration of untreated psychosis.

Introduction

Much of the research on suicidality in psychosis has focused on schizophrenia and fewer studies have systematically examined suicidal behaviour across a broad spectrum of patients with psychotic disorders (Radomsky et al., 1999). Studies involving mainly individuals with schizophrenia, have shown that the risk for suicide is influenced by the stage of the illness. Risk is consistently highest during the early phases of the illness, with two thirds of suicides occurring during the first 5 years after diagnosis (Harris and Barraclough, 1997, Copas and Robin, 1982). In examining the early stages of the illness, most studies have focused on suicidal behaviour from the time of presentation rather than the actual onset of illness. In this first episode psychosis study we explore whether variables associated with suicidal behaviour are influenced by stage of illness. We examine risk factors for suicidality at two separate time periods; during the period of untreated psychosis and after first presentation over a 4 year follow up. Furthermore, given the interest in early intervention in psychosis, we specifically ask whether suicidal behaviour is associated with duration of untreated psychosis (DUP).