Children and adolescents with a first episode of psychosis should be monitored closely for suicidal behavior, say researchers who found that more than 12% of such patients attempted suicide over a 24-month period.
The most significant predictor for suicidal behavior was a history of attempts before the onset of psychosis, followed by depressive symptoms, say Vanessa Sanchez-Gistau (Hospital Clinic Universitari, Barcelona, Spain) and colleagues.
"These findings should encourage physicians to systematically check for the above-mentioned factors associated with suicide attempts in order to detect and treat individuals at high risk of suicide as early as possible and to monitor them closely during follow up," they write in the Journal of Clinical Psychiatry.
The team studied 110 young people, aged between 9 and 17 years at baseline, who had experienced a first episode of psychosis.
All of the participants were assessed at baseline and during 24 months of follow up using the Clinical Global Impression for Severity of Suicidality (CGI-SS) and the Hamilton Depression Rating Scale (HDRS). At baseline, the participants were divided into nonsuicidal, low-risk, and high-risk groups based on scores from these scales.
Overall, 12.4% of the participants attempted suicide during the follow-up period. Of these, around half had also made suicide attempts before the onset of psychosis.
Analysis showed that a history of suicide attempts prior to psychosis onset, severe depressive symptoms, and antidepressant treatment were significantly associated with being classified as at high risk for suicide at baseline, at odds ratios (ORs) of 20.13, 8.78, and 15.56, respectively.
Furthermore, a high suicidal risk classification at baseline significantly predicted suicide attempts during follow up, at an OR of 81.66.
The researchers note that neither the severity of psychotic symptoms nor affective or nonaffective psychosis subtypes were associated with suicidality.
"The 24-month rate of suicide attempters in our sample was 12.4%, a figure in the highest range of the rates reported in adult first-episode psychosis samples with the same follow-up period," comment Sanchez-Gistau et al.
They conclude: "Suicide is a major concern in early-onset first-episode psychosis. Suicidal behavior and depressive symptoms at psychosis onset are important signs to be aware of to prevent suicide attempts during the early period after first-episode psychosis."
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