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The dynamic relationship between insight and suicidal behavior in first episode psychosis patients over 3-year follow-up

Abstract: Studies have established the high risk of suicide in first episode psychosis (FEP). Between 15% and 26% of FEP patients attempt suicide at least once before their first contact with psychiatric services and 2-5% die from suicide. Also, many patients with schizophrenia spectrum disorders lack insight into having a mental disorder. However, the relationship between insight changes and suicidal behavior in FEP remains poorly understood. In the present study information about suicidal behavior over a 3 years period was available on a cohort of 397 FEP patients, of whom 270 were assessed in the three dimensions of insight (into mental illness, the need for treatment, and the social consequences) at baseline, 1 and 3 years after treatment initiation. Survival analyses examined time to suicidal behavior in relation to (i) insight at baseline, (ii) the closest insight measure to the suicide attempt, and (iii) changes in insight during the follow-up. No associations were found between baseline insight dimensions and time to suicidal behavior. However, poor insight at the evaluation closest to the suicide attempt was associated with an increased risk of suicide. Stability of insight did not affect the risk of suicidal behavior, while changes in either direction were linked with an increased risk of suicidal behavior, particularly worsening insight. Insight in psychosis is a dynamic concept and we demonstrated the relationship between insight and suicide risk to be equally dynamic. Poor insight seems to increase the risk, especially when insight levels change. Repeated insight assessment to detect change from early psychosis may play a role in suicide prevention.

 Fuente: Eur Neuropsychopharmacol. 2018 Oct;28(10):1161-1172.

Editorial: Elsevier

 Año de publicación: 2018

Nº de páginas: 12

Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.euroneuro.2018.05.005

ISSN: 0924-977X,1873-7862

Url de la publicación: https://doi.org/10.1016/j.euroneuro.2018.05.005

Autores/as

MARIA ROSA AYESA ARRIOLA

PELAYO TERÁN, JOSE MARÍA

LÓPEZ MORÍÑIGO, JAVIER DAVID

CANAL RIVERO, MANUEL

Mª ESTHER SETIEN SUERO

AL-HALABI, SUSANA

CUESTA, MANUEL J.

DAVID, ANTHONY S.