Objective: There is emerging evidence that greater cognition is associated with increased risk for suicide among individuals with psychosis. Given this association, concerns have been raised that cognitive interventions might actually increase risk for suicide in this population. Therefore, the present study investigated the cross-sectional and longitudinal relationship between cognition and suicide risk among individuals with first-episode psychosis. Method: Sixty-five participants completed measures of suicide risk, depression, and cognition at baseline and 6 months. Within-subject mediation analysis was used to examine the indirect effect of cognition on suicide risk. Within-subject moderation analysis was used to examine whether participation in cognitive enhancing intervention (e.g., computerized drill-and-practice cognitive remediation and metacognitive remediation therapy) moderated changes in suicide risk. Results: Consistent with prior studies, our cross-sectional results suggest that greater cognition is associated with increased risk for suicide. However, this effect was limited in scope, as we found that verbal learning was the only cognitive domain associated with suicide risk in our sample. Results from our longitudinal analyses show that changes in depressive symptoms, but not changes verbal learning, mediate changes in suicide risk during the first 6 months of treatment. In addition, participation in cognitive enhancing interventions did not moderate changes in suicide risk. Conclusions and Implications for Practice: Our results suggest that cognition is a correlate, or a proxy risk factor, rather than a causal risk factor for suicide. Although these findings contradict previously raised concerns that cognitive interventions might unintentionally increase risk for suicide, ongoing assessment is warranted and additional research is needed. Impact and ImplicationsThe present study showed that better verbal learning was associated with suicide risk at baseline, though changes in verbal learning did not lead to changes in suicide risk during the first 6 months of treatment. In addition, treatments that improve cognition did not increase suicide risk. These findings indicate that cognition does not have a causal impact on suicide risk. These findings also alleviate previously raised concerns that cognitive enhancing treatments might inadvertently increase suicide risk. Overall, our findings support the continued use of cognitive enhancing interventions to assist patients in reaching their personal recovery goals.

Individuals with first-episode psychosis (FEP) are at elevated risk for suicide. The current study explored the applicability of the Interpersonal-Psychological Theory of Suicide (IPTS) as a model for understanding suicide in FEP. Thirty-nine individuals with FEP completed measures of thwarted belongingness, perceived burdensomeness, acquired capability for suicide, and suicidal ideation. Results indicate that participants with recent suicidal ideation have greater levels of perceived burdensomeness and thwarted belongingness than those without recent suicidal ideation. In contrast, the interaction of IPTS variables did not predict the severity of suicidal ideation across the entire sample. These findings suggest that burdensomeness and belongingness differentiate between individuals with and without suicidal ideation, although these constructs might be less useful in predicting the severity of suicidal ideation among individuals with psychosis. Further research is needed to understand both transdiagnostic and unique risk factors that contribute to the high rates of suicide in this population.

IntroductionIn October 2018, the Substance Abuse and Mental Health Services Administration funded 21 sites throughout the USA to develop, implement and evaluate specialised care programmes for individuals at clinical high risk for developing a psychotic disorder (CHR-P). Per the funding requirements, such programmes were required to provide ‘step-based care’—a model in which individuals are initially provided with low-intensity, non-psychosis-specific and more benign (ie, least side effects) interventions and only progress onto higher-intensity, psychosis-specific interventions with a greater risk of more severe side effects should they not meet a priori criteria for clinical response to such lower-intensity interventions. Here, we outline the evaluation component of the step-based care programme for individuals at CHR-P at The Ohio State University Early Psychosis Intervention Center (EPICENTER).Methods and analysesThe EPICENTER CHR-P programme provides a step-based care model comprising psychotherapy, medication management, family support/education, peer support and vocational/educational support. All participants who opt to receive care at the EPICENTER will complete a standardised assessment battery as part of usual care. This battery will be administered on enrolment and will be re-administered at 6-month intervals throughout individuals’ participation in EPICENTER clinical services. Participants will have the opportunity to allow for data from these usual care assessments to be used as part of an evaluation project for this new clinical service. The primary outcome for this evaluation project is time to remission of symptomatic and functional deficits commonly experienced by individuals at CHR-P. Participants will also have the opportunity to participate in a supplemental research project designed to further evaluate treatment outcomes and patient characteristics among individuals participating in EPICENTER clinical services.Ethics and disseminationThis project was approved by The Ohio State University Institutional Review Board. Results from this project will be disseminated through publications and presentations.Trial registration numberNCT03970005.

Aim: Although suicidal ideation may decrease over the course of participation in specialized clinical programmes for first-episode psychosis (FEP), it is unclear whether such improvements exceed those that occur during treatment as usual. Clarifying the mechanisms underlying reductions in suicidal ideation and behaviour among individuals with first-episode psychosis may highlight important strategies through which specialized clinical programmes can increase the potency of their services to reduce suicidality among this high-risk population. Thus, the goal of this study is to evaluate the longitudinal relationships between suicidality and social problem-solving skills among individuals with FEP participating in Coordinated Specialty Care.Methods: Within-subject mediational and moderational models were applied to explore the interrelationships and longitudinal course of suicidality, social problemsolving and duration of untreated psychosis (DUP).Results: Over the first 6 months of care, individuals with FEP experienced improvements in social problem-solving skills that were found to mediate concurrent reductions in suicidality. Although longitudinal changes in social problem-solving skills were moderated by DUP, these results should be interpreted cautiously as they may stem in part from a relatively limited number of participants with longer durations of illness.Conclusions: Improvements in social problem-solving skills during participation in CSC may facilitate reductions in suicidality. Treatments targeting suicidality among individuals with FEP may thus benefit from working to enhance social problemsolving skills among these individuals. Further research is needed to clarify if and how DUP may influence the magnitude of change in social problem-solving skills during participation in CSC.

Aim Metacognitive remediation therapy (MCR) has been shown to help individuals with first‐episode psychosis experience improvements in cognition, social functioning, vocational/educational functioning and quality of life. The theoretical model underlying MCR has yet to be empirically validated. Methods Seventy‐three individuals with first‐episode psychosis completed measures of metacognition and cognition at enrollment and after 6‐months of care at a specialized clinical program for individuals with first‐episode psychosis. Among this group, we compared changes in these variables between the 21 individuals who opted to participate in MCR and the 52 individuals who did not participate in MCR. Results Improvements in metacognition were moderated by MCR treatment participation. Consistent with the MCR theoretical model of change, increases in metacognition mediated the relationship between treatment and longitudinal changes in cognition. Conclusions Our findings suggest that the benefits of MCR on cognitive functioning may stem, in part, from the ability of MCR to produce improvements in metacognitive functioning.