Risk for Suicide in Schizophrenia and Other Psychotic and Nonpsychotic Disorders

Westermeyer, Jerry F.; Harrow, Martin; Marengo, Joanne T.

doi:10.1097/00005053-199105000-00003

Cited by 145 publications

(93 citation statements)

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“…Such trends were supported in the adult literature, which reported a correlation between poor premorbid adjustment (by various measures) and poor outcome (34,36,(41)(42)(43), irrespective ofdiagnosis. Other studies reported a correlation between poor premorbid adjustment and poor outcome in patients with schizophrenia (27,31,44) but not AP patients (31).…”

Section: Psychological Variablessupporting

confidence: 57%

“…Both adult and adolescent studies reported an absence of significant effect of sex on diagnosis or outcome (3,15,19,22,23,30,32,35). Trends suggested, however, that being female may be correlated with better prognosis: later onset of BAD (20), better general outcome (adolescents) (29), higher Global Assessment ofFunctioning (GAF) scores (adults) (31), shorter duration of illness or fewer readmissions or recurrences (adults) (27,33), and lower risk for suicide (adults, particularly in schizophrenia) (36).…”

Section: Biological Variablesmentioning

confidence: 99%

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First-Episode Psychosis: A Comparative Review of Diagnostic Evolution and Predictive Variables in Adolescents versus Adults

Menezes

Milovan

2000

Can J Psychiatry

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Objective: To review the diagnostic evolution andpredictive variables ofdiagnosis and outcome infirst-episode psychosis in adolescents (age 13-19 years) and adults.Method: Literature was reviewed through MEDLlNE, Psycinfo, and PubMed, and istorically, all presentations of childhood psychosis were grouped with schizophrenia, despite Kraepelin's original distinction between schizophrenia and bipolar affective disorder. With the advent of Kolvin's work (1) and the subsequent DSM-III (2), childhood schizophrenia, autism, and other childhood psychoses came to be regarded as separate entities, thus creating diagnostic challenges (3-8). In addition to substance use and the emotional instability intrinsic to adolescence, the nonspecific presentation of adolescent (age 13-19 years) first-episode psychosis (FEP) contributes to this diagnostic dilemma (5,8,9; reviewed in 4,7,10,11).The frequency ofpsychosis increases with age in adolescence (8), with 0.5% of the population developing psychotic symptoms, mostly in the 16-to-19-year-old age group (12). The manifestations of psychosis are influenced by emotional, social, and cognitive developmental processes (13), which are still developing in adolescents. Psychosis onset in adolescence can significantly affect personal development (14-16) and has been suggested to represent a vulnerability in which brain-maturation processes facilitate the development of'psychotic symptoms (17). It has been postulated that with a later onset of psychosis, there is lower probability for such a facilitating process to be present, and therefore the chances ofrecovery from an acute episode are better (16).In light ofthe general impact of psychosis on adolescents and the diagnostic dilemma of adolescent FEP, this review attempts to understand better the course and outcome of psychotic disorders by comparing the adolescent and adult literature. This review addresses 2 questions: Is the diagnosis of FEP more stable in adults than in adolescents? Are there variables that can predict the course ofdiagnosis and outcome over time? MethodWe searched MEDLINE, Psycinfo, and PubMed for literature from 1989 to 1999 using the following terms: adolescence, psychotic disorder, psychosis.first episode, diagnosis, diagnostic stability, follow-up studies, prognosis, risk factors. The key references of the selected articles were also reviewed, including pertinent articles published before 1989. Studies were selected if they met the following inclusion criteria: published in English, inclusion ofFEP data, subjects 13 years and older, and measurement ofvariables related to diagnosis or outcome over time. Studies with 1 diagnosis only, with no consideration to evolution of other diagnoses, were excluded. Notably, the literature contains an extensive array of studies that examine specific variables (such as age of onset, sex, IQ, medication, and neuroimaging) in psychotic

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Section: Psychological Variablessupporting

confidence: 57%

Section: Biological Variablesmentioning

confidence: 99%

First-Episode Psychosis: A Comparative Review of Diagnostic Evolution and Predictive Variables in Adolescents versus Adults

Menezes

Milovan

2000

Can J Psychiatry

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“…In a review of studies conducted through the mid-1970s, Miles (4) estimated that 10% of individuals with schizophrenia die by suicide. More recent studies with follow-up periods ranging from 1 to 40 years estimated long-term suicide risk to be between 10% and 13%, rates approaching those observed in affective disorders (5)(6)(7). Substantial morbidity associated with suicidal behaviors is also characteristic of schizophrenia.…”

mentioning

confidence: 99%

Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders

Fenton

McGlashan²,

Victor³

et al. 1997

AJP

243

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“…Des études prospectives suggèrent que la détérioration clinique, sociale et fonctionnelle associée à la psychose est beaucoup plus marquée au cours des deux à cinq premières années. Les rechutes, la réhospitalisation et les risques de suicide sont également élevés pendant cette période (Harrison et coll., 2001 ;Lieberman et coll., 2001 ;Mortensen et Juel, 1993 ;Robinson et coll., 1999Robinson et coll., , 2004Westermeyer, Harrow et Marengo, 1991). Un « effet plateau » (McGlashan, 1988) défini par la stabilisation de cette dété-rioration peut aussi se produire après une évolution rapide au début de la psychose (Carpenter et Strauss, 1991 ;Eaton,Thara, Federman, Melton et Liang, 1995 ;Harrison et coll., 2001 ;Menezes, Arenovich et Zipursky, 2006 Yoshida et coll., 2009).…”

Section: Hypothèse De La Période Critiqueunclassified

“…Les psychoses ont, au cours d'une vie, une préva-lence moyenne de 2 à 3,5 % (Mortensen et Juel, 1993 ;Westermeyer, Harrow et Marengo, 1991). La prévalence de la schizophrénie au cours d'une vie va de 1,6 à 12,1 (moyenne = 4,0) sur 1000 (Saha, Chant, Welham et McGrath, 2005).…”

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Intervention précoce pour la psychose : concepts, connaissances actuelles et orientations futures

Iyer

Malla

2014

smq

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Cet article fournit un survol de la logique de l’intervention précoce pour psychose, de ses fondements théoriques et de la littérature essentielle sur le concept. L’intervention précoce repose sur l’hypothèse de la période critique, qui vient accentuer l’importance des premiers stades de la maladie, et sur les résultats d’études dans le domaine, qui suggère que la durée d’une psychose non traitée en influence le pronostic. L’intervention précoce facilite l’accès à un traitement spécialisé adapté à la phase de la maladie par un processus de recommandations médicales plus ouvert, des délais rapides et l’éducation du public et des praticiens sur la psychose. L’intervention précoce, qui dure généralement deux ans à partir du dépistage, comprend une prise en charge intensive et des médicaments antipsychotiques à faible dose. L’accent est mis sur le fonctionnement social, l’intervention familiale, l’attention précoce aux troubles connexes ainsi qu’une alliance thérapeutique entre le jeune et sa famille. Selon les données scientifiques disponibles, une telle intervention donne de meilleurs résultats que les soins typiquement offerts. Les critiques du concept visent la qualité des études en sa faveur, sa mise en oeuvre, la répartition des ressources en intervention précoce et son utilité pour les personnes présentant un risque élevé de psychose. En termes de disponibilité et d’élaboration de politiques en intervention précoce, le Royaume-Uni détient une avance certaine, alors que le Canada se situe au milieu, et les États-Unis au bas de l’échelle. Au Québec, les résultats varient et d’autres études et investissements sont nécessaires. Récemment, le concept d’intervention précoce a servi d’exemple à des mesures plus importantes visant la transformation des soins de santé mentale des jeunes, ce qui constitue une toute nouvelle percée au Canada.Objectives: This paper seeks to provide an overview of the motives, rationale, theoretical underpinnings and foundational literature of the early intervention movement for psychoses. It also seeks to review the current status of the field, highlight its significant developments and identify its emergent trends.Methods: This paper begins by contextualizing the burden of psychosis. It then traces the origins of the early intervention movement and surveys the seminal literature that established and shapes the field. It describes the movement’s characteristic elements, types, approaches, strengths, criticisms and trajectories in select Western nations. It closes with a presentation of how the early intervention movement is informing broader endeavours to transform youth mental health.Results: We find that the early intervention movement is predicated on the critical period hypothesis that emphasizes the significance of the early stages of the illness; and on findings that the duration of untreated psychosis influences prognoses. Early intervention redresses this situation by facilitating access to specialized, phase-specific treatment. Access is enhanced through open referral, fast respo...

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Risk for Suicide in Schizophrenia and Other Psychotic and Nonpsychotic Disorders

Cited by 145 publications

References 0 publications

First-Episode Psychosis: A Comparative Review of Diagnostic Evolution and Predictive Variables in Adolescents versus Adults

First-Episode Psychosis: A Comparative Review of Diagnostic Evolution and Predictive Variables in Adolescents versus Adults

Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders

Intervention précoce pour la psychose : concepts, connaissances actuelles et orientations futures

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