Suicidal ideation in first-episode psychosis: Considerations for depression, positive symptoms, clinical insight, and cognition

Bornheimer, Lindsay A.; Wojtalik, Jessica A.; Li, Juliann; Cobia, Derin; Smith, Matthew J.

doi:10.1016/j.schres.2020.12.025

Cited by 30 publications

(35 citation statements)

References 66 publications

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“…Consistent with our postulation that cognition is a proxy risk factor for suicide, several researchers have proposed that insight might explain the relationship between cognition and suicide (e.g., Barrett et al, 2011; Bornheimer et al, 2021; Kim et al, 2003; Verma et al, 2016; Villa et al, 2018). Although the present study included a measure of clinical insight to explore this hypothesis, insight was not significantly related to suicide risk or verbal learning at baseline.…”

Section: Discussionsupporting

confidence: 88%

“…Prior studies have also been limited by samples that primarily include individuals with longstanding psychotic disorders, despite evidence suggesting that the suicide risk is greatest during the first few years of illness (e.g., Pompili et al, 2011; Ventriglio et al, 2016). The few studies examining cognition and suicide in first-episode psychosis (FEP) have been mixed, with one study showing no relationship between executive functioning and suicidal ideation (Chang et al, 2014) and another study finding that better working memory was associated with decreased suicidal ideation (Bornheimer et al, 2021). These findings suggest that the relationship between cognition and suicide might differ for individuals with FEP and highlights the need for additional research with this population (Bornheimer et al, 2021).…”

mentioning

confidence: 99%

“…The few studies examining cognition and suicide in first-episode psychosis (FEP) have been mixed, with one study showing no relationship between executive functioning and suicidal ideation (Chang et al, 2014) and another study finding that better working memory was associated with decreased suicidal ideation (Bornheimer et al, 2021). These findings suggest that the relationship between cognition and suicide might differ for individuals with FEP and highlights the need for additional research with this population (Bornheimer et al, 2021).…”

mentioning

confidence: 99%

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Cognition and suicide risk among individuals with first-episode psychosis: A 6-month follow-up.

Wastler¹,

Moe²,

Pine³

et al. 2022

Psychiatric Rehabilitation Journal

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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.

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Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Cognition and suicide risk among individuals with first-episode psychosis: A 6-month follow-up.

Wastler¹,

Moe²,

Pine³

et al. 2022

Psychiatric Rehabilitation Journal

View full text Add to dashboard Cite

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“…Despite the absence of significant differences between the groups at baseline, greater ability in working memory was found to be associated with decreased odds of SB (specifically, suicidal ideation) at the 2-year follow up. 14 However, at the 3-year follow-up of another study, the SB group scored significantly worse in working memory than the NSB group (p ≤ 0.01). 20 None of the five studies revealed significant differences in other executive function skills such as planning, cognitive flexibility, and cognitive fluency, which were assessed using the Trail Making Test (TMT), 39 the Modified Wisconsin Card Sorting Test (MWCST), 40 the Hayline Sentence Completion Test (HSCT), 41 and the Tower of London and the Semantic and letter fluency tasks from the BASC 42,43 (see Table 2).…”

Section: Study Resultsmentioning

confidence: 90%

“…In contrast, no significant differences were observed between the groups in a 2-year follow-up study. 14 At baseline, 1 out of 2 studies found that functioning in the visual memory domain was poorer in the SB group than in the NSB group (p = 0.08). 20 This impediment was also observed in the same study at 1 year of follow-up.…”

Section: Study Resultsmentioning

confidence: 97%

Neuropsychological functioning and suicidal behaviours in patients with first‐episode psychosis: A systematic review

Sánchez-Gutiérrez

Barbeito

Gómez-Juncal

et al. 2022

Acta Psychiatr Scand

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Introduction Suicidal behaviour is particularly frequent in patients with psychosis. Therefore, prevention is a key objective of mental health policies. The aim of the current work is to systematically review the association between neurocognitive functioning and suicidal behaviour in patients with first‐episode psychosis (FEP). Material and Methods Of the 3051 studies reviewed, only 7 met the inclusion criteria. Documents in English from their earliest date of coverage until January 2022 were searched for in the following databases: PubMed, Science Direct, Web of Science, Cochrane Library, PsycINFO (ProQuest), and Springerlink. We used the PICO strategy to collect and categorize the data from each selected manuscript. Results Overall, the results showed that the risk of suicidal behaviour is higher for FEP patients in the presence of a number of factors: poorer general neuropsychological functioning (except for working memory), poorer social cognition, more depressive symptoms, longer duration of untreated psychosis, higher awareness of the illness, poorer premorbid adjustment, and more frequent cannabis use. Discussion Comprehensive general neuropsychology and assessment of social cognition, together with routine clinical record keeping, may help to identify FEP patients at a greater risk of attempting suicide.

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The impact of psychosis symptoms and psychosocial factors on symptoms of depression among individuals in an early phase of psychosis illness

Holzworth,

Brdar,

Bornheimer

2024

Mental Health Science

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Depressive symptoms are common among individuals with schizophrenia spectrum disorders, yet few studies have examined how various psychosocial factors and psychosis symptoms relate to depression in an early phase of psychosis illness. A greater understanding regarding the connection between psychosis symptoms and depressive symptoms is needed to inform assessment and intervention efforts in this population. The current study examined the relationships between psychosocial factors (distress, peer rejection, emotional support, perceived hostility), psychosis symptoms (positive, negative, general), and depression among individuals in an early phase of psychosis illness. Data were obtained from the Human Connectome Project for Early Psychosis including 167 individuals between the ages of 16 and 35 at the time of consent who met criteria for having onset of affective or nonaffective psychosis within 5 years. Clinical assessments and questionnaires were administered, and data were analyzed in SPSS and MPlus. Peer rejection (p < 0.05), distress (p < 0.001), perceived hostility (p < 0.05), and general symptoms of psychosis (p < 0.001) significantly related to depression. Bivariate associations existed between all psychosocial factors and psychosis symptoms with the exception of negative symptoms. Understanding symptoms and factors that associate with depression among individuals with psychosis in an early phase of illness can inform tailored intervention approaches of clinicians to focus on distress, peer rejection, perceived hostility, and general psychosis symptoms.

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Suicidal ideation in first-episode psychosis: Considerations for depression, positive symptoms, clinical insight, and cognition

Cited by 30 publications

References 66 publications

Cognition and suicide risk among individuals with first-episode psychosis: A 6-month follow-up.

Cognition and suicide risk among individuals with first-episode psychosis: A 6-month follow-up.

Neuropsychological functioning and suicidal behaviours in patients with first‐episode psychosis: A systematic review

The impact of psychosis symptoms and psychosocial factors on symptoms of depression among individuals in an early phase of psychosis illness

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