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

Fenton, Wayne S.; McGlashan, Thomas H.; Victor, Brian J.; Blyler, Crystal R.

doi:10.1176/ajp.154.2.199

Cited by 243 publications

(35 citation statements)

References 43 publications

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“…We hypothesized that prevalence rates of SI in a CHR adolescent cohort would be similar to those reported in the literatures on schizophrenia (Fenton et al, 1997; Skodlar et al, 2008) and attenuated psychosis CHR cohorts (including a sample from the same cohort as the current study; DeVylder et al, 2012; Hutton et al, 2011). We compared symptoms between groups of individuals who had SI within the past six months and those who did not, predicting that individuals with recent SI would have higher total positive and negative symptoms, as previously reported (Andriopoulos et al, 2011).…”

Section: Introductionmentioning

confidence: 67%

“…The majority of individuals with schizophrenia (40–79%) have had suicidal ideation (SI) at least some time during their course of illness (Fenton et al, 1997; Skodlar et al, 2008), a finding which holds across gender and ethnicity (Harkavy-Friedman et al, 1999). Identified correlates of SI in this population have included mood variability, negative symptoms, and depressive symptoms (Fialko et.…”

Section: Introductionmentioning

confidence: 99%

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Assessing suicidal ideation in individuals at clinical high risk for psychosis

Gill

Quintero

Poe

et al. 2015

Schizophrenia Research

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Background The majority of individuals with schizophrenia and other psychotic illnesses have had suicidal ideation at some point during the illness. However, little is known about the variation in level and intensity of suicidal ideation and symptoms in the attenuated stage of psychotic illness. Our aims were to assess prevalence of suicidal ideation in this at risk group, and to examine the severity and intensity of suicidal ideation, and their relation to symptoms. Methods Suicidal ideation was assessed in 42 clinical high-risk participants using the Columbia Suicide Severity Rating Scale (C-SSRS). We hypothesized prevalence rates would be similar to what was found in previous studies, and individuals with suicidal ideation would have higher positive and negative symptoms, with poorer functioning. We assessed levels of severity and intensity of suicidal ideation related to these symptoms, and examined how depressive symptoms affected these relationships. Results Nearly half (42.9%) of participants reported having current suicidal ideation. We found no relationship to positive symptoms. However, severity and intensity of suicidal ideation was found to be related to negative symptoms and level of functioning. When controlling for depressive symptoms during exploratory analysis, this relationship still emerged. Conclusions This study adds to the literature demonstrating the complex nature of suicidal ideation in psychotic illness. The C-SSRS has shown to be helpful in determining relationships between severity and intensity in suicidal ideation in relation to specific symptoms in a research setting.

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Section: Introductionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Assessing suicidal ideation in individuals at clinical high risk for psychosis

Gill

Quintero

Poe

et al. 2015

Schizophrenia Research

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“…Previous studies have reported that individuals with SPD who score high on the SPQ, which was developed in accordance with the criteria for SPD, are at high risk for suicide attempts and completed suicide [20], [38]. Bornstein et al compared the clinical characteristics of SPD and non-SPD outpatients who sought psychiatric services and found that SPD was associated with a significant risk of attempted suicide [20].…”

Section: Discussionmentioning

confidence: 99%

“…Bornstein et al compared the clinical characteristics of SPD and non-SPD outpatients who sought psychiatric services and found that SPD was associated with a significant risk of attempted suicide [20]. In addition, Fenton et al reported that the rates of suicide attempts and suicidal ideation in patients with SPD were 24% and 45%, respectively [38]. This evidence is compatible with the observed association between SPQ scores and suicide attempts in patients with schizophrenia, suggesting support for a common suicidality mechanism in individuals with greater SPQ scores across schizophrenia spectrum disorders.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Lifetime Suicide Attempts and Schizotypal Traits in Patients with Schizophrenia

et al. 2014

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Patients with schizophrenia are at increased risk for suicide. Various risk factors for suicide have been reported in schizophrenia; however, few studies have examined the association between personality traits and suicidal behavior. We administered the Schizotypal Personality Questionnaire (SPQ) to 87 Japanese patients with schizophrenia (49 males; mean age 38.1±10.6 years) with and without a history of suicide attempts (SA and nSA groups, respectively), and 322 controls (158 males; mean age 40.8±13.9 years). As expected, an analysis of covariance (ANCOVA) controlling for age and sex showed that all SPQ indices (total SPQ score and all three factors, i.e., cognitive-perceptual, interpersonal, and disorganized) were significantly higher in patients with schizophrenia (SA+nSA groups), than controls (p<0.001 for all comparisons). Furthermore, there were significant differences in the total score and the interpersonal and disorganized factors between the SA and nSA groups (nSA

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“…206 The current study supports the link between the severity of positive symptoms of psychosis, in particular experiences of suspiciousness or paranoia, and suicidal ideation. [244][245][246] Moreover, it was found that this relationship was explained by perceptions of defeat and entrapment, which were amplified as symptoms became increasingly distressing and enduring. Suspiciousness may be particularly entrapping and defeating as such experiences can carry a sense of ongoing personal threat and negative implications concerning social rank.…”

Section: Discussionmentioning

confidence: 99%

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Morrison

Law

Barrowclough

et al. 2016

Programme Grants Appl Res

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BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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

Cited by 243 publications

References 43 publications

Assessing suicidal ideation in individuals at clinical high risk for psychosis

Assessing suicidal ideation in individuals at clinical high risk for psychosis

Relationship between Lifetime Suicide Attempts and Schizotypal Traits in Patients with Schizophrenia

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

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