British Journal of Psychiatry
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Schizophrenia and suicide: Systematic review of risk factors Background Suicide risk is greatly increased in schizophrenia. Detection of those at risk is clinically important. Aims To identify risk factors for suicide in schizophrenia. Method The international literature on case-control and cohort studies of patients with schizophrenia or related conditions in which suicide was reported as an outcome was systematically reviewed. Studies were identified through searching electronic databases and reference lists, and by consulting experts. Results Twenty-nine eligible studies were identified. Factors with robust evidence of increased risk of suicide were previous depressive disorders (OR=3.03, 95% CI 2.06–4.46), previous suicide attempts (OR=4.09, 95% CI 2.79–6.01), drug misuse (OR=3.21, 95% CI 1.99–5.17), agitation or motor restlessness (OR=2.61, 95% CI 1.54–4.41), fear of mental disintegration (OR=12.1, 95% CI 1.89–81.3), poor adherence to treatment (OR=3.75, 95% CI 2.20–6.37) and recent loss (OR=4.03, 95% CI 1.37–11.8). Reduced risk was associated with hallucinations (OR=0.50, 95% CI 0.35–0.71). Conclusions Prevention of suicide in schizophrenia is likely to result from treatment of affective symptoms, improving adherence to treatment, and maintaining special vigilance in patients with risk factors, especially after losses.
British Journal of Psychiatry - Tập 187 Số 1 - Trang 9-20 - 2005
High-potency cannabis and the risk of psychosis Background People who use cannabis have an increased risk of psychosis an effect attributed to the active ingredient δ9-tetrahydrocannabinol (Δ9-THC). There has recently been concern over an increase in the concentration of Δ9-THC in the cannabis available in many countries. Aims To investigate whether people with a first episode of psychosis were particularly likely to use high-potency cannabis. Method We collected information on cannabis use from 280 cases presenting with a first episode of psychosis to the South London & Maudsley National Health Service (NHS) Foundation Trust, and from 174 healthy controls recruited from the local population. Results There was no significant difference between cases and controls in whether they had ever taken cannabis, or age at first use. However, those in the cases group were more likely to be current daily users (OR = 6.4) and to have smoked cannabis for more than 5 years (OR = 2.1). Among those who used cannabis, 78% of the cases group used high-potency cannabis (sinsemilla, ‘skunk’) compared with 37% of the control group (OR 6.8). Conclusions The finding that people with a first episode of psychosis had smoked higher-potency cannabis, for longer and with greater frequency, than a healthy control group is consistent with the hypothesis that Δ9-THC is the active ingredient increasing risk of psychosis. This has important public health implications, given the increased availability and use of high-potency cannabis.
British Journal of Psychiatry - Tập 195 Số 6 - Trang 488-491 - 2009
Self-harm in first-episode psychosis Background Little is known about self-harm occurring during the period of untreated first-episode psychosis. Aims To establish the prevalence, nature, motivation and risk factors for self-harm occurring during the untreated phase of first-episode psychosis. Method As part of the æSOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study, episodes of self-harm were identified among all incident cases of psychosis presenting to services in south-east London and Nottingham over a 2-year period. Results Of the 496 participants, 56 (11.3%) had engaged in self-harm between the onset of psychotic symptoms and first presentation to services. The independent correlates of self-harm were: male gender, belonging to social class I/II, depression and a prolonged period of untreated psychosis. Increased insight was also associated with risk of self-harm. Conclusions Self-harm is common during the pre-treatment phase of first-episode psychosis. A unique set of fixed and malleable risk factors appear to operate in those with first-episode psychosis. Reducing treatment delay and modifying disease attitudes may be key targets for suicide prevention.
British Journal of Psychiatry - Tập 192 Số 3 - Trang 178-184 - 2008
Depression, Hopelessness and Suicide in Chronic Schizophrenia Hospital records for 104 schizophrenic patients, 15 of whom subsequently committed suicide, were rated blindly for individual depressive symptoms comprising DSM III major depressive episode, and for hopelessness. Our results indicate that a large proportion of schizophrenic patients experienced major depressive episodes, and that these can be reliably identified. Presuicidal schizophrenics also experienced depressed mood, but only a minority developed the full syndrome; they typically exhibited the psychological, but not somatic symptoms. The relationship between depression and suicide disappears when hopelessness is taken into account.
British Journal of Psychiatry - Tập 148 Số 5 - Trang 554-559 - 1986
Insight, grey matter and cognitive function in first-onset psychosis Background Several studies have suggested that neuropsychological and structural brain deficits are implicated in poor insight. Few insight studies however have combined neurocognitive and structural neuroanatomical measures. Aims Focusing on the ability to relabel psychotic symptoms as pathological, we examined insight, brain structure and neurocognition in first-onset psychosis. Method Voxel-based magnetic resonance imaging data were acquired from 82 individuals with psychosis and 91 controls assessed with a brief neuropsychological test battery. Insight was measured using the Schedule for the Assessment of Insight. Results The principal analysis showed reduced general neuropsychological function was linked to poor symptom relabelling ability. A subsequent between-psychosis group analysis found those with no symptom relabelling ability had significant global and regional grey matter deficits primarily located at the posterior cingulate gyrus and right precuneus/cuneus. Conclusions The cingulate gyrus (as part of a midline cortical system) along with right hemisphere regions may be involved in illness and symptom self-appraisal in first-onset psychosis.
British Journal of Psychiatry - Tập 197 Số 2 - Trang 141-148 - 2010
Treatment of depression in schizophrenia: Systematic review and meta-analysis Background Depression in schizophrenia predicts poor outcomes, including suicide, yet the effectiveness of antidepressants for its treatment remains uncertain. Aims To synthesise the evidence of the effectiveness of antidepressants for the treatment of depression in schizophrenia. Method Multiple databases Were searched and inclusion Criteria included participants aged over 18 years with schizophrenia or related psychosis with a depressive episode. Papers were quality assessed used the Cochrane risk bias tool. Meta-analyses were performed for risk difference and standardised mean difference of all antidepressants, antidepressant class and individual antidepressant where sufficient studies allowed. Results A total of 26 moderate- to low-quality trials met inclusion criteria. In meta-analysis a significant risk difference was found in favour of antidepressant treatment, with a number needed to treat of 5 (95% CI 4–9). Studies using tools specifically designed to assess depression in schizophrenia showed a larger effect size. However, after sensitivity analysis standardised mean difference of all antidepressants did not show a statistically significant improvement in depression score at end-point, neither did any individual antidepressant class. Conclusions Antidepressants may be effective for the treatment of depression in schizophrenia, however, the evidence is mixed and conclusions must be qualified by the small number of low- or moderate-quality studies. Further sufficiently powered, high-quality studies are needed.
British Journal of Psychiatry - Tập 211 Số 4 - Trang 198-204 - 2017
Suicidal behaviour and mortality in first-episode psychosis: the OPUS trial Background Those with first-episode psychosis are at high-risk of suicide Aims To identify predictive factors for suicidal thoughts, plans and attempts,
and to investigate the rate of suicides and other deaths during the 5
years after first diagnosis and initiation of treatment Method A longitudinal, prospective, 5-year follow-up study of 547 individuals
with first-episode schizophrenia spectrum psychosis. Individuals
presenting for their first treatment in mental health services in two
circumscribed urban areas in Denmark were included in a randomised
controlled trial of integrated v. standard treatment.
All participants were followed in the Danish Cause of Death Register for
5 years. Suicidal behaviour and clinical and social status were assessed
using validated interviews and rating scales at entry, and at 1- and
2-year follow-ups Results Sixteen participants died during the follow-up. We found a strong
association between suicidal thoughts, plans and previous attempts,
depressive and psychotic symptoms and young age, and with suicidal plans
and attempts at 1- and 2-year follow-up Conclusions In this first-episode cohort depressive and psychotic symptoms,
especially hallucinations, predicted suicidal plans and attempts, and
persistent suicidal behaviour and ideation were associated with high risk
of attempted suicide
British Journal of Psychiatry - Tập 191 Số S51 - Trang s140-s146 - 2007
Insight and Psychosis The concept of insight into psychosis has received scant attention in the psychiatric literature. Drawing on sources such as phenomenology, clinical research and experimental psychology, it is proposed that insight is not an ‘all-or-none’ phenomenon but is composed of three distinct, overlapping dimensions, namely, the recognition that one has a mental illness, compliance with treatment, and the ability to relabel unusual mental events (delusions and hallucinations) as pathological. A scheme is proposed to standardise the assessment of insight to assist further research.
British Journal of Psychiatry - Tập 156 Số 6 - Trang 798-808 - 1990
Panic Symptoms after Inhalation of Carbondioxide Summary The effects of inhaling a mixture of 35 per cent carbon dioxide and 65 per cent oxygen on the occurrence of panic symptoms defined by the DSM III, was investigated. Compared to a placebo (air), carbon dioxide produced more panic symptoms. If carbon dioxide inhalation was preceded by intake of a beta-blocker (60 mg propranolol), less symptoms occurred than if preceded by a placebo. The results are compared with earlier reports on the effects of lactate infusion. It is argued that panic disorders can be conceptualized as a fear of internal (panic) sensations and that inhalation of a mixture of carbon dioxide and oxygen may constitute an effective exposure treatment.
British Journal of Psychiatry - Tập 144 Số 5 - Trang 503-507 - 1984
Plasma Cortisol and Depression in Pathological Gamblers Basal serum cortisol and dexamethasone suppression test (DST) results were studied in 21 pathological gamblers who varied on the Beck Depression Inventory and selected scales of the Minnesota Multiphasic Personality Inventory, which had previously been shown to be related to depression in gamblers. All subjects were suppressors on the DST. There was a significant relationship between fluctuation in 08.00 h and 16.00 h basal cortisol levels and the psychological measures, suggesting a subtype of pathological gambler with potential clinical significance.
British Journal of Psychiatry - Tập 153 Số 5 - Trang 684-686 - 1988
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