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LETTERS TO EDITOR  
Year : 2018  |  Volume : 60  |  Issue : 4  |  Page : 515-516
Affective dimension of early psychosis and suicidality


Department of Psychiatry, Erenköy Mental Health and Neurology Training and Research Hospital, İstanbul, Turkey

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Date of Web Publication28-Nov-2018
 

How to cite this article:
Durmaz O. Affective dimension of early psychosis and suicidality. Indian J Psychiatry 2018;60:515-6

How to cite this URL:
Durmaz O. Affective dimension of early psychosis and suicidality. Indian J Psychiatry [serial online] 2018 [cited 2018 Dec 17];60:515-6. Available from: http://www.indianjpsychiatry.org/text.asp?2018/60/4/515/246190




Sir,

I have read the article entitled “Suicide in hospitalized early psychosis patients at the time of discharge from hospital: An exploratory study of attempters and nonattempters” written by Shrivastava et al. with great interest.[1] The study findings suggest inpatient psychotic patients remain at high levels of suicidality even if they have not been attempted to suicide before and highlights the comprehensive community care as a central part of treatment after discharge.

Although study was designed to examine the suicide risk in patients in early psychosis period, mean duration of the illness in patients was 32.5 months (standard deviation = 9.4), which suggest high proportion of the study population were beyond the early course of the psychosis.

In study, comparison of psychiatric comorbidities and clinical features between patients with low- and high-suicide risk showed substance use or alcoholism and male gender were associated with more severe suicide risk, consistent with previous reports.[2],[3] However, an interesting point in the results was the older age of illness onset was associated with higher levels of suicidality. Several studies suggested early onset of psychotic symptoms are related with poor prognosis while late onset of psychosis is related with better clinical outcome and higher functionality in schizophrenia.[4] In this respect, although study results suggested late onset of illness indicated higher suicidality risk, this finding could be interprated with considering the factors that include delayed diagnosis or misdiagnosis and thus, inadequate intervention to psychosis. Another phenomenon that should be considered is the affective symptoms in psychotic patients. Psychiatric comorbidities with psychosis have not included any affective spectrum disorders in the study. However, mean Hamilton Depression Rating Scale (HDRS) scores for both suicide attempters and nonattempters were consistent with a clinical depressive symptomatology. Furthermore, although depressive symptoms scores were interpreted as higher in nonattempters than suicide attempters, data in results section are contradictory. As shown in [Table 1], Brief Psychiatric Scale scores that measured general psychopathology levels were statistically higher while HDRS scores were not in nonattempters than suicide attempters. However, comparison of clinical features between high- and low-suicide risk groups showed greater depression symptoms were associated with high-suicide risk in [Table 2]. These results are pivotal in considering that depressive and psychotic symptoms severity might be associated with subsequent suicidal behavior at follow-up in the first episode psychosis.[2] In addition, affective spectrum disorders including bipolarity and psychotic depression are among the most suicidal behavior encountered psychiatric disorders.[4] Variation of clinical diagnosis over time in acute psychotic episodes is another challenge that should be kept in mind while assessing predictions of suicidal behavior in psychotic patients.[5] Studies showed early manic symptoms or dysphoria could be related with higher risk of later suicide attempt while depressive symptoms prone to be more prevalent and are obviously associated with suicidal behavior in early phases of psychosis.[3],[5] Thus, affective symptoms, even if they are in subthreshold diagnostic levels, should be taken into account while assessing suicidality in psychotic patients particularly in early phases of disorder.
Table 1: Comparison of clinical features and comorbidities between patients with and without a previous suicide attempt

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Table 2: Comparison of nonattempters and attempters with severe suicidality

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Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Shrivastava A, Berlemont C, Campbell R, Johnston M, De Sousa A, Shah N, et al. Suicide in hospitalized early psychosis patients at the time of discharge from hospital: An exploratory study of attempters and nonattempters. Indian J Psychiatry 2016;58:142-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Chan SK, Chan SW, Pang HH, Yan KK, Hui CL, Chang WC, et al. Association of an early intervention service for psychosis with suicide rate among patients with first-episode schizophrenia-spectrum disorders. JAMA Psychiatry 2018;75:458-64.  Back to cited text no. 2
    
3.
Coentre R, Talina MC, Góis C, Figueira ML. Depressive symptoms and suicidal behavior after first-episode psychosis: A comprehensive systematic review. Psychiatry Res 2017;253:240-8.  Back to cited text no. 3
    
4.
Gómez-de-Regil L, Kwapil TR, Blanqué JM, Vainer E, Montoro M, Barrantes-Vidal N. Predictors of outcome in the early course of first-episode psychosis. Eur J Psychiatry 2010;24:87-97.  Back to cited text no. 4
    
5.
Dutta R, Murray RM, Allardyce J, Jones PB, Boydell J. Early risk factors for suicide in an epidemiological first episode psychosis cohort. Schizophr Res 2011;126:11-9.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Onur Durmaz
Department of Psychiatry, Erenköy Mental Health and Neurology Training and Research Hospital, İstanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_203_16

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    Tables

  [Table 1], [Table 2]



 

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