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The dynamic relationship between insight and suicidal behavior in first episode psychosis patients over 3-year follow-up

Ayesa-Arriola, R; Pelayo Teran, JM; Lopez Morinigo, JD; Canal Rivero, M; Setien-Suero, E; Al-Halabi, S; Cuesta, MJ; ... Crespo-Facorroa, B; + view all (2018) The dynamic relationship between insight and suicidal behavior in first episode psychosis patients over 3-year follow-up. European Neuropsychopharmacology , 28 (10) pp. 1161-1172. 10.1016/j.euroneuro.2018.05.005. Green open access

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Abstract

Studies have established the high risk of suicide in first episode psychosis (FEP). Between 15% and 26% of FEP patients attempt suicide at least once before their first contact with psychiatric services and 2–5% die from suicide. Also, many patients with schizophrenia spectrum disorders lack insight into having a mental disorder. However, the relationship between insight changes and suicidal behavior in FEP remains poorly understood. In the present study information about suicidal behavior over a 3 years period was available on a cohort of 397 FEP patients, of whom 270 were assessed in the three dimensions of insight (into mental illness, the need for treatment, and the social consequences) at baseline, 1 and 3 years after treatment initiation. Survival analyses examined time to suicidal behavior in relation to (i) insight at baseline, (ii) the closest insight measure to the suicide attempt, and (iii) changes in insight during the follow-up. No associations were found between baseline insight dimensions and time to suicidal behavior. However, poor insight at the evaluation closest to the suicide attempt was associated with an increased risk of suicide. Stability of insight did not affect the risk of suicidal behavior, while changes in either direction were linked with an increased risk of suicidal behavior, particularly worsening insight. Insight in psychosis is a dynamic concept and we demonstrated the relationship between insight and suicide risk to be equally dynamic. Poor insight seems to increase the risk, especially when insight levels change. Repeated insight assessment to detect change from early psychosis may play a role in suicide prevention.

Type: Article
Title: The dynamic relationship between insight and suicidal behavior in first episode psychosis patients over 3-year follow-up
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.euroneuro.2018.05.005
Publisher version: https://doi.org/10.1016/j.euroneuro.2018.05.005
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Suicidal behavior, Insight, First episode psychosis, Schizophrenia
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10076233
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