Insight and risk of suicidal behaviour in two first-episode psychosis cohorts: Effects of previous suicide attempts and depression

López-Moriñigo, Javier-David; Forti, Marta Di; Ajnakina, Olesja; Wiffen, Ben; Morgan, Kevin; Doody, Gillian A.; Jones, Peter M.; Ayesa-Arriola, Rosa; Canal‐Rivero, Manuel; Crespo‐Facorro, Benedicto; Murray, Robin M.; Dazzan, Paola; Morgan, Craig; Dutta, Rina; David, Anthony

doi:10.1016/j.schres.2018.09.016

Cited by 31 publications

(47 citation statements)

References 94 publications

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“…Inconsistently with what previously reported in comparable FEP studies, we found no associations of baseline suicidal ideation with positive symptoms and insight (as measured with PANSS “Lack of judgment and insight” item subscore). In contrast, Lopez‐Morinigo et al () supported the role of insight in attempted suicide during FEP. Moreover, Robinson et al () observed that greater insight was a relevant predictor of suicide attempts in FEP patients.…”

Section: Discussionmentioning

confidence: 93%

Suicidal Ideation in Patients Experiencing a First‐episode Psychosis: Findings From the 2‐Year Follow‐up of the “Parma Early Psychosis” Program

Pelizza

Pellegrini

Quattrone

et al. 2020

Suicide & Life Threat Behav

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Objective Although suicide behavior is relevant in first‐episode psychosis (FEP), little is known about suicidal ideation and its longitudinal stability. The aim of this study was (1) to assess incidence rates of suicide attempts, completed suicide, and suicidal thinking in FEP individuals at baseline and over a 24‐month follow‐up period; (2) to explore any significant association of suicidal ideation with psychopathology at baseline; and (3) to monitor longitudinally suicidal thinking along the 2‐year follow‐up. Methods Participants (134 FEP patients, aged 13–54 years) were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). A Kaplan–Meier survival analysis to calculate cumulative incidence rates of attempted and completed suicide was also performed. Results FEP patients showed a 31.3% percentage of suicidal ideation (i.e., BPRS item 4 cutoff score of ≥ 3) and a 2‐year cumulative incidence rate of attempted suicide of 11%. No completed suicide was found. In the FEP total sample, suicidal thinking was positively correlated with general psychopathology (especially depression) and negative symptoms. Conclusions Suicidal ideation is relevant in FEP patients, supporting a routine monitoring of suicide risk during the baseline assessment of adolescents and adults with early psychosis.

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Section: Discussionmentioning

confidence: 93%

Suicidal Ideation in Patients Experiencing a First‐episode Psychosis: Findings From the 2‐Year Follow‐up of the “Parma Early Psychosis” Program

Pelizza

Pellegrini

Quattrone

et al. 2020

Suicide & Life Threat Behav

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“…Although this links neatly with metacognition and confidence, it runs counter to received clinical folklore that the gaining of insight, particularly after a psychotic episode, induces depression and at worst, may even lead to suicide. Empirical justification for unidirectional causality is lacking, 16 perhaps because of the messy complicating factors that often precede suicide in people with psychosis in the real world: longstanding depression, rejection of treatment and disengagement with social and professional support. These factors attest more to the loss of insight than its gain, notwithstanding the pain attached to the latter.…”

Section: Insight and Metacognitionmentioning

confidence: 99%

Insight and psychosis: the next 30 years

David

2019

Br J Psychiatry

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Academic interest in the concept of insight in psychosis has increased markedly over the past 30 years, prompting this selective appraisal of the current state of the art. Considerable progress has been made in terms of measurement and confirming a number of clinical associations. More recently, the relationship between insight and involuntary treatment has been scrutinised more closely alongside the link between decision-making capacity and insight. Advances in the clinical and cognitive neurosciences have influenced conceptual development, particularly the field of ‘metacognition’. New therapies, including those that are psychologically and neurophysiologically based, are being tested as ways to enhance insight.

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“…Specifically, the WAIS-IV [30] is administered by a MSc-level clinical psychologist (VGRR) in order to rule out an IQ ≤ 70, which is an exclusion criterion. Those with an IQ > 70 are administered the Trail Making Test (TMT) [31], which assesses executive function and has been found to correlate with insight scores in psychosis patients [32], by VGRR shortly after the WAIS-IV in order to complete the baseline neurocognitive assessment at this point.…”

Section: Recruitment Processmentioning

confidence: 99%

“…Given that the mean SAI-E score for psychosis patients is 13/28 with a standard deviation of around 6 [32,35], a difference of 2 points (e.g., 13 vs. 15) between groups (e.g., MCT vs. controls), which is considered to be clinically meaningful [26], is equivalent to an effect size of 0.33 with a two-tailed alpha significant level set at 5%. Under these assumptions, for reaching a sufficient statistical power of β = 80% at the end of the study, we will need n = 63 subjects in each arm, that is, a total sample size of N = 126 patients, who will be analysed at the end of the study on an intention-to-treat (ITT) basis.…”

Section: Power Calculations and Estimation Of Sample Sizementioning

confidence: 99%

“…In particular, insight was thought to lead to depression, hopelessness and suicidality, which is known as the demoralization syndrome [56,57] or 'Insight Paradox' [54]. However, recent research did not show a 'direct' relationship between insight and suicidality in firstepisode psychosis, which was due to the confounding effects of previous suicide attempts and depression on such an association [32]. The question therefore arises, i.e., whether an insight improving intervention (such as MCT, which is to be tested in this trial) may reduce suicide risk (and improve mood) in psychosis, which will be properly investigated in this RCT.…”

Section: Outcome Measuresmentioning

confidence: 99%

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Study protocol of a randomised clinical trial testing whether metacognitive training can improve insight and clinical outcomes in schizophrenia

López-Moriñigo¹,

Ruiz-Ruano²,

Martínez³

et al. 2020

BMC Psychiatry

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Background: Although insight in schizophrenia spectrum disorders (SSD) has been associated with positive outcomes, the effect size of previous treatments on insight has been relatively small to date. The metacognitive basis of insight suggests that metacognitive training (MCT) may improve insight and clinical outcomes in SSD, although this remains to be established. Methods: This single-center, assessor-blind, parallel-group, randomised clinical trial (RCT) aims to investigate the efficacy of MCT for improving insight (primary outcome), including clinical and cognitive insight, which will be measured by the Schedule for Assessment of Insight (Expanded version) (SAI-E) and the Beck Cognitive Scale (BCIS), respectively, in (at least) n = 126 outpatients with SSD at three points in time: i) at baseline (T0); ii) after treatment (T1) and iii) at 1-year follow-up (T2). SSD patients receiving MCT and controls attending a non-intervention support group will be compared on insight level changes and several clinical and cognitive secondary outcomes at T1 and T2, whilst adjusting for baseline data. Ecological momentary assessment (EMA) will be piloted to assess functioning in a subsample of participants. Discussion: To the best of our knowledge, this will be the first RCT testing the effect of group MCT on multiple insight dimensions (as primary outcome) in a sample of unselected patients with SSD, including several secondary outcomes of clinical relevance, namely symptom severity, functioning, which will also be evaluated with EMA, hospitalizations and suicidal behaviour. Trial registration: ClinicalTrials.gov: NCT04104347. Date of registration: 26/09/2019 (Retrospectively registered).

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Insight and risk of suicidal behaviour in two first-episode psychosis cohorts: Effects of previous suicide attempts and depression

Cited by 31 publications

References 94 publications

Suicidal Ideation in Patients Experiencing a First‐episode Psychosis: Findings From the 2‐Year Follow‐up of the “Parma Early Psychosis” Program

Suicidal Ideation in Patients Experiencing a First‐episode Psychosis: Findings From the 2‐Year Follow‐up of the “Parma Early Psychosis” Program

Insight and psychosis: the next 30 years

Study protocol of a randomised clinical trial testing whether metacognitive training can improve insight and clinical outcomes in schizophrenia

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