Negative Affective Features in 516 Cases of First Psychotic Disorder Episodes: Relationship to Suicidal Risk

Abstract

Objectives Plausible candidates of psychopathological phenomena that may associate with or anticipate suicidal risk, include negative affects, including admixtures of dysphoria, depression and anxiety described mainly in nonpsychotic disorders. We ascertained the distribution of such affective features in various first-episode psychotic disorders and correlated these and other clinical and antecedent features with intake suicidal status. Methods We evaluated 516 adult subjects in first-lifetime episodes of various DSM-IV-TR psychotic disorders. Blinded, protocol-guided, assessments of clinical features ascertained in SCID examinations, self- and family reports and clinical records supported analyses of associations of suicide attempts at first-psychotic episodes with antecedent and intake clinical characteristics, including negative affects and diagnoses, using standard bivariate and multivariate methods. Results Negative affective features in various combinations were prevalent (90%) and at >75% in both affective and nonaffective psychotic disorders; anxious depression was most common (22%). We identified antecedent and intake clinical factors preliminarily associated with suicide attempts. Factors remaining independently associated in multivariate logistic modelling (ranked by OR) were: (a) prior suicide attempt, (b) prior aggressive assault, (c) bipolar-mixed state or psychotic major depression diagnosis, (d) prior dysphoria, (e) intake dysphoric-anxiousdepression, (f) prior impulsivity, (g) previous affective instability, (h) previous nonpsychotic depression, (i) previous decline in vital drive, and (j) prior sleep disturbances. Conclusions Various types and combinations of negative affective features (especially anxious depression with and without dysphoria) were prevalent across nonaffective as well as affective first psychotic episodes and strongly associated with suicide attempts. These findings extend previous observations in nonpsychotic disorders.

Co-Occurrence of Anxiety and Bipolar Disorders: Clinical and Therapeutic Overview

“…[71] Moreover, rates of treatment-associated mania or hypomania in placebocontrolled trials of antidepressant treatment for juvenile anxiety disorders are at least as high as in trials for juvenile depression. In addition, first and subsequent episodes of BD often include admixtures of anxiety, depression, and sleep disturbances, [24,44,73] and episodes of anxiety as well as of depression or mania/hypomania recur episodically among patients with BDs. In addition, first and subsequent episodes of BD often include admixtures of anxiety, depression, and sleep disturbances, [24,44,73] and episodes of anxiety as well as of depression or mania/hypomania recur episodically among patients with BDs.…”

“…[72] This finding suggests that anxiety as well as depression can sometimes precede clinical expression of typical BD. In addition, first and subsequent episodes of BD often include admixtures of anxiety, depression, and sleep disturbances, [24,44,73] and episodes of anxiety as well as of depression or mania/hypomania recur episodically among patients with BDs. [7] Indeed, when followed longitudinally, patients with BD may experience anxiety syndromes even more frequently and for longer time than depressive, manic/hypomanic, or mixed mood states.…”

Long‐term morbidity in major affective and schizoaffective disorders following hospitalization in first psychotic episodes

“…Previous studies arising from the Project included assessments of psychopathology in first‐episode psychoses, 1,2 times to initial symptomatic and functional outcomes by 6 months, 8 syndromal and functional recovery by 6 months and 2 years, 9–11 predicting recovery from first episodes and latency to first‐recurrences, 12 mood changes with substance abuse in first‐episode bipolar‐I disorder (BD‐I) patients, 13 similar risk factors for suicide and accidents in first‐episode patients, 14 2‐year outcomes in first‐episode psychotic depression, 15,16 diagnostic changes (ICD or DSM criteria), 17–19 cycle length versus recurrences in first‐episode BD‐I patients, 20 predominant recurrence polarity in BD‐I patients, 21 suicidal risk factors in first‐episode patients, 22 psychopathological antecedents of first episodes of BD‐I, 23 Capgras’ delusional misperception in first‐episode patients, 24 early course in nonaffective psychotic disorders, 25 BD, schizoaffective disorder, and schizophrenia compared, 26 and factors associated with aggression among first‐episode BD‐I patients 27 …”