OPUS study: Suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis

Nordentoft, Merete; Jeppesen, Pia; Abel, M.; Kassow, Pernille Brændstrup; Petersen, L.; Thorup, Anne; Krarup, Gertrud; Hemmingsen, Ralf; Jørgensen, Per

doi:10.1192/bjp.181.43.s98

Cited by 264 publications

(210 citation statements)

References 37 publications

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“…Indeed, the available evidence from naturalistic and randomized studies strongly supports the value of specialized early psychosis programs in improving outcome in the short term (89,93). If these programs are only provided for 1-2 years, there is also evidence that some of the gains are eroded, suggesting that, for a substantial subset at least, specialized early psychosis care needs to be provided for a longer period, probably up to 5 years in many cases (77,94,95).…”

Section: Next Stepsmentioning

confidence: 99%

Early intervention in psychosis: concepts, evidence and future directions

2008

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Section: Next Stepsmentioning

confidence: 99%

Early intervention in psychosis: concepts, evidence and future directions

2008

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“…However, depression can easily be missed in patients with schizophrenia because symptoms of depression can be confused with negative symptoms of psychosis or side effects of neuroleptic medication [58]. Along with a coexisting depression, the feeling of hopelessness has been shown to be an important risk factor for suicidal behavior in schizophrenia [59], and the importance of hopelessness as a risk factor remains even without a concurrent depression [56]. …”

mentioning

confidence: 99%

Suicide in schizophrenia

Carlborg

Winnerbäck

Jönsson

et al. 2010

Expert Review of Neurotherapeutics

112

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SchizophreniaSchizophrenia is a devastating psychiatric disorder affecting approximately 1% of the population worldwide during a lifetime. The onset of the illness occurs relatively early in life, usually in the late teens or early adulthood, and most patients have long-lasting adverse effects. Schizophrenia is a clinical syndrome diagnosed on the basis of symptom profiles, and is characterized by a constellation of symptoms of psychosis, such as abnormalities in the perception or expression of reality, as well as negative symptoms, such as affective flattening and avolition. Cognitive deficits are also usually present, and the symptoms must have persisted continuously for a least 6 months: however, schizophrenia cannot be diagnosed if symptoms of mood disorder are present or the symptoms are the direct result of a medical condition or substance abuse (Box 1) [201].The specific causes of schizophrenia are not known and combinations of several factors are likely to be involved. Genetic factors play a major role in the development of the disease [1], and environmental factors are also of importance. These latter factors include a history of obstetric complications, such as asphyxia [2] and prematurity [3]. Advanced paternal age is also considered to be a risk factor [4], and birth during the spring and late winter also increases the risk [5]. Prenatal viral infections [6], serious viral infections of the CNS during childhood [7], migrant status and urban rearing [8], and a lifetime history of cannabis use [9] are other well-known risk factors.Contrary to previous interpretations, the incidence and prevalence of schizophrenia show marked variation between sites. For example, migrants have an increased incidence and prevalence of schizophrenia, and exposures related to urbanicity, economic status and latitude are also associated with various frequency measures [10]. Men have a higher risk than women [11], and a recent review concluded that men have a 40% higher incidence of schizophrenia than women [12]. SuicideSuicide is defined as a self-inflicted death with evidence that the person intended to die (Box 2) [13]. Suicide is among the leading causes of premature death in the world and it is estimated that approximately 1 million people die by suicide every year [202]. Suicide rates vary according to region, gender, age, time and ethnic origin, and also according to death registration practices. The annual suicide rate in the world is 14.5 out of 10,0000 (in 2000), which is equal to one suicide every 40 s. Suicide is approximately three-to four-times more common in men than in women [202]. Suicide rates vary between different regions, and underestimation of suicide rates is common due to under-reporting, lack of epidemiological data and misclassification [14]. It has been estimated from psychological autopsies that more than 90% of those dying by suicide have a diagnosable psychiatric disorder at the time of death, and approximately 60% of the Schizophrenia is a disorder with an estimated suicide risk of 4-5%. Many f...

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“…Previous reports on the reduction of suicide behaviours have tended to be secondary reports of larger studies, which have had more global clinical aims. For example, one study 277 conducted an evaluation of an integrated community treatment including assertive community treatment, antipsychotic medication, psychoeducational family treatment and social skills training with people experiencing first episodes of psychosis. Similarly, the Study of Cognitive Reality Alignment Therapy in Early Schizophrenia (SoCRATES) trial 42 was an evaluation of CBT with recent onset schizophrenia aimed to speed recovery in those suffering an acute episode of psychosis.…”

Section: Discussionmentioning

confidence: 99%

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Morrison

Law

Barrowclough

et al. 2016

Programme Grants Appl Res

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BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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OPUS study: Suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis

Cited by 264 publications

References 37 publications

Early intervention in psychosis: concepts, evidence and future directions

Early intervention in psychosis: concepts, evidence and future directions

Suicide in schizophrenia

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

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