Substance Use, Suicidality, and Adolescent-Onset Schizophrenia: An Israeli 10-Year Retrospective Study

Abstract

This study is the first report of the association between specific types of substances and suicidality in the high-risk population of adolescent psychotic inpatients. The strong association between inhalants, LSD, alcohol, and MDMA with suicidality is relevant to suicide prevention and intervention programs in adolescent-onset schizophrenia.

Suicidal Behavior in Adolescents with First-Episode Psychosis

“…Although female and male attempts in our sample were similar in overall number, females were more likely to be repeat attempters and to use less harmful methods, consistent with prior reports (33, 34). History of psychiatric comorbidities or history of self-injury was associated with a significant increase in suicide attempts in our sample, which supports Shoval and colleagues’ findings of historical self-harm behavior in schizophrenic adolescents who were suicidal (35, 36). They also reported the abuse of alcohol and specific drugs (inhalants, LSD, MDMA) to impact suicidality but we were unable to support this due to inadequate numbers of reported substance users in our sample (and our exclusion of substance abusers).…”

“…They emphasize the need for early diagnosis and treatment of psychotic symptoms, which would likely help to prevent and reduce the suicide-related mortality in patients with first-episode psychosis. Clinicians should take this into consideration when doing a risk assessment for hospitalization and in the provision of follow-up care (2, 3, 7, 12, 21, 24, 31, 33, 35). In addition, healthcare providers should be watchful for depressive symptoms and impulsivity, and patients presented with these symptoms should be closely monitored.…”

Suicide Ideation and Attempts among Inhalant Users: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

“…Future investigations should include more extensive assessments of use and abuse/ dependence on specific inhalant products and should focus on pathogenetic processes that contribute to findings of significant associations between suicidality and inhalant use, particularly among girls and women. Findings of this report are consistent with recent studies suggesting that inhalant use is associated with completed suicide (Wick, Gilbert, Felgate, & Byard, 2007) and suicide attempts in populations ranging from schizophrenics (Shoval et al, 2006) to homeless and runaway youth (Greene & Ringwalt, 1996) to men who have sex with men (Botnick, Heath, Cornelisse, Strathdee, Martindale, & Hogg, 2002). Far more research is needed to address the potential role that inhalant use and IUDs, which are prevalent in many nations, may play in suicidal ideation, suicide attempts, and completed suicides.…”

Early intervention in psychosis: concepts, evidence and future directions

“…While some factors may operate across several or all stage transitions, others may be stage-specific, for example substance abuse or stress may be especially harmful in triggering onset of the first episode of illness, yet be less toxic subsequently (or vice versa). Gene-environment interactions almost certainly underpin and mediate these transitions, where environmental variables − such as substance abuse, psychosocial stressors, cognitive style, medication adherence and social isolation − may interact with genetic and other biological risk factors (39)(40)(41).…”