González-Pinto Ana, Aldama Ana, González Cristina, Mosquera Fernando, Arrasate Marta, Vieta Eduard
Stanley Institute International Mood-Disorders Research Center, Vitoria, Spain.
J Clin Psychiatry. 2007 Feb;68(2):242-7. doi: 10.4088/jcp.v68n0209.
To determine the baseline demographic and clinical characteristics associated with suicide attempts over 5 years following a first admission for psychosis and to assess the relationship between suicidal behavior during 5-year follow-up and clinical factors.
All inpatients consecutively admitted between February 1997 and January 1999 with a first psychotic episode from a specific catchment area in Spain were included at baseline; they were followed up yearly over a 5-year period with an extensive protocol that included the Structured Clinical Interview for DSM-IV, the Positive and Negative Syndrome Scale, and the 21-item Hamilton Rating Scale for Depression. The primary outcome measure was suicide attempts. Comorbidity with alcohol and drug abuse was recorded, as were all suicidal acts made by patients over the follow-up period. Relationships between suicidal outcome and baseline clinical features were examined. Logistic regression modeling was used to test the significance and independence of associations of relevant factors to suicidal status.
Of 83 first-episode psychotic patients, 14.5% displayed suicidal behavior within the 5 years following the first admission, and 2.4% died by suicide. Suicide rate was 0.48%/ year and attempt rate was 2.89%/year, with a 1.5-fold (95% CI = 1.07 to 2.22) greater risk for each depressive symptom at index episode and with an 8-fold (95% CI = 1.45 to 44.40) higher risk among patients with baseline stimulant abuse (cocaine and amphetamine).
Patients with a first-episode psychotic disorder seemed to be a high-risk population for suicidal behavior. Depressive symptoms during the index psychotic episode and comorbidity with stimulant abuse at baseline were relevant predictive factors for suicidal behavior during the first years of first affective and nonaffective psychotic episodes.
确定首次因精神病住院后5年内与自杀未遂相关的基线人口统计学和临床特征，并评估5年随访期间自杀行为与临床因素之间的关系。
纳入1997年2月至1999年1月期间连续入住西班牙特定集水区且首次出现精神病发作的所有住院患者作为基线；在5年期间每年对他们进行随访，采用广泛的方案，包括《精神疾病诊断与统计手册》第四版的结构化临床访谈、阳性和阴性症状量表以及21项汉密尔顿抑郁评定量表。主要结局指标是自杀未遂。记录酒精和药物滥用的合并症以及随访期间患者的所有自杀行为。检查自杀结局与基线临床特征之间的关系。采用逻辑回归模型检验相关因素与自杀状态关联的显著性和独立性。
在83例首发精神病患者中，14.5%在首次入院后的5年内出现自杀行为，2.4%死于自杀。自杀率为每年0.48%，未遂率为每年2.89%，首发发作时每出现一种抑郁症状，风险增加1.5倍（95%置信区间=1.07至2.22），基线存在兴奋剂滥用（可卡因和苯丙胺）的患者风险高8倍（95%置信区间=1.45至44.40）。
首发精神病性障碍患者似乎是自杀行为的高危人群。首发精神病发作期间的抑郁症状以及基线时与兴奋剂滥用的合并症是首发情感性和非情感性精神病发作最初几年自杀行为的相关预测因素。
