Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, United Kingdom.
Schizophr Res. 2011 Mar;126(1-3):11-9. doi: 10.1016/j.schres.2010.11.021. Epub 2010 Dec 23.
Much remains unknown about whether there are early risk factors for suicide in psychosis.
The aim of the study was to determine whether there are any identifiable early symptom clusters, aetiological factors or illness course markers for suicide in first episode psychosis.
A total of 2132 patients with first episode psychosis presenting to secondary care services in London (1965-2004; n=1474), Nottingham (1997-1999; n=195) and Dumfries and Galloway (1979-1998; n=463) were traced after up to 40 years (mean 13 years) following first presentation. Risk factors were identified from the Operational Checklist for Psychotic Disorders rated for the first year following presentation.
Overall, there were 51 suicides and 373 deaths from other causes. Male gender (RR 2.84, 95% CI 1.20-6.69, p=0.02) and a cumulative threshold effect of symptoms early in the illness (RR 6.81, 95% CI 2.33-19.85, p<0.001) were associated with a higher propensity for later completed suicide. There was also a suggestion that early manic symptoms might increase the risk of later suicide irrespective of initial diagnosis.
Suicide risk was associated with a cumulative threshold effect of symptoms and manic symptoms. As suicide is a relatively rare event in psychotic disorders, general population-based prevention strategies may have more impact in this vulnerable group as well as the wider population.
精神分裂症患者自杀是否存在早期风险因素，这方面仍有很多未知。
本研究旨在确定首发精神分裂症患者中是否存在任何可识别的早期症状群、病因因素或疾病过程标志物与自杀有关。
1965 年至 2004 年期间，伦敦（n=1474）、1997 年至 1999 年期间的诺丁汉（n=195）和 1979 年至 1998 年期间的邓弗里斯和加洛韦（n=463）的二级保健服务机构共接诊了 2132 名首发精神分裂症患者。在首次就诊后最长 40 年（平均 13 年）进行了追踪。使用首次就诊后第一年评定的精神障碍操作性清单确定风险因素。
总体而言，共有 51 例自杀和 373 例其他原因死亡。男性（RR 2.84，95%CI 1.20-6.69，p=0.02）和疾病早期症状的累积阈值效应（RR 6.81，95%CI 2.33-19.85，p<0.001）与随后发生完全自杀的可能性更高相关。此外，有证据表明，即使初始诊断不同，早期躁狂症状也可能增加后期自杀的风险。
自杀风险与症状的累积阈值效应和躁狂症状有关。由于自杀在精神分裂症中是相对罕见的事件，基于一般人群的预防策略可能对该弱势群体以及更广泛的人群产生更大的影响。
