School of Psychological Science, La Trobe University, Melbourne, Victoria 3086, Australia.
Aust N Z J Psychiatry. 2011 Oct;45(10):838-45. doi: 10.3109/00048674.2011.595687. Epub 2011 Aug 23.
Understanding the characteristics of suicide attempts in people undergoing treatment for first episode psychosis (FEP) may have implications for risk management at a service level and local suicide prevention strategies. Although studies have focused on identifying individual-level risk factors for suicide attempts in this patient group, none have yet conducted an in-depth profile of suicide attempts. The aim of the present study was to examine the characteristics of suicide attempts in young people during the initial 18 months of treatment for FEP.
A retrospective medical record audit study of a cohort of patients accepted for treatment at a specialist FEP service between 1/12/2002 and 30/11/2005.
Of 607 patients, 73 (12%) attempted suicide during treatment. Of these 73, most (72.6%) attempted suicide on one occasion. The majority of attempts (85.3%) occurred when patients were treated as outpatients and were in regular contact with the service. Suicide attempts tended to be impulsive (77.6%), triggered by interpersonal conflict or distress due to psychotic symptoms. Two thirds involved self-poisoning, usually by overdose of prescribed medications. All inpatient suicide attempts were by hanging or strangulation. Individuals infrequently sought help immediately before or after the attempt; if help-seeking occurred, informal sources of support were contacted.
To reduce the number of suicide attempts among individuals treated for FEP, psychiatric services could consider: restricting the amount of medication prescribed per purchase; individualised suicide risk management plans for all newly admitted patients, including those who do not appear to be at risk; stringent reviews of inpatient psychiatric units for potential ligature points; providing information and psycho-education for significant others in recognition and response to suicide risk; fostering patients' problem solving and conflict resolution skills; and regular risk assessment and close monitoring of patients, particularly during the high risk period of 3 months after a suicide attempt.
了解首次发作精神分裂症（FEP）患者接受治疗期间自杀企图的特征，可能对服务层面的风险管理和当地预防自杀策略有影响。尽管研究集中在确定该患者群体自杀企图的个体风险因素，但尚无研究深入分析自杀企图的特征。本研究旨在探讨首次发作精神分裂症患者在接受治疗的最初 18 个月期间自杀企图的特征。
对 2002 年 12 月 1 日至 2005 年 11 月 30 日期间在一家 FEP 专科服务机构接受治疗的患者队列进行回顾性病历审核研究。
在 607 名患者中，73 名（12%）在治疗期间自杀。在这 73 名患者中，大多数（72.6%）仅尝试自杀一次。大多数尝试（85.3%）发生在患者作为门诊患者接受治疗并定期与服务机构联系时。自杀企图往往是冲动的（77.6%），由人际冲突或精神病症状引起的痛苦触发。三分之二涉及自伤，通常是过量服用规定的药物。所有住院自杀企图都是上吊或勒死。患者在尝试自杀前后很少立即寻求帮助；如果寻求帮助，他们会联系非正式的支持来源。
为了减少 FEP 患者自杀企图的数量，精神科服务机构可以考虑：限制每次购买的药物数量；为所有新入院患者制定个体化的自杀风险管理制度计划，包括那些似乎没有风险的患者；严格审查住院精神病病房是否存在潜在的缢索点；为重要他人提供信息和心理教育，以识别和应对自杀风险；培养患者的解决问题和冲突解决技能；并定期评估风险，密切监测患者，尤其是在自杀企图后 3 个月的高风险期。
