早发性、首发精神病自杀未遂的预测因素：一项纵向 24 个月随访研究。

Predictors of suicide attempt in early-onset, first-episode psychoses: a longitudinal 24-month follow-up study.

机构信息

Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Spain.

出版信息

J Clin Psychiatry. 2013 Jan;74(1):59-66. doi: 10.4088/JCP.12m07632. Epub 2012 Nov 13.

DOI:10.4088/JCP.12m07632

PMID:23217983

Abstract

OBJECTIVE

To study the prevalence of suicide attempts and factors associated with risk for suicide during the first episode of psychosis, and to identify early predictors of suicide attempts over a 24-month follow-up period in an early-onset, first-episode psychosis cohort.

METHOD

110 subjects in their first episode of psychosis aged between 9 and 17 years were assessed by using the DSM-IV diagnostic interview Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and a battery of clinical instruments at baseline and at 12 and 24 months. Patients were enrolled in the study from March 2003 through November 2005. Suicide attempts and level of suicidality at each assessment were evaluated by using the Clinical Global Impression for Severity of Suicidality and the Hamilton Depression Rating Scale. Subjects were classified as being at high, low, or no risk of suicide, depending on their scores on certain items of these scales. Clinical associations between the outcome measures high risk for suicide during acute episode and suicide attempts during follow-up were investigated by 2 sets of logistic regression analyses.

RESULTS

The 24-month prevalence of suicide attempters was 12.4%. History of suicide attempts prior to psychotic episode (OR = 20.13; 95% CI, 1.83-220.55; P = .01), severe depressive symptoms (OR = 8.78; 95% CI, 1.15-67.11; P = .003), and antidepressant treatment (OR = 15.56; 95% CI, 2.66-90.86; P = .002) were associated with being classified as high suicide risk at baseline. The categorization of high suicide risk at baseline predicted suicide attempts during follow-up (OR = 81.66; 95% CI, 11.61-574.35; P = .000).

CONCLUSIONS

Suicide is a major concern in early-onset first-episode psychosis. Suicidal behavior and depressive symptoms at psychosis onset are important signs to be aware of to prevent suicide attempts during the early period after first-episode psychosis.

摘要

目的

研究首次精神病发作期间自杀未遂的发生率和与自杀风险相关的因素，并确定在一项青少年首发精神病的队列中，在 24 个月的随访期间自杀未遂的早期预测因子。

方法

在 2003 年 3 月至 2005 年 11 月期间，对 110 名年龄在 9 至 17 岁的首发精神病患者使用 DSM-IV 诊断性访谈表进行评估，该表适用于情感障碍和儿童期精神病的学校年龄患者-目前和终生版本，以及一套临床工具。在基线和 12 个月和 24 个月时评估自杀未遂和自杀严重程度。使用临床整体印象严重程度自杀量表和汉密尔顿抑郁评定量表评估每次评估时的自杀未遂和自杀程度。根据这些量表某些项目的得分，将患者分为自杀高、低或无风险。通过两组逻辑回归分析研究急性期自杀风险高与随访期间自杀未遂之间的临床关联。

结果

24 个月时自杀未遂者的发生率为 12.4%。精神病发作前自杀未遂史（OR=20.13；95%CI，1.83-220.55；P=.01）、严重抑郁症状（OR=8.78；95%CI，1.15-67.11；P=.003）和抗抑郁治疗（OR=15.56；95%CI，2.66-90.86；P=.002）与基线时被归类为高自杀风险相关。基线时高自杀风险的分类预测了随访期间的自杀未遂（OR=81.66；95%CI，11.61-574.35；P=.000）。