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23-07-2013 | Mental health | Article

Psychotic symptoms warn of adolescent suicide attempt risk

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medwireNews: Psychotic symptoms in adolescents signal a high risk for suicide attempts in adolescents, particularly in those with psychopathology, researchers report.

They found that within 1 year of being assessed, more than one-third of 47 adolescents with psychopathology and psychotic symptoms had attempted suicide at least once.

This link was not explained by nonpsychotic psychiatric symptom burden or multimorbidity, note the researchers led by Ian Kelleher (Beaumont Hospital, Dublin, Ireland).

The findings point to a need for “a new clinical focus on careful assessment of psychotic symptoms (both attenuated and frank) in patients with nonpsychotic disorders; this should be considered a key element of suicide risk assessment,” they say in JAMA Psychiatry.

Among the 1112 adolescents aged 13–16 years who participated in the study, 77 (7%) reported psychotic symptoms at baseline. Of these, 7% reported a suicide attempt by the 3-month follow up, and 20% by the 12-month follow up, giving odds ratios of 10.01 and 11.27, respectively, compared with the rest of the group.

Of the 193 adolescents with psychopathology, 23% reported psychotic symptoms and 34% of these individuals reported a suicide attempt by 12 months. This compared with just 4% of all participants and 13% of participants with psychopathology but no psychotic symptoms.

Kelleher et al note that individuals with psychopathology without psychotic symptoms had a significantly increased risk for suicide attempt only at 12 months, at an odds ratio of 4.6, but this was not as great as for those with psychopathology and psychotic symptoms, at an odds ratio of 32.7.

It is possible that patients with psychopathology and no psychotic symptoms at baseline experienced psychotic symptoms close to the time of a suicide attempt. But the researchers found that the risk for acute suicide attempts in the 2 weeks before symptom assessment was no greater for patients with psychopathology than for all participants.

By contrast, the risk was increased nearly 70-fold for patients with psychopathology and psychotic symptoms.

“In absolute terms, among the total subsample of adolescents with psychopathology, nearly 80% of all suicide attempts occurred in participants with psychotic symptoms, even though they accounted for less than a quarter of the total subsample,” the researchers note.

Thus, assuming a causative relationship between psychotic symptoms and suicide risk, the population-attributable fraction for psychotic symptoms would be 56% in the whole sample and 75% in the subsample with psychopathology, Kelleher and team calculate.

They conclude that their findings “point to psychotic symptoms as a valuable means of identifying individuals who are clinically at highest risk for suicidal behavior.”

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter

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