Abstract
Background: Suicidal behavior is seen in the context of a variety of mental disorders. While many believe that, in general, first-episode psychosis is a particularly high-risk period for suicide, no general agreement regarding higher prevalence of suicide in first-episode psychosis is achievable.
Objective: In the present study, suicides and suicide attempts among psychiatric in-patients have been evaluated to assess the general profile of suicidal behavior among native psychiatric inpatients and any relationship between serum cholesterol level and suicidal behavior. Methods: Five acute academic wards, which have been specified for admission of first episode adult psychiatric patients, and five acute non-academic wards, which have been specified for admission of recurrent episode adult psychiatric patients, were selected for the current study. All inpatients with suicidal behavior (successful suicide and attempted suicide, in total), during the last five years (2013-2018), were included in the present investigation. Also, the assessment of serum lipids, including triglyceride, cholesterol, low-density lipoprotein and high-density lipoprotein, was done , for comparing the suicidal subjects with non-suicidal ones. Results: Among 19160 psychiatric patients hospitalized in Razi psychiatric hospital during a sixtymonths period, 63 suicidal behaviors, including one successful suicide and sixty-two suicide attempts, were recorded by the safety board of hospital. The most frequent mental illness was bipolar I disorder, which was significantly more prevalent in comparison with other mental disorders (p<0.04, p<0.02, p<0.007, and p<0.003 in comparison with schizophrenia, depression, personality disorders and substance abuse, respectively). Self-mutilation, self-poisoning and hanging were the preferred methods of suicide among 61.11%, 19.44% and 19.44% of cases, respectively. In addition, no significant difference was evident between the first admission and recurrent admission inpatients, totally and separately, particularly with respect to psychotic disorders. Besides, with respect to different components of serum lipids, no specific or significant pattern was evident. Conclusion: While in the present study, the suicidal behavior was significantly more evident in bipolar disorder in comparison with other psychotic or no-psychotic disorders, no significant difference was evident between the first admission and recurrent admission of psychiatric inpatients. Moreover, no significant relationship between suicidal behavior and serum lipids was found.Keywords: Psychiatric disorders, suicide, suicide attempt, first admission, recurrent admission, schizophrenia, bipolar disorder, depression, substance abuse disorder.
Graphical Abstract
[1]
American Psychiatry Association (APA). Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association 2013; pp. 801-6.
[2]
Nordentoft M, Madsen T, Fedyszyn I. Suicidal behavior and mortality in first-episode psychosis. J Nerv Ment Dis 2015; 203(5): 387-92.
[3]
American Psychiatry Association (APA). Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association 2013; p. 104.
[4]
Kahn MW. Emergency psychiatry: tools of engagement: avoiding pitfalls in collaborating with patients. Psychiatr Serv 2001; 52(12): 1571-2.
[5]
Ballard ED, Stanley IH, Horowitz LM, Pao M, Cannon EA, Bridge JA. Asking youth questions about suicide risk in the pediatric emergency department: Results from a qualitative analysis of patient opinions. Clin Pediatr Emerg Med 2013; 14(1): 20-7.
[7]
American Psychiatry Association (APA). Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association 2013; p. 131.
[8]
Bornheimer LA. Suicidal ideation in First-Episode Psychosis (FEP): examination of symptoms of depression and psychosis among individuals in an early phase of treatment. Suicide Life Threat Behav 2018; 23(2): 45-7.
[9]
González-Pinto A, Aldama A, González C, Mosquera F, Arrasate M, Vieta E. Predictors of suicide in first-episode affective and nonaffective psychotic inpatients: five-year follow-up of patients from a catchment area in Vitoria, Spain. J Clin Psychiatry 2007; 68(2): 242-7.
[10]
Barrett EA, Sundet K, Faerden A, et al. Suicidality in first episode psychosis is associated with insight and negative beliefs about psychosis. Schizophr Res 2010; 123(2-3): 257-62.
[11]
Björkenstam C, Björkenstam E, Hjern A, Bodén R, Reutfors J. Suicide in first episode psychosis: a nationwide cohort study. Schizophr Res 2014; 157(1-3): 1-7.
[12]
Beckman K, Mittendorfer-Rutz E, Lichtenstein P, et al. Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort. Psychol Med 2016; 46(16): 3397-405.
[13]
Shrivastava A, Johnston M, Campbell R, De Sousa A, Shah N. Serum cholesterol and Suicide in first episode psychosis: a preliminary study. Indian J Psychiatry 2017; 59(4): 478-82.
[14]
Ayesa-Arriola R, Canal Rivero M, Delgado-Alvarado M, et al. Low-density lipoprotein cholesterol and suicidal behavior in a large sample of first-episode psychosis patients. World J Biol Psychiatry 2018; 19(sup3): S158-61.
[15]
Gajwani R, Larkin M, Jackson C. What is the point of life?: An interpretative phenomenological analysis of suicide in young men with first-episode psychosis. Early Interv Psychiatry 2018; 12(6): 1120-7.
[16]
Canal-Rivero M, Barrigón ML, Perona-Garcelán S, et al. One-year follow-up study of first suicide attempts in first episode psychosis: personality traits and temporal pattern. Compr Psychiatry 2016; 71: 121-9.
[17]
Fedyszyn IE, Harris MG, Robinson J, Edwards J, Paxton SJ. Characteristics of suicide attempts in young people undergoing treatment for first episode psychosis. Aust N Z J Psychiatry 2011; 45(10): 838-45.
[18]
Cohen S, Lavelle J, Rich CL, Bromet E. Rates and correlates of suicide attempts in first-admission psychotic patients. Acta Psychiatr Scand 1994; 90(3): 167-71.
[19]
Preti A, Meneghelli A, Pisano A, Cocchi A. Risk of suicide and suicidal ideation in psychosis: results from an Italian multi-modal pilot program on early intervention in psychosis. Schizophr Res 2009; 113(2-3): 145-50.
[20]
Pompili M, Serafini G, Innamorati M, et al. Suicide risk in first episode psychosis: a selective review of the current literature. Schizophr Res 2011; 129(1): 1-11.
[21]
Crumlish N, Whitty P, Kamali M, et al. Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder. Acta Psychiatr Scand 2005; 112(6): 449-55.
[22]
Addington J, Williams J, Young J, Addington D. Suicidal behavior in early psychosis. Acta Psychiatr Scand 2004; 109(2): 116-20.
[23]
American Psychiatry Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association 2013; pp. 31-715.
[24]
Roy A, Draper R. Suicide among psychiatric hospital in-patients. Psychol Med 1995; 25(1): 199-202.
[25]
Pirkola S, Sohlman B, Heilä H, Wahlbeck K. Reductions in postdischarge suicide after deinstitutionalization and decentralization: a nationwide register study in Finland. Psychiatr Serv 2007; 58(2): 221-6.
[26]
Qin P, Nordentoft M. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry 2005; 62(4): 427-32.
[27]
Martelli C, Awad H, Hardy P. In-patients suicide: epidemiology and prevention. Encephale 2010; 36(2): D83-91.
[28]
Dutta R, Murray RM, Allardyce J, Jones PB, Boydell J. Early risk factors for suicide in an epidemiological first episode psychosis cohort. Schizophr Res 2011; 126(1-3): 11-9.
[29]
Dutta R, Murray RM, Hotopf M, Allardyce J, Jones PB, Boydell J. Reassessing the long-term risk of suicide after a first episode of psychosis. Arch Gen Psychiatry 2010; 67(12): 1230-7.
[30]
Chung DT, Ryan CJ, Hadzi-Pavlovic D, Singh SP, Stanton C, Large MM. Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA Psychiatry 2017; 74(7): 694-702.
[31]
Thong JY, Su AH, Chan YH, Chia BH. Suicide in psychiatric patients: case-control study in Singapore. Aust N Z J Psychiatry 2008; 42(6): 509-19.
[32]
Shoja Shafti S, Memarie A, Rezaie M, Hamidi M. Clinical profile of suicide among adolescent psychiatric inpatients in Iran. Biomed J Scientific Tech Res 2019; 18(1): 1-5.
[33]
Shoja SS, Memarie A, Rezaie M, Hamidi M. A preliminary survey regarding suicidal conduct among Iranian juvenile psychiatric inpatients. Arch Neurol Neurosci 2019; 3(5): 1-5.
[34]
Neuner T, Schmid R, Wolfersdorf M, Spiessl H. Predicting inpatient suicides and suicide attempts by using clinical routine data? Gen Hosp Psychiatry 2008; 30(4): 324-30.
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