title: Insight and suicidality in first-episode psychosis: understanding the influence of suicidal history on insight dimensions at first presentation.
abstract: OBJECTIVE
  Lack of insight is a cardinal feature of psychosis with crucial implications for outcome. Concerns have been raised regarding a link between insight and suicidality. This study aimed to test the relationship between suicidal behaviour preceding first-episode psychosis (FEP) and insight dimensions at treatment onset.
  
  
  METHODS
  A total of 112 FEP inpatients were recruited. Suicidal events prior to admission were recorded. Insight was assessed multidimensionally with the Schedule for the Assessment of Insight - Expanded version shortly after admission. Suicidal and non-suicidal patients were compared regarding scores on 'total insight' and three insight domains: 'awareness of mental illness', 'relabeling of psychotic experiences as abnormal' and 'compliance'. This analysis was also adjusted for a set of sociodemographic, clinical, neurocognitive and psychopathological variables.
  
  
  RESULTS
  Bivariate analyses demonstrated a direct association between previous suicidality and all insight domains. However, these associations did not survive multivariable regression models, which demonstrated gender (female), shorter duration of untreated psychosis (DUP) and psychopathological symptoms - depression and disorganization - to mediate the influence of suicidal history on insight, and therefore to underlie the latter.
  
  
  CONCLUSIONS
  Insight dimensions in FEP patients are influenced by having suicidal antecedents through some mediating variables such as gender, DUP and depression. Further prospective studies are needed to clarify the potential implications of these findings on the management of insight in FEP. As suicidal history is associated with greater levels of both depression and insight at first presentation, these three variables might be useful in predicting further suicidal events.
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Javier D
authors.initials: JD
authors.lastname: López-Moríñigo
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wiffen
authors.forename: Jennifer
authors.initials: J
authors.lastname: O'Connor
authors.forename: Rina
authors.initials: R
authors.lastname: Dutta
authors.forename: Marta
authors.initials: M
authors.lastname: Di Forti
authors.forename: Robin M
authors.initials: RM
authors.lastname: Murray
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000523:psychology*; D012647:Self-Assessment; D013406:Suicide, Attempted / Q000523:psychology*; D055815:Young Adult
keywords: depression; first-episode psychosis; insight; suicide