title: Suicidal behaviours during treatment for first-episode psychosis: towards a comprehensive approach to service-based prevention.
abstract: OBJECTIVE
  Suicidal behaviours (suicide attempts and suicides) are common among individuals experiencing, or having recently experienced, a first-episode psychosis (FEP). Current interventions for suicidal behaviours are crisis driven and focused on hospital admission of patients at imminent risk of ending their lives. This paper aims to describe ideas for universal, selective and indicated strategies that may complement existing practices to suicide risk management in first-episode patients.
  
  
  METHODS
  Key findings from the Suicidal Behaviours in FEP Project were used to develop suggested interventions. The project examined the temporal course of suicide risk, common characteristics of suicidal behaviours and predictors of suicidal behaviours in 699 patients with FEP.
  
  
  RESULTS
  Key findings included: (i) 12% of FEP cohort engaged in suicidal behaviours during treatment (up to 3 years); (ii) first month of treatment conferred the highest suicide risk; (iii) 64% of suicidal behaviours were overdoses, usually on antipsychotics; (iv) 20% of suicidal behaviours occurred on psychiatric units and all involved hanging/strangulation; (v) most suicidal behaviours were impulsive, precipitated by psychosocial stressors and with serious intent; and (vi) proximal non-suicidal self-injurious behaviour and proximal negative life events were the strongest predictors.
  
  
  CONCLUSIONS
  Comprehensive approach by mental health services to prevention of suicidal behaviours among first-episode patients could be facilitated by: delineating safe quantities of prescribed medications available to outpatients; regular audits of fixtures on inpatient units; enhancing risk recognition by family members; routinely monitoring suicide risk levels; developing crisis cards with all new FEP patients to facilitate help seeking during distress; and skills training programs targeting distress tolerance, interpersonal effectiveness and problem-solving.
authors: School of Psychological Science, La Trobe University, Melbourne, Queensland, Australia.
authors: Izabela E
authors: IE
authors: Fedyszyn
authors: Jo
authors: J
authors: Robinson
authors: Meredith G
authors: MG
authors: Harris
authors: Susan J
authors: SJ
authors: Paxton
authors: Shona
authors: S
authors: Francey
authors: Jane
authors: J
authors: Edwards
mesh_terms: D000293:Adolescent; D042241:Early Diagnosis; D006287:Health Planning Guidelines; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000517:prevention & control; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology; D055815:Young Adult; D000092864:Suicide Prevention
keywords: first-episode psychosis; suicidal behaviour; suicidal patient; suicide prevention; suicide risk