title: The development of insight and its relationship with suicidality over one year follow-up in patients with first episode psychosis.
abstract: OBJECTIVE
  Insight into psychosis has been linked to suicidality, although inconsistently. The co-variation between insight and suicidality over time is under-investigated. The aim of the present study was to investigate predictors of suicidality in patients with first episode of psychosis (FEP) over one year, focusing on the relationship between insight and suicidality.
  
  
  METHODS
  Patients with FEP (n=146) were interviewed as soon as possible after treatment starts and at one year follow-up.
  
  
  RESULTS
  At baseline 37% of patients were suicidal, significantly reduced to 20% at follow-up. The effect of insight on suicidality was in different directions at different time-points, with insight at baseline increasing and insight at follow-up decreasing the risk of suicidality at follow-up. Patients with stable levels of insight across baseline and follow-up did not differ in risk for suicidality at follow-up. However, patients who lost insight from baseline to follow-up were more often suicidal at follow-up, whilst patients who gained insight were more seldom suicidal at follow-up. Other predictors of suicidality at follow-up were more depressive episodes before study entry, longer duration of untreated psychosis, more suicide attempts six months prior to follow-up, and depression at follow-up.
  
  
  CONCLUSIONS
  The results indicate that the effect of insight on suicidality in FEP-patients depends on time of assessment and of changes in insight. Gaining insight during treatment was associated with reduced risk for suicidality, whilst losing insight had the opposite effect, underlining the need to monitor insight over time and tailor interventions according to illness phase.
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Section of Early Psychoses Treatment, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway. Electronic address: e.a.barrett@medisin.uio.no.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Barrett
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.
authors.forename: Erlend
authors.initials: E
authors.lastname: Mork
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Section for Acute Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway.
authors.forename: Ann
authors.initials: A
authors.lastname: Færden
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Division of Mental Health, Norwegian Institute of Public Health, 0403 Oslo, Norway.
authors.forename: Ragnar
authors.initials: R
authors.lastname: Nesvåg
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Department of Research and Development, Diakonhjemmet Hospital, 0319 Oslo, Norway.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Agartz
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway.
authors.forename: Ole A
authors.initials: OA
authors.lastname: Andreassen
authors.affiliation: NORMENT, K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Melle
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001364:Awareness; D003863:Depression / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology*; D013405:Suicide; D055815:Young Adult
keywords: Depression; Duration of untreated psychosis; Insight; Psychotic disorder; Schizophrenia; Suicide