Tuesday, November 6, 2018

Negative Thoughts, Fears Linked to Risk of Suicide in Patients With Psychosis

Negative thoughts about psychotic experiences and fears of losing mental control may heighten the risk of suicide in patients with psychosis who were not taking antipsychotics, suggests a report in Schizophrenia Bulletin.

“Overall, our findings emphasize the importance of clinicians promoting a recovery-focused and appropriately optimistic outlook when working with people with psychosis, taking care to avoid providing information that might heighten negative illness appraisals and/or fears of losing mental control,” wrote Paul Hutton, Ph.D., of the Edinburgh Napier University in the United Kingdom and colleagues.

Hutton and colleagues analyzed data on 68 patients in a pilot trial designed to assess the effects of cognitive therapy on individuals with schizophrenia who had not taken antipsychotics for at least six months. At the start of the study and follow-ups at nine and 18 months, the researchers measured the patients’ psychotic symptoms using the Positive and Negative Symptom Scale; they also measured negative beliefs and attitudes using the Personal Beliefs About Experiences Questionnaire and the Metacognitions Questionnaire-30.

The researchers found that symptoms of psychosis were more likely to be linked to suicidal thinking at nine to 18 months when the patients held negative thoughts and fears. Negative thoughts and fears about consequences of symptoms leading to loss of mental control accounted for 37 percent of the association between those symptoms and suicidal thinking, according to the report.

According to the researchers, the findings call for randomized, control trials of special therapies that address negative cognitive beliefs, such as metacognitive therapy, metacognitive reflection and insight therapy, and cognitive analytic therapy to examine their effect on suicidal thinking.

“Consistent with previous findings that fears of mental disintegration are strongly associated with suicide in psychosis, our results suggest that the way people appraise their symptoms and their consequences, including whether they [have] heighten[ed] concerns about losing mental control, may partly determine whether [their symptoms] lead to thoughts of suicide,” Hutton and colleagues wrote.

For related information, see the Psychiatric News article “Upping Our Game Against Suicide” by APA Past President Anita Everett, M.D.

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