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González-Pinto A, Aldama A, González C, et al. 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;68:242-247.

Patients with a first-episode psychotic disorder seem to be at high risk for suicidal behavior. Of 83 first-episode psychotic patients who were observed for 5 years, 12 patients (14.5%) displayed suicidal behavior during the follow-up period after the first admission and 2 patients (2.4%) died by suicide. Of the 12 patients who displayed suicidal behavior, 2 (16.7%) had a history of suicide attempts.

The per-year suicide and attempted suicide rates were 0.48% and 2.89%, respectively. The risk was 1.5-fold higher for each depressive symptom at index episode and 8-fold higher among patients with baseline abuse of stimulants (cocaine and amphetamine). There also was comorbidity with alcohol, tobacco, and cannabis abuse and a trend for older patients to be less suicidal.

Despite the assumption that risk of suicide after onset of psychosis decreases over time, the 2 completed suicides occurred during the fourth and fifth years of the study. These results underscore the need to carefully monitor patients for suicidal behavior in the years following a first psychotic episode.

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