A study conducted by the General Psychiatry Service (PGE) of the Vaud University Hospital Center show that the presence of paranoid symptoms combined with that of manic or depressive symptoms is associated with an increased risk of suicide in the first episodes of affective psychoses
from the first episode.
Suicide prevention is a major challenge in the treatment of early episodes of affective psychoses, which are characterized by the onset of both psychosis and mood disorders such as depression or mania. Indeed, suicidality is an important factor of premature mortality in the first episode of psychosis. The risk of suicide is particularly high in patients combining symptoms of mood disorders and psychotic disorders. It is therefore a major concern for people who are going through the initial phase of an affective psychosis. While the scientific literature suggests that the presence of paranoid symptoms combined with a manic or depressive state is associated with an increased risk of suicide in patients in the chronic phase of the disease, no data in this regard were available in the study. early phase of these diseases. Through this study, published in March 2023 in the scientific journalSchizophrenia Research
, we investigated whether interactions between manic, depressive and paranoid symptoms affect suicidality in young patients treated for a first episode of affective psychosis. We prospectively studied 380 patients with first-episode psychosis enrolled in the Treatment and Intervention Program for the Early Phase of Psychotic Disorders (TIPP) of the General Psychiatry Service (PGE) of the Department of Psychiatry and diagnosed as suffering from affective or non-affective psychoses. We compared the intensity and presence of suicidal thoughts and the occurrence of suicide attempts over a three-year follow-up period and investigated the impact of interactions between manic, depressive and paranoid symptoms on the level of suicidality.
Results After 12 months of follow-up, we observed a higher level of suicidal thoughts and suicide attempts in patients with affective psychoses compared to patients with non-affective psychoses. The combined presence of depressive and paranoid symptoms, or manic and paranoid symptoms, was significantly associated with an increase in suicidal thoughts. However, the combination of depressive and manic symptoms showed a significant negative association with suicidal thoughts.
This study suggests that the presence of paranoid symptoms combined with that of manic or depressive symptoms is associated with an increased risk of suicide in the first episodes of affective psychoses, even if the patients present only affective symptoms of modest intensity. rather than a major depressive state or an established manic state.
A detailed assessment of these dimensions is therefore essential in patients with a first episode of affective psychosis, and the integrated treatment should be adapted to the increased suicidal risk in these patients, even if they do not present with syndromes. depressive or complete maniacs.
Auteurs
Julie Ramain PhD, Philippe Conus MD, Philippe Golay PhD
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Source: Vaudois University Hospital Center, news The term “schizoaffective” was introduced by Jacob Kasanin in 1933 and appeared in nosographic classifications such as the DSM in 1952, first as a subtype of schizophrenia, then as a distinct disorder. He describes a form of “affective psychosis” associating symptoms of schizophrenia and mood symptoms (manic and/or depressive). Schizoaffective disorders are considered by some authors as a borderline form between schizophrenia and affective disorders with psychotic features, with blurred clinical boundaries. For others, they would constitute a clinical entity in their own right as proposed in the international nosographic classifications (CIM-10 and DSM-5)– Schizoaffective Disorders Bruno Etain InSchizophrenia
(2019), pages 130 to 134 (Lavoisier)