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Self-harm in first-episode psychosis

Department of Psychological Medicine, Institute of Psychiatry, King’s College London

Tuhina Lloyd, MRCPsych

University of Nottingham, Nottingham

Paul Fearon, MRCPsych

Department of Psychological Medicine, Institute of Psychiatry, King’s College London

Peter B. Jones, FRCPsych

Department of Psychiatry, University of Cambridge, Cambridge

Robin M. Murray, FRCPsych

Department of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

Correspondence: Dr Samuel B. Harvey, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. Email: s.harvey{at}iop.kcl.ac.uk

Declaration of interest

None. Funding detailed in Acknowledgements.

Background

Little is known about self-harm occurring during the period of untreated first-episode psychosis.

Aims

To establish the prevalence, nature, motivation and risk factors for self-harm occurring during the untreated phase of first-episode psychosis.

Method

As part of the ÆSOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study, episodes of self-harm were identified among all incident cases of psychosis presenting to services in south-east London and Nottingham over a 2-year period.

Results

Of the 496 participants, 56 (11.3%) had engaged in self-harm between the onset of psychotic symptoms and first presentation to services. The independent correlates of self-harm were: male gender, belonging to social class I/II, depression and a prolonged period of untreated psychosis. Increased insight was also associated with risk of self-harm.

Conclusions

Self-harm is common during the pre-treatment phase of first-episode psychosis. A unique set of fixed and malleable risk factors appear to operate in those with first-episode psychosis. Reducing treatment delay and modifying disease attitudes may be key targets for suicide prevention.

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BJP 2008 192: 10. [Full Text]