Abstracts of the 4th Biennial Schizophrenia International Research Conference / Schizophrenia Research 153, Supplement 1 (2014) S1–S384 S11

suicide-related behaviour in young people and the to examine in more

detail the evidence for a range of interventions designed to reduce risk that

could inform both clinical practice and government policy.

Methods: Three systematic reviews, and one narrative review, were con-

ducted in order to examine the range, and effectiveness, of interventions

designed to reduce suicide risk among young people, in clinical, school-

based and online settings. For each of the reviews conducted suicide-related

behaviour had to be a primary outcome of interest.

Results: Suicide prevention in clinical settings: Fifteen published trails were

included. Of them two targeted young people with mood disorders, one

targeted young people with borderline personality disorder and one study

targeted young people with a psychotic disorder. Interventions included

(but are not restricted to): medication, a family-based intervention, dialec-

tical behavioural therapy, problem-solving therapy, cognitive behavioural

therapy and group therapy. No differences were found between treatment

and control groups except in one study that found a difference in rates

of suicidal ideation between individual cognitive behavioural therapy and

treatment as usual. Suicide prevention in school settings: Forty-three stud-

ies were included here, of which 15 reported on universal education or

awareness programs, 23 reported on selective interventions (e.g. gatekeeper

training and screening programs), 3 reported on targeted interventions, and

2 examined a postvention response in schools. Of these studies the most

promising appeared to be gatekeeper training and screening programs,

although more research is necessary. Suicide prevention in online settings:

These reviews found that, despite the number, and potential effectiveness

of, online programs for young people with depression and/or anxiety dis-

orders, there are currently no published studies reporting on the effects

of online therapy for suicidal youth. Similarly a number of studies have

been found that discuss the relationship between suicide and social media,

however despite the popularity and the potential reach of social media, no

actual interventions studies were identified.

Discussion: Overall it is concluded that whilst we know much about the

epidemiology of suicide among youth, there is a dearth of well-conducted

studies that provide adequate evidence regarding what works in youth sui-

cide prevention. This has implications both clinically and at a policy level. A

greater emphasis on intervention studies – including novel interventions –

would lead to better practice in terms of detecting and supporting suicidal

young people, and could also contribute to a better informed, and more

evidence-based, policy agenda around the world.

PSYCHOTIC EXPERIENCES AS A PREDICTOR OF THE NATURAL COURSE OF

SUICIDAL IDEATION: A SWEDISH COHORT STUDY

Ian Kelleher1, Martin Cederlöf2, Paul Lichtenstein2

1Royal College of Surgeons in Ireland, Karolinska Institutet, Stockholm,

Sweden; 2Karolinska Institutet, Department of Medical Epidemiology and

Biostatistics, Nobels vag 12A, 17177 Stockholm, Sweden

Background: Psychotic experiences are far more prevalent in the popu-

lation than psychotic disorders and are associated with a wide range of

depressive, anxiety and behavioral disorders, as well as increased risk for

psychotic disorder. Recently, psychotic experiences have been highlighted

as a potentially valuable clinical marker of risk for suicidal behavior. There

have been few studies to date, however, to assess psychotic experiences as

a predictor of suicidality over time.

Method: Wewished to assess whether young persons with suicidal ideation

at baseline assessment who reported psychotic experiences were at higher

risk for persistence of suicidal ideation at follow up than young persons

who also reported suicidal ideation at baseline but who did not report

co-occurring psychotic experiences. A total of 2,263 Swedish adolescents

were assessed at ages 13 to 14 years for psychotic experiences, suicidal

ideation and internalizing and externalizing psychopathology. Participants

were re-assessed at ages 16 to 17 years and 19 to 20 years.

Results: Among 13- to 14-year olds with suicidal ideation, co-occurring

psychotic experiences did not predict an increased odds of persistence of

suicidal ideation to 16 to 17 years (OR=0.94, 95%CI=0.19-4.78). Among 16-

to 17-year olds with suicidal ideation, however, co-occurring psychotic

experiences predicted a 6-fold increased odds of persistence of suicidal

ideation to ages 19 to 20 years (OR=5.53, 95%CI=1.33-23.00). This finding

was not explained by internalizing or externalizing psychopathology or by

cannabis use.

Discussion: Although most suicidal ideation is transient and does not re-

quire close clinical attention, for some individuals, suicidal ideation becomes

persistent, causing long-term morbidity, mental distress and ultimately in-

creasing the risk of attempted and completed suicide. Identification of

individuals whose suicidal ideation is likely to become persistent, then,

is an important, if complex, challenge in clinical psychiatry. Our results

show that psychotic experiences are an important, but under-recognized,

marker of risk for persistence of suicidal ideation, in particular from mid-

adolescence. An increased emphasis on the clinical assessment of psychotic

experiences in mental health services should be a priority

DEPRESSION AND SUICIDALITY IN FIRST EPISODE PSYCHOSIS:

SUBORDINATION AND SHAME

Rachel Upthegrove1,2, Jonathan Ives3, Amrita Sandhu3, Lisa Jones3,

Kerry Ross4, Katerine Brunet4

1University of Birmingham; 2Early Intervention Service; 3School of Clinical and

Experimental Medicine, University of Birmingham; 4Early Intervention Service,

Birmingham and Solihull Mental Helath Trust

Suicidal behaviour in early psychosis is linked to depression and hope-

lessness, however the meaning and mechanisms of this association is

understudied. We may accept a depressive dimension in psychosis, in

keeping with a dimensional rather than categorical approach, however

our concepts of this depression here has been transported wholesale from

unipolar affective disorders. It is not clear that this is a valid approach.

We will present a series of short papers exploring the development and

phenomenology of depression and suicidal thinking in early psychosis. We

aimed initially to have a clearer understanding of the ebb and flow of

depression and suicidal thinking in the early phase of psychosis, whether

these events are predictable and how they relate to the early course of

psychotic symptoms. Ninety-two patients with first episode psychosis (FEP)

completed measures of self harm, hopelessness, depression, and duration of

untreated psychosis. Follow-up took place over 12 months. A combination

of depression and suicidal thinking was present in 63%. Depression in the

prodromal phase was the most significant predictor of future depression

and acts of self-harm and thus may be key to the development of fu-

ture depression and suicidal thinking. Exploring the relationship between

early psychotic symptoms and suicidal ideation in detail, we examined the

relationship of depression and suicidal thinking with appraisal of illness,

voices and persecutors. Prospective data was gathered on 72 patients with

acute FEP on depression, severity and experience of positive symptoms,

insight and appraisals of illness using validated interviews over12 months.

Malevolent voices, use of safety behaviours and subordination to persecu-

tors was associated with depression and suicidal behaviour in acute FEP.

Loss, shame, low level continuing positive symptoms and longer duration

of untreated psychosis were associated with post psychotic depression.

Negative appraisals remained stable despite recovery in other symptom

domains. Thus depression in early psychosis may be propagated by the

personal significance and content of positive symptoms experienced in FEP.

In recovery, low level symptoms, longer period of illness and negative

appraisals are significant factors. Using novel qualitative methodology, we

went on to explore the subjective experience and phenomenological fea-

tures of post-psychotic depression using photo-elicitation and unstructured

interviews. The psychotic episode was a traumatic event followed by sub-

jective doubt, shame and embarrassment. Common biological symptoms

of depression did not feature. Participants rather felt that the psychotic

episode had destroyed their personality and identity, leading to a loss of

role, status and suicidal ideation; “It’s a feeling of worthlessness, feeling of

no hope, feeling of you’re useless to anything, anyone . . . you got nothing

to look forward to, it’s all taken away from you.” Efforts to predict and

reduce suicide in psychosis may need to target the early phase of illness to

reduce later risk. Understanding this dimension of psychosis in and of itself

has the potential to improve and aid development of more effective and

appropriately targeted interventions.