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. 2025 May 1;31(3):125-138.
doi: 10.1097/PRA.0000000000000860.

Symptomatic Predictors of Suicidal Behavior in Early Psychosis: Systematic Review

Valerio Ricci  1 , Alessandro Sarni  1 , Domenico De Berardis  2 , Thomas Fraccalini  3 , Giovanni Martinotti  4 , Giuseppe Maina  1   5
Affiliations

Symptomatic Predictors of Suicidal Behavior in Early Psychosis: Systematic Review

Valerio Ricci et al. J Psychiatr Pract. .

Abstract

Psychotic disorders, including schizophrenia, carry a substantial risk of suicide, particularly during the first-episode psychosis (FEP) phase. This narrative review aims to identify key symptomatic predictors of suicidal behavior in individuals experiencing FEP by thoroughly analyzing existing literature. Studies highlight that the highest suicide risk occurs around the initial presentation for psychiatric services. This critical period encompasses the month before and the 2 months after the first contact with mental health professionals. Severe depressive symptoms and a prolonged duration of untreated psychosis emerge as primary risk factors for suicidal behavior. Depression, when combined with cognitive impairments and a history of childhood trauma, significantly increases the risk of suicidality. These combined factors create a compounded effect, making it more difficult for individuals to cope and increasing their feelings of hopelessness and despair. In addition, poor premorbid functioning-referring to the level of psychological and social functioning before the onset of psychosis-and substance abuse, particularly the use of stimulants, further exacerbate the risk. Substance abuse can also intensify symptoms and impair judgment, leading to an increased likelihood of suicidal behavior. This review underscores the critical importance of timely, comprehensive, and tailored interventions. Early detection and intervention can significantly mitigate the risk of suicide in patients with FEP. Providing targeted treatments that address depressive symptoms, cognitive impairments, and substance abuse issues can improve overall outcomes and enhance the quality of life for these individuals. Comprehensive care approaches and strategies to improve functioning are also essential in reducing suicidality and promoting long-term recovery.

Keywords: cognition; first episode psychosis; nonaffective psychosis; schizophrenia; substance misuse; suicide.

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Conflict of interest statement

The authors declare no conflicts of interest.

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