Julia Pfluger

and 7 more

Background: Individuals with psychosis symptoms are at high risk for suicidality. The prevalence and correlates of suicidality in clinical high risk for psychosis (CHR-P) have yet to be clarified. This study reports on the prevalence and clinical correlates of suicidality in a clinical CHR-P sample. Method: Participants (n = 135) included CHR-P clients at a CHR-P community specialty clinic, who participated in a clinical assessment between 2017 and 2022. Assessments measured attenuated psychosis symptoms, suicidality, clinical covariates, and functioning. Frequency analyses assessed the prevalence of lifetime suicidal ideation and attempts and T-test and Chi-square identified clinical correlates. Logistic regression assessed the relationship between significant clinical correlates and lifetime suicide attempts. Results: Sixty five percent of participants at CHR-P endorsed lifetime suicidal ideation, while 22.2% reported at least one lifetime attempt. Correlates for lifetime suicidal ideation included self-reported gender expansive identity, hopelessness, depression, trauma, obsessive compulsive symptoms, insight: reflectiveness, trauma diagnoses, mood disorder diagnoses, and perceptual abnormalities/hallucinations. Significant correlates for lifetime suicide attempts included self-reported hopelessness, depression, trauma diagnosis and mood disorder diagnosis. Conclusion: CHR-P clients are at a higher risk for suicidal ideation and attempts compared to the general population. Correlates of suicidality may be diagnostically heterogeneous and therefore interventions should be tailored to specific clinical needs. Clients with trauma-disorder diagnoses may be at highest risk for suicidality. Continued intervention and longitudinal research is needed to clarify causal risk factors and establish evidence-based treatments for suicidality in CHR-P.

Danielle Pham

and 12 more

Background: Posttraumatic stress disorder (PTSD) is a common comorbid diagnosis in psychotic disorders. However, little is known about the effect of comorbid PTSD in youth at clinical high risk (CHR) for psychosis. Purpose: The purpose of this study was to investigate group differences in symptom severity, risk for psychotic conversion, and functioning among youth at CHR for psychosis with and without PTSD. Methods: This longitudinal study utilized data from N = 693 individuals who met criteria for CHR as part of the North American Prodrome Longitudinal Study 3 (NAPLS-3). Individuals who met criteria for PTSD were compared to those who did not meet criteria for PTSD on demographic, symptom and functional variables. Results: Individuals diagnosed with PTSD (N=54) reported more severe overall positive symptoms (p<0.001), negative symptoms (p<0.01), and general symptoms (p<0.001) compared to those without the diagnosis (N=639). These symptom differences were primarily accounted for by more grandiose (p<0.01) and perceptual symptoms (p<0.04), decreased experience of emotions (p<0.01) and occupational functioning (p<0.03), sleep disturbance (p<0.01), dysphoric mood (p<0.002) and impaired tolerance to stress (p<0.001) in those with PTSD. A diagnosis of PTSD was not associated with a greater rate of psychotic conversion or greater functional deficits. Conclusions: Our findings suggest that a diagnosis of PTSD is associated with more severe overlapping symptoms in individuals meeting the criteria for CHR but not psychotic conversion. Our findings underscore the importance of recognizing and treating comorbid psychiatric conditions including PTSD in CHR populations as a means of reducing symptoms and improving outcome.