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      Suicide in Recent Onset Psychosis Revisited: Significant Reduction of Suicide Rate over the Last Two Decades — A Replication Study of a Dutch Incidence Cohort

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          Abstract

          This study aims to compare the suicide risk over the past decade following recent onset psychosis to findings from the eighties and nineties in the same catchment area and to identify predictors of suicide in the context of the Psychosis Recent Onset Groningen-Survey (PROGR-S). A medical file search was carried out to determine the current status of all patients admitted between 2000 and 2009. The suicide rate was compared with a study executed in 1973–1988 in the same catchment area. Predictors of suicide were investigated using Cox regression. The status of 424 of the 614 patients was known in July 2014. Suicide occurred in 2.4% of patients with psychosis disorders (n = 10; mean follow-up 5.6 years); 6 out of 10 suicides took place within two years. Within two decades, the suicide rate dropped from 11% (follow-up 15 years, 8.5% after 5 years) to 2.4%. The Standardized Mortality Rate (SMR) of suicides compared with the general population was 41.6. A higher age was the only significant predictor for suicide. Neuroticism, living situation, disorganized and negative symptoms, and passive coping style all showed a trend for significance. A significant reduction in the suicide rate was found for people with psychosis over the past decades. Given the high SMR, suicide research should be given the highest priority. Identifying predictors may contribute to further reduction of suicide among patients with psychosis.

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          Most cited references44

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          Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia.

          Although the developers of the Positive and Negative Syndrome Scale (PANSS) grouped items into three subscales, factor analyses indicate that a five-factor model better characterizes PANSS data. However, lack of consensus on which model to use limits the comparability of PANSS variables across studies. We counted "votes" from published factor analyses to derive consensus models. One of these combined superior fit in our Caucasian sample (n=458, CFI=.970), and in distinct Japanese sample (n=164, CFI=.964), relative to the original three-subscale model, with a sorting of items into factors that was highly consistent across the studies reviewed. Published by Elsevier B.V.
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            Suicide and schizophrenia: a systematic review of rates and risk factors

            Risk assessment is a core skill in psychiatry. Risk prediction for suicide in schizophrenia is known to be complex. We undertook a systematic review of all original studies concerning suicide in schizophrenia published since 2004. We found 51 data-containing studies (from 1281 studies screened) that met our inclusion criteria, and ranked these by standardized quality criteria. Estimates of rates of suicide and risk factors associated with later suicide were identified, and the risk factors were grouped according to type and strength of association with suicide. Consensus on the lifetime risk of suicide was a rate of approximately 5%. Risk factors with a strong association with later suicide included being young, male, and with a high level of education. Illness-related risk factors were important predictors, with number of prior suicide attempts, depressive symptoms, active hallucinations and delusions, and the presence of insight all having a strong evidential basis. A family history of suicide, and comorbid substance misuse were also positively associated with later suicide. The only consistent protective factor for suicide was delivery of and adherence to effective treatment. Prevention of suicide in schizophrenia will rely on identifying those individuals at risk, and treating comorbid depression and substance misuse, as well as providing best available treatment for psychotic symptoms.
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              Validation of the five-factor model of personality across instruments and observers.

              Two data sources--self-reports and peer ratings--and two instruments--adjective factors and questionnaire scales--were used to assess the five-factor model of personality. As in a previous study of self-reports (McCrae & Costa, 1985b), adjective factors of neuroticism, extraversion, openness to experience, agreeableness-antagonism, and conscientiousness-undirectedness were identified in an analysis of 738 peer ratings of 275 adult subjects. Intraclass correlations among raters, ranging from .30 to .65, and correlations between mean peer ratings and self-reports, from .25 to .62, showed substantial cross-observer agreement on all five adjective factors. Similar results were seen in analyses of scales from the NEO Personality Inventory. Items from the adjective factors were used as guides in a discussion of the nature of the five factors. These data reinforce recent appeals for the adoption of the five-factor model in personality research and assessment.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 June 2015
                2015
                : 10
                : 6
                : e0129263
                Affiliations
                [1 ]Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
                [2 ]Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
                [3 ]NeuroImaging Center, Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
                [4 ]University Center for Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
                [5 ]Department of Psychology, University of Groningen, Groningen, The Netherlands
                University of Vienna, AUSTRIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: RB HK SC. Analyzed the data: EL JSDL SC. Contributed reagents/materials/analysis tools: EV. Wrote the paper: EL SC JSDL FDVE EV AA RB HK.

                Article
                PONE-D-14-50753
                10.1371/journal.pone.0129263
                4466318
                26068417
                a6c55bb0-e7b1-40c8-8760-41bd04b320b7
                Copyright @ 2015

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                History
                : 8 December 2014
                : 6 May 2015
                Page count
                Figures: 2, Tables: 2, Pages: 13
                Funding
                This work was supported by investments of local health care organizations ( http://www.rgoc.nl/#home/englishpages).
                Categories
                Research Article
                Custom metadata
                All relevant data are within the paper and its Supporting Information file S1 Dataset.

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