Risk of suicide and suicidal ideation in psychosis: Results from an Italian multi-modal pilot program on early intervention in psychosis Antonio Preti a , Anna Meneghelli b,c , Alessia Pisano b,c , Angelo Cocchi b,c, ⁎ for the Programma 2000 Team 1 a Centro Medico Genneruxi, via Costantinopoli 42, 09129 Cagliari, Italy b Azienda Ospedaliera, Ospedale Niguarda Ca' Granda, Milan, Italy c Dipartimento di Salute Mentale. Centro per l'individuazione e l'intervento precoce nelle psicosi-Programma 2000, Italy article info abstract Article history: Received 11 January 2009 Received in revised form 4 June 2009 Accepted 9 June 2009 Available online 1 July 2009 Suicidality is high in schizophrenia, particularly in first-episode patients. Little is known about patients with prodromal symptoms of psychosis or otherwise high-risk persons. In a sample enrolled in an early intervention program implemented in Milan (Italy), a history of attempted suicide before enrollment was found in 6 first-episode schizophrenia (out of 87, 6.9%), and 7 high-risk of psychosis (out of 81, 8.6%) patients. In the first-episode group, a history of suicide attempts was related to a shorter duration of untreated psychosis. In the high-risk group, a family psychiatric history in first/second degree relatives of patients and a personal history of substance abuse were both associated with an enhanced risk of attempted suicide before enrollment. During the first year of treatment, 3 new attempted suicides were recorded among 57 (5.3%) high-risk patients, and none among first-episode patients (n = 58) (no dropout in the sample). The levels of suicide ideation on the BPRS did not differ by group at assessment, and significantly declined from assessment at entry to 1-year follow-up, except in seven HRP patients who become positive for core symptoms of schizophrenia, as measured on the BPRS. At enrollment, patients at high risk of psychosis had the same prevalence of past suicide attempts than first-episode schizophrenia patients: since suicide attempt is the most important predictor of a future suicidal attempt, the assessment of suicide risk should be given a privileged role in patients at high risk of psychosis as well. © 2009 Elsevier B.V. All rights reserved. Keywords: Psychosis Suicide Prevention Duration of untreated psychosis Early detection of psychosis 1. Introduction In schizophrenia, up to 5% of patients die by suicide (Inskip et al., 1998; Palmer et al., 2005), and 20–40% attempt suicide during the course of their illness (Harkavy-Friedman et al., 1999; Radomsky et al., 1999). Symptoms of psychosis (De Hert et al., 2001; Heila et al., 1997), male gender, depression, alcohol and substance abuse, traumatic or stress events in the preceding months, poor social support and a family history of suicide represent risk factors for suicide in schizophrenia (Fenton, 2000; Hawton et al., 2005). The risk of suicide in schizophrenia is higher during the early phases of the illness (Nordentoft et al., 2004; Palmer et al., 2005). Indeed, 15 to 26% of patients have attempted Schizophrenia Research 113 (2009) 145–150 ⁎ Corresponding author. A.O. Ospedale Niguarda Ca' Granda, Programma 2000 - Via Livigno, 3, 20128 Milano, Italy. Tel.: +39 02 64445554, +39 02 66809801; fax: +39 02 66809809. E-mail addresses: angelo.cocchi@ospedaleniguarda.it, programma2000@ospedaleniguarda.it (A. Cocchi). 1 The Programma 2000 Team includes: Prof. Angelo Cocchi, M.D. (team leader); Anna Meneghelli, Psy.D. (clinical and scientific coordinator); Andrea Alpi, Psy.D., Laura Bislenghi, Psy.D., Tiziana Bolis, Psy.D., Noelia Moreno Granados, Psy.D., Giovanni Patelli, Psy.D., Marco Ponteri, Psy.D., Nicoletta Pafumi, Psy.D. (all clinical psychologists); Federico Galvan, M.A. (educator); Alessia Pisano, Psy.D. (psychologist); Simona Barbera, M.D. (psychiatrist); Stefano Romanò M.D. (psychiatrist); Daniele von Morghen, M.D. (psychia- trist). The team includes a very active group of psychologists in training, too. Antonio Preti, M.D., is a scientific advisor and consultant to the Programma 2000 project. 0920-9964/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2009.06.007 Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres