First-Episode Drug-Naive Patients With Schizophrenia More Likely to Attempt Suicide

Depressed woman
Depressed woman
Researchers found a suicide attempt rate of 12.0% in first-episode, drug-naive inpatients.

First-episode, drug-naive (FEDN) individuals with schizophrenia attempt suicide more often than the general population, according to research published in the Journal of Clinical Psychiatry. Researchers found that in FEDN patients, suicidal patients were more likely to smoke, have less severe negative symptoms, and exhibit better attention than non-suicidal patients.

The cross-sectional case-control study enrolled 357 inpatients at the Beijing Hui-Long-Guan Hospital in China who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia and 380 healthy controls. Subjects completed an in-house questionnaire and researchers collected data from medical records and interviews with patients and family members. Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) measured cognition in 28 patients with and 95 patients without a suicide attempt history and 151 healthy controls. Researchers rated patients on the Positive and Negative Syndrome Scale.

The study was limited by a small sample size and the cross-sectional case-control design, which cannot show causality between suicide attempts and risk factors. In addition, premorbid IQ, suicide attempt severity, and neurocognitive features not included in RBANS were not assessed.

Researchers found a suicide attempt rate of 12.0% in FEDN inpatients. Attempters were more likely to smoke, had lower negative symptom severity, and showed better attention than non-attempters. FEDN patients demonstrated significantly lower cognitive performance than healthy controls. The prevalence of suicide attempts in FEDN patients was significantly higher than chronically ill, medicated patients (9.2%), suggesting that there is not a significant change in the suicide attempt rate over the progression of the illness and that most attempts occur early in the disease course.

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Because the suicide risk is increased 2-fold at the onset of psychotic illness, researchers note that “it is of great importance to investigate the relevant risk factors in this population, particularly since early intervention and therapy may reduce suicidality among first-episode psychosis patients.” Researchers also advocate further investigation of FEDN patients.


Zhang XY, Du X, Yin G, et al. Prevalence and clinical correlates of and cognitive function at the time of suicide attempts in first-episode and drug-naive patients with schizophrenia. J Clin Psychiatry. 2018;79(4):17m11797.