By Mark Moran
Courtesy of Psychiatric News

Psychiatrists should emphasize a recovery-focused approach and an optimistic outlook when working with people with psychosis.

Negative thoughts about psychotic experiences and fears of losing mental control may heighten the risk of suicide in patients with psychosis who were not taking antipsychotics, suggests a report posted November 2 in Schizophrenia Bulletin.

“Overall, our findings emphasize the importance of clinicians promoting a recovery-focused and appropriately optimistic outlook when working with people with psychosis, taking care to avoid providing information that might heighten negative illness appraisals and/or fears of losing mental control,” wrote Paul Hutton, Ph.D., of the Edinburgh Napier University in the United Kingdom and colleagues.

They analyzed data on the effect of “metacognition” on suicidal thinking. Metacognition refers to knowledge and beliefs relating to the structure and integrity of the self and one’s own cognitive processes.

In their report, they noted that estimates of suicide rates among individuals diagnosed with schizophrenia spectrum disorders range from 5 to 10 percent, making it a leading cause of premature death in this population.

“Given antipsychotics have their strongest effects on the positive symptoms of psychosis, it is plausible that individuals not taking this medication may have greater positive symptom severity than those who do—and that this accounts for their increased suicide risk,” Hutton and colleagues wrote. Yet the researchers said evidence on the contribution of positive symptoms to suicide risk remains unclear, with some studies suggesting no association.

Other studies, however, have found that the way a person interprets or “appraises” their psychotic experiences may be more important than symptom severity for predicting suicidal behavior. For instance, a review published in the British Journal of Psychiatry in 2005 found that people with psychosis who die by suicide were more likely to have “fears of mental disintegration” than those with psychosis who did not die by suicide.