Potentially lethal suicide attempts using sharp objects during psychotic illness

Background: Recent studies have reported that serious violence toward self and others is more common in the first episode of psychosis than after treatment. Aims: To estimate the proportion of survivors of potentially lethal suicide attempts with sharp objects who have a diagnosis of psychotic illness, and the proportion of those patients who had never received treatment for psychosis with antipsychotic medication. Methods: An audit of the medical records of patients from three major teaching hospitals in Sydney, Australia, who survived a self inflicted stab wound to the abdomen, torso, or a laceration to the neck. Results: The files of 95 survivors of self-inflicted wounds by cutting or stabbing who met the inclusion criteria for the study were examined. A psychotic illness was diagnosed in 46 cases (48%), of which 26 (57%) had never received treatment with antipsychotic medication and, hence, were in the first episode of psychosis. Conclusions: Psychosis is strongly associated with potentially lethal suicide attempts using sharp objects and patients who have never received treatment for psychosis appear to be at particular risk.