Suicidal activity and suicidal motivation among patients after their first psychotic episode

Introduction. Suicidal behavior among individuals with mental illness represents an acute medical and social problem. This study explores personality traits, primary stress-coping strategies, suicidal activity, and suicidal motivation in patients who have experienced their first psychotic episode and have a documented history of suicide risk. Material and Methods. The study was conducted at N. A. Alekseev Clinical Hospital No. 1 of Moscow Health Department. A total of 72 patients (aged 27.69 ± 0.79) were examined, all undergoing treatment in the Clinic of the First Psychotic Episode and having a documented history of suicidal risk. The methods included: the Mini-Mult Questionnaire, the Coping Behavior Questionnaire, the Suicidal Motivation Test and the Anti- Suicidal Motivation Test (both by Yu. Vagin), the Suicide Risk Questionnaire, the SAD PERSONS Suicide Risk Scale, and the Pierce Suicide Intent Scale. Data processing was performed using SPSS v. 25.0 and Excel 2010. Results. The respondents showed significant deviations from normative values in personality traits, behavioral characteristics, stress-coping strategies and suicidal motivation. In most cases, suicidal behavior after a first psychotic episode was limited to suicidal thoughts, with actual suicide attempts occurring less frequently. The motivation for suicide most often involved a loss of meaning in life and intolerance of suffering. Protective cognitive constructs against suicide comprised ‘narcissistic’ motivation (self-love), ‘ethical’ motivation (a sense of responsibility toward loved ones), and ‘cognitive hope’ (the hope to find a way out and overcome the situation), alongside a deeply held conviction that suicide is unacceptable and taboo. Patients within the suicide risk group diagnosed with schizophrenia spectrum disorders demonstrated a destructive personality profile, characterized by elevated scores on the ‘depression’, ‘psychasthenia’, ‘hysteria’, and ‘schizoid traits’ scales compared to normative data. This group predominantly employed maladaptive coping strategies focused on ‘avoidance of problem-solving’, ‘confrontation’, and ‘distancing’, while showing reduced use of constructive coping mechanisms. Conclusions. Patients who have experienced a first psychotic episode and have a history of suicide risk differ from the normative population in several personality and behavioral parameters. The distinct features of their emotional experiences and motivational sphere represent important targets for psychological intervention.