Pathways to Care for Patients With First-Episode Psychosis in Singapore.

In this study, we aim to describe the pathways to care for patients with first-episode psychosis in Singapore. We analyzed data from 900 individuals accepted by the Singapore Early Psychosis Intervention Programme between 2007 and 2012. The most common first contacts were specialist care (59%), primary care (27%), and the police (12%). Multivariate regression models showed that first contact with services varied according to demographic variables and diagnosis. The duration of untreated psychosis, total number of contacts before referral, and rate of referral to the Early Psychosis Intervention Programme varied according to demographic and clinical variables and first contact. We hope that this information will enable clinicians, managers, and other service providers to target interventions to streamline referrals, reduce distress, and improve the treatment of young people with psychotic illnesses.

Hippocampal volumes in first-episode psychosis.

Studies have shown that patients with schizophrenia have smaller hippocampi than healthy comparison subjects. There are, however, inconsistencies regarding the relationship between clinical characteristics and topographical differences in hippocampal volumetry. The authors investigated hippocampal volumes in minimally treated patients with first-episode schizophrenia spectrum disorders, relative to comparison subjects. Thirty-nine consecutive patients and 29 matched comparison subjects were scanned using 1.5 tesla MR system. Patients had significantly smaller right anterior, right, and anterior hippocampal volumes than comparison subjects. There was a gender by diagnosis effect: female patients showed significantly smaller anterior and right hippocampal volumes than female comparison subjects, an effect not seen in male patients. Our results suggest that smaller hippocampal volumes are present even in early stages of the illness.

White matter abnormalities and neurocognitive deficits associated with the passivity phenomenon in schizophrenia: a diffusion tensor imaging study.

The passivity phenomenon is a distressing Schneiderian first rank symptom in patients with schizophrenia. Based on extant data of functional and structural cerebral changes underlying passivity, we sought to examine cerebral white matter integrity in our subjects. We hypothesised that the passivity phenomenon would be associated with white matter changes in specific cortical (frontal, parietal cortices, and cingulate gyrus) and subcortical regions (thalamus and basal ganglia) and correlated with relevant neurocognitive deficits, compared with characteristics in those without the passivity phenomenon. Thirty-six subjects (11 with passivity and 25 without passivity) with schizophrenia were compared with 32 age-, gender- and handedness-matched healthy controls using diffusion tensor imaging. Neuropsychological testing was administered. Patients with passivity were associated with increased fractional anisotropy within the frontal cortex, cingulate gyrus, and basal ganglia and decreased fractional anisotropy within the thalamus when compared with patients without passivity. Within patients with passivity, fractional anisotropy in the frontal cortex correlated with the age of onset of illness and neurocognitive deficits related to attention and executive functioning. The findings suggest distributed involvement of cortical and subcortical regions underlying passivity and support the notion of neural network models underlying specific psychiatric symptoms such as passivity.

Effect of treatment on weight gain and metabolic abnormalities in patients with first-episode psychosis.

OBJECTIVE: The aim of the present prospective and naturalistic study was to examine the effects of antipsychotic medication on weight and serum levels of lipids, glucose and insulin in first-episode psychosis patients. METHOD: Fifty-six patients admitted to the Singapore Early Psychosis Intervention Programme participated in this study. They were assessed at baseline (i.e. within 72 h of starting antipsychotics), and 6 months later. Weight (kg) and height (m) were measured and body mass index (BMI) was calculated. Blood samples were taken after a 12 h overnight fast. Choice of antipsychotics was based on the treating physician's clinical decision. Total cumulative Chlorpromazine (CPZ) equivalent of antipsychotic exposure during the 6 months was calculated. Statistical analyses were carried out for comparisons between baseline and 6 months, and for the two outcome event groups of > or =7% versus <7% weight gain. Where appropriate, confounders were controlled. RESULTS AND CONCLUSION: There were significant increases in BMI, serum levels of triglyceride, low-density lipoprotein and total cholesterol from baseline to 6 months. Mean increase in weight was 6.2+/-7.0 kg (p < 0.05) and 65% of the patients had clinically significant weight gain (i.e. > or =7% increase from baseline). On logistic regression lower baseline BMI, female gender, and younger age, were associated with clinically significant weight gain.

Medication adherence in first-episode psychosis patients in Singapore.

AIM: Early intervention programmes for first episode psychosis (FEP) aim to reduce the duration of untreated psychosis (DUP) and improve functional outcomes. The sustained maintenance of improved outcomes depends largely on patients' adherence to prescribed treatment. This paper examines the prevalence of non-adherence in a cohort of patients with FEP and the sociodemographic and clinical factors associated with non-adherent behaviour. METHODS: The sample included consecutive patients accepted from 2007 to 2012 into the Early Psychosis Intervention Programme (EPIP) in Singapore. Sociodemographic variables as well as DUP, insight, severity of psychopathology and clinical diagnoses were collected. Patients were assessed at baseline and 1 year with the PANSS and Global Assessment of Functioning Scale (GAF). Medication adherence was grouped into 3 categories: no-adherence, partial adherence and regular adherence. RESULTS: Of the 445 patients included, 51% were male with a mean age of 26.3 years, 74.6% had schizophrenia spectrum and delusional disorders, 14% had affective psychosis and 11.3% had brief psychotic disorder or psychotic disorder not otherwise specified. At 1 year follow up, 65.5% reported regular adherence, 18.7% were partially adherent and 15.8% were non-adherent. Non-adherence was correlated with male gender, living alone and having poorer judgement and insight. Partial adherence was associated with Malay ethnicity and having undergone national service. CONCLUSION: Medication adherence is prevalent in FEP and associated with a variety of factors. This study supports the use of culturally appropriate interventions in addressing barriers to adherence. Further studies would need to be done to address specific factors affecting adherence outcomes.

Subjective Quality of Life and Its Associations among First Episode Psychosis Patients in Singapore.

Background-Mental disorders have been found to affect quality of life (QOL) in patients. The current study aimed to determine QOL among first episode psychosis (FEP) patients and explore its associations with sociodemographic as well as clinical factors. Methods-Data for this study were collected as a part of an Early Psychosis Intervention Program (EPIP)-Smoking and Alcohol use survey. At baseline, 280 outpatients aged 15-40 years old diagnosed with FEP, with no prior or minimal treatment, no history of medical or neurological disorder, and no history of substance abuse, were recruited. Sociodemographic details, diagnosis, length of duration of untreated psychosis (DUP), and World Health Organization Quality of Life assessment-abbreviated version (WHOQOL-BREF) scores were obtained. Results-After adjusting for all covariates, older age (p = 0.036), females, and participants diagnosed with brief psychotic disorder (p = 0.04) were associated positively, whereas separated/divorced participants, those with lower education, unemployed (p = 0.01), and longer DUP were seen to be negatively associated with different domains of QOL. Conclusion-Higher WHOQOL-BREF scores denote better QOL. Overall, female participants as compared to male participants and those diagnosed with brief psychotic disorder in this sample reported better QOL.

Evaluating Singapore's CHAT Assessment Service by the World Mental Health Organisation (WHO) "Youth-Friendly" Health Services Framework.

Young people experience high rates of mental health issues. However, many do not seek professional help. In order to encourage help-seeking behavior among young people, it is important to ensure that services are youth-friendly. This study aims to evaluate the Community Health Assessment Team (CHAT)'s mental health assessment service model using the World Health Organization (WHO) youth-friendly health service framework of accessibility, acceptability, and appropriateness (AAA), and to ascertain the extent to which the CHAT service model is youth-friendly. Three hundred young people aged 16-30 years, who had gone through CHAT mental health assessments, completed a 27-item questionnaire. Majority rated the items in the questionnaire favorably. Our results suggest that majority of the young people who accessed CHAT mental health assessment service found it to be youth-friendly.

Spontaneous dyskinesia in first-episode psychosis in a Southeast Asian population.

Spontaneous dyskinesia in first-episode psychosis was described previously with varying incidence rates ranging from zero to 53%. Dyskinesia was also found to be more common in siblings of patients with both schizophrenia and dyskinesia. This condition was linked with structural brain abnormalities and posited to be another subtype of schizophrenia with striatal pathology. Whether there are ethnic variations in the rates of spontaneous dyskinesia is unknown because of the paucity of studies in this area. This study aims to establish the rates of spontaneous dyskinesia in a Southeast Asian population of drug-naive patients experiencing their first psychotic episode and to examine the clinical correlates. A total of 908 patients were examined, of which, 76.1% were Chinese; 15.4%, Malays; 6.2%, Indians; and 2.3%, from other minor ethnic groups. Schizophrenia was diagnosed in 48.9% of the population. There were 3 patients of Chinese descent who had "minimal" or "mild" dyskinetic movements when rated with the Abnormal Involuntary Movement Scale, but none fulfilled the Schooler and Kane criteria for spontaneous dyskinesia. Their dyskinetic movements resolved when reassessed 3 and 6 months after treatment with antipsychotic medications. Of the 3 patients, 2 were treatment resistant and subsequently treated with clozapine. This is the largest study to date examining the prevalence of spontaneous dyskinesia. We hypothesize that there is an ethnically based difference in the rates of spontaneous dyskinesia that could reflect underlying genetic variations. Patients with dyskinetic movements at baseline could have a more treatment refractory course of illness.

Trajectories of positive, negative and general psychopathology symptoms in first episode psychosis and their relationship with functioning over a 2-year follow-up period.

BACKGROUND: Few studies have examined the trajectories of symptom severity in first episode psychosis (FEP) and their impact on functioning. This study aimed to identify discrete trajectories of positive, negative and general psychopathological symptoms and functioning, determine predictors of the identified symptom trajectories and subsequently investigate the relationship between symptom and functioning trajectories over the 2-year follow-up period. METHODS: Data were extracted from the Singapore Early Psychosis Intervention Programme clinical database. Trajectories of the Positive and Negative Syndrome Scale and Global Assessment of Functioning (GAF) scale over the two-year follow up were modelled using latent class growth curve modelling. RESULTS: Two distinct trajectories (early response and stable trajectory and delayed response trajectory) for positive symptoms, four distinct trajectories (early response and stable trajectory, early response and relapse trajectory, slower response and no response trajectory and delayed response trajectory) for negative and general psychopathology symptoms and three distinct trajectories for functioning (high functioning trajectory, moderately stable functioning trajectory and deterioration in functioning trajectory) were identified in our sample. Compared to individuals in the early response and stable trajectory, those in the delayed response trajectory for positive and negative symptoms, early response and relapse for negative and general psychopathology symptoms and slower response and no response trajectories for general psychopathology symptoms were significantly associated with higher odds of having deterioration in functioning over time. Poor symptom trajectories were also significantly predicted by younger age, male gender, unemployed and economically inactive status, lower education, longer duration of untreated psychosis and diagnosis of schizophrenia spectrum and delusional disorders. CONCLUSIONS: The results confirm that the symptoms trajectories among patients with FEP are heterogeneous and suggest that a small group of patients may be at higher risk of deterioration in symptom severity and functioning over the 2-year follow-up.

Reducing polypharmacy through the introduction of a treatment algorithm: use of a treatment algorithm on the impact on polypharmacy.

INTRODUCTION: Polypharmacy is very common in the psychiatric setting despite the lack of evidence to justify its use. The objective of this study was to review the prescription patterns in a tertiary mental health institute in Asia and evaluate the impact of a treatment algorithm for patients with first-episode psychosis (FEP) on the use of polypharmacy. MATERIALS AND METHODS: A treatment algorithm was implemented for patients accepted into an Early Psychosis Intervention Programme (EPIP) and the prescription patterns of these patients were compared with a comparator group (pre-EPIP) before the use of the algorithm. The prescribing pattern was established at 2 points: at baseline after the diagnosis was made, and 3 months later. RESULTS: There were 68 subjects in the comparator group and 483 EPIP patients; the latter were on the average younger. None in the comparator group was diagnosed to have an affective psychosis. There was a significant reduction in the rate of antipsychotic polypharmacy, prolonged use of benzodiazepines and anticholinergic medication in EPIP patients. This group also had an increase in the use of second-generation antipsychotics and received lower doses of antipsychotics. CONCLUSION: The implementation of a treatment algorithm coupled with audit has changed the trend towards polypharmacy among patients with FEP.

Making in-roads across the youth mental health landscape in Singapore: the Community Health Assessment Team (CHAT).

AIM: Adolescence and early adulthood is marked by physical, emotional and psychological changes, and is the peak onset of mental disorders. Internationally, one-fifth of children and adolescents have serious mental health problems, yet services catering to them are scarce. Locally, traditional mental health services are associated with much stigma. In 2009, the Community Health Assessment Team (CHAT), a youth-focused outreach and assessment service, was set up to address service gaps and care barriers. METHODS: CHAT's key offering is a free and confidential mental health assessment service to facilitate help-seeking individuals between the ages of 16 and 30 gain access to early treatment. Young persons' profile and assessment outcomes were collected and entered into a database. RESULTS: Between May 2009 and March 2013, CHAT received 601 referrals: 40.1% (241/601) from young persons themselves and 40.9% (246/601) from school or community counsellors. 79.2% (313/395) of those assessed had mental health issues. 61.5% (243/395) were referred to specialist clinics and 28.6% (113/395) to school or community counsellors. CONCLUSION: There is a steady increase in our referrals; majority are self-referred or referred from school and community counsellors. This attests to the success of our general outreach and targeted capacity-building efforts. Cognizant of young persons' distress, CHAT continues to work with downstream services for continuity of care, which also presents opportunities to consolidate and expand our network of specialist and community partners. Future directions seek to address current challenges: having a mobile platform to complement our face-to-face assessments, and building collaborations to provide holistic services for young persons.

Clozapine Use in First-Episode Psychosis: The Singapore Early Psychosis Intervention Programme (EPIP) Perspective.

OBJECTIVE: Early symptomatic response is pertinent in improving outcomes in first-episode psychosis. One of the ways in which this may be achieved is by reducing inappropriate delays in clozapine initiation. This study aimed to examine clozapine prescribing practices among clinicians by establishing the prevalence of clozapine use, identifying baseline clinical and demographic factors that were associated with clozapine use, examining outcomes in clozapine users versus nonusers, and identifying inappropriate antipsychotic prescription patterns prior to clozapine initiation. METHODS: A retrospective study including all consecutive patients who had presented to the Singapore Early Psychosis Intervention Programme (EPIP) from April 2001 to June 2012 was conducted. Clinical and demographic data were extracted from the EPIP database. Incident cases of clozapine users were identified, and additional treatment histories were obtained from medical records. In addition to descriptive statistics, multivariate analysis was performed to identify factors associated with clozapine initiation. RESULTS: Data from 1,603 patients were available for baseline analyses. Of these, 69 patients (4.3%) had been prescribed clozapine. Having a younger age at onset, lack of employment, a lower Global Assessment of Functioning disability score, and a higher Positive and Negative Syndrome Scale total score at baseline were factors associated with clozapine use. After adjustment was made for confounders, clozapine users were found to have attained similar rates of remission and recovery as patients who did not use clozapine. Clozapine initiation was delayed by a mean of 19.3 weeks (SD = 27.1; range, 0-117). Prior to commencing clozapine, 29.4% of patients had received antipsychotic treatments above maximum limits, whereas 75% of patients were prescribed ≥ 3 different antipsychotics (median = 3; range, 2-7). CONCLUSIONS: This study has confirmed that the prescribing of clozapine is low, delayed, and preceded by dosing of antipsychotic drugs above maximum limits. Identification of the factors found to be associated with clozapine use may encourage clinicians to consider clozapine sooner in relevant patients in hopes of achieving early symptomatic response.

Gender differences in patients with first-episode psychosis in the Singapore Early Psychosis Intervention Programme.

AIMS: This study aimed to identify the gender differences among multi-ethnic, Asian patients with first-episode psychosis attending the Early Psychosis Intervention Programme (EPIP) in Singapore. METHODS: Data for this study were derived from 533 (258 female, 275 male) patients aged 16-41 years old in the EPIP database. Socio-demographic data, Positive and Negative Syndrome Scale for schizophrenia (PANSS) and Global Assessment of Functioning (GAF) scores at baseline, 3 months, 6 months and 1 year were obtained. RESULTS: Significant gender differences were identified in terms of age, marital status, referral source, PANSS scores, GAF scores, remission and recovery over 1 year in the cohort. At service entry, female participants were older, more likely to be married and more likely to be referred from general practitioner/polyclinics (P < 0.0001). They showed better improvement over 1 year in PANSS positive, PANSS total, GAF disability and GAF total scores. CONCLUSIONS: Overall, female participants in this sample show better improvement than male participants. They showed a better course of illness over 1 year with one-third (33.3%) of female participants achieving recovery compared with approximately a quarter (23.6%) of male participants.

Typology of people with first-episode psychosis.

AIMS: The aim of the current study was to create a typology of patients with first-episode psychosis based on sociodemographic and clinical characteristics, service use and outcomes using cluster analysis. METHODS: Data from all respondents who were accepted into the Early Psychosis Intervention Programme (EPIP), Singapore from 2007 to 2011 were analysed. A two-step clustering method was carried out to classify the patients into distinct clusters. RESULTS: Two clusters were identified. Cluster 1 comprised largely of younger people with mean age of 25.5 (6.0) years at treatment contact, who were predominantly male (55.3%), single (98.3%) and living with parents (86.3%). Cluster 1 had a higher proportion of people diagnosed with the schizophrenia spectrum disorder (71.4%) and with a positive family history of psychiatric illness. Patients in cluster 2 were generally older with a mean age of 33.6 (4.7) years and the majority were women (74.2%). Cluster 1 had people with higher Positive and Negative Syndrome Scale (PANSS) scores at baseline as compared with cluster 2. After a 1-year follow up, their scores were still poorer than their counterparts in cluster 2, especially for PANSS negative score. The functioning level of people in cluster 1 showed less improvement than the people in cluster 2 after a year of treatment. CONCLUSIONS: There is a compelling need to develop new therapies and intensively treat young people presenting with psychosis as this group tends to have poorer outcomes even after 1 year of treatment.

Aggression in Asian patients with first-episode psychosis.

AIMS: The aims of this study were to examine the prevalence and severity of aggression in patients with first-episode psychosis and to identify the association between aggression and sociodemographic and clinical factors. METHODS: Consecutive patients with first-episode psychosis admitted to the Early Psychosis Intervention Programme, Singapore, were assessed for a history of aggressive acts. Diagnosis was confirmed using the Structured Clinical Interview for DSM-IV and psychopathology was assessed using PANSS. RESULTS: Of the 146 patients, 63.0% had no history of aggressive acts, 13.7% demonstrated severe aggression (defined as weapon use, sexual assault or victim injury) and 23.3% had lesser aggression (all other acts of aggression). Patients with aggression had a significantly longer duration of untreated psychosis (DUP) than those with no history of aggression (p = .01). The mean total PANSS scores did not differ significantly among the three groups. However, the General Psychopathology scores and the scores for 'hostility', 'poor impulse control', 'lack of insight and judgement' and 'somatic concern' were all significantly elevated in patients with aggression (p < .05). CONCLUSION: The significant association between aggression and longer DUP once again reiterates the need for early detection and effective management of first-episode psychosis.

Does ethnicity have an impact on duration of untreated psychoses: A retrospective study in Singapore.

BACKGROUND: Some studies have suggested ethnicity as being one of the causes leading to a longer duration of untreated psychosis (DUP) in first episode psychosis. AIM: We sought to investigate this issue, in a large cohort of patients with a first episode of psychosis, in Singapore. METHOD: In this naturalistic retrospective study, 794 patients accepted into Early Psychosis Intervention Programme (EPIP) services in Singapore were recruited. Diagnosis was made based on SCID 1 (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), Axis I Disorders). Information about DUP and sociodemographic characteristics was collected from patients and relatives. Positive and Negative Symptom Scale (PANSS) and Global Assessment of Functioning (GAF) Scale were used as tools to assess the severity of symptoms and functioning of the patient, respectively, at baseline, 3, 6, 12 and 24 months. RESULTS: The mean and 50th quantile (median) of DUP for this sample were 14.2 and 6, respectively. The mean and median DUP were higher among Indians than in the other ethnic groups. After adjusting for demographic variables, Indian ethnicity was significantly associated with higher median and 75th Percentile DUP than Chinese. Secondary and tertiary education and diagnosis of affective psychosis and brief psychotic disorder (vs. schizophrenia spectrum and delusional disorder) were also significantly associated with lower mean, median and 75th percentile DUP symptoms. Increase in age was significantly associated with higher mean, median and 75th percentile DUP while married and separated/divorced (vs. single) was significantly associated with lower mean and 75th percentile DUP. CONCLUSION: This study found a positive correlation between certain ethnic groups and DUP. Indian ethnicity, older age, single, lower education and patients diagnosed with schizophrenia spectrum and delusional disorders were more likely to be associated with longer DUP.

Support for Wellness Achievement Programme (SWAP): clinical and demographic characteristics of young people with at-risk mental state in Singapore.

AIM: Individuals with at-risk mental state (ARMS) experience subtle changes in thinking, behaviour and emotion before their first psychotic episode. Research has shown intervention provided during this period could delay, reduce, or even prevent the conversion to psychosis. In March 2008, the Support for Wellness Achievement Programme (SWAP) was launched for the assessment and treatment of patients with ARMS in Singapore. This paper examines the sociodemographic and clinical characteristics of patients at baseline. METHODS: In total, 384 patients were screened and 155 were accepted into the service. All patients were evaluated using the Comprehensive Assessment of At-Risk Mental State (CAARMS). Severity of psychopathology was assessed by Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and levels of functioning were assessed using the Social and Occupational Functioning Assessment Scale (SOFAS). RESULTS: The mean age of the patients was 21.0 years (standard deviation (SD) = 3.5) and 69.7% were men, 42.6% had a relative with a mental health problem and 69.8% met the criterion solely for the attenuated symptoms group. The mean PANSS total score was 48.9 (SD = 10.8). There was also a high rate of comorbidity with 34.8% having depression and 20.0% had anxiety disorders. The mean baseline SOFAS score was 51.5 (SD = 9.8), indicating moderate impairment in their functioning. CONCLUSION: These preliminary findings have highlighted that our data are similar to other ARMS programmes, and in addition to the management of ARMS, there is a need to treat both the comorbidities and impairment in social occupational functioning.

EQ-5D as a measure of programme outcome: results from the Singapore early psychosis intervention programme.

The current study aimed to establish the Health-Related Quality of Life (HRQoL) among participants with First Episode Psychosis (FEP) in Singapore, to elucidate the sociodemographic and clinical correlates of HRQoL, and ascertain the change after 1-year of treatment. Two hundred and forty one patients accepted into an Early Psychosis Intervention Programme (EPIP) from April 2009 to June 2011 and who had completed baseline EuroQol-5D (EQ-5D) assessments were included in this analysis. The mean (S.D.) EQ-5D index at baseline was 0.788 (0.258). One hundred thirty five (56.0%) patients who completed the EQ-5D assessment at the 12-month follow-up had a significantly higher EQ-5D index as compared to baseline. EQ-5D index was significantly higher among those patients who met criteria for remission at the 12-month interval than those who were not in remission. Our results suggest that the EQ-5D is responsive to improvement as it corresponded well to objective ratings of remission in our patients with FEP.

Rate and predictors of service disengagement among patients with first-episode psychosis.

OBJECTIVE: This study determined the rate of service disengagement among patients in the Early Psychosis Intervention Program (EPIP) in Singapore and predictors of disengagement. METHODS: EPIP is a two-year multidisciplinary program targeting first-episode psychosis. The sample comprised patients consecutively accepted (2001-2009) who had two years of follow-up data. Disengagement was assessed with a semistructured scale. Sociodemographic and clinical variables were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders, the Positive and Negative Syndrome Scale, and the Global Assessment of Functioning. Regression analyses were conducted. RESULTS: Among 775 patients, 109 (14%) disengaged from EPIP within two years. Significant baseline predictors included Malay ethnicity (odds ratio [OR]=1.93, 95% confidence interval [CI]=1.12-3.29) and less than six years of education (OR=2.30, CI=1.23-4.29). CONCLUSIONS: EPIP's engagement strategy should focus on patients of Malay ethnicity and of low educational attainment. Further studies should examine how these factors affect service disengagement.

Predictors of suicide in Asian patients with first episode psychosis.

UNLABELLED: High rates of suicide have been reported in psychotic disorders, particularly in the early phases. Studies examining suicide risk during the first episode of psychosis (FEP) are lacking, especially in the Asian context. The present study aims to investigate the prevalence of completed suicides and associated risk factors in a multi-ethnic Asian society. METHOD: Data from 1397 patients accepted into a local Early Psychosis Intervention Programme (EPIP) was collected. This included sociodemographic and clinical data. Cox proportional-hazards regression models were performed in order to explore factors associated with time to completed suicide. RESULTS: The sample comprised of 1397 FEP patients, with 687 females and 710 males. The mean age was 28.2 years. The prevalence of suicide in this sample was 1.9%. Of the 26 FEP patients who committed suicide, data on time to suicide was available for 23 of them. 56.5% committed suicide during the first year of follow-up. A higher risk of suicide was associated with an older age (Hazard Ratio (HR)=1.31, 95% CI, 1.05-1.63), longer DUP (HR=1.05, 95% CI, 1.02-1.11), higher PANSS positive (HR=1.91, 95% CI, 1.37-2.67), higher GAF symptomatology (HR=1.16, 95% CI, 1.04-1.30) and GAF disability scores (HR=1.12, 95% CI, 1.02-1.22). CONCLUSION: Older patients with longer DUPs, higher PANSS positive and negative scores and better functioning appear to be at higher risk of suicide in this sample. Early intervention services should focus on a thorough risk assessment in order to reduce the risk of suicide during FEP.