• L Fialko, D Freeman, P E Bebbington, E Kuipers, P A Garety, G Dunn, and D Fowler.
• Department of Psychology, Institute of Psychiatry, King's College London, University of London, London, UK. l.fialko@iop.kcl.ac.uk
• Acta Psychiatr Scand. 2006 Sep 1; 114 (3): 177-86.

ObjectiveTo examine the clinically important phenomenon of suicidal ideation in psychosis in relation to affective processes and the multidimensional nature of hallucinations and delusions.MethodIn a cross-sectional study of 290 individuals with psychosis, the associations between level of suicidal ideation, affective processes, positive symptoms, clinical and demographic variables were examined.ResultsForty-one per cent of participants expressed current suicidal ideation. Suicidal ideation was associated with depressed mood, anxiety, low self-esteem, negative illness perceptions, negative evaluative beliefs about the self and others and daily alcohol consumption. Frequency of auditory hallucinations and preoccupation with delusions were not associated with suicidal ideation; however, positive symptom distress did relate to suicidal thoughts.ConclusionAffective dysfunction, including distress in response to hallucinations and delusions, was a key factor associated with suicidal ideation in individuals with psychotic relapse. Suicidal ideation in psychosis appears to be an understandable, mood-driven process, rather than being of irrational or 'psychotic' origin.

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