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We thank Falcone et al for their interest in our paper. The results they share from their own review of self-harm among children and adolescents with first-episode psychosis are both interesting and concerning. They report nearly a third of young patients engaged in self-harm immediately prior to their first admission to hospital. Although this is significantly higher than the 11% in our study, it is difficult to make direct comparisons without knowing more about the comparability of the two services and populations. It should also be noted that our study included all individuals with psychosis presenting to any mental health service, whereas their study only included admissions, thus focusing on a potentially higher-risk group.

Despite this, their results did prompt us to re-examine the effect of age within our data. As we initially reported, young age did not seem to confer any increased risk of self-harm in our sample. Our sample included 44 adolescents between 16 and 18 years of age. Of these, 6 (13.6%) engaged in some form of self-harm during the pre-treatment period of psychosis. We were not able to determine whether adolescents with first-episode psychosis presented with a different range of risk factors for self-harm.