Schizophrenia and Suicide: Treatment Optimization

Gaurava Agarwal*, Megan Pirigyi, Herbert Y Meltzer

*Corresponding author for this work

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

In the aftermath of a serious suicide attempt, 25–50 % of patients with schizophrenia or schizoaffective disorder will make another attempt within 2 years; within 10 years, 3 % will have completed suicide, which represents about 60 % of all patients with these diagnoses who complete suicide. When treating such high suicide risk patients, initiating or continuing treatment with clozapine must always be the initial consideration. Clozapine is the only treatment approved to reduce suicide risk in this (or any other) population. Its efficacy for this purpose is supported by the highest quality evidence, including a prospective, randomized controlled trial, InterSePT. A trial of clozapine should be strongly considered even for first-episode patients and those whose psychotic symptoms have responded to other antipsychotics, as amelioration of psychotic symptoms may be insufficient to reduce suicide risk. When recommending a trial of clozapine, thorough psychoeducation for the patient and his or her support system is necessary. This should include informing patients that indefinite treatment with clozapine may be needed because of the elevated risks of suicide and relapse to psychosis upon drug discontinuation. Discussion of the anticipated side effects and the providers’ commitment to help minimize side effects are needed to make the trial of clozapine more attractive. If a trial of clozapine is unacceptable or impossible, alternative antipsychotic medications should be used and adherence monitored. A long-acting injectable atypical antipsychotic drug is preferable to oral medication, and certainly, to no antipsychotic treatment. The clinician should regularly inquire about suicidal thoughts and hopelessness and limit patients’ access to means of self-harm. In addition, one should identify the symptoms, behaviors and social factors that contribute to each patient’s suicide risk, and provide a combination of pharmacotherapy, psychosocial rehabilitation modalities, and psychotherapeutic interventions to address these factors.

Original languageEnglish (US)
Pages (from-to)149-162
Number of pages14
JournalCurrent Treatment Options in Psychiatry
Volume1
Issue number2
DOIs
StatePublished - Jun 1 2014

Fingerprint

Clozapine
Suicide
Schizophrenia
Antipsychotic Agents
Therapeutics
Substance-Induced Psychoses
Psychotic Disorders
Randomized Controlled Trials
Recurrence
Drug Therapy
Injections
Population

Keywords

  • Clozapine
  • Nonadherence, Long-acting injectable
  • Risk factors, Depression, Antidepressants, Citalopram, Naltrexone
  • Schizoaffective disorder
  • Schizophrenia
  • Side effects
  • Substance abuse
  • Suicide

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

@article{dd9628ee1fe34279ae75038a6f4aef6c,
title = "Schizophrenia and Suicide: Treatment Optimization",
abstract = "In the aftermath of a serious suicide attempt, 25–50 {\%} of patients with schizophrenia or schizoaffective disorder will make another attempt within 2 years; within 10 years, 3 {\%} will have completed suicide, which represents about 60 {\%} of all patients with these diagnoses who complete suicide. When treating such high suicide risk patients, initiating or continuing treatment with clozapine must always be the initial consideration. Clozapine is the only treatment approved to reduce suicide risk in this (or any other) population. Its efficacy for this purpose is supported by the highest quality evidence, including a prospective, randomized controlled trial, InterSePT. A trial of clozapine should be strongly considered even for first-episode patients and those whose psychotic symptoms have responded to other antipsychotics, as amelioration of psychotic symptoms may be insufficient to reduce suicide risk. When recommending a trial of clozapine, thorough psychoeducation for the patient and his or her support system is necessary. This should include informing patients that indefinite treatment with clozapine may be needed because of the elevated risks of suicide and relapse to psychosis upon drug discontinuation. Discussion of the anticipated side effects and the providers’ commitment to help minimize side effects are needed to make the trial of clozapine more attractive. If a trial of clozapine is unacceptable or impossible, alternative antipsychotic medications should be used and adherence monitored. A long-acting injectable atypical antipsychotic drug is preferable to oral medication, and certainly, to no antipsychotic treatment. The clinician should regularly inquire about suicidal thoughts and hopelessness and limit patients’ access to means of self-harm. In addition, one should identify the symptoms, behaviors and social factors that contribute to each patient’s suicide risk, and provide a combination of pharmacotherapy, psychosocial rehabilitation modalities, and psychotherapeutic interventions to address these factors.",
keywords = "Clozapine, Nonadherence, Long-acting injectable, Risk factors, Depression, Antidepressants, Citalopram, Naltrexone, Schizoaffective disorder, Schizophrenia, Side effects, Substance abuse, Suicide",
author = "Gaurava Agarwal and Megan Pirigyi and Meltzer, {Herbert Y}",
year = "2014",
month = "6",
day = "1",
doi = "10.1007/s40501-014-0012-7",
language = "English (US)",
volume = "1",
pages = "149--162",
journal = "Current Treatment Options in Psychiatry",
issn = "2196-3061",
publisher = "Springer International Publishing AG",
number = "2",

}

Schizophrenia and Suicide : Treatment Optimization. / Agarwal, Gaurava; Pirigyi, Megan; Meltzer, Herbert Y.

In: Current Treatment Options in Psychiatry, Vol. 1, No. 2, 01.06.2014, p. 149-162.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Schizophrenia and Suicide

T2 - Treatment Optimization

AU - Agarwal, Gaurava

AU - Pirigyi, Megan

AU - Meltzer, Herbert Y

PY - 2014/6/1

Y1 - 2014/6/1

N2 - In the aftermath of a serious suicide attempt, 25–50 % of patients with schizophrenia or schizoaffective disorder will make another attempt within 2 years; within 10 years, 3 % will have completed suicide, which represents about 60 % of all patients with these diagnoses who complete suicide. When treating such high suicide risk patients, initiating or continuing treatment with clozapine must always be the initial consideration. Clozapine is the only treatment approved to reduce suicide risk in this (or any other) population. Its efficacy for this purpose is supported by the highest quality evidence, including a prospective, randomized controlled trial, InterSePT. A trial of clozapine should be strongly considered even for first-episode patients and those whose psychotic symptoms have responded to other antipsychotics, as amelioration of psychotic symptoms may be insufficient to reduce suicide risk. When recommending a trial of clozapine, thorough psychoeducation for the patient and his or her support system is necessary. This should include informing patients that indefinite treatment with clozapine may be needed because of the elevated risks of suicide and relapse to psychosis upon drug discontinuation. Discussion of the anticipated side effects and the providers’ commitment to help minimize side effects are needed to make the trial of clozapine more attractive. If a trial of clozapine is unacceptable or impossible, alternative antipsychotic medications should be used and adherence monitored. A long-acting injectable atypical antipsychotic drug is preferable to oral medication, and certainly, to no antipsychotic treatment. The clinician should regularly inquire about suicidal thoughts and hopelessness and limit patients’ access to means of self-harm. In addition, one should identify the symptoms, behaviors and social factors that contribute to each patient’s suicide risk, and provide a combination of pharmacotherapy, psychosocial rehabilitation modalities, and psychotherapeutic interventions to address these factors.

AB - In the aftermath of a serious suicide attempt, 25–50 % of patients with schizophrenia or schizoaffective disorder will make another attempt within 2 years; within 10 years, 3 % will have completed suicide, which represents about 60 % of all patients with these diagnoses who complete suicide. When treating such high suicide risk patients, initiating or continuing treatment with clozapine must always be the initial consideration. Clozapine is the only treatment approved to reduce suicide risk in this (or any other) population. Its efficacy for this purpose is supported by the highest quality evidence, including a prospective, randomized controlled trial, InterSePT. A trial of clozapine should be strongly considered even for first-episode patients and those whose psychotic symptoms have responded to other antipsychotics, as amelioration of psychotic symptoms may be insufficient to reduce suicide risk. When recommending a trial of clozapine, thorough psychoeducation for the patient and his or her support system is necessary. This should include informing patients that indefinite treatment with clozapine may be needed because of the elevated risks of suicide and relapse to psychosis upon drug discontinuation. Discussion of the anticipated side effects and the providers’ commitment to help minimize side effects are needed to make the trial of clozapine more attractive. If a trial of clozapine is unacceptable or impossible, alternative antipsychotic medications should be used and adherence monitored. A long-acting injectable atypical antipsychotic drug is preferable to oral medication, and certainly, to no antipsychotic treatment. The clinician should regularly inquire about suicidal thoughts and hopelessness and limit patients’ access to means of self-harm. In addition, one should identify the symptoms, behaviors and social factors that contribute to each patient’s suicide risk, and provide a combination of pharmacotherapy, psychosocial rehabilitation modalities, and psychotherapeutic interventions to address these factors.

KW - Clozapine

KW - Nonadherence, Long-acting injectable

KW - Risk factors, Depression, Antidepressants, Citalopram, Naltrexone

KW - Schizoaffective disorder

KW - Schizophrenia

KW - Side effects

KW - Substance abuse

KW - Suicide

UR - http://www.scopus.com/inward/record.url?scp=85060548207&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060548207&partnerID=8YFLogxK

U2 - 10.1007/s40501-014-0012-7

DO - 10.1007/s40501-014-0012-7

M3 - Review article

AN - SCOPUS:85060548207

VL - 1

SP - 149

EP - 162

JO - Current Treatment Options in Psychiatry

JF - Current Treatment Options in Psychiatry

SN - 2196-3061

IS - 2

ER -