TY - JOUR
T1 - Schizophrenia and Suicide
T2 - Treatment Optimization
AU - Agarwal, Gaurava
AU - Pirigyi, Megan
AU - Meltzer, Herbert
N1 - Funding Information:
Dr. Herbert Meltzer has received honoraria for consulting, or research contracts within the last 5 years from Alkermes, Astellas, EnVivo, DaiNippon Sumitomo, Forest, Merck, Naurex, Novartis, Otsuka, Sunovion Pharmaceuticals Inc., SureGene, Takeda, and TEVA. Dr. Meltzer was the Principal Investigator of the InterSePT study, funded by Novartis and has prepared an educational program regarding suicide and clozapine sponsored by Teva. He has served as a board member or received payment to lecture at Acadia, Asenapine, BioLine Rx, Boehringer Ingelheim Pharma GmbH &Co. KG, Janssen, Sunovion, SureGene, and Teva, Additionally, Dr. Meltzer owns stock or stock options in Arcadia, SureGene and GlaxoSmithKline. Dr. Gaurava Agarwal has received salary support for clinical research from Takeda, Naurex, Otsuka, and Sunovion Pharmaceuticals. Dr. Megan Pirigyi has no disclosures to report.
Publisher Copyright:
© 2014, Springer International Publishing AG.
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 -
