Managing Suicide Risk in Patients with Schizophrenia

Overview

Journal CNS Drugs

Specialties Neurology
Pharmacology

Date 2011 Jan 25

PMID 21254789

Citations 38

Authors

John Kasckow

Kandi Felmet

Sidney Zisook

Affiliations

Soon will be listed here.

Abstract

The management of suicide risk in patients with schizophrenia poses many challenges for clinicians. Compared with the general population, these patients have an 8.5-fold greater risk of suicide. This article reviews the literature dealing with the treatment of at-risk patients with schizophrenia. An integrated psychosocial and pharmacological approach to managing this population of patients is recommended. Although there is at least modest evidence suggesting that antipsychotic medications protect against suicidal risk, the evidence appears to be most favourable for second-generation antipsychotics, particularly clozapine, which is the only medication approved by the US FDA for preventing suicide in patients with schizophrenia. In addition, treating depressive symptoms in patients with schizophrenia is an important component of suicide risk reduction. While selective serotonin receptor inhibitors (SSRIs) ameliorate depressive symptoms in patients with schizophrenia, they also appear to attenuate suicidal thoughts. Further research is needed to more effectively personalize the treatment of suicidal thoughts and behaviours and the prevention of suicide in patients with schizophrenia.

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References

Pompili M, Mancinelli I, Girardi P, Tatarelli R . Nursing schizophrenic patients who are at risk of suicide. J Psychiatr Ment Health Nurs. 2003; 10(5):622-4. DOI: 10.1046/j.1365-2850.2003.00658.x. View

Copas J, Robin A . Suicide in psychiatric in-patients. Br J Psychiatry. 1982; 141:503-11. DOI: 10.1192/bjp.141.5.503. View

Andia A, Zisook S, Heaton R, Hesselink J, Jernigan T, Kuck J . Gender differences in schizophrenia. J Nerv Ment Dis. 1995; 183(8):522-8. DOI: 10.1097/00005053-199508000-00005. View

Crammer J . The special characteristics of suicide in hospital in-patients. Br J Psychiatry. 1984; 145:460-3. DOI: 10.1192/bjp.145.5.460. View

MORGAN H, Priest P . Suicide and other unexpected deaths among psychiatric in-patients. The Bristol confidential inquiry. Br J Psychiatry. 1991; 158:368-74. DOI: 10.1192/bjp.158.3.368. View

Barak Y, Mirecki I, Knobler H, Natan Z, Aizenberg D . Suicidality and second generation antipsychotics in schizophrenia patients: a case-controlled retrospective study during a 5-year period. Psychopharmacology (Berl). 2004; 175(2):215-9. DOI: 10.1007/s00213-004-1801-2. View

Van Putten T, May R . "Akinetic depression" in schizophrenia. Arch Gen Psychiatry. 1978; 35(9):1101-7. DOI: 10.1001/archpsyc.1978.01770330075006. View

Lenroot R, Bustillo J, Lauriello J, Keith S . Integrated treatment of schizophrenia. Psychiatr Serv. 2003; 54(11):1499-507. DOI: 10.1176/appi.ps.54.11.1499. View

Montross L, Zisook S, Kasckow J . Suicide among patients with schizophrenia: a consideration of risk and protective factors. Ann Clin Psychiatry. 2006; 17(3):173-82. DOI: 10.1080/10401230591002156. View

10.

Bustillo J, Lauriello J, Horan W, Keith S . The psychosocial treatment of schizophrenia: an update. Am J Psychiatry. 2001; 158(2):163-75. DOI: 10.1176/appi.ajp.158.2.163. View

11.

Salokangas R, Saarijarvi S, Taiminen T, Kallioniemi H, Lehto H, Niemi H . Citalopram as an adjuvant in chronic schizophrenia: a double-blind placebo-controlled study. Acta Psychiatr Scand. 1996; 94(3):175-80. DOI: 10.1111/j.1600-0447.1996.tb09844.x. View

12.

Kerwin R . Preventing suicide. Br J Psychiatry. 2003; 182:366. DOI: 10.1192/bjp.182.4.366. View

13.

Pompili M, Mancinelli I, Tatarelli R . Suicide and schizophrenia. Psychiatr Serv. 2003; 54(5):747-8. DOI: 10.1176/appi.ps.54.5.747. View

14.

. Practice guideline for the assessment and treatment of patients with suicidal behaviors. Am J Psychiatry. 2003; 160(11 Suppl):1-60. View

15.

Altamura A, Bassetti R, Bignotti S, Pioli R, Mundo E . Clinical variables related to suicide attempts in schizophrenic patients: a retrospective study. Schizophr Res. 2002; 60(1):47-55. DOI: 10.1016/s0920-9964(02)00164-0. View

16.

Kasckow J, Fellows I, Golshan S, Solorzano E, Meeks T, Zisook S . Treatment of subsyndromal depressive symptoms in middle-age and older patients with schizophrenia: effect of age on response. Am J Geriatr Psychiatry. 2010; 18(9):853-7. PMC: 3079763. DOI: 10.1097/JGP.0b013e3181dba12f. View

17.

Walker A, Lanza L, Arellano F, Rothman K . Mortality in current and former users of clozapine. Epidemiology. 1997; 8(6):671-7. DOI: 10.1097/00001648-199710000-00010. View

18.

Restifo K, Harkavy-Friedman J, Shrout P . Suicidal behavior in schizophrenia: a test of the demoralization hypothesis. J Nerv Ment Dis. 2009; 197(3):147-53. DOI: 10.1097/NMD.0b013e318199f452. View

19.

Saarinen P, Lehtonen J, Lonnqvist J . Suicide risk in schizophrenia: an analysis of 17 consecutive suicides. Schizophr Bull. 1999; 25(3):533-42. DOI: 10.1093/oxfordjournals.schbul.a033399. View

20.

Goh S, Salmons P, WHITTINGTON R . Hospital suicides: are there preventable factors? Profile of the psychiatric hospital suicide. Br J Psychiatry. 1989; 154:247-9. DOI: 10.1192/bjp.154.2.247. View