Comparative effect of antipsychotics on risk of self‐harm among patients with schizophrenia

Ma, Chia-Hao; Chang, Shu‐Sen; Tsai, Hui‐Ju; Gau, Susan Shur‐Fen; Chen, I-Ming; Liao, Shih‐Cheng; Chien, Yi‐Ling; Hsieh, Ming H.; Wu, Chi‐Shin

doi:10.1111/acps.12857

Cited by 13 publications

(7 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The guidelines of treatment for schizophrenia should emphasize the underutilization among patients with a history of self-harm. In fact, clozapine is underutilized in many countries [ 32 ], although research suggests that clozapine reduces self-harm [ 7 – 9 ] and mortality compared with other antipsychotics [ 10 , 33 ]. Underutilization may become a barrier to recovery from schizophrenia and high suicide risk.…”

Section: Discussionmentioning

confidence: 99%

“…In Danish outpatients with treatment-resistant schizophrenia, the risk of self-harm was higher for non-clozapine antipsychotics than clozapine (hazard ratio [HR]: 1.36) [ 8 ]. Moreover, clozapine has shown the strongest protective effect against hospitalization for self-harm compared to other second-generation antipsychotics for individuals with initial diagnoses of schizophrenic disorders in Taiwan [ 9 ]. Continuous treatment with clozapine is associated with a 44% lower long-term mortality rate than treatment with other antipsychotics [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

History of suicidal behavior and clozapine prescribing among people with schizophrenia in China: a cohort study

Yin,

Lin,

Wei

et al. 2024

BMC Psychiatry

View full text Add to dashboard Cite

Background Clozapine is an off-label drug used in most countries to prevent suicide in individuals with schizophrenia. However, few studies have reported real-world prescription practices. This study aimed to explore the association between a history of suicidal behavior and clozapine prescribing during eight weeks of hospitalization for individuals with early-stage schizophrenia. Methods This observational cohort study used routine health data collected from a mental health hospital in Beijing, China. The study included 1057 inpatients who had schizophrenia onset within 3 years. History of suicidal behavior was coded from reviewing medical notes according to the Columbia Suicide Severity Rating Scale. Information on antipsychotic use during hospitalization was extracted from the prescription records. Time to clozapine use was analyzed using Cox regression models adjusted for sociodemographic and clinical covariates. Results The prevalence rates of self-harm, suicidal behavior, and suicide attempt were 12.3%, 7.5%, and 5.4%, respectively. A history of self-harm history was positively associated with clozapine uses upon admission (4.1% vs. 0.8%, exact p = 0.009). Among those who had not used clozapine and had no clozapine contraindication, A history of suicidal behavior increased the possibility of switch to clozapine within 56 days after admission (Hazard Ratio[95% CI], 6.09[2.08–17.83]) or during hospitalization (4.18[1.62–10.78]). Conclusion The use of clozapine for early-stage schizophrenia was more frequent among those with suicidal behavior than among those without suicidal behavior in China, although the drug instructions do not label its use for suicide risk.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

History of suicidal behavior and clozapine prescribing among people with schizophrenia in China: a cohort study

Yin,

Lin,

Wei

et al. 2024

BMC Psychiatry

View full text Add to dashboard Cite

show abstract

“…It should also be considered that there may be other factors that could affect NSSI in patients with poor adherence to treatment. In recent years, studies reporting that clozapine treatment is effective in reducing the risk of NSSI in the clinical population have attracted attention (70,71). Patients were not classified according to pharmacotherapy protocols in our study; therefore, the possible effects of different drug treatments, such as clozapine, on NSSI in SSD patients could not be evaluated.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and predictive factors of non-suicidal self-injury in patients with schizophrenia spectrum disorders

Alniak¹

2021

Dusunen Adam

View full text Add to dashboard Cite

show abstract

“…Antipsychotic medications have long been the primary treatment for schizophrenia [ 11 ]. Literature suggests that psychotropic drugs are effective in reducing the risk of self-inflicted violence behaviors [ 12 – 14 ]. Although medication adherence is important in treatment effectiveness and as a modifiable factor, little is known about the association between medication non-adherence and self-inflicted violence behaviors.…”

Section: Introductionmentioning

confidence: 99%

Medication non-adherence and self-inflicted violence behaviors among 185,800 patients with schizophrenia in the community: a 12-year cohort study

Zuo,

Yang,

et al. 2024

BMC Med

View full text Add to dashboard Cite

Background Despite the importance of medication adherence in treatment effectiveness, little is known about the association between medication non-adherence and self-inflicted violence behaviors. We aimed to assess whether medication non-adherence increased the risk of self-inflicted violence behaviors among schizophrenics in communities (hypothesis 1) and whether the dose–response relationship existed (hypothesis 2). Methods This 12-year cohort study in western China recruited 292,667 community-dwelling schizophrenics. The proportion of regular medication (PRM) was calculated by dividing the time of “regular adherence” by the total time of antipsychotic treatment during follow-up period as an indicator of medication adherence. For hypothesis 1, medication adherence was designated as a binary variable with a threshold of 0.8 (PRM); for hypothesis 2, medication adherence was specified as five-category and continuous variables, respectively. Inverse probability weighting and mixed effects Cox proportional hazards models were conducted for confounders control and survival analyses. Results One hundred eighty-five thousand eight hundred participants were eligible for the final analyses, with a mean age of 47.49 years (SD 14.55 years), of whom 53.6% were female. For hypothesis 1, the medication non-adherence group (PRM < 0.8) had a lower risk of suicide (HR, 0.527, 95% CI, 0.447–0.620), an increased risk of NSSI (HR, 1.229, 95% CI, 1.088–1.388), and non-significant risk of attempted suicide compared with adherence group (PRM ≥ 0.8). For hypothesis 2, the lowest medication adherence (PRM < 0.2) was associated with increased risks of suicide attempt (HR, 1.614, 95% CI, 1.412–1.845), NSSI (HR, 1.873, 95% CI, 1.649–2.126), and a decreased risk of suicide (HR, 0.593, 95% CI, 0.490–0.719). The other non-adherence groups had lower risks for all three self-inflicted violence behaviors. The associations between medication adherence in continuous-variable and three outcomes were consistent with the categorical medication adherence results. Conclusions Almost no medication taken as prescribed was associated with an increased risk of suicide attempt and NSSI. However, medication adherence did not appear to prevent completed suicide. Besides, patients with moderate adherence had a lower incidence of suicide attempt and NSSI. These findings highlight the need for a more detailed portrayal of medication adherence and the need to be vigilant for suicide intent in schizophrenics with good medication adherence who may be overlooked previously.

show abstract

Comparative effect of antipsychotics on risk of self‐harm among patients with schizophrenia

Abstract: The protective effect on self-harm may vary across different antipsychotics. Further studies are needed to replicate the findings.

Cited by 13 publications

References 29 publications

History of suicidal behavior and clozapine prescribing among people with schizophrenia in China: a cohort study

History of suicidal behavior and clozapine prescribing among people with schizophrenia in China: a cohort study

Characteristics and predictive factors of non-suicidal self-injury in patients with schizophrenia spectrum disorders

Medication non-adherence and self-inflicted violence behaviors among 185,800 patients with schizophrenia in the community: a 12-year cohort study

Contact Info

Product

Resources

About