Suicidality and second generation antipsychotics in schizophrenia patients: a case-controlled retrospective study during a 5-year period

Barak, Yoram; Mirecki, Ilona; Knobler, H. Y.; Natan, Z.; Aizenberg, Dov

doi:10.1007/s00213-004-1812-z

Cited by 15 publications

(16 citation statements)

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“…In the 1990s, the atypical antipsychotics were introduced and it seems that these drugs might have some anti-suicidal properties, especially clozapine [230,245]. This might be to due their lesser propensity to cause extra pyramidal side-effects (EPS).…”

Section: Resultsmentioning

confidence: 99%

Suicide risk in schizophrenia: learning from the past to change the future

et al. 2007

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Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures.This review paper is the results of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophenia patients.

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Section: Resultsmentioning

confidence: 99%

Suicide risk in schizophrenia: learning from the past to change the future

et al. 2007

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“…In a 5-year retrospective case-control study of records for patients with schizophrenia or schizoaffective disorder, Barak et al (2004) reported a reduced rate of suicide attempts with the use of atypical antipsychotics (odds ratio = 3.54, 95% confidence interval = 2.4 to 5.3). Although a larger effect size was calculated for risperidone relative to olanzapine (3.16 vs. 1.76), the difference was not statistically significant.…”

Section: Relevance To Pharmacological Treatmentmentioning

confidence: 97%

Factors affecting outcome in schizophrenia and their relevance for psychopharmacological treatment

Altamura

Bobo

Meltzer

2007

International Clinical Psychopharmacology

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A major focus of current treatment research in schizophrenia is the determinants of long-term outcome, including functional outcome and general medical well being, rather than just specific domains of psychopathology such as positive and negative symptoms, mood symptoms, and cognitive impairment. This focus does not negate the importance of the latter issues but sees them as factors contributing to long-term outcome to variable extents. A long-term treatment focus facilitates a more clinically relevant assessment of benefits versus risks of available treatments. For instance, atypical antipsychotic drugs as a group have clear advantages for several important domains of efficacy that may influence long-term outcome, but are also more expensive over the long term. Use of some agents may also result in deleterious physical health consequences as well as large additional costs over the long term owing to metabolic adverse effects. The present paper focuses on several key issues in schizophrenia which are important determinants of long-term outcome in schizophrenia, or influence choice of antipsychotic drugs, or both, including: (i) duration of untreated psychosis; (ii) impact of relapse on long-term outcome; (iii) limited efficacy for specific domains of psychopathology of current treatments; (iv) mortality owing to suicide; and (v) mortality owing to other causes (e.g. cardiovascular disease).

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“…One 5-year, retrospective, case-control study concluded that there was a decreased rate of suicide attempts with second-generation antipsychotic medications. [97] In this study, the index group consisted of patients who attempted suicide prior to admission; the control group comprised the next admission of a patient with schizophrenia (or schizoaffective disorder), matched for sex and age, who did not attempt suicide. Among 378 patients who attempted suicide (index group), 16.1% were exposed to second-generation antipsychotics while 37% of the control group were similarly exposed (p = 0.0001).…”

Section: Pharmacological Approachesmentioning

confidence: 99%

Managing Suicide Risk in Patients with Schizophrenia

2011

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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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Suicidality and second generation antipsychotics in schizophrenia patients: a case-controlled retrospective study during a 5-year period

Cited by 15 publications

References 0 publications

Suicide risk in schizophrenia: learning from the past to change the future

Suicide risk in schizophrenia: learning from the past to change the future

Factors affecting outcome in schizophrenia and their relevance for psychopharmacological treatment

Managing Suicide Risk in Patients with Schizophrenia

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