Managing Suicide Risk in Patients with Schizophrenia

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 anti-psychotics, 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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Table I

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Acknowledgements

Supported by MH6398 (SZ, JK), a VISN 4 CPPF grant (JK) and a grant from the American Foundation for Suicide Prevention (JK), the VISN 4 and VISN 22 MIRECC and the University of California, San Diego Center for Community-Based Research in Older People with Psychoses. The contents do not represent the views of the Department of Veterans Affairs of the US government.

Sidney Zisook, MD, has received research support from Aspect Medical and PamLab and speaker’s honoraria from Forest Pharmaceuticals, Inc. and GlaxoSmithKline. John Kasckow, MD, PhD, has received grant support as well as honoraria for speaking and consultation from Forest, AstraZeneca, Bristol Meyers Squibb, Pfizer, Johnson & Johnson, Solvay and Eli Lilly. Ms Felmet has no conflicts of interest to declare.

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Correspondence to Dr John Kasckow.

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Kasckow, J., Felmet, K. & Zisook, S. Managing Suicide Risk in Patients with Schizophrenia. CNS Drugs 25, 129–143 (2011). https://doi.org/10.2165/11586450-000000000-00000

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Keywords

  • Depressive Symptom
  • Schizophrenia
  • Clozapine
  • Olanzapine
  • Suicidal Ideation