Some antipsychotics and adjunctive antidepressants may minimize the risk of suicide in patients with schizophrenia
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Some antipsychotics and adjunctive antidepressants may minimize the risk of suicide in patients with schizophrenia Limited evidence indicates that antipsychotic agents, particularly second-generation antipsychotics, may help protect against suicide in patients with schizophrenia, with the most favourable evidence being for clozapine. Depressive symptoms appear to increase the risk of suicide and there is evidence to suggest that antidepressants, particularly selective serotonin reuptake inhibitors, may be effective in augmenting antipsychotic therapy.
Suicide risk is increased in schizophrenia Individuals with schizophrenia have a life-long risk of suicidal behaviour, with suicide a leading cause of premature death in these patients.[1] Their risk of suicide is 8.5fold greater than that of the general population, with suicidal ideation (driven by psychotic or depressive symptoms) occurring in 40–50% of patients, and suicide previously attempted in 20–50% and completed in 4–13%.[1] Most suicides occur within the first 10 years of schizophrenia onset, with half being committed in the first 2 years, and the likelihood of suicide is greater in the initial weeks or months after being discharged from the hospital.[1] Patients with schizophrenia who commit suicide generally do so between the age of 22 and 40 years, with suicide committed more frequently and at a younger age in men than in women, potentially because men often have an earlier onset and worse course of disease.[1] Duration of psychosis is positively associated with suicide risk, highlighting the need for early treatment to prevent suicidal behaviour as well as alleviate disease symptoms.[1] Other risk factors for suicide among patients with schizophrenia are summarized in table I.[1,2]
Determine best treatment The management of suicidal patients with schizophrenia requires an integrated psychosocial and pharmacological approach.[1] Whether patients are more suited for inpatient or outpatient treatment requires comprehensive assessment of their suicide risk, what may be contributing to their suicidal symptoms and the nature of their suicidal behaviour and ideation;[1] those with antecedents of strong suicidal ideation or suicide attempts should be hospitalized.[2] The aims of treatment are to:[1] reduce psychotic symptoms; reduce depressive symptoms; alleviate the patient’s sense of despair and demoralization;
instil hope; address anxiety disorders, substance abuse and any other issues. All available treatments (i.e. pharmacological treatment, psychosocial programmes and restrictions to the means of self-harm) should be considered. However, decisions may need to be based on the findings of studies directed at the management of affective disorders, as there is a paucity of data pertaining specifically to the treatment of suicidality.[1] Further research is needed to provide evidence on the most effective methods to treat suicidal thoughts and behaviours and prevent suicide in patients with schizophrenia.
Antipsychotic agents seem to be beneficial
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