Reduction of suicidality during clozapine treatment of neuroleptic- resistant schizophrenia: impact on risk-benefit assessment
1995; American Psychiatric Association; Volume: 152; Issue: 2 Linguagem: Inglês
10.1176/ajp.152.2.183
ISSN1535-7228
Autores Tópico(s)Tryptophan and brain disorders
ResumoBack to table of contents Previous article Next article No AccessReduction of suicidality during clozapine treatment of neuroleptic- resistant schizophrenia: impact on risk-benefit assessmentPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.152.2.183AboutSectionsView articleAbstractPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleAbstractOBJECTIVE: Suicide has been reported to occur in 9%-13% of schizophrenic patients. It has been suggested that neuroleptic- resistant or neuroleptic-intolerant schizophrenic patients are at higher risk for suicide than neuroleptic-responsive patients. Clozapine is the treatment of choice for neuroleptic-resistant patients, but its use has been greatly limited because of its ability to cause potentially fatal agranulocytosis. The purpose of this study was to compare the suicidality of neuroleptic-resistant and neuroleptic- responsive patients and to determine if clozapine treatment decreased suicidality in the former group. METHOD: Prior episodes of suicidality were assessed in a total of 237 neuroleptic-responsive and 184 neuroleptic-resistant patients with schizophrenia or schizoaffective disorder. Eighty-eight of the neuroleptic-resistant patients were treated with clozapine and prospectively evaluated for suicidality for periods of 6 months to 7 years. RESULTS: There was no significant difference in prior suicidal episodes between neuroleptic-responsive and neuroleptic-resistant patients. Clozapine treatment of the neuroleptic-resistant patients during the follow-up period resulted in markedly less suicidality. The number of suicide attempts with a high- probability of success decreased from five to zero. This decrease in suicidality was associated with improvement in depression and hopelessness. CONCLUSIONS: These results suggest a basis for reevaluation of the risk-benefit assessment of clozapine, i.e., that the overall morbidity and mortality of patients with neuroleptic- resistant schizophrenia are less with clozapine treatment than with typical neuroleptic drugs because of less suicidality. This conclusion also has implications for increasing the use of clozapine with neuroleptic-responsive patients. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. 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