Division of Psychopharmacology, Vanderbilt University School of Medicine, Psychiatric Hospital at Vanderbilt, Nashville, Tennessee 37212, USA
Address for correspondence: Dr. Herbert Y. Meltzer, Director, Division of Psychopharmacology, Vanderbilt University School of Medicine, Psychiatric Hospital at Vanderbilt, 1601 23rd Ave. South, Suite 306, Nashville, TN 37212. Voice: 615-327-7049.
herbert.meltzer{at}mcmail.vanderbilt.edu
Between 4 and 13% of people with schizophrenia commit suicide
and between 25 and 50% make a suicide attempt, a reflection
of the devastating toll this syndrome takes on the quality of
life, that is, the subjective and objective sense of well-being.
Many risk factors for suicide in schizophrenia have been identified,
the most important of which are previous suicide attempts, depression,
hopelessness, substance abuse, and male gender. Insight into
having a serious mental illness and less severe cognitive impairment
are also associated with increased risk for suicide in schizophrenia,
most likely when accompanied by feelings of hopelessness. Typical
neuroleptic drugs have not been shown to reduce the risk of
suicide. However, several types of evidence suggest that clozapine,
an atypical antipsychotic drug, appreciably reduces the suicide
attempt and completion rates in schizophrenia and schizoaffective
disorder, perhaps by as much as 75-85%. Other atypical antipsychotic
drugs may have a similar effect, but direct evidence is lacking.
Improvement in positive and negative symptoms, reduced extrapyramidal
side effects (EPS), a direct antidepressant action, improved
cognitive function, and improved compliance may contribute to
reduced suicidality. The International Suicide Prevention Trial
(InterSePT) is a large prospective, randomized study intended
to compare the effectiveness of clozapine with that of olanzapine
in reducing suicide and suicide-related events in schizophrenic
and schizoaffective patients. Some information about suicidality
in the patient sample is reported here.
